The first 100 days... and a new President!

The first 100 days of the new Westminster Government has seen a necessary focus on our health services and the health of the population as one of its ‘five missions’. Increasingly, and rightly so, policy makers have focused on preventative health measures and a greater emphasis on the provision of health care by primary and community services.

The BOA has been looking at these approaches with a view to identifying where trauma and orthopaedic (T&O) surgeons can add value.

Earlier this year, our Immediate Past President, Simon Hodkinson, along with Andrea Sott, Chair of the BOA Orthopaedic Committee, contributed to workshops with the MSK teams in NHS England and GIRFT to review the current MSK pathways across primary and secondary care. The findings have yet to be published, but it is apparent that in many parts of England, patients are not seeing orthopaedic surgeons appropriately; either so late that the outcome of any intervention has been compromised or they do not actually need the services of the surgeon at all. In many instances only the surgeon can determine the appropriate action. Most T&O surgeons are certainly not just technicians and see themselves as vital in helping patients make informed decisions about managing MSK conditions. Part of the problem is the perception that T&O surgeons are all about performing operations and that their habitat is limited to the hospital. The latter may be true, but clinics need not be so. This misconception that surgeons do operations and little else also underpins some of the challenges the BOA faces in protecting the rich tapestry of competencies and roles that being a T&O surgeon, especially a consultant, comprises.

Our new President, Mark Bowditch, set out the themes of his Presidential year in his acceptance speech at Congress. It includes prevention: primary, secondary and tertiary. Alignment and engagement with national policies is key to being heard.

Primary prevention refers to prevention is better than cure. This reflects work Mark has been driving in matters such as ACL injury prevention - an injury that not only can end participation in competitive sport but deny young people (especially young women) any incentive to adopt an active lifestyle. Similarly, led by the Trauma Committee, chaired by Cheryl Baldwick, the BOA has actively supported the Royal Osteoporosis Society campaign for universal access to Fracture Liaison Services.

Secondary prevention refers to reducing harm when we do intervene with T&O procedures. Work is also underway on a number of initiatives around infection prevention and control in theatres and promoting human factors. The BOA is also increasingly working with industry and regulators to address reductions in the range of available implants as well as the development of tools and technologies to facilitate and enhance the skills of a profession that is gradually becoming more diverse.

Tertiary prevention is all about physical and mental wellbeing; preventing toxic team cultures with better leadership - looking after BOA members…

The education and training of the T&O workforce remains a priority for the BOA. The BOA has raised concerns with government over a two-pronged threat: the perception by government and others that industry has too much direct access to healthcare services and the clinical workforce (see the DHSC disclosure of industry payments to the healthcare sector consultation), and that the role of consultants is to reduce the waiting lists to the exclusion of all other activities.

Industry has a significant but largely unquantified role in supporting education and training of orthopaedic services, not only in making such events as the BOA Congress possible but in providing the opportunities to enable surgeons to be exposed to and to adopt (some) of the novel technologies and ways of working that enable T&O services to be more efficient and to improve the quality of outcomes for patients.

The second threat is from NHS trust managers, themselves under pressure, to deliver more of the activity that can be crudely measured: more procedures, more patients during clinic. Such an approach assumes that all patients are the same and that the training of tomorrow’s workforce is not something that needs to be addressed today. This approach risks reducing the T&O surgical workforce to technicians and orthopaedic services to production lines.

Therefore, the challenges that the BOA must help the new Government with are how to reduce the waiting lists whilst not sacrificing the development of tomorrow’s workforce and a sustainable T&O service. Productivity increases are difficult when there are such severe shortages of necessary staff such as anaesthetists and other members of the theatre team. The BOA is keen to help with reducing inefficiencies and secure a sustainable, sensible increase in activity. T&O services are the largest component of the waiting lists but are the first to be sacrificed by trusts when ‘Winter’ or financial pressures are present. As a new Government, the current Health and Social Care Ministers will likely blame the last Government for this coming Winter, but beyond that the finger will be pointing in their direction.

In the longer term the Westminster Government will rely upon a 10-year Plan – consultation on this will begin shortly. How will the Plan, informed by the Darzi Review 2024, provide for a sustainable T&O service if we do not address the current problems that threaten the availability of a qualified, thoroughly trained and engaged workforce; issues that were covered in numerous sessions at the Congress.

The next 100 days will see the first Budget of the new Government (30th October) – will the Elective Recovery Fund survive? This is the incentive funding for doing additional work, without it, more trusts are likely to struggle to make their budgets balance, let alone be incentivised to increase activity. Preparations for the Spring Spending Review announcement that will set the parameters for spending on health services for the next three years will also be underway. The Secretary of State, Wes Streeting wants the NHS to contribute to both the health and wealth of the nation.

The BOA in its submission to the Darzi Review 2024 highlighted the need to address the significant economic inactivity due to MSK amongst the working population, especially in the 40 years plus. Whilst not all these people will require treatment by a T&O surgeon, most will benefit from the opportunity of being seen by one.

The message that the BOA is communicating to the Government is that T&O services are key to delivering the pressing political headaches of waiting lists and economic inactivity in the population due to ill health – currently at a higher rate than any other European nation.

As for the longer term, what should the T&O workforce look like?

As the Congress sessions showed, with input from the Carousel Presidents and other invited speakers, the T&O workforce has much in common around the world, but there are also differences, including in the training journeys taken in pursuit of a career in T&O. The BOA will work with BOTA and others to try to address the current challenges identified by BOTA and to further improve this process.

What should the T&O workforce look like in 10 years’ time? What are the qualifications and training journeys necessary to meeting the needs of an older, more active - but possibly less healthy- population? These are the questions that the 10-year Plan and associated NHS Long Term Workforce Plan must address. The BOA has a key role in answering those questions and with your insights and input the BOA can help the current and subsequent governments answer those questions.

Watch this space.