Annual progress: Introduction

In 2013/14, the NJR was funded through a levy raised on the sale of hip, knee, ankle, elbow, and shoulder implants and HQIP managed the levy payment collection and holds the NJR budget on behalf of the Steering Committee. The NJR’s funding model was reviewed during this reporting period and will adopt a new model from 1 April 2014.

Income and expenditure 2013/14

The NJR is self financing. In 2013/14, it was funded by a levy raised on the sale of hip, knee, ankle, shoulder, and elbow implants to NHS and independent healthcare providers in England, Wales, and Northern Ireland (the latter from February 2013). Details about the change to funding arrangements from 1 April 2014 can be found under 'Highlights: Our work'.

The rate of the levy is recommended by the NJR Steering Committee for approval by the NHS England, and is subject to a Memorandum of Understanding between NHS England, Welsh Government, Health and Social Care Board Northern Ireland, Independent Healthcare Advisory Services and the Association of British Healthcare Industries (ABHI) Orthopaedics Special Interest Section.

The levy was set at £20.00 per joint from 1 April 2013 to 31 March 2014. Levy income in 2013/14 was £3,378,841 (2012/13: £3,292,579). Expenditure for the same period was £3,029,494 (2012/13: £2,509,721).

The total governance costs for the registry during 2013/14 was £158,015.00. This comprised:

• Members’ expenses £17,629.00
• Remuneration of Committee Chairmen* £108,000.00
• Members’ appointments £30,414.00
• Legal fees £1,972.00

*From 2013/14 remuneration of the NJRSC Chairman and NJRSC Sub-committee Chairmen commenced to reflect the responsibility and work load associated with undertaking these roles. Payments were not fully implemented during the year and will be backdated during 2014.

Below are some of the 2013/14 costs associated with major NJR project areas:

• Publication of consultant-level data £75,196.16
• Price Benchmarking Phase Two £67,995.00
• Clinician Feedback Phase Two £71,150.00
• NJR PROMs Year Three £103,644.00
• DNA Bio Bank study £74,059.00

The NJR’s financial results are included in the audited accounts of HQIP (Healthcare Quality Improvement Partnership) which manages the registry.

The full audited accounts are available on HQIP’s website from September 2014 (www.hqip.org.uk), and also from the Charity Commission and Companies House.

HQIP and the NJR Steering Committee

The NJR is managed by the Healthcare Quality Improvement Partnership (HQIP) under a contract with NHS England as part of the delivery of the National Clinical Audit and Patient Outcomes Programme (NCAPOP). The NJR management team at HQIP support the work of the NJR Steering Committee and all its sub-committees.

The NJR Steering Committee, which met four times in 2013/14, is responsible for overseeing the strategic direction and running of the NJR and has the status of an NHS England Committee of Experts.

Its members are currently appointed by the Department of Health (DH) Appointments Team following a formal recruitment process and the current list of members and their declarations are listed in the online appendices. The Steering Committee has a lay Chairman, Mrs Laurel Powers-Freeling.

NJR Sub-committees

Six sub-committees supported the work of the NJR Steering Committee in 2013/14:

• Editorial Board ~ Chairman, Mr Martyn Porter
• Implant Performance ~ Chairman, Mr Keith Tucker
• Surgeon Outliers ~ Chairman, Professor Paul Gregg
• Research ~ Chairman, Professor Alex MacGregor
• Data Quality ~ Chairman, Professor Paul Gregg
• Regional Clinical Coordinators’ Network ~ Chairman, Mr Peter Howard

NJR services

The NJR services continue to be delivered under three separate contracts, managed and monitored by the NJR management team:

• The NJR Centre, managed and staffed by Northgate Information Solutions (UK) Ltd. Northgate is responsible for the management and development of the NJR’s IT infrastructure, software applications, data management and reporting services. This work is complemented by the NJR Service Desk, a team who provide day-to-day information and support to stakeholders, and the NJR Regional Coordinators (RC), an eight-strong team providing on-site support to orthopaedic units in hospitals.
• The NJR statistical support, analysis and research team is based at the University of Bristol. The team is responsible for the delivery of statistical analyses of NJR data and data from other sources, and for developing the statistical methodologies for the identification of potential outlier performance. Their role also includes ad hoc data analyses, in addition to those included in the NJR Annual Report, that are central to the work of the Implant Performance Group and the Surgeon Outliers Sub-committee.
• NJR Communications are managed by HQIP. This is a programme of stakeholder and multi-media communication to support the delivery of the strategic plan including the publication of the Public and Patient Guide to the NJR Annual Report. The HQIP communications team also support the Editorial Board and Regional Clinical Coordinators’ Network.

About the content of the NJR 11th Annual Report

Readers familiar with NJR Annual Report will note its difference publication format for 2014. The reports’ content remains consistent however and further supporting information can be found below:

Part One ‘Executive summaries, annual progress and highlights 2013/14’

These sections provide a general outline of the work of the NJR for the financial year 1 April 2013 to 31 March 2014. In addition to summary statistics relating to the NJR’s key data quality indicators, this section includes a summary of the major activities undertaken by the NJR and individual reports on the work of the sub-committees.

Part Two ‘Clinical activity 2013’

These sections, accessibly by joint type, provide a series of reports about clinical activity reported to the NJR as having been carried out in the calendar year 1 January 2013 to 31 December 2013.

Part Three ‘Outcomes after joint replacement 2003/2013’

These sections provide an analysis of survivorship of hip, knee, ankle and shoulder replacement procedures carried out between 1 April 2003 to 31 December 2013. This year, no Hospital Episodes Statistics data or data from the NHS England Patient Reported Outcomes Measures programme was available to the NJR from the NHS Health and Social Care Information Centre (NHS HSCIC).  The 2012 data set was used for the analysis of early mortality. 

Part Four ‘Trust-, Local Health Board- and unit-level activity and outcomes 2013’

This section provides a series of indicators about clinical activity and outcomes at both Trust and hospital level.

At the time of publication (September 2014), readers will note that Parts One, Two and Four will have moved solely to online publication whilst Part Three, NJR analysis, will remain part of a traditional printed report. Notably, Part Two’s clinical activity data will offer users the opportunity to interact with the data via www.njrreports.org.uk.

About the National Joint Registry 

The National Joint Registry (NJR) of England, Wales and Northern Ireland has collected joint replacement data on:

• hip and knee surgery since April 2003
• ankle surgery since April 2010 and 
• elbow and shoulder surgery since April 2012
• Northern Ireland started to submit data in February 2013

The NJR remains the largest register of its kind in the world, with almost 1.7 million recorded procedures. The registry's purpose is set out in its strategic plan and is summarised below:

Mission statement

‘The purpose of the National Joint Registry for England, Wales and Northern Ireland is to collect high quality and relevant data about joint replacement surgery in order to provide an early warning of issues relating to patient safety. In a continuous drive to improve the quality of outcomes and ensure the quality and cost effectiveness of joint replacement surgery, the NJR will monitor and report on outcomes, and support and enable related research.’

Strategic goals

1. Monitor in real time the outcomes achieved by brand of prosthesis, hospital and surgeon, and highlight where these fall below an expected performance in order to allow prompt investigation and to support follow-up action

2. Inform patients, clinicians, providers and commissioners of healthcare, regulators and implant suppliers of the outcomes achieved in joint replacement surgery

3. Evidence variations in outcome achieved across surgical practice in order to inform best practice

4. Enhance patient awareness of joint replacement outcomes to better inform patient choice and patients’ quality of experience through engagement with patients and patient organisations

5. Support evidence-based purchasing of joint replacement implants for healthcare providers to support quality and cost effectiveness

6. Support suppliers in the routine post-market surveillance of implants and provide information to clinicians, patients, hospital management and the regulatory authorities