Leak reveals winners from NHSE surgery centralisation

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Dramatic reduction of hospitals delivering surgical care for intestinal failure
Internal slides obtained by HSJ reveal the hospitals chosen
Controversy over the tender process

Eleven hospitals have been chosen as specialist surgical centres as part of a controversial reconfiguration led by NHS England, according to internal documents seen by HSJ.

The plans to consolidate intestinal failure services involve surgical care being withdrawn from dozens of other acute sites.

Official slides obtained by HSJ reveal the specialist centres are “confirmed” to be the acute hospitals in Bristol, Southampton, Oxford, Cambridge, Birmingham, Salford, Nottingham, Coventry, Leeds, Newcastle, and Harrow in north west London. A twelfth centre is also proposed for central London.

Up to 40 hospitals have been delivering IF surgical care in recent years, but a process was launched by NHSE in 2018 to dramatically reduce that number.

Larger hospitals which will not deliver surgical care include those in Norwich, Exeter, Leicester, Sheffield, Hull, Liverpool, Portsmouth, Preston and Reading. The plan is for these hospitals to host non-surgical intravenous feeding services instead. Surgery has already ceased at some of these sites, such as Liverpool, due to the departures of senior staff.

NHSE did not respond when asked to comment.

There is an acceptance in the profession that consolidating surgery on fewer sites should improve outcomes, due to surgeons performing operations more regularly.

Concerns were revealed about the system used to select the centres, with doctors in some areas accusing NHSE of an “unfair” process. The British Society of Gastroenterology said some hospitals had failed to achieve surgical centre status despite scoring highly in the process.

HSJ submitted a freedom of information request to NHSE for details about the process, including the scoring system, but the national body refused this, claiming the information would predjudice commercial interests.

Asked whether it accepted its non-surgical designation, or whether it had concerns about the process, Norfolk and Norwich University Hospitals Foundation Trust said: “There are ongoing discussions with the regional severe intestinal failure unit and the national reference centre to ensure a patient-centred approach for patients in Norfolk and Waveney with intestinal failure.”

Royal Berkshire Foundation trust, in Reading, said it only undertakes a limited amount of surgical activity and it did not apply to become a specialist centre.

Liverpool University Hospitals has previously said it accepts the designation and will work to develop its intravenous feeding services, with surgical patients treated in Salford.

Portsmouth Hospitals University Trust confirmed patients needing specialist surgery would be treated in Southampton, with a specialist intravenous feeding service developed at Portsmouth.

University Hospitals Leicester, Sheffield Teaching Hospitals, Royal Devon University Healthcare, Lancashire Teaching Hospitals, and Hull University Teaching Hospitals either did not respond to questions, or referred enquiries to NHSE.

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