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Future of vascular surgery at Queen Alexandra Hospital in Portsmouth is in public’s hands

Queen Alexandra Hospital

Queen Alexandra Hospital

THE future of specialist vein services at a Portsmouth hospital will rest in the hands of the public.

The plan to move vascular surgery out of the city has raised concerns, with Portsmouth Hospitals NHS Trust (PHT), which runs Queen Alexandra Hospital in Cosham, insisting it has everything needed to keep services in the city.

Councillors from the city council’s Health, Overview and Scrutiny Panel (Hosp) have agreed that the long-running proposal to move the majority of specialist vein surgery from Portsmouth to Southampton would be a significant change for the area.

Now commissioners Wessex Area Team will need to respond by holding a full three-month public consultation.

Four options will now be made available to the public as part of a consultation.

That decision was made at yesterday’s meeting at Portsmouth Guildhall after a two-hour debate on the future of the service.

Currently, both QA Hospital, in Cosham, and Southampton General Hospital provide vascular services.

But Wessex would like all emergency abdominal aortic aneurysm surgery to move over to Southampton, in order to meet national vascular specifications. This would count as phase one of a three-part plan to then move non-emergency work.

And after a review of the first two phases, plans to move stroke and major amputations to Southampton will also be discussed.

Graham Sutton, chief vascular consultant at QA, said: ‘Portsmouth excels in the surgery it carries out.

‘We have an integrated cardiovascular service, and the largest heart attack centre in the region.

‘We have the region’s renal transplant service, which has said it’s essential to have 24-hour cover.’

PHT also came up with a fifth option yesterday, and that was to share work and research between the two hospital trusts.

Simon Jupp, director of commissioning for Wessex, said: ‘I would welcome and encourage both trusts to hold talks and devise a network model that works for this population.’

Until then, a three-month consultation scheduled to start on May 26 will go ahead.

Changes are likely to be implemented by November 1.

Hosp chairman Cllr Peter Eddis said: ‘We are saying this is a major change.

‘Even if numbers of emergency vascular patients are low, we need to look at the impact on other services.’

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.

It found bigger centres would be better at serving health needs.

In August 2011, the now-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.

The News launched one of its biggest health campaigns urging readers to ask for a full three-month consultation.

In autumn 2011, more than 6,000 people signed our Keep It At QA letter, forcing Ship to reconsider its plans.

QA put together plans to create a ‘vascular centre’ in Portsmouth, which would have formed one of two options due to go out to consultation in January 2012. But in a U-turn, Ship scrapped plans to make any changes.

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.

The four options outlined are what it has come up with, with its preferred option being the fourth.

However it is willing to listen to a network model devised by both Portsmouth and Southampton, if the two hospital trusts can come to an agreement.

What is prompting changes to vascular provision?

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.

It found bigger centres would be better at serving health needs.

In August 2011, the now-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.

The News launched one of its biggest health campaigns urging readers to ask for a full three-month consultation.

In autumn 2011, more than 6,000 people signed our Keep It At QA letter, forcing Ship to reconsider its plans.

QA put together plans to create a ‘vascular centre’ in Portsmouth, which would have formed one of two options due to go out to consultation in January 2012. But in a U-turn, Ship scrapped plans to make any changes.

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.

The four options outlined are what it has come up with, with its preferred option being the fourth.

However it is willing to listen to a network model devised by both Portsmouth and Southampton, if the two hospital trusts can come to an agreement.

The four options

THESE four options are what commissioners Wessex Area Team have come up with over the future of vascular surgery, with its preferred choice being option four.

It will form part of a public consultation, which is scheduled to start on May 26.

OPTION one would be to maintain services as they are.

This would mean Southampton continuing as the arterial centre for the Southampton, Winchester and West Hampshire Vascular Network.

It would also see Portsmouth remain as a stand-alone vascular centre for Portsmouth.

This option was dismissed as neither centre alone can meet the specification as set by the Vascular Society of Great Britain and Ireland criteria.

In 2010 it published a report which said England had a higher vascular death rate compared to Europe.

It also found bigger centres are more beneficial, than having smaller ones.

To date there are 72 units that provide the service, and is likely to come down to 50.

OPTION three would mean that a network would be established between Southampton and Portsmouth vascular services.

The network would have one major arterial centre which would be in Southampton.

The arterial centre would undertake all emergency and planned major complex arterial procedures with minor procedures being undertaken as close to the patient’s home as possible. Following surgery in Southampton all patients would be able to transfer home or back to their local hospital for their post-operative stay if this was needed.

This would include:

n Establishing a single rota for emergency seven-day vascular assessment and interventions and support for the major trauma and renal centres.

·n All emergency and non-emergency abdominal aortic aneurysm patients being operated on in Southampton.

n All surgery following a transient ischaemic attack (TIA) or stroke (such as carotid endarterectomy) taking place in Southampton.

n All major amputations being undertaken in Southampton.

n Patients requiring minor procedures would continue to be cared for in hospitals as close to their home as possible.

OPTION two would create two vascular networks along the south coast.

Southampton would continue as the arterial centre for the Southampton, Winchester and West Hampshire Network.

A second network would be created in Portsmouth, utilising surgeons from St Richard’s Hospital, in Chichester, and the Queen Alexandra Hospital, Cosham, to serve Portsmouth, south-east Hampshire and the Chichester area.

Currently heart and stroke patients from West Sussex come to QA for stroke and cardiac treatment.

About 18 months ago, it was decided

vascular patients from Chichester would go to Brighton.

OPTION four would be to establish a Southern Hampshire Vascular Network.

Under this preferred option, there are three phases.

The first would be to move major complex arterial vascular surgical procedures to Southampton by December.

Next all non-emergency AAA patients (open and keyhole), including those who picked up as part of the AAA screening programme, would be operated on in Southampton, if not already implemented as part of phase one.

Under phase three commissioners and providers should review the options relating to surgery following a transient ischaemic attack (TIA) or stroke (such as carotid endarterectomy) and major amputations, and agree the way forwards by the end of March 2016.

However this would only be properly established after a review of the previous two phases.

 

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