Different vascular plans casts doubt over future of QA services

Vascular surgeons
Vascular surgeons

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FRESH fears have been raised over the future of lifesaving vascular surgery in Portsmouth.

NHS England Wessex, the health trust which pays for the service at QA, has revealed in its latest business case that it wants to see all major vein operations move to Southampton.

So many different recommendations has come before us over the years, it hard to know what to believe.

Councillor Peter Edgar

It’s the latest development after five years in which health bosses have repeatedly suggested moving the service from Portsmouth to Southampton – only to be met with implacable resistance from patients and clinicians who know how important the surgery is.

NHS England Wessex says that the altered service will be better than the current one, but a health scrutiny group is more sceptical, with members calling it ‘a move into the unknown’.

And councillors say they are frustrated that the changes have taken so long to formulate – and that they are being given mixed messages about what may happen.

The latest version, in the business case, would see University Hospital Southampton become an arterial centre.

Patients who need the vein surgery, which helps repair blood vessels following a stroke as well as treating aneurysms, where blood vessels become enlarged and burst, will be treated at either hospital depending on the severity of their needs.

Members of the Portsmouth Health Overview and Scrutiny Panel (Hosp) said parts of the recommendation contradict statements in earlier proposals.

Councillor Peter Edgar, who sits on the Portsmouth Hosp board, said: ‘This has not been Wessex’s finest hour in the way this has been handled over the last few years.

‘It has taken so long to get here and we are being told different things. Originally we were told if vascular moved it would have an effect on renal and diabetes care.

‘This new plan says otherwise.

‘So many different recommendations have come before us over the years, it hard to know what to believe.

‘The concern for me is the effect this will have on major services at QA. No-one knows what effect it could have.’

Chairman of the panel Cllr John Ferrett agreed.

He added: ‘There are concerns of QA not only losing vascular but other services because of a knock-on effect.

‘We were given assurances that would not be the case but there are still worries.

‘I have concerns about QA losing its role and expertise.’

He added: ‘It has taken too long for a decision to be made especially when we are being told both services at the hospitals are below the levels they should be.

‘But I do recognise there was a strong campaign in Portsmouth not to see vascular moved.’

The proposal, which will go to the public for consultation, suggests patients will still be treated at QA Hospital but only for day surgeries, after-care, initial assessments and smaller treatments.

Cllr Edgar said the recommendation saw the hospitals going into the unknown.

‘It is vital that scrutiny panels and patient groups remain vigilant,’ he said.

‘What has been proposed is moving into the unknown. But it is encouraging at last to see a proposal that has not been rejected by QA Hospital.’

The business case was put before the Portsmouth Hosp meeting earlier this month.

During the meeting Dr Liz Mearns, medical director for NHS England Wessex, said people in Portsmouth would benefit from a world-class sustainable service which she says QA will become if the recommendation is approved.

Dr Mearns said: ‘At QA our proposals will establish two to three surgeons a day to see the patients there. There will be provision for day-case surgery and support for the emergency department.’

She added: ‘We believe this proposal will be at least as good as the present service or a little better.’

The meeting heard that about 300 major operations which take place each year at QA would move to Southampton.

Dominic Hardy, director of operations at NHS England Wessex, said a minimal amount of work would be moving to Southampton. ‘It is just the major surgeries that are complicated,’ he said.

‘Pre-operation assessments, outpatient care and rehabilitation will all be carried out in Portsmouth still.

‘Our aim is for patients to spend as much time at their nearest hospital as possible.’

Peter Mellor, director of corporate affairs and business development​ at Portsmouth NHS Hospitals Trust which runs QA Hospital, said the plans do not seem unreasonable.

​But he added PHT had questions about the recommendation which needed answering.

He said: ‘We want to provide the very best care for patients whether they come from Portsmouth or Southampton.

‘The critical point is about the sustainability of both services.

‘I think it will be difficult to sustain the services in both cities and what has been put forward is not unreasonable.

‘But we have asked NHS England Wessex for some answers to questions and are yet to receive anything.

‘Once we do and have discussed the business case, we can give a full response to it.’

Portsmouth North MP Penny Mordaunt added: ‘It has taken an age to reach this position.

‘My prime concern was that the foundation expertise vascular surgery provides to a hospital was available to the QA given it is a major hospital.’

Public asked to give views on vein surgery proposal

WHEN announcements were first made that vascular services could be moving to Southampton, The News launched a major campaign.

We encouraged people living in Portsmouth to write in to us and say why they thought vascular surgery should remain in the city.

Thousands of people responded and a three-month consultation was held by the now defunct primary care trust cluster Ship. Nearly five years later and people are being asked to give their views on the latest recommendation put forward by NHS England Wessex.

Next month and in May, people will have the chance to share their experiences and views on how vascular services can be improved in the south.

The dates and details of the events will be released nearer the time.

NHS England medical director for Wessex, Dr Liz Mearns, said: ‘Our vision is aimed at creating a world-class vascular service in our area.

‘It has been developed by surgeons working together and we now want to hear from patients and those who have an interest in vascular services so that we understand how we can make changes that work in the best interests of patients.’

TIMELINE

THE Vascular Society of Great Britain and Ireland found the country has a higher death rate due to vascular-related diseases than the rest of Europe.

​n​ In its review published in 2010, it found bigger centres would be better at serving health needs.

n In response in April 2011, the now-defunct regional strategic authority South Central announced it had looked at this report and wanted to move the majority of vascular services to Southampton.

n In August of the same year the also defunct primary care trust cluster Ship, which covered Southampton and Portsmouth, drew up three options. One was to move surgery from QA to Southampton, the second was to split services between the two cities, and a third looked at Portsmouth and Chichester hospitals sharing. But South Central only wanted to carry out a six-week ‘engagement process’.

n In August 2011, The News launched one of its biggest health campaigns urging readers to ask for a full three-month consultation. More than 6,000 people signed our Keep It At QA letter, and in September 2011, Ship bowed down to pressure and promised a three-month consultation.

n In December 2011, QA announced plans to ‘go it alone’ and create a vascular centre at the Cosham site. This would have formed one of two options due to go out to consultation in January 2012.

n But in a U-turn, in February 2012, Ship scrapped plans to make any changes.

n In April 2013, the NHS changed. NHS England, which has seven local bodies – Portsmouth and Southampton come under the Wessex Area Team – became the new commissioner. Wessex felt QA still did not meet the criteria set, and four options were outlined, with the commissioners preferring the one that would have involved moving major complex arterial vascular surgical procedures to Southampton by December 2013, followed by all non-emergency patients. After this a review would have looked to see whether stroke and major amputation patients would also move to Southampton.

n In November 2013, an independent body called the Wessex Clinical Senate recommended vascular services should be delivered from one site and that should be Southampton.

n However in January 2014, Wessex said it would look favourably on a network model between Southampton and Portsmouth, so work would be shared across both sites.

n This started in July 2014, and it was felt vascular services in QA were safe.

n But in November of the same year Wessex said a plan for centralising the service in Southampton was still on the cards and a business case was being prepared.

n This document was supposed to be ready by January last year, a decision should have been made in March and the changes implemented in April.

n However in February, Wessex said the documents were not ready and wouldn’t be until March. But this deadline was also missed, after which Wessex said the business cases would be unveiled in June, after the general election had taken place.

n But months on from this no business cases had been revealed.

n Wessex said it was waiting on a report by the Vascular Society to be published, after it visited both QA and Southampton, after which a consultation will take place.

​n In October last year, a review carried out by the Vascular Society found vascular surgery should be centralised in Southampton. The review said change is needed to ensure services comply with the standards set by the society and to provide seven-day cover.​

n The report also said there were not enough surgeons at QA which needed to be addressed.

n In December last year, it was revealed that Portsmouth surgeons were having to step in to help vascular patients in Chichester. It was suggested this was another reason why Portsmouth should become a vascular hub.

n The business case has now been revealed.