Latest / Deep Dive Ortho — Orthopaedic Surgery, AI & Digital Health Podcast. / New Consultant Advice in the NHS

Transcript

New Consultant Advice in the NHS · Deep Dive Ortho — Orthopaedic Surgery, AI & Digital Health Podcast.

• 0:00
  Welcome to the deep dive. Today we're getting
• 0:01
  into something really fundamental, how high quality
• 0:05
  trauma in orthopedic care is actually delivered
• 0:08
  or should be delivered within the NHS. And we're
• 0:11
  using a fascinating source for this, aren't we?
• 0:13
  The British Orthopedic Association's advisory
• 0:15
  book for consultants. It's not exactly bedside
• 0:18
  reading, but it's critical stuff. Exactly. It's
• 0:21
  aimed squarely at senior doctors, consultants
• 0:23
  who are navigating what the book itself calls
• 0:25
  unprecedented change. That's right. More demand.
• 0:29
  resources stretched thin, constant pressure on
• 0:32
  targets. That 18 -week wait time, for instance.
• 0:35
  It's a tough environment. So our mission today,
• 0:37
  using this BOA book, is to really unpack what
• 0:40
  it takes. What are the standards, the challenges,
• 0:44
  the absolute must -haves for leading an orthopedic
• 0:46
  service safely and effectively? Well, it kicks
• 0:49
  off by highlighting quite a big shift in what's
• 0:51
  expected of a consultant. Oh, how so? He talks
• 0:54
  about moving away from just being consultant
• 0:56
  -led sort of overseeing things towards being
• 0:58
  consultant delivered. Meaning much more hands
• 1:01
  -on involvement right through the patient's journey.
• 1:04
  Precisely. Direct involvement. And it's not just
• 1:06
  about the surgery itself. It's leadership, it's
• 1:08
  engaging with commissioning, shaping how care
• 1:11
  pathways work. Yeah. You know, the whole system.
• 1:13
  And showing that the care is high quality. How
• 1:15
  does the book advise on that? Ah, well, outcomes
• 1:19
  measurement is central. And orthopedics actually
• 1:21
  has a bit of history here. The book mentions
• 1:23
  EA Codman way back. pushing this idea of the
• 1:27
  end result concept, basically tracking what actually
• 1:30
  happens to patients. That's quite forward thinking
• 1:32
  for the early 20th century. And today, that means
• 1:35
  things like PROMs, patient reported outcome measures.
• 1:38
  Exactly. PROMs, patient reported experience,
• 1:41
  measures PREMS, the friends and family test.
• 1:44
  So it's not just did the operation fix the problem,
• 1:47
  but what was the patient's actual experience
• 1:49
  like? Which feels much more holistic. It is.
• 1:52
  And it's not just optional data collection. For
• 1:54
  GMC revalidation, the process all doctors go
• 1:57
  through every five years to prove they're fit
• 1:58
  to practice. There's a clear expectation to measure
• 2:01
  your own patient's experience. It's about accountability,
• 2:04
  really. And speaking of patients, the book tackles
• 2:07
  something quite specific, doesn't it? About patients
• 2:10
  wanting to see the same surgeon. Yes. This is
• 2:13
  a really key point for the BOA. They're, well,
• 2:17
  they're quite wary of pooled waiting lists if
• 2:20
  they aren't managed very carefully. Because of
• 2:22
  the risk of feeling like just a number? Partly,
• 2:24
  yes. Depersonalization. Not knowing who's actually
• 2:28
  going to do your operation, but also lack of
• 2:31
  clarity on who's responsible. The BOA insists
• 2:34
  on proper patient consent for that model, and
• 2:36
  that should only happen after a full pre -assessment,
• 2:39
  ideally where the patient meets the operating
• 2:41
  surgeon. You shouldn't be meeting them for the
• 2:42
  first time just before you go under. Definitely
• 2:45
  not. It undermines that trust, doesn't it? Absolutely.
• 2:48
  Okay, let's shift focus slightly to the consultant's
• 2:50
  professional life. Revalidation is obviously
• 2:53
  huge. It is. Fundamentally, it's there to assure
• 2:56
  everyone, patients, the public, employers, that
• 2:59
  doctors are up -to -date, competent, and safe.
• 3:02
  It's a five -year cycle linked to a responsible
• 3:05
  officer in their organization who then recommends
• 3:07
  to the GMC. And staying up to date involves continuing
• 3:10
  professional development, CPD. Essential. And
• 3:13
  it's a statutory requirement for revalidation.
• 3:16
  It can't just be narrow clinical stuff either.
• 3:18
  It needs to cover everything, clinical practice,
• 3:20
  academic work, management, leadership. The book
• 3:23
  suggests about 50 hours or points a year. And
• 3:26
  reflective practice is important there too. Very
• 3:28
  much so. Not just attending a course, but reflecting
• 3:31
  on what you learned and how it changes your practice.
• 3:34
  And study leave, maybe 10 days a year with pay
• 3:36
  and expenses, is needed to make this happen.
• 3:39
  But how does that fit into a packed consultant
• 3:42
  schedule? That's where SBA time comes in. Exactly.
• 3:46
  Supporting professional activity time. The BOA
• 3:48
  book is really clear. This isn't downtime or
• 3:51
  an optional extra It's essential for professional
• 3:54
  development for quality improvement for patient
• 3:56
  safety. It has to be part of the job plan So
• 3:58
  it's protected time for things other than direct
• 4:01
  patient contact. That's it and the book splits
• 4:03
  it a bit There's core SPA things like your CPD
• 4:06
  keeping up with journals appraisal prep mandatory
• 4:08
  training and then employer directed SPA that
• 4:11
  could be audit research governance meetings managing
• 4:14
  roles teaching And external duties, too, like
• 4:17
  working with the royal colleges. Yes, that counts,
• 4:19
  too. And the evidence, particularly thinking
• 4:21
  back to reports like the Francis Inquiry, just
• 4:24
  underlines how vital protected SBA time is for
• 4:27
  maintaining quality and safety. You can't do
• 4:30
  it on the fly. OK, that makes sense. So moving
• 4:33
  from the individual consultant to the service
• 4:35
  itself, what are the building blocks? What does
• 4:38
  the book say is required for a good TNO service?
• 4:42
  Right. The nuts and bolts. It talks about beds
• 4:44
  and facilities, no magic number, but guiding
• 4:47
  principles. Things like efficient pre -assessment
• 4:49
  clinics are highlighted. They're key for sorting
• 4:51
  patient fitness, reducing cancellations, getting
• 4:54
  discharge planning started early. And things
• 4:55
  like day surgery. Yes, ambulatory care. It can
• 4:59
  work well, help manage bed pressures, but only
• 5:01
  with really careful patient selection and good
• 5:04
  post -op support, like follow -up calls. And
• 5:07
  infection control must be huge in orthopedics.
• 5:09
  Absolutely massive. You cannot overseed it. Think
• 5:12
  MRSA screening and treatment, how you manage
• 5:14
  patients who do have infections, the devastating
• 5:17
  cost, human and financial, of infected joint
• 5:20
  replacements. It's critical. And that relies
• 5:22
  on staff as well as processes. Totally. You need
• 5:25
  enough properly trained staff, orthopedic nurses
• 5:28
  who know the procedures, physios, OTs. And the
• 5:32
  book flags the need for seven -day working to
• 5:34
  maintain standards across the week, not just
• 5:36
  Monday to Friday. It also mentions the debate
• 5:38
  about where services are located, combining trauma
• 5:41
  and elective or keeping them separate. Yeah,
• 5:43
  pros and cons. Combined sites can seem efficient,
• 5:47
  but elective lists often get canceled for trauma
• 5:49
  emergencies. That's huge. disruptive. I can imagine.
• 5:52
  Separate sites protect the planned work, but
• 5:55
  then you have potential issues with staff traveling,
• 5:57
  duplicating kit, maybe losing that cross -cover.
• 5:59
  There's no single perfect model. It depends on
• 6:02
  local circumstances. And the book is emphatic
• 6:04
  about needing the right staff beyond just doctors.
• 6:07
  Oh absolutely. High quality nursing is vital.
• 6:10
  Ideally, nurses with specific orthopedic qualifications
• 6:13
  or experience. Staffing numbers need to reflect
• 6:16
  the workload and patient dependency with the
• 6:18
  right skill mix. What about advanced practitioners,
• 6:21
  nurse practitioners, physio practitioners? They
• 6:23
  have an important role, definitely. Extended
• 6:25
  scope practitioners, advanced nurse practitioners.
• 6:28
  But the book is clear. The consultant keeps overall
• 6:32
  clinical responsibility, and patients must know
• 6:35
  who they're seeing and what their qualifications
• 6:38
  are. Transparency is key. And physio and OT.
• 6:42
  Obviously crucial for recovery. Fundamental for
• 6:45
  getting people moving, getting them home safely,
• 6:47
  helping them regain independence. For inpatients,
• 6:50
  the book recommends a specialist ortho -physio
• 6:53
  lead. Staffing needs to match the case complexity.
• 6:56
  Major trauma or big revision surgeries need more
• 6:58
  input. And 7 -Day Physio helps with that, getting
• 7:00
  people home sooner. It does, helps reduce length
• 7:02
  of stay. And occupational therapists are vital
• 7:05
  to assessing home environments, organizing equipment,
• 7:08
  splints, helping with the return to work. They're
• 7:10
  key for timely discharge. Consultant support
• 7:13
  is often needed to make sure these therapy services
• 7:15
  get the resources they need. Hand therapy even
• 7:17
  gets its own section. It does because it's so
• 7:20
  specialized and makes such a difference to outcomes
• 7:22
  after hand injuries or surgery. Needs dedicated
• 7:25
  therapists, physios, or OTs, ideally working
• 7:28
  towards accreditation. The book even suggests
• 7:31
  a staffing ratio roughly one senior therapist
• 7:33
  plus support per hand consultant. Okay, let's
• 7:36
  step inside the operating theater. What are the
• 7:39
  essentials there, according to the BOA? Dedicated
• 7:41
  theater time is non -negotiable. Not enough allocated
• 7:44
  time just leads to cancellations. Simple as that.
• 7:47
  Which impacts waiting lists and patient stress.
• 7:50
  Hugely. So you need regular scheduled trauma
• 7:52
  lists every day, plus 247 emergency cover with
• 7:56
  senior surgeons and anesthetists available. Clean
• 7:59
  elective cases need to be separated from trauma
• 8:01
  or potentially infected cases. And timing is
• 8:04
  critical for emergencies. Yes. Immediate access
• 8:07
  for some things dislocated hips, compartment
• 8:09
  syndrome, and for most long bone fractures, access
• 8:12
  within 24 hours is the standard. Open fractures
• 8:15
  need timely debridement too, although the old
• 8:17
  strict six -hour rule is less rigid now unless
• 8:20
  it's heavily contaminated. Access to good imaging
• 8:23
  and theater is also vital. What about the air
• 8:25
  in the theater? I know that's a big focus for
• 8:27
  joint replacements. It is. Ultra -clean air ventilation
• 8:29
  systems, UCA, are mandatory for joint replacements
• 8:32
  and major implant surgery. It's a key part of
• 8:35
  preventing infection. Does it make a difference?
• 8:37
  The evidence suggests it does, significantly.
• 8:39
  The book cites data showing that UCA, combined
• 8:42
  with prophylactic antibiotics, slashed deep infection
• 8:45
  rates historically, from maybe 11 % right down
• 8:48
  to nearer 0 .3%. Patient factors like diabetes
• 8:51
  or smoking matter, too. Of course, they need
• 8:54
  optimizing. But the environment is critical.
• 8:57
  And the BOA has strong views on general theater
• 9:00
  practice. Very strong. Orthopedic implant surgery
• 9:03
  demands, they argue, higher sterile precautions
• 9:05
  than many other types of surgery. Strict control
• 9:08
  of who's in theater, how they move, impermeable
• 9:11
  gowns, drapes, hoods, masks, the whole setup.
• 9:14
  And they back surgeons who refuse to operate
• 9:16
  if standards aren't met. Yes. The book explicitly
• 9:19
  states they support members who feel patient
• 9:21
  safety is compromised by substandard conditions.
• 9:24
  That's quite a statement. Instrument cleaning,
• 9:26
  decontamination, another vital step. Absolutely
• 9:29
  vital. Whether it's done onsite or centrally,
• 9:31
  the process has to be robust. A crucial point
• 9:34
  the book makes. If you don't have an immediate
• 9:37
  way to re -sterilize a dropped instrument onsite,
• 9:40
  you really need two sets available before you
• 9:42
  start. And teamwork between the theater team
• 9:45
  and decontamination staff is essential. What
• 9:48
  about small things like screws? Should they be
• 9:51
  in individual packets? Interestingly, the BOA
• 9:54
  view is... No, probably not. They argue it's
• 9:57
  actually more expensive, takes longer during
• 9:59
  the operation, and might even increase infection
• 10:01
  risk because of all the extra handling movement
• 10:04
  opening packets. So better to have them sterilized
• 10:06
  on a rack with the main instruments? That's their
• 10:09
  preference, yes. Seems counterintuitive, perhaps,
• 10:12
  but their reasoning is about minimizing operating
• 10:14
  time and movement. What else? Blood banks? Tissue
• 10:17
  banks? Need access to both, and they must be
• 10:19
  properly accredited by the MHRA. Hospitals need
• 10:22
  clear protocols for blood use, transfusion triggers,
• 10:25
  maybe using cell salvage techniques to conserve
• 10:27
  blood. And risks to staff. Bloodborne viruses.
• 10:31
  Yes. Orthopedics is higher risk because of power
• 10:33
  tools, sharp bone fragments, irrigation fluid,
• 10:37
  hep B immunization is recommended, assume every
• 10:40
  patient is potentially infectious, use proper
• 10:42
  PPE like splash card masks, and have clear procedures
• 10:45
  if someone does get an exposure. Okay. Outside
• 10:48
  of theaters clinics, outpatient and fracture
• 10:50
  clinics need specific things too. They do. Ideally,
• 10:53
  purpose designed, near x -ray in the plaster
• 10:56
  room. Enough rooms, big enough for teaching.
• 10:59
  Proper walls for privacy, not just curtains.
• 11:01
  Separate areas for clean dressings and potentially
• 11:05
  contaminated ones. Enough staff for smooth flow,
• 11:07
  chaperones available. Fracture clinics should
• 11:09
  also check for falls risk, bone health. And getting
• 11:12
  information, write notes, letters. Crucial. Medical
• 11:15
  records need to be easily available. Letters
• 11:17
  to GPs should be out within three working days,
• 11:19
  accurate, saying what the plan is, risks, benefits.
• 11:22
  Same for discharge summaries. Operation notes
• 11:24
  need to be detailed, legible or typed, listing
• 11:27
  everyone involved, the implants used, any issues,
• 11:30
  clear post -op instructions. Sounds like a lot
• 11:32
  of admin. Where does the consultant do all this?
• 11:34
  Good point. The book stresses that proper office
• 11:37
  accommodation isn't a luxury. Each consultant
• 11:40
  needs their own office, ideally equipped with
• 11:43
  IT access. It's needed for that admin time, for
• 11:46
  SPA activities, leadership tasks, hot desking,
• 11:50
  strongly discouraged, inefficient, insecure.
• 11:53
  Juniors need decent space, too. And medical secretaries
• 11:56
  are key to managing that admin load. Absolutely
• 11:59
  essential. The book is very firm. At least one
• 12:02
  full -time trained medical secretary per consultant
• 12:04
  is needed for a safe, effective service. They're
• 12:07
  the link with GPs. patience, coordinating everything.
• 12:11
  A name secretary helps the consultant work efficiently
• 12:13
  and safely. And you need cover for when they're
• 12:15
  on leave. Teaching facilities also get a mention.
• 12:18
  Yes, a dedicated room for teaching, for multidisciplinary
• 12:21
  meetings, trauma handovers. Access to simulation
• 12:23
  facilities is increasingly important for training
• 12:25
  safely. And good IT for accessing online journals
• 12:28
  and resources. Let's just quickly revisit SBA
• 12:30
  Times supporting professional activity. You said
• 12:32
  it was crucial. Yes, the book really hammers
• 12:35
  this home. It's fundamental for keeping skills
• 12:37
  up, improving the service, patient safety, innovation.
• 12:40
  It cites the Francis Report. It lists those core
• 12:43
  things like CPD and appraisal and the employer
• 12:46
  -directed stuff like audit, research management,
• 12:48
  plus time for external roles. It's not optional.
• 12:51
  Okay. Now, what about patients with particularly
• 12:53
  complex needs? How should services cater for
• 12:57
  them? This requires access to a whole range of
• 12:59
  support services, and the book notes that provision
• 13:02
  varies across the country. Things like rehab,
• 13:04
  physio, OT, hand therapy, but also special support
• 13:07
  like care of the elderly teams, especially for
• 13:10
  hip fractures, social services input for discharge.
• 13:13
  Seven -day trauma management is vital here too.
• 13:16
  And often, it means linking with regional specialized
• 13:18
  services in other hospitals. Clear pathways,
• 13:21
  named contacts are needed. Things like image
• 13:23
  exchange portals, IDPs are essential for sharing
• 13:26
  scans for discussion. What sort of specialized
• 13:28
  services? Major trauma networks, obviously. Specialist
• 13:32
  spinal injury services. Plastic surgery for complex
• 13:35
  limb reconstruction. Vascular surgery for injuries
• 13:39
  involving blood vessels. Neurosurgery. The list
• 13:41
  goes on. Smooth pathways and communication between
• 13:44
  centers are key. And specialist orthopedic hospitals,
• 13:47
  they have a particular role? They do. Centers
• 13:50
  of Excellence, Homes for Networks, dealing with
• 13:52
  the most complex cases, leading on training and
• 13:55
  research. They face funding challenges, as the
• 13:58
  national tariff doesn't always reflect that complexity,
• 14:00
  but they're vital. They need top -notch facilities
• 14:03
  themselves, of course. The book also talks about
• 14:05
  treatment centers, ISTCs, or NHSTCs. What was
• 14:08
  the take on those? Well, it outlines their development
• 14:11
  set up to boost capacity, sometimes using non
• 14:13
  -UK staff initially. They often focused on straightforward
• 14:16
  elective cases, which could concentrate the complex
• 14:19
  back in NHS hospitals. Were there concerns? Yes.
• 14:23
  The BOA flagged concerns about quality assurance,
• 14:26
  short contracts, lack of mandatory audit, into
• 14:29
  complications. And a big one was the risk of
• 14:32
  separating elective and trauma work, potentially
• 14:34
  descaling surgeons in acute hospitals and harming
• 14:37
  training. The hope or expectation was they'd
• 14:39
  become better integrated, staffed by UK -trained
• 14:42
  surgeons. And the major trauma networks themselves,
• 14:45
  set up from 2012 in England? A big shift. Getting
• 14:48
  patients to the right place fast. Major trauma
• 14:51
  centers or trauma units. Orthopedic surgeons
• 14:54
  are key members of the MTC teams, needing to
• 14:56
  be readily available. Surgeons in the TU's manage
• 14:59
  a range of trauma, but need to be expert in that
• 15:01
  initial stabilization phase. Good communication
• 15:04
  for repatriation is crucial. Underpinning all
• 15:06
  of this, though, is the workforce itself. The
• 15:08
  book seems quite concerned here. Definitely.
• 15:10
  It's a major theme. Trying to pin down exact
• 15:13
  numbers needed is hard because care is spread
• 15:15
  across NHS, private sector, treatment centers.
• 15:18
  But the trend is undeniable. Demand is soaring.
• 15:21
  Aging population, more active population, rising
• 15:24
  joint replacements. And trauma isn't going away.
• 15:27
  No, hip fractures particularly. The book estimates
• 15:29
  a capacity gap may be 15 % shortfall currently.
• 15:31
  And the workforce is changing more women, people
• 15:34
  working longer. But the absolute key message
• 15:36
  is, consultants cannot work effectively or safely
• 15:39
  without enough support staff. Junior doctors,
• 15:41
  nurses, therapists, admin staff. There's often
• 15:44
  a mismatch between the need and the actual posts
• 15:47
  available. Right. Let's touch on how the book
• 15:49
  advises assessing consultant workload. Section
• 15:52
  two, I think. Yes. It starts by stating the obvious,
• 15:55
  perhaps, but it's crucial. Workload capacity
• 15:57
  depends hugely on facilities and support. Deficiencies
• 16:01
  hold consultants back. It also acknowledges consultants
• 16:03
  often work well beyond their contracts. The 2003
• 16:06
  contract introduced programmed activities, PAs.
• 16:09
  That's right in England, Scotland, and Northern
• 16:11
  Ireland. Replacing the old notional half days.
• 16:14
  A PA is roughly four hours. Standard week is
• 16:16
  10 PAs. Wales had a slightly different system.
• 16:19
  The idea through job planning was to make the
• 16:21
  whole workload transparent and ensure extra work
• 16:24
  was recognized. So the job plan is key. It's
• 16:27
  an agreement. reviewed annually, detailing all
• 16:29
  the duties. Direct clinical care, DCC, supporting
• 16:33
  professional activities, SPA, any extra roles
• 16:36
  like clinical director, on -call work, emergency
• 16:39
  visits, travel times, it's all part of it and
• 16:41
  should be factored in. The 2003 -04 contract
• 16:45
  specifically allocated PAs for being on -call.
• 16:48
  What about how often consultants should be on
• 16:50
  -call? Ideally, the book suggests no more frequent
• 16:52
  than a one in six rota. though small units might
• 16:55
  struggle with that. The intensity, how busy it
• 16:57
  actually is, whether there's good junior support
• 16:59
  needs to be reflected in the PA allocation. The
• 17:02
  aim is to plan activity rather than rely on excessive
• 17:05
  unplanned extra hours. Up to 12 PAs total can
• 17:08
  be paid. Beyond that might be time off in lieu.
• 17:10
  Resident on call isn't standard unless specifically
• 17:13
  agreed. And specific tasks. How do they fit in
• 17:16
  the workload? Fracture clinics can be unpredictable
• 17:19
  with new patients but need proper staffing under
• 17:22
  consultant direction. Trained orthopedic practitioners
• 17:25
  can see some patients. Ward rounds are a central
• 17:28
  clinical time, part of DCC. Need to maximize
• 17:32
  theater use. Trend towards more complex cases
• 17:34
  on inpatient lists. Need enough time between
• 17:37
  cases orthopedics often needs longer turnover.
• 17:40
  And crucially, time for supervising trainees
• 17:42
  must be built in. It's a balancing act between
• 17:45
  theater and clinic time to manage waiting lists.
• 17:48
  Ardent is non -negotiable too. Part of governance.
• 17:51
  Regular sessions needed. Contributing data to
• 17:53
  national registries like the NJR is standard,
• 17:56
  but needs admin support. Consultant involvement
• 17:58
  and management, clinical directorates is also
• 18:00
  important. Orthopedics is expensive, needs clinical
• 18:03
  input on spending. And emergency surgery. We
• 18:05
  touched on theater access. Yes, resources need
• 18:08
  to be there when needed. Dedicated emergency
• 18:10
  theater. And training means supervision. Complex
• 18:13
  emergencies need direct consultant supervision,
• 18:15
  or at least the consultant needs to be informed,
• 18:17
  even for minor cases done by trainees. Rotas
• 18:20
  should allow the on -call consultant to be free
• 18:22
  to supervise. Finally, what about part -time
• 18:24
  consultants? Generally, duties are pro rata.
• 18:28
  But the book rightly points out that things like
• 18:30
  committee work or departmental roles might need
• 18:33
  specific allocation, irrespective of their part
• 18:35
  -time hours, to ensure their contribution isn't
• 18:38
  lost. The standard DCC to SPA ratio under the
• 18:41
  2003 contract is roughly 2 .1. So, reading through
• 18:46
  this book, it paints an incredibly detailed picture
• 18:48
  of just how vast the consultant orthopedic surgeon's
• 18:51
  role is now. It's far beyond just operating.
• 18:54
  It really is. Clinical expertise, yes, but also
• 18:56
  leadership, team coordination, upholding really
• 18:59
  strict safety standards, theater protocols, infection
• 19:01
  control, record keeping, plus that constant need
• 19:05
  for professional development, revalidation, CPD,
• 19:08
  that vital SPA time. And doing all that while
• 19:10
  navigating the complexities of the NHS structure,
• 19:13
  the workforce shortages we talked about, the
• 19:15
  different ways services are provided, it's a
• 19:17
  huge undertaking. The book really does feel like
• 19:19
  that essential guide, trying to help consultants,
• 19:22
  as it says, get things right against a backdrop
• 19:24
  of huge demand and constant change. It highlights
• 19:28
  how much relies on having the right infrastructure,
• 19:30
  the right staffing, and that protected time.
• 19:33
  Absolutely. And understanding these pressures,
• 19:36
  these standards, these requirements outlined
• 19:38
  here, it's valuable insight for anyone involved
• 19:40
  in health care and the NHS, whatever their role.
• 19:43
  If you found this deep dive helpful, we'd really
• 19:45
  appreciate it if you could take a moment to rate
• 19:47
  and share this show. So here's a final thought.
• 19:50
  Given the increasing demand we know is coming,
• 19:52
  the aging population, people staying active longer,
• 19:55
  and that acknowledged capacity gap in orthopedics,
• 19:58
  how can innovation in service delivery genuinely
• 20:01
  ensure that quality and safety are protected
• 20:03
  for every patient needing musculoskeletal pair
• 20:06
  in the future?