Ashford and St Peter’s Hospitals currently provide a vascular service which delivers around 200 major arterial procedures per year, 2,700 investigations, and over 8,000 outpatient clinic reviews for the 400,000 population of North West Surrey and adjoining areas.
The Vascular Society of Great Britain and Ireland (VSGBI) and the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) called for a reorganisation of vascular services for both emergency and elective care to maximise productivity and overall improve patient outcomes. Evidence shows best outcomes are achieved in larger specialist units providing emergency and elective vascular surgery 24/7.
As a result, all vascular services commissioned by NHS England should deliver to a national service specification for ‘specialised vascular services’, which mandates a revision in the model of vascular service delivery to vascular networks.
To achieve national best practice as mandated in the national commissioning service specification for vascular services (2018), and recommended by Getting it Right First Time for Vascular Surgery (March 2018) and the Vascular Society of Great Britain and Ireland (2015), we have formed a vascular network with St George’s University Hospital NHS Foundation Trust and Frimley Health NHS Foundation Trust.
Through the network, patients will have local and network-wide access to all vascular services seven days a week through specialist vascular surgeons from all the network providers with vascular specialist nurses to realise optimal outcomes for patients. The aim of the vascular network is to provide evidence-based models of care that improve diagnosis and treatment, ultimately improving mortality and morbidity from vascular diseases.
The vascular network will consist of vascular experts from all three sites working together to provide 24/7 emergency and elective vascular care that meets national standards and improves patients’ outcomes.
Some interim changes were made to major vascular surgery services in March 2020. The changes, which involve those people having major vascular surgery, have now been put in place on a permanent basis as it has not been possible to have the required specialist staff to sustain the service at ASPH due to the relatively small number of these procedures undertaken in the area each year.
The only change is for patients requiring arterial surgery or major limb amputations who will be operated on at one of the hub sites (St George’s Hospital in Tooting or Frimley Park Hospital in Frimley.)
There is no change to the majority of services with the following all remaining at ASPH:
- All outpatient services
- Most specialised vascular investigations
- All day case surgery
- Rehabilitation post operatively
When patients are invited for their appointment to have major surgery they will be given an appointment at the hospital where their regular consultant would perform the operation but if they would prefer to be treated at the other hospital they can choose to do so.
The proposed service model will include:
- All outpatients to remain at ASPH
- Most specialised vascular investigations to remain at ASPH.
- All day case surgery to remain at ASPH
- Patients requiring arterial surgery or major limb amputations to be operated on at one of the hub sites (St George’s or Frimley Park)
- Rehabilitation post operatively to remain at ASPH
The Vascular Network will deliver key benefits to patients including:
- An integrated approach to emergency vascular care
- Improved outcomes for patients with reduced mortality and morbidity
- Provision of 24/7 access for patients to expert emergency vascular services
- Providing patients with faster assessment and treatment by vascular experts
North West Surrey vascular patients will continue to be seen as outpatients, have vascular investigations, and receive day-surgery care at Ashford and St Peter’s NHS Trust.
The circa 200 patients per year needing major surgery (arterial or major amputations) will be either transferred to one of the hub sites in an emergency, or booked in for their planned/elective major surgery at one of the hubs.
Although we realise that this may cause some inconvenience to patients and their families (e.g. travel distance), however, with improved surgical outcome and overall better standards of care, we strongly believe that our patients and families will appreciate the new national recommendations as a compromise to serve them in the best possible way. We are considering how we can minimise the effect whilst providing the highest standard of surgical care.
The manner in which patients access the vascular service will not change, although surgical treatment may then be delivered at St Peter’s or at one of the hubs. For example:
- Emergencies will continue to access the service from St Peter’s A/E with expert vascular advice available where and when needed.
- Emergency patients will either undergo minor procedures at St Peter’s, or if major surgery is required and it is safe to do so, will transfer to a hub site for urgent surgery
- Patients referred to the vascular service via their GP will have their initial outpatient review and most investigations at St Peter’s, with appropriate care actions taken from there.
- Elective surgery that is major will be booked at a hub site and patients sent the details for admission at the hub site. Some patients may complete their post-op recovery at the hub site and discharged home, whilst others may be transferred back to St Peters when it is safe to do so, to complete their recovery
- Limb revascularisation interventional radiology procedures to remain at St Peter’s Hospital
Providing a high standard of care for our patients remains a priority, and with this change, we hope to provide a better outcome for all who access the vascular service.