STRUCTURE: Reconfiguration plans for stroke, vascular and trauma services in the South Central region has caused disagreement among trusts, some of whom could lose specialties under the proposals.

A report published by the Southampton, Hampshire, Isle of Wight and Portsmouth primary care trust cluster has recommended a new round of consultation on vascular care, after Portsmouth Hospitals NHS Trust objected to plans to move services out of its Queen Alexendra Hospital to Southampton General.

“Safe and Sustainable Acute Services”, which followed a six-week engagement exercise in August and September, recommended that the John Radcliffe Hospital in Oxford and Southampton General would become the region’s centres for acute vascular and major trauma care.

Less severe trauma cases would also be treated in Stoke Mandeville in Aylesbury, Wexham Park in Slough, the Royal Berkshire in Reading, Basingstoke, Queen Alexandra in Portsmouth and St Marys on the Isle of Wight.

For stroke services, the proposals are for Winchester and Eastleigh NHS Foundation Trust to become the main provider for hyper-acute services in north Hampshire, meaning Basingstoke and North Hampshire would only provide acute stroke and rehabilitation services. The two trusts are set to merge. St Mary’s would become the hyper acute provider on the Isle of Wight.

However, the vascular plans proved controversial in Portsmouth. The report says: “Portsmouth Hospitals NHS Trust made clear that it has serious concerns about the proposal for Southampton General to provide emergency and elective complex vascular surgery for the population of Southampton, Portsmouth, Winchester and the Isle of Wight.

“In particular its concerns relate to the process the panel used to arrive at their recommendation and the implications of the recommendation on other clinical services at PHT.”

The Portsmouth trust backed the stroke proposals, but on trauma, the report said: “Portsmouth highlighted its status as the second largest provider of trauma services within the South Central SHA area and its unique ability to provide specialist orthoplastic services.

“As such PHT was clear that the long term sustainability of the major trauma centre at Southampton should not be dependent on the resources of other trauma units.”

Consultation responses also showed concern among the public. Responses included 44 letters from the public, 19 email responses, 44 completed online questionnaires, and 6,184 letters via the Portsmouth News’s “Keep it at Queen Alexandra” campaign.

However a response from the University Hospital Southampton NHS Foundation Trust expressed clear support for the plans. The report said their response “underlined that the proposal for Southampton General to become the vascular centre received unanimous support from the expert panel.

“They recognised concerns from colleagues and the public in Portsmouth but made clear that they felt these were resolvable and could be mitigated in discussions between commissioners and clinicians.”

The study concluded that further consultation would be needed. “It is recognised that further detail on the options for vascular surgery is required before stakeholders and the public can make a fully informed decision.”

A formal public consultation will be undertaken once proposals have been developed further and assessed by a “newly convened expert panel”.

The proposals for major trauma and stroke were broadly well received, the report said.