Staff shortage forces service centralisation ahead of plan

Since 6 January, Medway Maritime Hospital has no longer been able to carry out either emergency or elective abdominal aortic aneurysm repairs, as there are too few surgeons to cover the work. 

Only two of Medway Foundation Trust’s four vascular surgeons were carrying out the procedure. However, one is now on restricted duties and unable to operate because of ill-health. 

The operations will now take place at Kent and Canterbury Hospital, which is run by East Kent Hospitals University FT and is 30 miles, or a 45 minute drive by car, from MFT. 

The move of the services to Canterbury had been planned for a later date. Both the Kent and Canterbury and the Medway Maritime units have been operating under a “derogation”, meaning they cannot meet all required standards. Discussions about centralisation of inpatient services started as early as 2014.

An NHS England review of vascular services in Kent and Medway, published in 2018, suggested the services be moved to Kent and Canterbury on an interim basis before a permanent arterial centre was established to carry out all inpatient work. This centre would be the main emergency and specialist hospital in East Kent, the location of which is expected to be consulted on later this year. 

The interim move to Kent and Canterbury was planned for April 2020. This would cover all emergency and elective specialist vascular procedures requiring an overnight stay.

However, the staffing situation at Medway meant the AAA service was centralised earlier than planned at the Kent and Canterbury — which already carries out surgery for east Kent patients — where an on-call consultant rota will offer 24/7 cover.

The number of patients affected is likely to be between 20 and 36 a year, of whom fewer than a dozen will be emergencies. The patients will be from the Medway and Maidstone areas. Patients in north and west Kent are served by other arterial centres.

However, a report in West Kent Clinical Commissioning Group’s most recent governing body papers warned: “Services would be far more robust if arrangements for the management of these patients was arranged in a planned way rather than having to arrange last minute emergency cover and ad hoc emergency transfers.”

A ruptured AAA is a life-threatening condition with an 80 per cent mortality rate. If a patient with a ruptured aneurysm makes it to hospital, they need an immediate operation where the affected section of aorta is replaced with a graft.

Men aged 65 are screened for AAA and may be offered elective surgery if they have a large aneurysm — a swelling in the aorta.

Meanwhile, nearby Maidstone and Tunbridge Wells Trust is planning to move complex elective gastrointestinal surgery from Maidstone Hospital to Tunbridge Wells Hospital.

In a report to Kent County Council’s health overview and scrutiny committee, the trust said having both elective and emergency work at the same hospital would improve continuity of care for both sets of patients, which it described as “exceptionally poor”.

The proposed move should also reduce locum and agency costs which have been running at nearly £5m a year. The plan is expected to affect 600 patients a year and the trust wants to put the changes into place in March.