• HSJ research shows multiple trusts planning to centralise vascular services
  • Moves follow review of vascular surgery by £60m Getting It Right First Time programme
  • Plans to centralise in Essex, Hertfordshire, Yorkshire, Devon and Surrey

Trusts have begun taking steps to centralise vascular surgery following an NHS Improvement clinical review, HSJ can reveal.

NHSI’s Getting It Right First Time clinical team has visited all 70 vascular surgery sites across England and made recommendations about the minimum number of procedures they should perform to remain viable.

An HSJ analysis of the most recent National Vascular Registry data against the two GIRFT procedure thresholds showed 12 that missed both, and another 43 missed one of them.

The latest data gives an average figure for the number of procedures carried out over the three calendar years from 2014 to 2016. It is the most recent available and had not been published when the GIRFT team began its work.

The GIRFT review specified that vascular hubs should perform 60 abdominal aortic aneurysm procedures and 40 carotid endarterectomies a year.

The National Vascular Registry data is broken down by trust rather than hospital site – meaning it is possible to identify trusts that do not hit those thresholds but not individual hospitals.

Trusts that missed both procedure thresholds

  • Torbay and South Devon Foundation Trust
  • Basildon and Thurrock University Hospitals FT
  • Southend University Hospital FT
  • Ashford and St Peter’s Hospitals FT
  • University Hospital of South Manchester FT
  • Northampton General Hospital Trust
  • Royal Devon and Exeter FT
  • Shrewsbury and Telford Hospital Trust
  • Barts Health Trust
  • London North West Healthcare Trust
  • Doncaster and Bassetlaw Hospitals FT
  • City Hospitals Sunderland FT

Several trusts said they now had plans to centralise vascular surgery elsewhere.

For example, a spokeswoman for Torbay and South Devon FT – which was under the threshold for carotid endarterectomies – said the organisation would be transferring elective arterial surgery to its hub partner the Royal Devon and Exeter FT from January 2019. Torbay employs two consultant vascular surgeons and two interventional radiologists. The GIRFT recommendations are that vascular hubs have six of each.

Across west Essex and Hertfordshire there are plans to concentrate work from three hospitals into the Lister Hospital in Stevenage.

The hospital, run by East and North Hertfordshire Trust, is the preferred option for a vascular hub including Princess Alexandra Hospital Trust and West Hertfordshire Hospitals Trust. Princess Alexandra carried out five carotid endarterectomies from 2014 to 2016, the lowest in the country, and less than one third of the recommended amount of AAA procedures.

The GIRFT report said NHS Improvement’s objective is for implementation of its recommendations across England by July 2019.

Three trusts in Essex are looking to network their services and centralise procedures in the wake of the GIRFT review and an NHS England service review.

Basildon and Thurrock University Hospitals FT performs the lowest amount of abdominal aortic aneurysm procedures in the country, 14. Basildon is not part of a hub and spoke model, as recommended by GIRFT, but is working on this with Southend University Hospital FT and Mid Essex Hospital Services Trust. Southend also missed both thresholds and Mid Essex was beneath the threshold for AAA procedures.

Their combined AAA totals did not meet the threshold of 60. The three trusts have a single leadership team.

It is not known which hospital vascular surgery will be centralised at.

The next GIRFT review, into cardiothoracic surgery, is expected in April.

Trusts beneath the carotid endarterectomy threshold

  • Princess Alexandra Hospital Trust
  • Royal Free London FT
  • Medway Foundation Trust
  • Basildon and Thurrock University Hospitals FT
  • Torbay and South Devon FT
  • University Hospital of South Manchester FT
  • Gateshead Health FT
  • Ashford and St Peter’s Hospitals FT
  • St George’s University Hospitals FT
  • Barking, Havering and Redbridge University Hospitals Trust
  • North Cumbria University Hospitals Trust
  • Bedford Hospital Trust
  • Southend University Hospital FT
  • University College London Hospitals FT
  • Royal Devon and Exeter FT
  • East and North Hertfordshire Trust
  • County Durham and Darlington FT
  • Heart of England FT
  • Shrewsbury and Telford Hospital Trust
  • London North West Healthcare Trust
  • Northampton General Hospital Trust
  • Doncaster and Bassetlaw Hospitals FT
  • Barts Health Trust
  • City Hospitals Sunderland FT

Trusts beneath the AAA procedure threshold

  • Basildon and Thurrock University Hospitals FT
  • Mid Essex Hospital Services Trust
  • University Hospital of South Manchester FT
  • Royal Cornwall Hospitals Trust
  • Torbay and South Devon FT
  • King’s College Hospital FT
  • East Lancashire Hospitals Trust
  • Southend University Hospital FT
  • Royal Devon and Exeter FT
  • Princess Alexandra Hospital Trust
  • Shrewsbury and Telford Hospital Trust
  • United Lincolnshire Hospitals Trust
  • Lancashire Teaching Hospitals FT
  • East and North Hertfordshire Trust
  • Taunton and Somerset FT
  • London North West Healthcare Trust
  • City Hospitals Sunderland FT
  • Ashford and St Peter’s Hospitals FT
  • Doncaster and Bassetlaw Hospitals FT
  • North Cumbria University Hospitals Trust
  • University Hospitals Birmingham FT
  • Gloucestershire Hospitals Foundation Trust
  • Pennine Acute Hospitals Trust
  • University Hospitals Coventry and Warwickshire Trust
  • Worcestershire Acute Hospitals Trust
  • East Kent Hospitals University FT
  • Barts Health Trust
  • Northampton General Hospital Trust
  • Countess of Chester Hospital FT
  • Colchester Hospital University FT
  • Bedford Hospital Trust
  • York Teaching Hospital FT

 

This story was amended on 19 March at 4pm to correct a data error

 

Trusts reveal plans to centralise services after GIRFT review