Agenda item

To receive a presentation regarding Health Optimisation.

12:00 noon – 25 mins – Ruth Grabham/Jon McFarlane

The Board received a presentation from Dr Ruth Grabham and Jon McFarlane regarding pre-operative health optimisation.

·  It is important for patients to be as fit as possible prior to undergoing surgery.  Evidence relating to the effects of smoking and obesity on outcomes has been considered. 

·  Smokers are 38% more likely to die after surgery and are at increased risk of heart and lung complications, post-surgical infections and poor wound healing.  Pre-operative smoking cessation is effective.

·  The statistical evidence relating to obesity is more limited.  However, there is an overall increased risk of anaesthetic airway complications and surgical site infection for all surgeries.

·  It was proposed that prior to surgery GPs would discuss smoking cessation and weight loss with patients as appropriate.  Patients would then be offered physiotherapy and advice about weight loss and giving up smoking.  Patients would then have three months in which to prepare for surgery.

·  There will be a staged approach to the pathway as follows:

o  Stage 1 – Hip and knee replacement surgeries – this will aim to build on the success of the Hip and Knee Programme

o  Stage 2 – Smoking cessation across all surgeries

o  Stage 3 – Weight loss across all surgeries

·  This will be introduced from 1 October 2017.

·  The proposals will lead to improved patient outcomes following surgery and reduced length of stay in hospital.

·  There will be a public engagement process.

The following issues were then discussed:

·  Councillor Vic Pritchard noted the strong evidence relating to smoking.  It was acknowledged that some patients will not wish to engage and that they cannot be compelled to take part.

·  Councillor Paul May stressed the need for publicity about the proposals to raise awareness.  Tracey Cox confirmed that further patient engagement is planned prior to the introduction of stages 2 and 3. 

·  Alex Francis stated that Healthwatch has been involved in this project.  She queried the capacity for health organisations to support patients.  She also noted the complexity of patients and the many different reasons for certain lifestyle choices such as smoking.  It will be important to support healthcare professionals to enable them to carry out these, often difficult, conversations with patients.

·  Dr Grabham stated that Virgin Care has the capacity to support patients through this process.  The initial conversations with patients will be with their GP who will then make a referral. The referral support service will then provide the necessary support and advice.

·  Professor Bernie Morley commented on the data provided and the need to make this as clear as possible to understand.

·  Ashley Ayre noted that people are often more willing to make lifestyle changes at a time of crisis.

·  Hayley Richards endorsed the proposals and pointed out that people suffering from a mental illness are often less likely to attend for regular health checks. It will be important to evaluate the impact of intervention on different sectors of the population.

·  Bruce Laurence felt that it was very important to give people support and opportunities to improve their health.  He noted that this proposal appears to be the right level of “carrot and stick” as it provides an assertive approach while not being mandatory.

·  Mark Coates recommended that patients should be asked why they did or did not take up the offer of advice and support.

A copy of the presentation slides are attached as Appendix 3 to these minutes.

RESOLVED: To fully endorse the pre-operative health optimisation proposals.