Decision time: your choice determines your healthcare
The advent of NHS Choices nearly five years ago means that everyone who is cared for by the NHS in England now has the right to choose about the service that they receive. So you can choose a GP surgery, which doctor you see within the surgery and which hospital you’re treated at, and information will be given to you to support your decisions.
So what is important to think about when you’re about to have an arthritis-related procedure, such as a knee or hip replacement?
A number of factors jostle for the primary position at the top, but safety is the fundamental concern, followed by expertise and reputation of the hospital and surgeon, quality of immediate after-care and that of outpatients. Other factors are distance, visiting policies, parking facilities and comments from previous patients.
The first port of call is a detailed discussion with your GP, advises Mr Venu Kavarthapu, a consultant orthopaedic surgeon from King’s College Hospital in London.
“Ask your GP about known outcomes of the procedure in your regional hospital,” he suggests. “The GP receives information from local hospitals and knows which are performing better in your area. He or she can relate the information to your personal situation in terms of medical history, current problems and family support.”
Patient Reported Outcome Measures (PROMS) are particularly useful. These assess the quality of care delivered to NHS patients from the patient perspective. Currently including knee and hip replacements, PROMs calculate the health gains after surgical treatment using surveys from patients collected before and after the operation.
Today it is even possible to find out detailed information about your surgeon, thanks to the National Joint Registry Surgeon and Hospital Profile (see below).
“It is important for people to know who is going to perform the operation and what experience that surgeon has had in the past,” explains Jane Vince, centre operations manager from The Horder Centre, a specialist orthopaedic centre in East Sussex. “People generally want to know that there is a low risk of them getting an infection while in hospital and that the nursing care is of a high standard. Members of the public can visit the NHS Choice network and view entries that past patients have posted.”
Located in the South East, a high percentage of the Horder Centre’s NHS patients come from Sussex, Kent and Surrey but because it is recognised as being amongst the best providers for hip and knee replacements, an increasing number of people from across the UK are opting to have procedures carried out there.
“The Horder Centre is a specialist orthopaedic centre so can offer an outstanding level of patient care and services that many general hospitals are unable to provide,” Jane says. “We have specifically tailored all aspects of the patient pathway to enable the best possible recovery for our patients and as a result consistently score higher than national average for PROMS.”
But safety is paramount and hospitals will turn people away when appropriate.
“Some hospitals may not have the infrastructure to deal with complex joint replacements or complicated medical problems and in these cases will refer potential patients elsewhere,” Mr Kavarthapu says.
If your GP decides that you have a medical need for transport to the hospital you have chosen to attend for your procedure, patient transport services should be provided. You may be entitled to help with your travel costs through the Healthcare Travel Cost Scheme if you’re under the care of a consultant and receive either Income Support, income-based Jobseeker’s Allowance or Pension Credit Guarantee Credit, or if you’re named on an NHS tax exemption certificate or qualify under the NHS low-income scheme.
“Consider too the need to make your house safe after the procedure,” says Mr Kavarthapu. “Occupational therapy related items are covered by the NHS if needed, such as raised toilet seats, ramps in entranceways and other relevant modifications to the house. Before surgery, the hospital team should assess the situation and contact community services if this is thought to be necessary. “This is particularly important as most patients rehabilitate quickly following a knee or hip replacement procedure using the modern treatment approaches that we have; the expected length of stay is usually less than three days in our unit.”
Don’t get distracted
“The main point to consider is the hospital as a whole, as this has the most influence on outcome,” recommends Mr Kavarthapu. “Surgeons are one part of the entirety so do not worry as much about their individual profiles.”
“Some people are keen to consider newer unproven techniques and/or implants over well-established methods but do beware of being a guinea pig,” warns Mr Kavarthapu. “Make sure the procedure you’re having is tried, tested and clinically proven.”
NHS Choices has had a positive impact on the medical care of the public. By creating internal competition between secondary care providers it has encouraged improved outcomes and increased quality of patient care. But it means that it’s up to you where you have your procedure so do your homework properly. Start by asking your GP’s opinion and then access and assess further information from reliable sources. Here are some starting points:
· NHS Choices has a useful search tool where you can compare hospitals for various procedures: www.nhs.uk
· The National Joint Registry Surgeon and Hospital Profile allows you to find out about particular surgeons and hospitals where knee and hip replacements are carried out: www.njrsurgeonhospitalprofile.org.uk
· The National Joint Registry of England, Wales and Northern Ireland holds statistics on hospitals and you can request information from them: www.njrcentre.org.uk, tel 0845 345 9991