Report spells bad news for QA Hospital vascular services

An operation underway at ''QA Hospital
An operation underway at ''QA Hospital
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A NEW report suggests the majority of vascular services in the region will not be centred in Portsmouth.

The recommendations of an independent panel looking into plans to restructure vascular services – surgery on veins – on the south coast have been published online.

The last time a reorganisation was mooted, there was an outcry and 6,000 people signed a News petition. Eventually health bosses scrapped the idea, but it has resurfaced.

The new report recommends there be one service covering Portsmouth and Southampton. Its recommendations suggest that Southampton should be the main centre, and that any of the team left in Portsmouth should be working on minor vascular surgery, and post-op support. A seven-day rota should be set up around the area’s trauma centre in Southampton.

Moving the services would mean patients face a longer journey getting to hospital, and being further away from loved ones.

Councillor Peter Edgar, of Gosport Borough Council, has been fighting to keep vascular services at Queen Alexandra Hospital.

He said: ‘When the Royal Hospital Haslar closed, it was agreed acute services would be at QA. It feels like the NHS is going back on that and the assurances given aren’t being met. I’m concerned the specialism is going to be based in Southampton, as the recommendations appear to make that quite clear.’

As reported, the Wessex Area Team (Wessex) will be deciding if specialist vein surgeons will be working jointly between Portsmouth and Southampton, or mainly in Southampton.

The Wessex Clinical Senate is made up 18 people in the medical field that were brought together in September to look at three options.

NHS England declined to give the names of the people on the senate, which looked at these three possibilities:

n Maintaining two independent centres.

n Creating a network model between the two trusts (preferred model by Wessex).

n Moving all surgery to Southampton.

At the meeting, Portsmouth Hospitals NHS Trust, which runs QA, presented a fourth option, which would see Southampton and Portsmouth share the workload more equally than option two.

The senate rejected the first option as it found neither centre had enough resources to provide 24/7 vascular care.

For the second and third options, the senate noted significant deprivation in areas of both cities and to consider the need for support for patients after surgery.

Lastly, the panel did not think option four addressed the issue of having 24/7 cover or potential costs of technological advances, and noted talks between both trusts had broken down in the past.

The senate produced a list of 10 recommendations for Wessex to consider, which is given in the panel below.

Councillor Roger Allen, of Gosport council, sits on the Fareham and Gosport Clinical Commissioning Group.

He said: ‘The reference in option four that speaks of confidence in collaboration between trusts, flies in the face of government determination to improve partnership working, and I find it unfortunate that collaboration is not considered feasible because of past conversations between the trusts.

‘After reading through the reasons given for the recommendation that vascular surgery is centred on Southampton, the real reason does appear to be a failure to train sufficient surgeons and radiologists. At present those under training will not become effective for five to seven years which is a damning indictment of those who are tasked with forward thinking and planning.

‘This decision will impact on the other disciplines undertaken at QA that need vascular surgical support.’

But PHT remains confident it will retain vascular services. Peter Mellor, director of corporate affairs and business development, said: ‘We have had no contact from Wessex in the last month and have no idea if the recommendations will be heeded.

‘Until we hear from Wessex, we don’t have an opinion to give, and reserve our judgement. The trust is still confident the service will remain at QA.’

Wessex said it would make an announcement in the next few weeks.

A spokesman said: ‘The national process will be complete in a few weeks. We will take into account the review findings and recommendations, and make an decision on the next steps.

‘Any decision taken will be based on ensuring we have the best organisation of services, maximising the clinical outcomes for those patients receiving vascular surgical services.’

THE Wessex Clinical Senate has made the 10 following recommendations:-

1. Services for patients in south east Hampshire requiring vascular expertise are provided by a single clinical service across the Portsmouth and University Hospitals Southampton NHS Trusts.

2. The single clinical service includes all vascular surgeons, vascular radiologists, together with other staff as the service and commissioners determine.

3. The service has a single clinical director and management team who are accountable for patient access, safety, experience and outcomes of the service.

4. The clinical director and management team are accountable for the sustainability of high quality services, research, innovation, teaching and training.

5. The service should ensure interventional clinicians undertake an appropriately high volume of procedures as determined by the NHS Standard Contract for Specialised Vascular Services, and at the same time meet the challenge of providing local services to support an extended pathway into primary and community care.

6. The service should establish, as a matter of urgency, a single rota for emergency seven-day vascular assessment and interventions, including radiological, endovascular and surgical procedures and support for the regional major trauma centre.

7. As a matter of urgency, all emergency and elective major inpatient interventions (such as AAA repair, symptomatic and ruptured aneurysm treatment) should be delivered at Southampton.

8. The service should bring forward proposals, with implementation dates, for the management of carotid arterial disease and major amputations, with assessment and re-enablement, in the light of the NHS Standard Contract for Specialised Vascular Services, for agreement with commissioners.

9. The service should focus on the needs of the local populations for vascular clinical care including diagnosis and day case surgery with demonstrable high quality outcomes, re-enablement and psychological support of patients as close to their homes as possible.

10. Commissioners should regularly monitor performance and quality metrics and ensure vascular outcomes improve in accordance with domains one to five of the NHS Outcomes Framework.

The metrics should reflect the recommendation to provide care closer to home and the extended recovery and re-enablement pathway.

The story so far in fight to keep surgeons

CHANGES to vascular services have been on the table since 2010, following a national report.

The Vascular Society of Great Britain and Ireland found the country has a higher death rate due to vascular-related diseases than Europe. It found bigger centres would do 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, to implement this guideline on the south coast.

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.

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

In autumn last year, more than 6,000 people signed our Keep It At QA letter, forcing Ship to reconsider its plans – and many people told how vascular surgeons had saved their lives.

QA put together plans to create a ‘vascular centre’ in Portsmouth, which would have formed one of two options due to go out to public consultation in January 2012.

But in a U-turn, Ship scrapped plans to make any changes, and Portsmouth and Southampton then began talks on how to set up a surgeon rota system.

In April this year, it was all change for the NHS.

For a service as important as vascular, the money comes from commissioner NHS England, which has seven local bodies, and Portsmouth and Southampton come under the Wessex Area Team.

It believes Portsmouth does not meet the national specifications, so QA bosses provided further details on its vascular surgeons and how a network between the two hospitals would work.

Wessex have not yet responded to QA. The senate was put together in September.

‘We need vein surgery to remain in Portsmouth’ - Read The News Comment on this issue

Read health reporter Priya Mistry’s view on the threat to vascular service at the QA Hospital