• Royal Cornwall Hospitals Trust moves elective orthopaedics from main site
  • Trust remains in special measures after CQC inspection last autumn
  • New clinical divisions set up to improve governance and safety

A special measures trust is shifting nearly all its elective orthopaedic work out of its main hospital as part of a raft of initiatives aimed at getting out of special measures.

Royal Cornwall Hospitals Trust, one of the trusts with the highest number of patients waiting more than a year for elective treatment, is moving its orthopaedic service 18 miles west from Treliske Hospital in Truro to St Michael’s Hospital in Hayle.

According to the trust’s November board papers, there were 151 patients waiting longer than a year for treatment – of which 89 need orthopaedic care.

Some trusts have sought to separate acute and elective care on different sites in recent years, and it has been given some priority nationally, but progress has been limited.

Last month, the Care Quality Commission moved the trust’s rating from “inadequate” to “requires improvement”, a year after it was put in special measures. But concerns over safety and leadership meant the trust continued to be subject to regulatory action.

Kate Shields, the trust’s interim chief executive, told HSJ moving elective orthopaedics to Hayle would address the issue of year-plus waits for procedures, reduce the number of cancelled operations, and free up space for a frailty unit which will improve the flow of patients through Treliske Hospital this winter.

When the CQC visited the trust last September around 40 per cent of elective orthopaedic work is carried out at Hayle, but the trust wants to increase this to 95 per cent.

Ms Shields said there was “way more” chance an orthopaedic operation would get cancelled at Treliske than St Michael’s, which causes waiting lists to pile up quickly. The hospital’s catchment has a substantially higher share of its residents aged 75 and over.

Ms Shields said clinicians had spent six months studying patient cohorts to work out how to move the service to St Michael’s, with staff at the Hayle site spending time at Treliske to get used to treating more complex patients.

The move, initially scheduled for completion in October 2018, is still ongoing but set to be finished early this year.

Much needed space will be created at Treliske, which Ms Shields said would be used for a “rapid throughput frailty unit” this winter.

“We don’t want to turn it into a care of the elderly long-stay ward – it’s got to be for patients who might be in bed for one day,” she said.

“It also means we’ve got a spare ward in future, so if we do need to move a ward temporarily then we’ve got the ability to do that. We haven’t had that luxury in the past.”

In response to the CQC’s concerns over the trust’s leadership, Ms Shields has expanded the number of clinical divisions in the organisation from four to seven. She hopes this will increase the scrutiny and accountability of each division, leading to safety and performance improvements.

“It’s a huge undertaking because it means we’ll have seven performance reviews every month, but it’s only by being close to the point of delivery that we’ll get nearer to supporting our teams and making sure safety is a priority,” she said.

A director of integrated governance has also been hired.

The seven divisions are:

General surgery and cancer;

Specialist services and surgery;

Clinical support;

Women, children and sexual health;

Anaesthetics, critical care and theatres;

Specialist medicine; and

Urgent, emergency and trauma.

Speaking after the latest inspection of the trust, Ted Baker, chief inspector of hospitals at the CQC, said “significant progress” had been made, but there were “some remaining concerns”.