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This briefing from Arthritis UK finds that almost a fifth (19%) of integrated care boards (ICBs) in England are rationing joint replacement surgery by disadvantaging patients with a higher body mass index (BMI). A further 54.7% have policies that restrict or alter access to surgery in some other way for those with overweight or obesity. Not only are these policies unfair, but they also contradict National Institute for Health and Care Excellence (NICE) guidelines and government policy. Arthritis UK is calling for all ICBs to stop using these policies and stop rationing surgery based on a person’s BMI.

Guidance from the Getting It Right First Time (GIRFT) initiative in the UK that lists thirteen clinical recommendations for decarbonising elective hip replacement surgery. The GIRFT Greener Pathways ‘identify opportunities for the NHS to improve or maintain the quality of patient care while mitigating its environmental impact.’ ‘The guide describes best practice, alongside estimates of the associated greenhouse gas emissions for a typical UK hospital, to guide prioritisation. Each recommendation is intentionally deliverable on a relatively short timescale.

A new report from the All-Party Parliamentary Group on Osteoporosis and Bone Health, supported by the Royal Osteoporosis Society, highlights how many people with osteoporosis are diagnosed late, struggle to access clear information, and receive little or no follow-up care. Drawing on patient evidence, MPs call for better coordination, clearer responsibility and stronger support to help people manage their condition day to day. Osteoporosis is one of the most significant threats to healthy life expectancy in the UK – affecting over 3.5 million people and causing over 550,000 broken bones every year. The scale of the disease burden, the effectiveness of early treatment, and the significant savings made by preventing fractures make osteoporosis particularly well-suited to a population health model that prioritises primary identification of people at risk and proactively prevents fractures. Instead, however, osteoporosis remains an under-prioritised condition within health policy compared to conditions of similar prevalence and impact. Osteoporosis care is characterised by underdiagnosis, inconsistent access to services, and limited long-term management. Our Inquiry found care to be often poor, fragmented, lacking clear clinical accountability, and frequently reactive rather than preventative. Key levers for system transformation 1. Enhanced services for the identification, assessment and management of osteoporosis and high fracture risk in the community. 2. National audit of the whole osteoporosis pathway – extending the current audit of FLS to include osteoporosis healthcare delivered in primary and community care settings where most people with osteoporosis are managed over the long term. 3. Technological solutions for case-finding, identification of people at high risk, and routine follow-up of patients. 4. Local development of comprehensive osteoporosis pathways to deliver consistent, coordinated care to people with osteoporosis and reduce inequality. 5. National and regional leadership for osteoporosis care to promote collaboration and support the development of osteoporosis pathways. 6. Structured osteoporosis education for people diagnosed with the condition. 7. Patient-held Bone Health Management Plans that set out the appropriate actions, timings and responsibilities across the pathway.

Verita conducted this independent investigation commissioned by Cambridge University Hospitals NHS Foundation Trust (CUH) into potential missed opportunities to identify and avoid harm to paediatric orthopaedic patients under the care of Ms Kuldeep Stohr, Consultant Paediatric Orthopaedic Surgeon. Concerns were raised in 2024 about patient outcomes and aspects of Ms Stohr’s decision-making. An external review confirmed issues with her operative technique and judgment in complex hip surgeries. Ms Stohr has not practised since she began a leave of absence in March 2024. The Trust formally excluded her from work in February 2025. This report sets out to show what was known about Ms Stohr’s practice, when it was known, and whether earlier intervention could have prevented harm. Summary of recommendations The Trust should consider implementing a more organised approach to the initial job and role planning process for new consultants. This should include clear identification of the consultant’s line management arrangements, and the responsibility for their clinical supervision. The workplace induction process for new consultants should be reviewed to ensure that appropriate mentoring and/or buddying arrangements are in place to enable consultants joining the Trust to have a resource to assist them to integrate quickly to their role and their division. Line managers should intervene with clinicians more promptly to address and resolve relationship problems where they might adversely affect patient safety (especially in small specialties). Line managers should consider whether informal approaches to resolve any problems, such as encouraging colleagues to talk through issues are needed. Support may also be considered for more explicit conflict resolution or mediation if problems persist. The Chief Medical Officer’s team should develop written guidance on the commissioning of external reviews to ensure they are properly specified, that their findings and recommendations are actioned, and that appropriate monitoring arrangements are established to track progress with any improvement plans. This guidance should be developed in collaboration with line management. The agreed guidance should be set out in a standard operating procedure (SOP). To ensure that reliable records are available in any further investigation or review, we recommend that the Trust should maintain more comprehensive written records or file notes of meetings and important conversations with people involved in patient safety issues and their investigation. In evaluating reports produced by external reviewers we recommend that the commissioner, or the manager responsible for interpreting the report, should always speak with the reviewer to test understanding of the findings and any recommendations flowing from the report. Outcomes, findings and recommendations from an external review should be shared with a senior clinician in the specialty for the purpose of understanding the findings, conclusions, and recommendations. The Chief Medical Officer (CMO) should develop a protocol for ensuring that the handover from their office of an external report for action is managed in concert with the specialty or divisional manager. We recommend that a named individual should be held responsible for ensuring that actions are taken consequent upon a review. That individual should be responsible for ensuring any improvement plan for a clinician whose practice has been reviewed is properly resourced and enabled by the Trust. The Chief Medical Officer’s office and the named individual should agree what monitoring and reporting mechanisms are needed to track progress, and to ensure key steps and outcomes are accurately recorded. We recommend the CMO’s office, and the named individual should sign off and record the closure of any actions arising from the review. The CMO’s team should ensure that the findings and conclusions of any external review are shared with the management team involved and that an appropriate plan is developed and implemented that sets out the actions to be taken and by whom. The CMO’s team should satisfy itself in the commissioning and delivery of an external review that any information and/ or findings are recorded in the appropriate Trust data streams and risk registers. Any completed review should be assessed by the CMO’s team to identify any need to exercise the Trust’s duty of candour. We recommend that the Chief Medical Officer and the Chief People Officer should produce guidance that clearly sets out the respective roles of appraisers and line managers in the management of consultants. This guidance should also clarify who is responsible for clinical supervision of consultants and how that supervision should operate. To improve the confidence that the Trust has in the competence of its surgeons we recommend that the Chief Medical Officer should consider developing appropriate mechanisms to ensure surgical practice is routinely observed by qualified colleagues. The Trust should consider whether to develop a more formal mechanism to share outputs from appraisals with line management. Any concerns about a clinician’s practice, or factors that might affect it, need to be routed, with the clinician’s agreement, into the management of the Trust so that they can be considered and acted upon. While the personal and medical content of Occupational Health referrals and reports are private to the individual, the Trust should assure itself that appropriate arrangements are in place for line management to understand whether any reasonable adjustments need to be made to support the individual to maintain good health and performance. Line managers should be encouraged to be proactive in identifying and correcting excessive workload for their team members. Managers should be alert to the possible effect that staff carrying excessive workloads may have on patient safety and quality of care. We recommend that the Trust should develop a more consistent approach to the establishment and management of MDTs. The aim should be to standardise, where appropriate, those common elements that apply to MDTs across the Trust. Such an approach could be set out in a Standard Operating Procedure (SOP). The Trust should consider an audit of all existing MDTs to consider their effectiveness in enabling the consistent delivery of safe care. Such an audit should consider; clarity of the MDT’s aims; team working; use of data and information for decision-making, and regularity/inclusiveness of meetings. The CMO and the Chief People Officer should establish an implementation working group to ensure that changes to clinical governance structures, processes and practice are embedded effectively across the Trust. The group should include corporate management, and staff from a ‘deep slice’ of the organisation to ensure representation from all the key groups responsible for patient safety. The Trust should establish a structured process for supporting clinicians whose participation in MDT meetings is affected by health or interpersonal difficulties. The aim 291 should be to ensure that safe, collaborative clinical practice is maintained. This process should comprise early discussion of reasons for withdrawal; assessment of any risk to clinician or patients; mitigation of such risk; alternative mechanisms for peer review and monitoring of safe practice. The CMO’s team should ensure that the Trust has the necessary procedures in place to meet the expectations of the IHPN Medical Practitioners Assurance Framework.

The Royal College of Surgeons of Edinburgh launched a series of blogs in recognition of the World Patient Safety Day (WPSD) 2024 theme of "Improving Diagnosis for Patient Safety". RCSEd World Patient Safety Day 2024 A Novel Facial Cellulitis Pathway: Improving the Time to Surgery for Facial Necrotising Fasciitis Improving Diagnosis for Safety in Dentistry Using Audit to Improve Outcomes for Patients with Upper Tract Urothelial Cancer Diagnostic Safety in Surgery WHO World Patient Safety Day 2024: Improving Diagnosis for Patient Safety The Importance of Teamwork for Surgical Diagnostic Safety in Outpatients Challenges in the Diagnosis of Twin Silent Killers: Aortic Aneurysm and Acute Aortic Dissection Improving Diagnostic Safety in Orthopaedics NCEPOD: Prioritising Diagnostic Safety for Better Health Outcomes Protecting our Precious Gift of Life World Patient Safety Day 2024 — A View from the Bridge Can My Stool be Tested for Bowel Cancer? Virtual Diagnostics The Potential of AI to Help Reduce Diagnostic Errors Non-Technical Skills for Surgeons (NOTSS). Vignette 3 of 3. Leadership in Surgery: A Case Study Non-Technical Skills for Surgeons (NOTSS). Vignette 2 of 3. Team Communication: The Key to Clarity and Precisio Non-Technical Skills for Surgeons (NOTSS). Vignette 1 of 3. Situation Awareness: Staying Ahead of Potential Issues Enhancing Diagnostic Safety in Surgery Through Non-Technical Skills Diagnosing Acute Aortic Dissection – The Patient Perspective

Despite their widespread use, the impact of commissioners’ policies for body mass index (BMI) for access to elective surgery is not clear. Policy use varies by locality, and there are concerns that these policies may worsen health inequalities. This study in BMC Medicine aimed to assess the impact of policies for BMI on access to hip replacement surgery in England. The authors used National Joint Registry data for 480,364 patients who had primary hip replacement surgery in England between January 2009 and December 2019. They found that rates of surgery fell after localities introduced policies restricting access to surgery based on BMI, whereas rates rose in localities with no policy. Localities with BMI policies have higher proportions of independently funded surgery and more affluent patients receiving surgery, indicating increasing health inequalities, and policies enforcing extra waiting time before surgery were associated with worsening mean pre-operative symptom scores and rising obesity. The authors recommend that BMI policies involving extra waiting time or mandatory BMI thresholds are no longer used to reduce access to hip replacement surgery.

This state-of-the-nation report from the National Hip Fracture Database (NHFD) focuses on the period from 1 January to 31 December 2022. It shows that the number of people who died in the month following a hip fracture now stands at 6.2%; down from 10.9% in 2007, when the NHFD was set up. However, the report also finds that it took longer for patients to reach a ward where a hip fracture team can work together (where there is the best chance of recovery) in 2022. It also states that fewer patients received prompt surgery to repair their broken hip by the day after they presented to hospital. There was an improvement in how many people with hip fracture received bone strengthening medicines to avoid future fractures in 2022, but some hospitals continue to report that none of their patients receive such treatment. The report calls for hospitals to improve how they move patients to the right ward, operate and get patients out of bed promptly, recommending that hip fracture teams: review the care provided in the Emergency Department (ED), so that patients are seen promptly, offered pain relief, and admitted to an appropriate specialist ward within four hours. use the NHFD website to see why surgery is delayed, and work together so that this happens by the day after patients present with a hip fracture. use the NHFD website to see what more can be done to avoid patients becoming confused in hospital and to ensure that they are well enough to get out of bed on the day after their operation.

How one Devon ICS has worked with local trusts to cut deliver extra capacity at a former Nightingale hospital, now converted into an elective centre. Waiting lists for some procedures in Devon have been cut by converting a Nightingale hospital into a protected elective centre delivering additional orthopaedic, ophthalmology and diagnostic activity. Cooperation between clinicians from different trusts has resulted in innovative ways of working. The Devon integrated care system has worked with local trusts – principally the Royal Devon University Health Foundation Trust but also Torbay and South Devon Foundation Trust and University Hospitals Plymouth Trust – to deliver the extra capacity. Key benefits and outcomes Patients who would have faced a long wait from across Devon are being seen more quickly in a facility that is not at risk of cancellation from emergency pressures. Shorter stays for orthopaedic patients receiving hip and knee replacements, many of whom can be discharged on the same day as their operation. The centre has been a catalyst to encourage a ‘system first’ mindset.

A repository of resources aimed at patients and carers which have been co-produced by the Falls and Fragility Fracture Audit Programme (FFFAP) patient and carer panel. The resources below have been categorised into the three audits within FFFAP: National Hip Fracture Database (NHFD) National Audit of Inpatient Falls (NAIF) Fracture Liaison Service Database (FLS-DB) Hip fracture: a guide for families and carers All about your hip fracture and what to expect on the road to recovery Recovering after a hip fracture: helping people understand physiotherapy in the NHS How should your hospital prevent and respond falls during your stay Inpatient falls Falls prevention in hospital: a guide for parents, their families and carers What should happen if you or someone you know experiences a fragility fracture Six golden rules for stronger bones Strong bones after 50 - after staying on treatment