England’s vascular surgery services are “not configured to meet clinical need” and are resulting in unnecessarily long waits and less safe care, a government analysis has found.
The Getting It Right First Time team working on vascular surgery this morning published its report into the specialty and recommended arterial surgery be reconfigured from its current 70 sites.
However, it did not specify an ideal number of sites providing the service.
The surgeon who led the review said the traditional elective/emergency split did not suit vascular work because only a small proportion was an emergency but most was far more urgent than other elective specialties.
Professor Michael Horrocks said in his introduction to the report: “The GIRFT process – a combination of data analysis and indepth face-to-face discussions during hospital visits with clinicians and managers – has shown, in unambiguous terms, how much more we could be doing.
“It has demonstrated that, in many areas, patients have to wait too long for the vital surgery we can provide.”
Professor Horrocks said some units undertook preventative surgery after a mini-stroke within five days but 19 of the 70 hospitals had a median wait of more than two weeks, breaching National Institute for Health and Care Excellence guidelines.
The report proposed a new hub and spoke arrangement for vascular surgery. Hubs should employ six vascular surgeons and six vascular interventional radiologists by July this year, it recommended, and perform a minimum of 40 carotid endarterectomy and 60 abdominal aortic aneurysm procedures a year.
The researchers found delays were down to lack of staff and facilities but that “crucially, the majority of vascular surgery has become restricted to ‘normal’ working hours, immediately limiting the number of procedures that can be carried out per week.”
Only six hospitals offer elective vascular surgery at weekends.
The report said: “this model of care needs to change – and it requires first a shift in mindset. To deliver sufficient procedures urgently, all surgical hubs should ideally provide theatre activity seven days a week.
“Clearly, this cannot happen in every hospital; the costs would be too great and the volume of activity would not justify it.”
The current hub and spoke arrangements are inconsistent with a six-fold variation in bedbase at hubs. The review team also found some spoke hospitals had a larger bedbase than some hubs, and did more procedures.
The report said getting all the hub-and-spoke networks to the same level was “no small task – as evidenced by the fact that it has not yet been delivered, despite strong recommendations to this same effect in the past.
“There are cultural, financial and logistical barriers, some of which continue even within established networks.”
The report said some hospitals had identified a perverse incentive to keep patients in longer than required.
It said the emergency readmission penalty could encourage trusts to keep patients in for observation for longer than clinically necessary.
The report said: “For all sorts of reasons, this would not be desirable: it means valuable vascular resources would be being used to monitor patients that may not need monitoring or additional care, while others in need of surgery might have to wait for a bed to be free.” It added that the size of this issue was unclear.
Roughly 43,000 vascular surgery procedures are carried out in the English NHS each year. There are 450 consultant vascular surgeons.
The GIRFT team made individual recommendations to each of the 70 organisations and these will be followed up by regional GIRFT teams.
The report is the third of 35 the GIRFT team are working on, covering a range of medical and surgical specialties. The project has a £60m budget over four years, ending in 2020-21.