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Focus On Series


Review of Orthopaedic Services

Review of Orthopaedic ServicesAudit Summary

Publication Date:
March 2010

Audit Office:
Audit Scotland

Link to full report:
http://www.audit-scotland.gov.uk/docs/health/2010/nr_100325_orthopaedic_services.pdf

Audited Entities

  • National Health Service (NHS)

Audit Objectives

  • The audit looked at how effectively the NHS in Scotland manages orthopaedic services, how much is spent and whether this represents value for money.
  • The audit also assessed whether there is scope to improve the efficiency of orthopaedic services by comparing activity across Scotland and identifying areas of good practice where efficiencies have been made.

Audit Scope

  • The report focuses on orthopaedic services provided in hospitals and highlights examples of services being provided in the community, such as orthopaedic clinics led by general practitioners or physiotherapists. The audit did not review the work of other departments that support orthopaedic services, such as diagnostics, rheumatology and anaesthetics.

Audit Criteria

  • Not available.

Main Audit Findings

  • Waiting times for orthopaedic services have reduced considerably in recent years. This has been achieved by the NHS changing the way it delivers services and through additional activity funded by waiting times money from the SGHD. NHS boards are meeting national waiting times targets, but making further sustainable improvements to achieve the planned 18-week referral to treatment target will be challenging.
  • There is variation across Scotland in the efficiency of orthopaedic services which is not fully explained by the resources available or by the types of procedures carried out. There is scope to use existing resources more efficiently and improve how these services are managed. Efficiency savings can be made by moving more inpatient care to day surgery or outpatients and by reducing length of stay in hospital.
  • In 2008/09, £373 million was spent on orthopaedics, a 68 per cent increase in real terms over ten years. The average amount spent on inpatient and day cases and the amount spent per orthopaedic procedure vary significantly across Scotland. Savings can be made by more efficient purchasing of surgical implants.
  • It is not possible to draw clear conclusions about productivity in orthopaedic services due to limitations in the data. Productivity indicators suggest that NHS boards which manage their planned and emergency activity separately have higher consultant activity and a lower cost per case.

Audit Recommendations

  • The Scottish Government and NHS boards should:
    • develop better information on costs, quality and activity to plan and deliver efficient services to a high quality;
    • ensure that benchmarking information on cost and activity is collected to allow NHS boards to compare efficiency; and
    • improve tariff information to support accurate costing and financial planning for orthopaedic services.
  • NHS boards should:
    • monitor levels of day case and outpatient activity and look to deliver care in the most efficient and effective setting;
    • develop a better understanding of productivity, including activity, cost and quality indicators, to deliver efficient services;
    • monitor levels of activity for the whole orthopaedic team and take action where levels are low;
    • review performance against quality indicators to ensure patient care is not adversely affected by service changes;
    • use the Audit Scotland checklist detailed in Appendix 3 (see full report) to help improve the efficiency and effectiveness of orthopaedic services.