Woman with injured leg

Sarah Taylor, Head of Specialist and Practitioner Relations

Understanding our MSK data

Why we're working with orthopaedics expert David Elliott

26 January 2022

“Next slide, please” – we won’t soon forget the graphs of the last two years.  

A benefit of those rising and falling lines was that we in the UK got a Zoom lecture, straight into our living rooms, on how data can help us understand healthcare and trends and I remember – probably along with the rest of you – chatting about these graphs and what they meant.  

Chris Whitty, Chief Medical Officer for England, has said that we all want to know what is going on and to have it explained to us so that we can make our own informed decisions. I think he is right but at times we do need someone to help us to understand what the information means to us. 

"We want to know if there is consistency in the care that is being delivered and if not, why not?"

Claudio Gienal, AXA UK and Ireland CEO, has written (here and here) on the challenges and opportunities in big data – the information that companies like ours hold on every service that our claimants receive. Because we work in health, this data comes from care delivered across the UK and, to a certain extent, gives us a unique insight into what is going on both at a local and national level.  

Our members receive care from some two and a half thousand orthopaedic surgeons across the country. We want to know if there is consistency in the care that is being delivered and if not, why  not? Is there a good reason that someone in Brighton is more or less likely to have a particular treatment when compared to people in Leeds? Are they more or less likely to have treatment if they are private or NHS patients? Good, evidence-based medical care should be the same wherever you are and regardless of how it is being paid for. 

To help us answer these questions we have asked David Elliott, consultant trauma and orthopaedic surgeon, to help us.

David has a background in transformational change in the provision of musculoskeletal (MSK) services. He and his colleagues were commissioned by the North West Surrey Clinical Commissioning Group to provide a comprehensive MSK service in the region via the Ashford and St Peter’s Hospitals NHS Foundation Trust. David is fascinated by data and by what drives individual decision making in the choices that a clinician makes when offering care to their patients. We felt he was perfectly placed to give us objective insight into what our data may be telling us. 

When I spoke to David about this he said: “Whether you’re a private or an NHS patient you should have access to the right care. There shouldn’t be a difference, and so I’m completely unafraid of applying the same process in the independent sector for AXA Health as I applied in the NHS.” 

Initially, we’ve asked him to check whether there are differences in what we see in our members’ treatment, compared to what’s delivered on the NHS. He will be looking across all our orthopaedic data and in the first instance comparing incidence across both data sets.  

“All of us are going to have to be driven by patient demand for the best thing for them, rather than the best thing for the clinician."

It is the first time we’ve commissioned a report into the behaviour of the UK’s private orthopaedic surgeon population viewed through the lens of our data and conducted by someone who is not only an orthopaedic surgeon but also hugely interested in data and population health.  

We will, of course, take into account patient selection and whether healthcare is offered in different ways in the two sectors – we’ve all heard about NHS waiting lists – but we hope this insight will give us a view into how care is delivered to private patients and whether any differences can be explained and evidenced. More graphs for the nation there. 

David has seen the work he’s done in the NHS bring a change for good, creating a focus on how to deliver the best outcome for patients, in the safest way, with the lowest level of intervention. “The pandemic has resulted in us being in a very different place now,” he says. “All of us are going to have to be driven by patient demand for the best thing for them, rather than the best thing for the clinician. 

“The NHS has pretty much flipped over now to be patient-centred, rather than surgeon-centred. If the data does show differences in the private sector then we need to ask whether [that difference] is in the best interest of the patients - or of the surgeons and the hospitals.” 

We all want to do what’s best for the patient. Too much treatment is not always best and what we want to do is make sure that any treatment or intervention that a patient has is of value to them. As a physiotherapist myself I have seen so many patients who have gone through surgery only to come out the other side and say: ‘Actually, I am no better’ or even ‘I am worse’. Unless surgery is needed as an emergency then it should be the last resort. If they choose surgery people need to clearly understand the risks and benefits. This takes us back to data, and the importance of understanding what data we have. 

“Everyone should be interested in and welcome this report,” David says. “It will help us, as a profession, to improve care and to remove practice that is on the fringe of what people would regard as acceptable.”  

This is just part of our work to influence the provision of MSK in the private sector: as they say, next slide, please. 

Sarah Taylor

Sarah Taylor, Head of Specialist & Practitioner Relations

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About the author:

Sarah is responsible for leading our specialist and practitioner strategy. As part of this role she is tasked with developing initiatives that, through collaboration and insight with healthcare professionals, ensure the delivery of better quality healthcare for our members and clients.

Initially training as a physiotherapist, Sarah has over 25 years’ experience in both clinical and commercial setting – including the NHS, private hospitals and occupational health.