DGH launches service to grab market share from teaching hospitals

London North West Healthcare Trust has opened the new unit at its Northwick Park Hospital, centralising vascular services in the north west London region.

The trust hopes it will increase its market share for vascular services and help repatriate some procedures sent to the large teaching trusts in central London.

The trust headhunted a specialist in mid-2018 to develop the service in response to a high death rate from some vascular procedures.

LNWH had an in-hospital mortality rate of 63.5 per cent for ruptured abdominal aortic aneurism cases. The trust said this was because it treated frailer patients, but it brought in Martin Molina to institute less invasive procedures.The trust as a whole is rated ‘requires improvement’.

The Getting it Right First Time review of vascular services recommended the minimum number of procedures that should be performed for a unit to remain viable. An HSJ analysis found LNWH was one of 12 trusts that were below the threshold against the two procedures identified as critical to unit viability in the GIRFT report.

The new unit centralises vascular services previously offered by multiple sites across north west London. It also combines vascular surgery, endovascular surgery and interventional radiology – two specialisms historically at loggerheads – in what the trust says is a first for the UK.

“In order to be able to offer [north west London residents] top treatment, we cannot have this many centres who do a bit of this and that. We need a hub that can offer it all,” Professor Molina, the centre’s clinical director, told HSJ. “You cannot have it in every hospital in the area because the volumes of patients will not be enough, and you don’t have the resources.”

“We need centralisation, we need integration of vascular surgery and interventional radiology,” he said. “In that way, we can improve patient safety, experience and care. It’s less invasive surgery.”

The centralised unit also “reduces duplication of services and staff, and it increases our market share and enables us to repatriate our work to this institution and to this part of London,” he added.

“The advanced institutions all sit in the so-called congestion area of London. I don’t think it’s quite fair to the people who live here,” he said.

The vascular centre will serve 1.2 million people with “endemic vascular disease” who may “disappear along the way” if referred from outer west London to institutions in the centre of the city, Professor Molina added.