NHSHERE024_Executive_Summary_2010_FINAL

Arthroscopy of the knee joint
East Surrey Hospital
Canada Avenue
Redhill
Surrey RH1 5RH
Tel: 01737 768511
Fax: 01737 231769
A local solution for Herefordshire:
The future provision of health and
social care services
Executive Summary of the Transition Board Report
to Sponsor Organisations
NHS Herefordshire
Herefordshire Council
Hereford Hospitals NHS Trust
PCT Provider Services
and
West Midlands Strategic Health Authority

A brief introduction to arthroscopy
Arthroscopy is a “keyhole” operation that is used to look inside
and treat joints, especially the knee joint.
It is performed through very small incisions in the skin, using a
narrow telescope (arthroscope) attached to a video camera.
Compared to open surgery, which involves a larger incision,
keyhole surgery is less painful, carries less risk of infection, and
enables people to recover more quickly.
Why do I need this operation?
The surgeon needs to look inside your knee to find out exactly
what is causing your troubles. You may have a tear of one of your
cartilages. These are half moon shaped pieces of gristle cushioning
the bones in the knee. You may have torn one of the ligaments
within your knee joint. These are strong bands of gristle holding
the bone ends together inside the joint. You may have a loose
piece of bone in your knee joint. You may have arthritis in part of
your knee.
1 Contents 2
2 Chair’s Foreword 3
3 Executive Summary 6
Introduction 6
Background 6
Transition Board 7
Pre-Consultation 7
Future State – Statement of Common Purpose 8
Future State – Service Principles 8
Risk Stratification 8
Shifting the Focus of Care 8
Locality Health & Social Care Teams 9
Integration of Health & Adult Social 9
Care Across Care Pathways
Financial Assessment 10
3.1 Organisational Implications 11
The Proposition 11
Recommendations 12
1 Contents
Arthroscopy of the
knee joint
your knee.
2

What are the benefits of surgery?
The first aim of arthroscopy is as an investigation to reach a
diagnosis of the cause of your knee symptoms. It may be
possible to improve the symptoms if a loose body or torn
cartilage are found, which can be removed at the same
operation. An arthroscopy does not guarantee to improve your
symptoms. Arthroscopy is the only way to give a direct view of
the inside of the joint.
Are there any alternatives to surgery?
Not everyone with a knee problem will need an arthroscopy.
The problem can be diagnosed using non-surgical methods such
as MRI (Magnetic Resonance Imaging) and some problems can
be treated with physiotherapy.
3
2 Chair’s Foreword
A huge step but only the
beginning
Herefordshire is unique. It is not just its fine
buildings, beautiful scenery, mainly rural
population and strong sense of place but
also in the existence of a difficult puzzle
that has foxed previous efforts to solve it.
It has been my privilege over the last eight
months to work with clinical, social care
and management colleagues from across
the county to solve that puzzle. As the
national economic position tightens with its
impact on the NHS and local government
in general and Herefordshire in particular,
the need to agree how to sustain the future
of Herefordshire’s health and social care
becomes even more intense.
There have been several previous attempts
to identify that future. Those studies have
clarified that the catchment population
of the county and surrounding areas of
approximately 230,000 is half of what is
now nationally considered necessary to
support a fully functioning district general
hospital with accident and emergency,
maternity, intensive care, medical and
surgical specialties. The uniqueness of
Herefordshire and what makes it so
challenging, is the delivery of a full range of
services to a dispersed population.
Yet the geographical position of
Herefordshire and distances to other cities
mean that a local hospital with a broad range
of specialties is needed in the centre of the
county. Combined with this position, the
rural nature of the county determines that
strong locality and community based services
are also required.
Prior to this project, a clinically safe and
financially viable solution had eluded sincere
efforts to spot it. In August 2009 the four
Sponsors backed by the SHA, established
the Transition Board to develop a solution
for Herefordshire that would take health
and social care services into a good future.
The Transition Board brought together
social care, general practitioners, hospital
and community consultants, nursing, non
medical clinicians, patients’ representative,
senior management, financial expertise,
the joint PCT/Council commissioner, the
SHA and specialist external advice with an
independent chair to solve the puzzle.
The Transition Board began against a
background of scepticism about whether
this time the effort required to resolve the
Herefordshire puzzle would lead to any
action as recommendations from previous
studies had not been implemented. I was
very aware of this feeling both within
the Transition Board itself and the wider
community of health and social care
practitioners. However, building on the
previous work in the county, learning from
other health and social care economies in
the country and with the committed and

Arthroscopy of the
knee joint
your knee.
your knee.
4
thoughtful contribution of 100 clinical and
social care practitioners, the Transition Board
has reached a unanimous conclusion about
the overall way forward. Not surprisingly
there remain caveats, concerns and some
anxieties but these exist alongside a growing
enthusiasm for the prospects that are
opening up for a better future.
The Transition Board concluded that a
model of care provided by a new integrated
care organisation combining community
services (currently provided by PCT Provider
Services), acute health services (provided
by Hereford Hospitals NHS Trust) and
social services (provided by Herefordshire
Council), could create not only a viable but
a compelling option.
However, the Transition Board did not
start with an organisational solution in
mind. In fact the Transition Board actively
sought to establish whether it would be
possible to achieve virtual service integration
and financial sustainability without the
distraction of another organisational change.
Following the successful completion of four
workstreams including the definition of five
new clinical and social care pathways, and
the financial requirements associated with
them, the Transition Board has concluded
that a new integrated care organisation
would be the most effective mechanism to
achieve better services for patients, service
users, carers and families while creating a
sustainable and affordable health and social
care system for the future.
The new organisation will need to inspire
its existing and future staff with a shared
purpose across community, hospital and
social care. It will need to be a great
partner to general practice and primary
care, the children’s services Trust, mental
health services and other statutory
agencies, the West Midland Ambulance
Service, the private health sector and the
Third Sector of community, voluntary and
charitable associations.
It is also essential that concerns are
acknowledged. Practical measures of
reassurance are needed to make sure that
the hospital as the larger element of the
new organisation does not take over and
is seen not to have taken over community
services and social care without any change
in culture or approach. That required
change is captured in the Statement of
Common Purpose later in this report. All
elements of the local health and social care
system, including those within the new
organisation if approved and those partners
outside it, will need to do things differently
if the many benefits identified in the work
streams and pathways are to be achieved.
A simple organisational merger will not
achieve those outcomes.

5
Rather, the social care, community and
hospital services through combining in a way
unique to Herefordshire could create a new
and shared understanding of what it means
to provide excellent services within the
resources that it has and in a way that makes
its staff pleased to be part of the endeavour.
The new organisation, if approved, has the
potential to be different and better than the
sum of the existing parts.
It is important to acknowledge that even if
the 4 Sponsors had not set up this project
and were trying to make the current position
work, they would still have to find a solution
to the Herefordshire puzzle, to agree what
the future would be for the PCT-provided
community services and to cope with the
national financial squeeze.
The current configuration is not sustainable
and would not provide a viable future that
is local to Herefordshire and capable of
passing the rigours of becoming an NHS
Foundation Trust.
I consider that the proposition about a new
organisation with a new culture and the
more detailed recommendations, offer to
the four Sponsors and the SHA the potential
to resolve the issue of achieving clinical and
financial sustainability with a catchment
population small by national standards. There
is now clarity about a very positive future
for community services. The concept of a
new organisation founded on the wisdom
and experience of its clinical and social care
practitioners and managers is an exciting one.
The proposition offers patients, service users,
staff, primary care and other partners to do
something great for Herefordshire. Others
outside the county will wish to come and see
how it can be done.
Peter Gluckman
Independent Chair
Transition Board
Provider Services Integration Project
Herefordshire Health and Social Care Community

Arthroscopy of the
knee joint
your knee.
your knee.
6
3 Executive Summary
Introduction
The purpose of this document is to:
• set out the Transition Board’s
recommendations to the four Sponsor
organisations and the West Midlands
Strategic Health Authority (SHA) regarding
the organisation and delivery of health and
social care in Herefordshire;
• recommend a preferred option for
consideration and approval by the relevant
statutory bodies (NHS Herefordshire,
Herefordshire Council and Hereford
Hospitals NHS Trust) and;
• indicate to the sponsor organisations
and the SHA what is required to make
the integrated service model better for
patients and the public
This report is not a full business case. It does
not cover the full range of material that
would be part of such a document. The
work to prepare a full business case would
take place if the sponsors were to approve
the proposed option in principle.
Background
Herefordshire’s population is relatively elderly
and in the next five years is projected to
grow by 2%. This growth is confined to
the over 65 client group which will grow to
represent 23% of the population. Services
are provided over a broad geographic range;
across Herefordshire and into mid-Wales.
Geographical context is a key consideration
because, even though the population is
smaller than the estimated 450-500,000
required to sustain an acute general hospital,
without an acute hospital located in the
County many residents would need to travel
over an hour to a neighbouring hospital.
NHS Herefordshire spent £275 million in
2008/09 on care in the county and the local
authority spent £39 million in 2008/09 on
residential, nursing home and domiciliary
care. The largest single client group, in terms
of expenditure, is the elderly.
In 2008, the Herefordshire health and social
care community commissioned the Health
Services Management Centre (HSMC) to
undertake a strategic ‘Provider Services
Review’ that was designed to ensure that
provider services are fit for purpose and
organised in sustainable configurations in
order to both drive service improvement
and deliver real efficiency. There was
significant consensus from clinical teams
for the development of integrated care
pathways delivered by an integrated
hospital, community health and adult
social care organisation, although the final
review report did not make this explicit
recommendation. Following the conclusion
of the Provider Services Review in 2009,
KPMG were commissioned to:

7
• Assess the viability of HHT and the PCT
Provider Arm as standalone organisations
• Determine the potential clinical and
financial viability of a single integrated
healthcare provider
KPMG reported back that HHT and PCT
Provider Services, as currently configured,
faced a significant cumulative financial
deficit £23 million for the four year forecast
period ending 31st March 2014. However,
KPMG also pointed to the scope to achieve
significant clinical and financial benefit
through the redesign and integration of
services, shifting work from bed-based
settings to the community (potentially via a
single organisation).
Government policy also signals a shift in
health and social care towards a service
model that focuses on care provided in the
home and community as an alternative
to hospital. The model is characterised
by strong partnership arrangements and
integration between health and social care
providers, where partners agree shared
outcomes in order to support people to live
independently and stay healthy.
Transition Board
In August 2009 the Herefordshire health
and social care community formed an
independently-chaired Transition Board with
multi-disciplinary membership to:
• Develop options for the organisation and
delivery of health and social care services
• Recommend a preferred option for
consideration and approval by the relevant
statutory bodies
• Prepare public consultation documents and
organise/lead public consultation on behalf
of NHS Herefordshire
• Ensure that the subsequent proposals
will contribute to maximising health and
well being and reducing health and social
inequalities in Herefordshire
• Create new integrated care pathways in
adult services but recognise that these
would be extended in due course to other
areas such as children and young people
and maternity services
• Recognise that mental health services,
while essentially linked to any new
arrangements will be provided by a
different organisation
Pre-Consultation
The Transition Board undertook a pre-
consultative process on behalf of NHS
Herefordshire beginning in November 2009
and ending in February 2010. The exercise
focussed on asking staff, stakeholders and
the public how they think their local health
and social services could be improved
through closer integration. Feedback from
consultees has been incorporated into
this document.

Arthroscopy of the
knee joint
your knee.
your knee.
8
Future State - Statement of
Common Purpose
The Transition Board has developed a high-
level statement of common purpose to
reflect its ambition for health and social care
in Herefordshire:
‘We will provide integrated, high quality
and safe care to support personal health,
well being and independence within a
sustainable Herefordshire health and social
care community.’
The full statement containing the under-
pinning values and project benefits is
included in the report.
Future State – Service Principles
The Transition Board has developed a new
integrated model of care based on a number
of key principles:
• Risk stratification – identifying our
most ‘at risk’ clients and shifting from a
diagnose and treat service to one that
predicts and prevents
• Shifting the focus from institutional
(primarily bed based) to non-institutional
health and social care
• Services focussed heavily on locality health
and social care teams with a GP acting in
a crucial ‘gatekeeper’ role
• Clinical and operational integration of
primary, community, acute and adult
social care
These principles underpin the design of
the proposed new model of care and are
consistent with both the approach suggested
by KPMG and the policy context.
Risk Stratification
Proactive risk management is central to the
success of the new service model and care
pathways. This is derived from a focus on
‘at risk’ populations as opposed to those
that are currently known service users. Risk
stratification focuses on minimising the
likelihood of ill-health, disease progression,
need for hospitalisation and costly
interventions. Risk stratification will be
used to:
• Identify the most at risk, frail elderly
people within the community by ‘case
finding’ from GP practice registers.
• Case find those at risk from chronic
obstructive pulmonary disease (COPD),
diabetes and cardiovascular disease
Shifting the Focus of Care
The tiered model of care is predicated
on the needs of the population across
five ‘tiers’ of care. The model places a
greater emphasis on health promotion,
self care and screening/case finding as a

9
way of improving health outcomes. Active
management and community intervention
averts crisis management and unscheduled
hospital admission. The overall effect of
implementing risk stratification and a tiered
approach to care means that non-acute care
shifts back into a more appropriate setting.
This translates into major changes in the way
care is provided:
• The vast majority of chronic disease
management care will be provided
across the community in a variety of
different settings
• Community Hospitals will be used as the
locality focus for a range of activities from
step up/step down beds to specialist clinics
and unscheduled care
• Hospital care will only be provided where
appropriate. In practice, less care will
be provided from acute hospital beds
and more care provided in community
care settings
Locality Health
Social Care Teams
Locality teams will be the engine of the new
model of health and social care delivery in
Herefordshire with the GP acting as a crucial
gatekeeper for access to other parts of the
system. Effective locality teams will:
• Maximise independence and recovery for
the service user
• Reduce AE attendance and inpatient
admissions
• Reduce inpatient length of stay
• Support centralised services (acute/tertiary/
specialist)
Locality teams are key to the implementation
of a new model of integrated working
through their ability to:
• Provide care that is designed and delivered
around the needs of their local population.
• Promote a culture that fosters
accountability and consistency across all
the care settings of Herefordshire.
• Enable a structure of integrated working
across existing organisational and
professional boundaries, that make it
certain that service users receive treatment
at the right time and in the right location
Integration of Health Adult
Social Care Across Care Pathways
The Transition Board has concluded that
there are a number of key components
which are essential to the delivery of an
integrated service with the ability to provide
consistent care across a pathway from
beginning to end:
• Locality teams made up of GP’s, social
care professionals, nurses, therapists
and support workers, responsible for the
overall care of service users

Arthroscopy of the
knee joint
your knee.
your knee.
10
• An Urgent Care Centre fully integrated
with the AE Department, Clinical
Decisions Unit and Minor Injuries Units
• Frail elderly Multi-Disciplinary Team
consisting of nurses, therapists, social
care professionals, support workers, GP
and Geriatricians
• Step up/Step down COPD service
working across primary and acute care
on both admission avoidance and early
supportive discharge
• A single Diabetes service incorporating
diabetic nurse specialists, physicians,
dieticians and podiatrists
• A multi-disciplinary approach, including
early social care involvement, in the stroke
rehabilitation service
Financial Assessment
KPMG’s Due Diligence Review (2009)
indicated that the two main providers in
Herefordshire faced a cumulative combined
deficit of £23 million for the four year period
to March 2014. Since this analysis there has
been a further deterioration in prospects for
public sector funding and further analysis
suggests that the cumulative deficit could
potentially reach some £46 million, of which
£16million would be recurring.
Given the likely magnitude of the future cost
improvements required at HHT and the PCT
Provider Services, it is unlikely that either
HHT or PCT Provider services could meet this
challenge through internal efficiencies alone.
Initial modelling of the financial contribution
from the care pathways workstream
indicates that potential savings of up to
£12.5 million per annum could be available
across a range of scenarios. The financial
modelling for NHS Herefordshire’s World
Class Commissioning Strategy has assumed
a mid-range scenario of £5 million annual
savings derived from pathway redesign.
Further financial analysis will undoubtedly
be required as implementation progresses
but there is confidence at this stage
that the new service model represents a
financial positive.
The conclusion of the Transition Board
is that an integrated service solution has
the potential to close a proportion of
the gap between income and spend in
the local provider economy. However,
cost improvement programmes will still
be needed as will an open and evolving
discussion on risk sharing between the
commissioners and the new integrated care
organisation as the national funding position
clarifies over the summer of 2010.

11
Eleven options for organisational restructure
were drawn up by HSMC in their report
as part of the Provider Services Review.
Of the three preferred options, there
was strong consensus for an integrated
hospital, community health and social care
organisation. The review concluded that
it would be premature to recommend this
configuration without more detailed work
on integrated care pathways.
The KPMG due diligence report
recommended that integration was an
option that should be explored in order to
overcome the difficult financial futures that
both health providers face.
Supported by KPMG, the Transition Board
has modelled a number of detailed,
integrated care pathways which suggest
that better, more appropriate care can
be provided at lower cost through
integrated delivery.
Transforming Community Services: the
assurance and approvals process for PCT-
provided community services (DH 02/10)
mandates a number of options for preferred
organisational forms, including integration
between community services and an NHS
acute trust.
The Proposition
The proposition to the four sponsors falls
into two related parts:
1) The creation of a new integrated model
of health and social care provision
in Herefordshire, aimed at providing
personalised high quality, safe and
sustainable care for local people which
promotes personal health, well being and
independence; a model which is focused
on providing care as close as possible
to people’s homes, rather than in an
institutional setting; a model which is also
aimed at identifying our most vulnerable
clients and shifting the emphasis from
diagnosis and treatment to prediction
and prevention.
2) The creation of an integrated care
organisation under one management
structure composed of an integrated NHS
Trust combining community and acute
health services that is also integrated with
social care so far as is practicable under
current legislation; an organisation that is
characterised by a new culture, common
purpose and shared objectives and has
revised clinical, managerial and financial
governance arrangements suitable for an
organisation focused on patients, service
users and the catchment population;
that is an inspiring employer; is firmly
rooted in the community and enjoys close
3.1 Organisational Implications

Arthroscopy of the
knee joint
your knee.
your knee.
12
relationships with general practitioners
and primary care, localities, other health
service providers and its wider partners in
the statutory, private and Third sectors.
Recommendations
The recommendations are grouped into five
themes that support the proposition above:
Theme 1 – The proposed integrated model
of health and social care:-
• The commissioners/sponsors agree as a
fundamental principle that the service
model should be founded on the early
identification of ‘at risk’ or vulnerable
clients in the primary or community
setting in order to minimise the likelihood
of ill health or disease progression, with
a universal risk stratification tool being
applied to support this approach.
• The commissioners/sponsors also
support the adoption of a tiered model
of care (tiers 0-4) as set out in the
report to complement the focus on ‘at
risk’ groups and to ensure appropriate
integration of services and the shift from
institutional provision.
• The commissioners/sponsors support
the principle that care should, wherever
possible, be based on clear pathways,
focussed on improving patient outcomes
and sanction the implementation of
the five initial care pathways outlined
in the document, subject to sign off of
implementation plans and business cases
where necessary for:
• Frail elderly
• Stroke care
• COPD
• Diabetes
• Lower back pain
• The commissioners provide guidance to
the Transition Board / Implementation
team (if approved) on further pathways
that they would wish to see designed and
implemented (with clarity of timescales),
taking account of feedback from the
Clinical Task Group.
• The commissioners/sponsors agree
in principle to the establishment of
integrated locality health and social care
teams as a crucial underpinning to the
proposed tiered model of care, subject to
further detailed assessment of workforce
and financial implications and preparation
of an appropriate business case/
implementation plan.
• The commissioners/sponsors agree in
principle the desired future state of the
unscheduled care system as set out in the
report and authorise the implementation
team to:

13
• Address those practical issues not
requiring formal decisions or additional
resources.
• Prepare business cases for crucial
components of the new system
e.g. rapid response teams, urgent
care centre.
• The commissioners/sponsors consider the
steps identified in the report to sustain
and better integrate key acute hospital
services (Accident Emergency, Trauma,
Emergency Surgery and Maternity), and
provide feedback as to whether external
validation of the proposals is required.
• The commissioners support the developing
role of the GP, which is vital to the success
of the proposition, in providing the right
care in the right place.
• Sponsors and providers acknowledge
that effective links will be essential with
mental health services though they will
be provided by a different organisation
following the tendering process.
• The commissioners/sponsors and the
new integrated care organisation will
need to have an agreed joint risk sharing
arrangement in place that is frequently
reviewed on a collaborative basis as the
new provider organisation is established
and the national economic position
clarifies over the summer 2010.
Theme 2 – The proposed integrated
care organisation and its governance
arrangements:-
• NHS Herefordshire should recommend to
the West Midlands SHA, in the context
of the eight tests set out in Transforming
Community Services: the assurance
and approvals process for PCT-provided
community services (DH 02/10) integration
of PCT Provider Services with an NHS acute
provider (Hereford Hospitals NHS Trust)
plus integration with the Local Authority’s
social care services, so far as is practicably
possible given the current legislative and
funding framework.
• The four Sponsors and the SHA continue
to strengthen their joint leadership
of the integration process, providing
guidance to the Transition Board,
proposed implementation team, staff
and partners on the path to the new
organisational arrangements.
• In full consultation with the West Midlands
SHA, the statutory organisations establish
a Governance Group composed of Chairs
and Chief Executives (or their very senior
representatives) to take forward and to
commission additional work as necessary
so that a clear and detailed set of
proposals is developed as to how the new
organisation will be managed.

Arthroscopy of the
knee joint
your knee.
your knee.
14
• The four Sponsors take account of
discussions with the SHA, the statutory
options and the valuable experience of the
Transition Board’s visits to other health and
social care economies, in agreeing the right
legal framework for the new integrated care
organisation, including its name, using the
existing legal entity of Hereford Hospitals
NHS Trust and changing the governance
within it to reflect the requirements of a
new organisation and culture.
Theme 3 – Managing the change – Transition
Board and Implementation Team
• Subject to accepting the recommendations
with any amendments required by the
four Sponsors, that they establish an
implementation team authorised to do
the necessary work in order to make
the proposition a reality and with the
appropriate resources at its disposal (people
and funding).
• The Implementation Team should be
accountable to the four Sponsors with the
reconstituted Transition Board acting as
both a reference group to provide guidance
and as a source of assurance to sponsors.
• The commissioners provide guidance
on the future configuration of children’s
services including the relationship to the
Children’s Trust.
• The Implementation Team to be led
by a senior executive backed up by
suitable clinical, management, financial,
administrative and other capacity
as required
• The Implementation Team will meet
regularly to monitor its progress and
to hold contributing individuals and
organisations to account for delivering
their element of the project.
• The Implementation Team should develop
a business case and an integrated project
plan, with a clear timetable and milestones
and that is subject to approval and scrutiny
by the four Sponsors and the SHA.
• The project plan will include detailed
planning for implementing each agreed
element of the new service model,
including care pathways and financial
modelling, over the next two to three
years, starting in 2010/11.
Theme 4 – Creating a new organisational
culture
• The Statement of Common Purpose, and
its supporting principles and objectives
should form the basis for discussions
with staff across the health and social
care system as to how best to achieve the
ambitions for the new organisation.

15
• The proposed implementation team (if
approved) consider as one of its first tasks
how to develop a new organisational
culture and objectives for the proposed
integrated care organisation, building
on the statement of Common Purpose
developed by the Transition Board and set
out in this report.
• The four Sponsors and the SHA to
recognise that even with widespread
support for the proposition of an
integrated care organisation, there may
well be a period of uncertainty for staff
and that a joint Workforce Development
Group is established to consult with
staff and manage and to mitigate any
difficulties and risks so far as is possible,
learning from previous organisational
change and visits to other economies.
• An organisational development
programme is established to support
the new integrated care organisation
with a new culture, common purpose
and objectives.
• The implementation team consider how
best to build on the clinical and social care
engagement achieved so far in order to
strengthen and deepen such links across the
integrated care organisation and primary
care as a continuing legacy of the project
to the Herefordshire health and social
care community.
• The new integrated care organisation
is characterised by a commitment to
partnership with primary care, the provider
of Mental Health Services in Herefordshire,
West Midlands Ambulance Service, other
health service providers, the Third Sector
and relevant organisations beyond the
county boundary.
• That if the four sponsors accept the
proposition and recommendations, the
Transition Board will have completed its
work by 14th May 2010. It would then
be replaced be a differently constituted
Transition Board to help to maintain
momentum and to provide scrutiny of and
guidance to the Implementation Team
along with assurance to the sponsors that
their ambitions for the integrated care
organisation were being achieved.
Theme 5 – Transitional Issues
• That Commissioners consider how they
can support the care pathway work to
achieve the best use of resources; this may
be through investment in order to improve
the standards of care and lower the
eventual overall cost of delivery.
• Building on the experience, scope and
feedback from the pre-consultation period
(November 2009 to February 2010), the
formal consultation on the proposition be
led by the NHS Herefordshire in association

• General complications of any operation
The main possible complications of any surgery are excessive
bleeding, infection or an unexpected reaction to the anaesthetic.
• Specific complications of this operation
Complications are rare and seldom serious. Bleeding into the
joint and infection of the joint may rarely happen after the
arthroscopy.
Sometimes a repeat operation is needed to remove a damaged
cartilage. If there is arthritis, the operation may do no more
than make this clear, without making the knee better.
How soon will I recover?
It may take up to three weeks to get back to usual activities.
Date of publication: April 2006
Review Date: April 2008
Ref: Arthroscopy of the knee joint
www.surreyandsussex.nhs.uk
Author: Terry Young, Senior Nurse Matron
Trauma Orthopaedics Team
Further Information:
NHS Direct Health Advice Line (24 hr) - 0845 4647
www.nhsdirect.nhs.uk
This information can be made available in other formats and languages.
Please telephone 01737 768511 ext 6831.
• General complications of any operation
The main possible complications of any surgery are excessive
bleeding, infection or an unexpected reaction to the anaesthetic.
• Specific complications of this operation
Complications are rare and seldom serious. Bleeding into the
joint and infection of the joint may rarely happen after the
arthroscopy.
Sometimes a repeat operation is needed to remove a damaged
cartilage. If there is arthritis, the operation may do no more
than make this clear, without making the knee better.
How soon will I recover?
It may take up to three weeks to get back to usual activities.
Date of publication: April 2006
Review Date: April 2008
Ref: Arthroscopy of the knee joint
www.surreyandsussex.nhs.uk
Further Information:
NHS Direct Health Advice Line (24 hr) - 0845 4647
www.nhsdirect.nhs.uk
This information can be made available in other formats and languages.
Please telephone 01737 768511 ext 6831.
with the Council but be delegated to
the Implementation Team working with
others in the PCT and Council to manage
and to prepare suitable documentation
and implementation plans. The proposed
restructured Transition Board would
provide scrutiny, advice and reassurance
that the proposed consultation was fully
and properly planned and carried out.
• The Boards of the four Sponsors consider
how they can best meet jointly in order to
collaborate in the development of the new
integrated care organisation and its new
culture.
• The implementation team develops an
interactive communications plan for NHS
and social care staff directly affected
by the proposition and for the wider
partnerships across general practice,
primary care, other health care providers,
the community, voluntary and charitable
sectors and public.
For further information about this document
please contact:
Programme Team on: 01432 372928
Release/Status: Final Executive Summary
Version: 1.0
Date: 14th May 2010

NHSHERE024_Executive_Summary_2010_FINAL

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