Agenda item

OenaWindibank (Programme Director, Kent & Medway Specialist Vascular Services Review, NHS England) and Diana Cargill (Specialised Lead, Specialised Commissioning, NHS England South (East), NHS England) were in attendance for this item.

(1)       The Chairman welcomed the guests to the meeting.  Ms Windibank began by outlining the case for change. She explained that the review was only considering specialist vascular services, it would not be looking at heart disease, heart surgery or the management of the common types of stroke. She reported that in 2012 there were very poor clinical outcomes for patients in England and Wales receiving vascular services. In response to this the Vascular Society produced best practice guidance which was developed into a national service specification through the specialised Clinical Reference Group in 2013. She reported that following the introduction of the national service specification there had been improved mortality outcomes.

(2)       Ms Windibank explained that a vascular services review was initiated in Kent and Medway to determine compliance with the national service specification and best practice. She noted that vascular services were currently delivered at two sites in Kent and Medway: Kent and Canterbury Hospital and Medway Maritime Hospital. A number of patients in North and West Kent were also transferred to Guy’s and St Thomas’ NHS Foundation Trust. She reported that non-compliance with the national service specification by the East Kent Hospitals University NHS Foundation Trust and Medway NHS Foundation Trust had been identified. The key issues were that the total Kent and Medway activity was borderline for meeting the minimum requirements for Abdominal Aortic Aneurysm procedures and the Carotid Endarterectomy levels at Medway NHS Foundation Trust were routinely below the minimum requirements. There were also concerns regarding workforce availability, retirement and the sustainability of consultant rotas.

(3)       Ms Windibank stated that the national service specification had been reviewed nationally including in Surrey and Sussex to determine the work needed to ensure local vascular providers comply with best practice outlined in the specification. She noted that the Kent review was at an early stage and was building on learning from the other reviews. The aim of the review was to ensure the delivery of high quality, sustainable vascular outcomes for all Kent and Medway patients which complied with the national service specification. She also noted that the review was looking to develop centres of excellence in Kent and Medway in the future.

(4)       The Chairman enquired about the timescale of the review. Ms Windibank advised that NHS England were looking to develop options over the summer with the preferred option being approved in November 2015. She noted that a number of public listening events had already been held. She stated it was difficult to capture the views of service users as they were only 900 total procedures in 2013/14 for Kent and Medway residents.

(5)       In response to a direct question about the affordability of clinical best practice, Ms Windibank explained that affordability would be one of the factors looked at during the option appraisal in Phase 2. She stated that the focus of the review was safe and sustainable clinical care and quality. Ms Cargill explained that there were 591 procedures in Kent and Medway in 2013/14 and these were paid on a case by case basis. She noted that money was available to NHS England South to pay for all these procedures. Further questions were asked about a larger Market Forces Factor in London and patient choice. Ms Cargill explained that any procedure undertaken in London on a Kent and Medway resident was paid for by NHS England London. Ms Windibank acknowledged patient choice and committed to making this clearer in the decision making report.

(6)       A number of comments were made about Abdominal Aortic Aneurysm (AAA) screening, consultant rotas and other NHS England reviews. Ms Windibank explained that there was a national screening programme which was delivered by East Kent Hospitals University NHS Foundation Trust for all Kent and Medway residents. Any man registered with a GP would receive a letter inviting him to screening in the year he turns 65. The AAA Screening Programme was provided by EKHUFT has been audited as good.  Ms Windibank confirmed that consultant rotas were part of the review. Ms Windibank stated that she was not aware of any other reviews by NHS England in addition to the stroke review. She highlighted the alignment of stroke and vascular services.

(7)       RESOLVED that the report be noted and NHS England be invited to submit an update to the Committee at its September meeting.