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Royal Devon and Exeter spinal surgeon leads national report to help improve care for patients


A consultant spine surgeon from the Royal Devon and Exeter NHS Foundation Trust has published a national report into spinal services which aims to improve care for tens of thousands of patients.


Mike Hutton, who has been at the Royal Devon and Exeter hospital since 2007, is the author of the Getting It Right First Time (GIRFT) national report into spinal services, published on 30 January 2019, which makes a series of 22 recommendations for improving the service.


Among them is a call for short-term pain relief injections to be replaced with long-term physical and psychological rehabilitation programmes could help tens of thousands more patients cope with debilitating back pain.


Lower back or radicular pain (sciatica) is the primary cause of disability in the UK. It affects one-third of the population at any one time, and 84% of people in their lifetime.


The latest GIRFT national report found that, despite NICE guidance, a significant number of patients are still receiving facet joint injections (injections of local anaesthetic and/or steroids to block pain), which have limited clinical value. On average between 2015 and 2018, almost 6% of patients with back pain received three or more facet joint injections in a year, at a cost to the NHS of £10.5m. Mr Hutton recommends reinvesting money in longer-term physical and psychological rehabilitation programmes, in line with the National Low Back and Radicular Pathway, endorsed by NICE.


Alongside caring for patients at the Royal Devon and Exeter Hospital, Mr Hutton has been conducting a review of spinal services across England as one of the 57 GIRFT clinical leads. His role has involved visiting 127 spinal units to meet with clinicians and discuss the issues facing the specialty.


He said: “During my visits, I have been repeatedly struck by the passionate commitment of the clinical staff towards the NHS as a force for good in society. The majority of units expressed pride in their work, a sense of ownership of their unit and a loyalty to the communities they service. They do so, however, under significant increasing demand on their services and financial constraints.


“I am grateful to the Royal Devon and Exeter NHS Foundation Trust for allowing me the time to conduct this important review and put forward the recommendations in this report. I firmly believe they offer the potential to achieve significant improvements in patient care and to create significant financial opportunities.”


The GIRFT national report focuses on spinal emergency conditions such as spinal cord injury and spinal infection, in addition to the management of common conditions such as back and radicular pain (sciatica). It shows that in 2017/18 the NHS carried out 52,523 surgical procedures on the spine.


The 22 recommendations bring opportunities to improve the patient experience through earlier discharge from hospital, reducing cancelled operations and ensuring trusts are equipped to deliver the best care in the most-timely manner. It is estimated the recommendations could deliver cost efficiencies of up to £27m.


Among the other key recommendations in the report are:

  • Referral without delay to 24-hour MRI scanning in all hospitals for patients with suspected cauda equina syndrome (a spinal emergency which can lead to limb paralysis and permanent loss of bowel and bladder function if not treated quickly);
  • All major trauma centres to have the ability 24/7 to stabilise and decompress the spine in patients with fractured and dislocated spines;
  • Suggested changes to the referral pathway of paediatric spinal deformity patients to enable children to be treated close to home where appropriate but at a centre with the shortest waiting time;
  • Better recording of implants, their use and patient outcomes.

Health Minister Stephen Hammond added his support to the report. He said: “This is a significant step forward in the way the NHS cares for people living with spinal conditions, focusing on rehabilitation rather than just relief to improve patient experience and lead to better treatment outcomes.


“These clinically-endorsed recommendations could have a major beneficial impact on the quality of life for tens of thousands of patients a year. This reflects a wider drive in the NHS Long Term Plan to reduce variation in treatment and deliver exceptional patient care at the best price for our taxpayers.”


The recommendations are also endorsed by the UK Spine Societies Board, the British Association of Spinal Surgeons, the Society of British Neurological Surgeons, the British Orthopaedic Association and the National Backpain Pathway Clinical Network. They will be implemented in partnership with NHS Improvement and NHS England, as well as directly with hospital trusts and Sustainability and Transformation Partnerships.


Added 30 January 2019

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