North Central London adult elective orthopaedic services review: Nuffield Trust assessment against the Mayor’s six tests

In 2017, following the Nuffield Trust/King's Fund report into London’s five sustainability and transformation plans, the Mayor announced six tests to be met before support could be given to any health service reconfiguration proposals in London. The Nuffield Trust was recently commissioned by the Mayor's office to apply those six tests to a set of proposals developed by five North Central London CCGs and five NHS provider trusts currently providing adult elective orthopaedic surgery in north central London. This review provides the results of this assessment.

In 2017, following the Nuffield Trust/King's Fund report into London’s five sustainability and transformation plans, the Mayor announced six tests he expected to be met before he would give his support to any major health and care transformation or service reconfiguration proposals in London. The Mayor's six tests require suitable consideration to be given to the following:

  1. Health inequalities and prevention of ill health
  2. Hospital beds 
  3. Financial investment and savings
  4. Social care impact 
  5. Clinical support 
  6. Patient and public engagement.

The Nuffield Trust was commissioned by the Mayor of London's office to apply those six tests to assess a set of proposals developed by the five North Central London (NCL) CCGs and five NCL NHS provider trusts currently providing adult elective orthopaedic surgery in north central London, who have all come together as part of North London Partners in Health and Care (NLP).

The proposals involve splitting and ring fencing orthopaedic elective (planned) inpatient surgery away from non-elective (emergency) care. There is significant evidence such a model will improve care by reducing infection rates, increasing surgeon experience and by reducing patient waiting times and cancelled operations, which occur when elective procedures are unable to go ahead due to post-operative beds being utilised by emergency patients.

The proposals are for two dedicated Elective Orthopaedic Centres (EOC): one in the north of the patch, already based and running with spare capacity at Chase Farm Hospital. That scheme will be run as a partnership between the Royal Free London group of hospitals and North Middlesex Hospital. In the south, a partnership between University College London Hospitals (UCLH) and Whittington Health will oversee patient care at a new EOC based near Euston road as part of UCLH’s “phase 4” development. Both EOCs are also expected to treat a small number of patients who would currently be treated at the Royal National Orthopaedic Hospital in Stanmore.

This analysis was undertaken in May 2020, revised in August 2020 and published by the Greater London Authority on 15 September 2020 and remains unchanged.

Suggested citation

Gainsbury S, Edwards N Buckingham H, Baracaia S and Rosen R (2020) North Central London adult elective orthopaedic services review: Nuffield Trust assessment against the Mayor’s six tests. Report, Nuffield Trust