Ophthalmology and Orthopaedic Services - NHS Kirklees

Proposals for developing
Ophthalmology and Orthopaedic
Services in mid Yorkshire
NHS Kirklees
The Mid Yorkshire Hospitals NHS Trust
NHS Wakefield District
July / August 2012

Ophthalmology and
Orthopaedic Services
Proposed changes
Introduction
This document is designed to let you know about proposed changes to
ophthalmology (eye) services and orthopaedic services (bones, joints and fractures)
provided by The Mid Yorkshire Hospitals NHS Trust, and how you can let us know
your views.
The proposals do not affect the range of services provided by the Trust but would
mean changes to where some of them are provided.
We believe these changes will help us provide the best possible eye care and
orthopaedic care in a modern environment with the most up-to-date equipment.
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire

About these services
Ophthalmology services
The service is provided by a team of dedicated doctors, nurses, opticians, orthoptists
and many other support staff who provide a wide range of eye care services and
clinics to both adults and children. These include medical and surgical services,
general eye clinics, and planned and unplanned ophthalmology services – a detailed
list is shown in the questions in section E on page iv of the questionnaire.
Visits to our ophthalmology clinics are by appointment only with no walk-in service.
Anyone with any concerns about their vision or eyes should contact their General
Practitioner (GP), local optician, walk-in centre or, in an emergency, the Emergency
Department (ED) at hospital.
Orthopaedic services
Orthopaedic surgeons deal with the repair and treatment of any bone in the body,
usually with the exception of the ribs and the skull. Often an orthopaedic surgeon
is needed in a ‘trauma’ case – that is, an accident or injury. At other times an
orthopaedic operation may be used to treat a condition of the bone that has been
caused by something other than trauma – such as a serious infection, or a birth
deformity. A large part of the orthopaedic workload involves the fitting of artificial
joints like hip joints and knee joints.
Orthopaedic surgeons also deal with parts of the body other than bones, like
tendons and ligaments. In complicated trauma cases they may work closely with
colleagues from other specialties like plastic surgery or hand surgery to ensure the
best possible outcome for the patient.
The Trust provides a wide range of orthopaedic services and clinics to both adults
and children, including surgical services, general clinics, and planned and unplanned
services.
Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire 3

What changes are we proposing?
Proposed changes to eye care services
There are two parts to the changes being proposed:
• moving glaucoma, medical retina and cataract services from Pinderfields Hospital
in Wakefield to Pontefract Hospital. Currently the service carries out 18,000 to
20,000 outpatient appointments and surgical procedures each year on 2445
patients. This works out as 49 people per week. Patients from Wakefield District
– particularly those living in the west of the district will also have the option to
receive their surgery and procedures at Dewsbury and District Hospital.
• moving the Macular Degeneration Service from Clayton Hospital in Wakefield,
which is due to close, to Pinderfields Hospital in Wakefield. There are currently
around 760 patients receiving this service at Clayton Hospital who would in future
receive their treatment at Pinderfields.
Proposed changes to inpatient orthopaedic services
To develop Pontefract Hospital as a major elective orthopaedic centre. This would
mean that the majority of planned orthopaedic surgery for patients across the
district would take place here, rather than in both hospitals. At present only day
case orthopaedic surgery is done at Pontefract and all inpatient surgery is done at
Pinderfields. This will include first time hip and knee replacement operations and
upper limb (arm and shoulder) surgery.
Patients from Wakefield District would also have the option to receive their surgery
and procedures at Dewsbury and District Hospital.
There will be no changes to outpatient appointment arrangement with
appointments provided in Wakefield, Pontefract and Dewsbury.
Some specialist orthopaedic work would continue to be done at Pinderfields
Hospital in Wakefield, including unplanned orthopaedic work and inpatient
orthopaedic surgery for children – making use of the state of the art children’s ward
at Pinderfields. Pinderfields Hospital would also provide care for patients with more
complex orthopaedic needs – including second-time knee and hip replacements
(revisions) and people more likely to require high dependency care or intensive care
after their operation.
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire

Why are these changes being proposed?
To improve care for patients
There is clear evidence that centres of excellence deliver better outcomes for
patients and help with the recruitment and retention of highly qualified staff.
Developing centres of excellence for orthopaedics and glaucoma, medical
retina and cataract procedures would bring together specialist equipment and
expertise leading to improved quality of care.
To make better use of hospital capacity
Moving planned orthopaedic services out of Pinderfields would allow us to reuse
this space to meet a demand for additional general ‘medical’ beds. An additional
24 beds would be available at Pinderfields for sick patients with a wide variety
of conditions who require hospital admission. This would reduce the need in
the future for people from Wakefield District to be admitted to Dewsbury and
District Hospital for urgent hospital care.
Improved diagnostics/patient convenience
Creating the ophthamology centre at Pontefract would mean that we could
offer a wider range of diagnostics that would be available on the day, reducing
the need for return visits or referrals to other hospitals.
Maintaining the Macular Degeneration Service in Wakefield
This service is currently provided for patients from both North Kirklees and
Wakefield District at Clayton Hospital in Wakefield. Clayton Hospital is due to
close as part of changes previously agreed. Moving glaucoma, medical retina
and cataract treatments from Pinderfields to Pontefract would mean that there
would then be space at Pinderfields Hospital for the Macular Degeneration
Service, so that it would still be accessible for patients from North Kirklees.
Reducing spend on independent sector hospitals
Currently, the local NHS pays around £1.5m for patients to receive planned
orthopaedic operations and treatment at independent hospitals, which may
be outside of Wakefield District. For example, 431 out of 860 knee and hip
replacement operations for people from Wakefield District are carried out at
independent hospitals.
Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire 5

The changes proposed to orthopaedic services would allow the vast majority of
orthapaedic work to take place in a local NHS hospital. This would help to increase
the Trust’s income, and make services more sustainable. It will also reduce the
inconvenience of patients having to travel out of the area for their care.
When would the changes take place?
We would like to make the changes to eye care services by autumn
2012. The changes to inpatient orthopaedics would take place
from spring 2013.
Your views
We would like to know what you think about these proposals and any concerns you
may have. Your views are important to us and mean that we can make changes that
will benefit patients. We would be very grateful if you would use the response form
at the back of this booklet to tell us what you think.
Questions and answers
Are you doing this to save money?
This is about improving patient care and providing services as efficiently as possible.
These changes will allow better services to be provided for patients. They will also
ensure that Macular Degeneration services continue to be centrally located and help
to reduce the need to cancel planned orthopaedic operations due to emergency
work.
While saving money is not the main reason for the proposals, the Trust’s financial
position means that we need to think about how we can provide services more
efficiently so this is an important consideration of any plans.
The changes to orthopaedic services would help to boost the income available to
the Trust by up to £1.5m. The proposed changes to eye care services would move
us closer towards vacating Clayton Hospital and the South side of the old Pontefract
Hospital, saving more than £750,000 a year.
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire

Why are you committed to developing centres of excellence?
We want the best possible results for our patients and evidence shows that creating
centres of excellence achieves that.
Will these proposals affect me if I currently go to Dewsbury and
District Hospital?
No, there will be no impact on patients currently using Dewsbury and District
Hospital. These proposals only relate to changes in Wakefield District. Dewsbury
and District Hospital will continue to provide a full range of orthopaedic services
and glaucoma, medical retina and cataract services alongside other ophthalmology
services.
People who live in Wakefield District will have the choice to go to either Dewsbury
or Pontefract for planned inpatient orthopaedic services and for glaucoma, medical
retina and cataract services.
How will you use my comments?
The information we receive will help us to understand what works well and what
can be improved, and to plan the best way to organise and deliver services.
We will consider all responses and take your comments into account before making
any changes. The views of patients and the public are one of the three main factors
that are considered when making decisions about how services are provided, with
the other two being patient safety and value for money.
Please use the following questionnaire to tell us your views and return it to
the FREEPOST address on the form. We would like to have all your views by
16 August 2012.
Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire 7

If you require this document in another language or another format such
as large print or audio tape please contact PALS on: 0845 602 4832.
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire

Please print out the
following eight pages
when you have read
the whole document.
Complete the form and
send it back to us.
No stamp is required.
Ophthalmology and
Orthopaedic Services
Your views
A
Developing Centres of Excellence
1. Do you agree with the principle of The Mid Yorkshire Hospitals NHS Trust developing
centres of excellence to improve patient outcomes?
Yes No Not sure
Please give your reasons for this
B
Access and transport
2. How do you generally travel to hospital for appointments, operations or procedures?
(please state the main form of transport used)
Public Transport
(bus or train)
Car
Patient transport
Walk
Taxi
Cycle
Free hospital
shuttle bus
Any other form of transport (please describe)
3. Are you likely to have any difficulties travelling to Pontefract or Dewsbury to receive
eye care services or orthopaedic operations? Could anything be done to help you
access these services?
Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire
i

C
Proposed change to eye care services
Please also complete section E if you have used ophthalmology services in
the last 2 years.
4. Do you have any concerns about the proposal to move glaucoma, medical retina and
cataract services from Wakefield to Pontefract?
Yes No Not sure
Please give your reasons for this.
5. Could anything be done to make this change easier for you?
6. If glaucoma, medical retina and cataract services were no longer provided in
Wakefield would you prefer to use Dewsbury or Pontefract?
Dewsbury Pontefract Neither preference
7. Do you have any concerns about the proposal to keep the Macular Degeneration
service in Wakefield (for all patients in North Kirklees and Wakefield District) by
moving them from Clayton Hospital to Pinderfields Hospital?
Yes No Not sure
Please give your reasons for this and if you think anything could be done to make this
change easier for you.
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire

D
Proposed changes to inpatient orthopaedic services
Please also complete section F if you have used inpatient orthopaedic
services in the last 2 years.
8. Do you have any concerns about the proposal to move inpatient planned orthopaedic
services from Wakefield to Pontefract Hospital?
Yes No Not sure
Please give your reasons for this.
9. Could anything be done to make this change easier for you?
10. If orthopaedic services were no longer provided in Wakefield would you prefer to use
Dewsbury or Pontefract?
Dewsbury Pontefract Neither preference
11. Do you agree with the principle of increasing the number of procedures carried out in
local hospitals rather than independent hospitals?
Yes No Not sure
Please give your reasons for this.
Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire
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E
Eye care services - current and recent service users
Please complete this section if you have used ophthalmology services in the
last 2 years?
12. Which hospital did you have your appointment, procedure or treatment?
Clayton (Wakefield)
Pinderfields (Wakefield)
Dewsbury
Pontefract
13. What kind of service or clinic did you use?
General ophthalmology clinics
Oculoplastics and lacrimal services including repair of droopy eyelids, tear duct
obstructions, removal of tumors in and around the eyes, eyelid reconstruction,
laser skin resurfacing, nurse-led cyst clinics and tear duct operations
Cornea and anterior segment services, including retrieval of eyes for donation
Glaucoma services including selective laser trabeculoplasty (SLT)
Macular degeneration
Medical retinal and uveitis (inflammation of the middle layer of the eye)
Diabetic virtual screening clinics
Children’s ophthalmology, including retinopathy screening and strabismus
(squints and cross eye)
Adult strabismus (squints and cross eye)
Cataract clinic
Laser clinics
Orthoptic services including visual fields or peripheral vision checks and preschool
vision screening
Glaucoma
Low vision aid (LVA) clinic
Registration of a visual impairment
Ophthalmic imaging (taking detailed pictures of the eye using a variety of techniques)
Other (please describe)
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire

14. What was your experience of using these services? For example - did the appointment
run to time, were the facilities adequate and did you receive good care?
15. Is there anything that could be done to improve the experience you had in hospital?
F
Orthopaedic services - current and recent service users
Please complete this section if you have used inpatient orthopaedic services
in the last 2 years?
16. What kind of operation or procedure did you have?
Knee replacement
Children’s
orthopaedics
Hip replacement
Other (please describe)
Arm, elbow or shoulder
operation or procedure
17. What was your experience of using these services?
18. Is there anything that could be done to improve the experience you had in hospital?
Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire
v

G
Equality Data Collection
In order to ensure that we provide the best services for all of our communities,
and to ensure that we do not knowingly discriminate against any section of our
community, it is important for us to gather the following information.
This information cannot be used to identify you and will be kept confidential. You
do not have to answer any of these questions, but we would be very grateful if you
would.
19. What is the first part of your postcode? e.g. HX1, HD2, WF10 etc.
Please enter here
Prefer not to say
20. What gender are you?
Female Male Prefer not to say
21. Do you consider yourself to be transgender?
Do you live in the gender opposite to that assigned at birth?
Yes No Prefer not to say
22. What is your age?
Under 16 16 - 25 26 - 35
36 - 45 46 – 55 56 - 65
66 – 75 76 - 85 86 +
Prefer not to say
23. What is your sexual orientation?
Bisexual (both sexes) Lesbian (same sex) Gay man (same sex)
Heterosexual / Straight (opposite sex)
Prefer not to say
Other (please state)
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire

24. What is your ethnic background?
Asian, or
Asian British
Black, or
Black British
Mixed
White
Bangladeshi African White & Asian British
Chinese
Caribbean
White & Black
African
European
Indian
White & Black
Caribbean
Gypsy/
Traveller
Kashmiri
Irish
Pakistani
Prefer not to say
Other (please state)
25. Do you consider yourself to belong to any religion?
Buddhism Christianity Hinduism
Islam Judaism Sikhism
No religion
Prefer not to say
Other (please state)
26. Do you consider yourself to have a disability?
Under the Equality Act 2010 a disability is defined as ‘a physical, sensory or mental impairment
which has, or had a substantial and long-term adverse effect on a person’s ability to carry out
normal day to day activities’.
Yes No Prefer not to say
Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire
vii

27. If yes, what type of disability do you have?
Learning disability/
difficulty
Long-standing illness
or health condition
Physical or mobility Hearing Visual
Mental health
condition
Prefer not to say
Other (please state)
28. Do you provide care for someone?
Such as family, friends, neighbours or others who are ill, disabled or who need support
because they are older.
Yes No Prefer not to say
Please return this form to:
Communications and Engagement
NHS Calderdale, Kirklees and Wakefield District
FREEPOST NEA12747
Wakefield
WF1 1LT
Thank you very much for your time.
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Proposals for developing Ophthalmology and Orthopaedic Services in mid Yorkshire