The Clinical Care Programmes provide a national, strategic and co-ordinated approach to a wide range of clinical services. They have three main objectives – to improve the quality of care, to improve access and to improve cost-effectiveness. Their primary aim is to modernise the way hospital services are provided across a wide range of clinical areas. This is being done through standardising access to and delivery of high quality, safe and efficient hospital services, and maximising linkages to primary care and other community services. Currently there are 29 Clinical Care Programmes in different stages of development/implementation.
As part of the Orthopaedic Clinical Care Programme, prospective funding for total hip and knee replacements was introduced. Seven hospitals were initially selected and a price was agreed per procedure. This agreed price also takes account of other medical conditions which patients may have, that may impact on their length of stay. The reforms introduced have facilitated a reduction in the average length of stay (AvLOS) for total hip and knee replacements. The introduction of new care pathways identified a target AvLOS of 7 days for total hip and knee replacement and 10 days for revision hip replacement. As per the table below, the AvLOS for hip replacements is currently 6.7 days and for knee replacements is 6.6 days. These are below the target AvLOS of 7 days.
Year
|
Hip replacements
|
AvLOS
|
Knee Replacements
|
AvLOS
|
2009
|
3,062
|
9.5
|
1,720
|
9.32
|
2010
|
3,108
|
8.8
|
1,845
|
8.74
|
2011
|
3,102
|
7.6
|
1,867
|
7.33
|
Current
|
|
6.7
|
|
6.6
|
In 2012, it is projected that this will result in savings of approximately 5,200 bed days for total hip/total knee replacements.