Health campaigners say rise in private surgery undermines services at Brighton hospital

A rise in the number of private knee and hip replacement operations is undermining the future of services at Brighton and Hove’s NHS hospital trust, health campaigners said today (Wednesday 3 July).

Members of Sussex Defend the NHS cited an analysis of NHS-funded surgery by Brighton and Hove health chiefs.

It showed that the number of NHS patients from Brighton and Hove opting for private knee and hip operations more than doubled from 179 to 395 a year in the five years to 2017-18.

The increase of 216 was matched by a similar fall – of 219 – in the number of local patients having knee and hip operations carried out by the NHS. The number went down from 527 to 308.

The analysis by health chiefs said that the rise in private surgery “has had an adverse impact on the criticial mass of the service” within Brighton and Sussex University Hospitals (BSUH).

BSUH is the NHS trust that runs the Royal Sussex County Hospital, in Brighton, as well as the Princess Royal Hospital, in Haywards Heath.

The analysis also said that the falling number of NHS knee and hip operations had “a potential impact on the sustainability of the service and BSUH as a major trauma centre”.

Three members of Sussex Defend the NHS asked about the impact of the trend from NHS to private surgery when they quizzed health chiefs from the Brighton and Hove Clinical Commissioning Group (CCG).

At the Brighthelm Centre, one of the campaigners, Carolyn Pickering, asked what “impact assessment” led to a decision last year to increase the number of patients having their surgery with BSUH.

She was told: “There was no formal assessment process but a joint recognition that … there had been a shift of elective orthopaedic activity from BSUH to the independent sector.”

The CCG added that there had also been “a small but significant reduction in elective activity as conservative treatment uptake has increased”.

This can include, for example, patients opting for physiotherapy rather than a hip or knee replacement.

In 2016-17 some 774 patients from Brighton and Hove had knee and hip surgery, with the number falling to 703 – the lowest number for five years – in 2017-18.

But effects of the overall trend had caused concern. The CCG said: “The impact of this is loss of income to BSUH but it has also impacted on their ability to train junior staff and also potentially, if a longer-term trend, could affect the sustainability of the service with a knock-on effect on its major trauma centre status.”

The surgery is currently carried out as part of a contract for “musculoskeletal” – or MSK – services.

A five-year £210 million contract covers patients in areas served by CCGs for Brighton and Hove, Horsham and Mid Sussex and Crawley.

The contract – with the Sussex MSK Partnership – was due to end in September. Earlier this year it was extended for a further two years.

The partnership is led by Here – formerly known as the Brighton and Hove Integrated Care Service (BICS). It includes Horder Healthcare, the Sussex Community NHS Foundation Trust and Sussex Partnership NHS Foundation Trust.

In a formal paper outlining its commissioning intentions for the past financial year (2018-19), the Brighton and Hove CCG said: “As a CCG, we need to develop the future commission and delivery model for MSK services.

“The project will focus on the following outcomes

• To evaluate the current service model and develop an appraisal of options for future service delivery
• To develop a commissioning model for MSK services
• To reduce acute MSK related activity through the use of pathways with a high clinical value
• To deliver savings by supporting clinically appropriate decision-making”