'Best possible care' promised to North-East patients from vascular changes

A strategic review has advised that services in the North-East should be reconfigured to a maximum of three hubs.

Vascular services are currently provided from four sites - James Cook University Hospital, in Middlesbrough, the Freeman Hospital, in Newcastle, Sunderland Royal Hospital and University Hospital of North Durham.

But an independent clinical review is recommending that full vascular services, which include surgery to unblock or bypass arteries, should instead be delivered from three centres - in Middlesbrough, Newcastle and Sunderland.

University Hospital of North Durham (UHND) would continue to see about 3,600 patients a year for vascular outpatient appointments.

County Councillor John Robinson, who chairs Durham County Council’s health overview and scrutiny Committee, has already expressed serious concerns and questioned the rationale for a centre being in Sunderland rather than Durham.

He said: "The committee has concerns at the reference to Sunderland Royal Hospital being geographically located in the centre of the region as a criteria for selection given that UHND is equally equidistant to Newcastle and Middlesbrough.

“Members also have serious concerns at the approach that appears to be being adopted to centralise all major acute service provision at hospitals within Newcastle, Sunderland and Middlesbrough to the detriment of all other acute hospitals across the region, not least UHND.”

Professor Chris Gray, NHS England’s medical director in North Cumbria and the North- East, said: “All NHS organisations involved in this reconfiguration support the recommendation that Sunderland Royal Hospital should be the third vascular centre in our region.

"It is vital, as always, that high quality, safe and sustainable patient care remains at the core of reconfiguration decisions.

“Sunderland has been recommended as it already has the physical infrastructure in place including a new emergency department and an intensive care unit with sufficient bed capacity.

"It also has a state-of-the-art imaging hub which is key for interventional radiology, which uses a range of minimally invasive treatments that diagnose or treat vascular diseases, for example, the use of stents.

“The hospital also provides a number of related speciality services such as cardiology care, which deals with disorders of the heart and parts of the circulatory system, and renal care, which treats kidney disorders.

"Vascular disease is a generalised condition. Centralising specialist care together in one organisation provides patients with the best possible care at the point of need.”

Prof Gray said the reconfiguration would also improve the overall sustainability of the service in the region and aid recruitment, while minimising any potential gaps in staffing rotas and fragility within a service which is under increasing pressure.

Carole Langrick, executive director of operations at County Durham and Darlington NHS Foundation Trust, said: “Following the independent review we have been working with our vascular surgeons and clinical colleagues alongside the clinical team at City Hospitals Sunderland to discuss and understand in more detail the recommendation to centralise the service at Sunderland Royal Hospital and what it would mean for the service and patients going forward.

"We recognise the recommendation and believe that the report evidences the improvements to patient care which could be achieved through establishing a centralised service in this way.

“We understand, however, that any proposed change can be unsettling for patients and staff.

"That is why, together with City Hospitals Sunderland and NHS England, we are sharing information with local health and social care partners including the local authority’s overview and scrutiny committee.

"There are also plans for a series of patient and public engagement events to explain the recommendation and listen to views and feedback.

“We would also like to reassure our local populations that while the recommendation would mean a change to where patients would have their vascular surgery, follow-up care and out-patient appointments would still be provided at University Hospital of North Durham.

"We are clear that this hospital has a strong role to play in the delivery of healthcare services now and in the future.”

Dr Sean Fenwick, director of operations at City Hospitals Sunderland NHS Foundation Trust, said: “We have been working closely with colleagues at County Durham and Darlington NHS Foundation Trust, NHS England, the CCG and NEAS to look at how we can together continue to provide a high quality, safe vascular service to our patients.

“We support the findings of the independent review along with our NHS colleagues and are confident that this reconfiguration will help to improve health outcomes for patients and enable us to enhance the specialist skills that we already have at City Hospitals Sunderland.”

Sunderland already had the physical infrastructure in place along with a state-of-the art imaging hub and a number of related speciality services such as cardiology care.

He said: “Centralising specialist care together in one organisation provides patients with the best possible care at the point of need.”

Prof Gray also said the reconfiguration would improve the overall sustainability of the service, while minimising any gaps in staffing rotas.

Vascular care manages disorders of arteries and veins. Vascular surgery is done to reconstruct, unblock or bypass arteries to restore blood flow to organs. These procedures reduce the risk of sudden death, prevent stroke and reduce the risk of amputation.

In June 2014 the Northern England Strategic Clinical Network, who provides targeted health system support to improve health outcomes for patients and reduce unwarranted variation of patient care, published ‘North East Vascular Services - Case for Change’.

This strategic review concluded that the North East vascular service should be re-configured to a maximum of three vascular ‘hubs’ – centres that provide a full, high quality vascular service. Centralising services enables clinicians to work together to gain the best possible experience in providing care to patients. The provision of specialist vascular care is highly dependent on other technical and specialist services, including intensive care.

James Cook University Hospital and the Freeman Hospital are both major trauma centres so must continue to provide a full vascular service.

County Durham and Darlington NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust requested an independent clinical review, which was carried out by the Vascular Society of Great Britain and Ireland in 2015.

This clinical review also advised that there is a strong case to remodel vascular services in the North East and that there is only sufficient specialised vascular activity and vascular clinicians to support three centres.

Carole Langrick, Executive Director of Operations at County Durham and Darlington NHS Foundation Trust, said: “Following the independent review we have been working with our vascular surgeons and clinical colleagues alongside the clinical team at City Hospitals Sunderland to discuss and understand in more detail the recommendation to centralise the service at Sunderland Royal Hospital and what it would mean for the service and patients going forward. We recognise the recommendation and believe that the report evidences the improvements to patient care which could be achieved through establishing a centralised service in this way.

“We understand, however, that any proposed change can be unsettling for patients and staff. That is why, together with City Hospitals Sunderland and NHS England, we are sharing information with local health and social care partners including the local authority’s Overview and Scrutiny Committee. There are also plans for a series of patient and public engagement events to explain the recommendation and listen to views and feedback.

“We would also like to reassure our local populations that while the recommendation would mean a change to where patients would have their vascular surgery, follow-up care and out-patient appointments would still be provided at University Hospital of North Durham. We are clear that this hospital has a strong role to play in the delivery of healthcare services now and in the future.”

Dr Sean Fenwick, Director of Operations at City Hospitals Sunderland NHS Foundation Trust, said: “We have been working closely with colleagues at County Durham and Darlington NHS Foundation Trust, NHS England, the CCG and NEAS to look at how we can together continue to provide a high quality, safe vascular service to our patients.

“We support the findings of the independent review along with our NHS colleagues and are confident that this reconfiguration will help to improve health outcomes for patients and enable us to enhance the specialist skills that we already have at City Hospitals Sunderland.”

The reviewers also recommended that each of the three vascular centres (hubs) in the region ‘network’ with hospitals that don’t provide specialist and other types of vascular surgery (spoke sites).

• James Cook University Hospital, in Middlesbrough, will network with Darlington Memorial Hospital

• Freeman Hospital, in Newcastle, will network with the Queen Elizabeth Hospital in Gateshead

• Sunderland Royal Hospital will network with University Hospital of North Durham and South Tyneside District Hospital

Patients who are currently accessing or who have accessed vascular services at University Hospital North Durham over the last three years will receive further detailed information and an invitation to attend an event to find out more about the reconfiguration of services, how the changes may impact on them and to give them an opportunity to give their views and feedback.

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