Agenda item

Oena Windibank (Programme Director, Kent & Medway Vascular and Stroke Services Reviews), James Thallon (Medical Director, NHS England South and Senior Responsible Officer, Kent & Medway Vascular Review), Rachel Jones (Director of Strategy, East Kent Hospitals University Foundation NHS Trust), Noel Wilson (Vascular Services Clinical Lead and Consultant Surgeon, East Kent Hospitals University Foundation NHS Trust and Clinical Lead for the Kent & Medway Vascular Network), Ben Stevens (Director of Clinical Operations, Co-ordinated Surgical Directorate, Medway Foundation Trust) and Anil Madhven (Interventional Radiologist Consultant, Medway Foundation Trust and Deputy Clinical Lead, Kent & Medway Vascular Network) were in attendance for this item.

(1)       The Chairman welcomed the guests to the Committee. Dr Thallon began providing an update to the Committee about the Vascular Services Review; he explained that East Kent Hospitals University NHS Foundation Trust (EKHUFT) and Medway NHS Foundation Group (MFT) had established a Network to deliver vascular services jointly in East and Mid Kent. He noted that the Committee had requested NHS England to present an update on the engagement events; he explained that these had been delayed until the early next year.

(2)       Following a change of membership at the previous meeting, the Chairman asked for a description of vascular services. Dr Wilson explained that vascular diseases related to disorders of the arteries and veins but excluded the heart and cardiothoracic diseases. He stated that vascular services included interventions to remove interruptions to arterial blood supply in the limbs, neck and abdomen to prevent stroke and repair aneurisms. He noted that aneurisms particularly affected men and common vein conditions included varicose veins and ulceration.

(3)       Dr Wilson stated that he was the Vascular Services Clinical Lead and Consultant Surgeon at EKHUFT and was the lead for the Kent & Medway Vascular Screening Programme which screened 11,000 – 12,000 men a year for Abdominal Aortic Aneurysm. He also worked with Public Health England to peer review vascular services across the country and was currently working with NICE to review the vascular guidelines. He explained that resulting from the vascular services review in Kent and Medway, a collaboration between EKHUFT and MFT had developed the Kent & Medway Vascular Network. He noted that the pathway to London for specialist tertiary treatment would continue. He reported that a Network Board had been established, by the Chief Executives of the two Trusts, to move the service forward; Dr Wilson had been appointed as the Clinical Lead and Dr Madhven had been appointed as the Deputy Clinical Lead. He explained that the Network Board was working to develop and build the best service for patients and their families and was very optimistic about its future. He stated that he attended a patient and family engagement event which had given him a greater understanding of patients and their families’ priorities for vascular services.

(4)       Dr Madhven explained that he was an Interventional Radiologist Consultant at MFT and provided minimally invasive specialist procedures for vascular patients. He highlighted that, although he was not a vascular surgeon, he provided specialist treatment to compliment the work of vascular surgeons. He noted that both Trusts recognised the importance of different specialities working together to provide vascular services. He reported that he been appointed to the role of Deputy Clinical Lead to the Network Board last month and had attended one Board meeting. He stated that he was responsible for identifying and implementing the clinical governance structure for the Network. He stated that he was keen for the Network Board to move forward and develop an improved and safe service.

(5)       Dr Thallon introduced Ms Jones and Mr Stevens as the executive leads from both Trusts. Ms Jones stated that alongside the clinical model, the clinically-led business case was being developed which incorporated finance, activity and demand; the impact on patients and their family would also be included following the planned engagement events. Mr Stevens added that the primary purpose of the Network was to provide effective and sustainable vascular services.

(6)       The Chairman enquired about the impact of the Sustainability and Transformation Plan (STP) on the review. Dr Thallon explained that the review was started before the STP process with the aim of creating excellent outcomes for patients and sustainability of the service following Vascular Society guidance. He stated that the both Trusts recognised that actions were required to improve the service. He reported that although the review could exist independently outside of the STP process, it was fully integrated into the process and did not need to adapt itself to support the STP. He stated that there was an argument for joint public consultation on the Vascular Review and elements of the STP to enable those elements to be fully articulated and not cloaked by other high profile choices.

(7)       Members of the Committee then proceeded to ask a series of questions and make a number of comments. In response to a specific question about the impact of South East Coast Ambulance NHS Foundation Trust (SECAmb) being placed into quality special measures, Dr Thallon acknowledged that SECAmb was facing temporary operational difficulties but stated that by the time the proposed services were operationalised, it was hoped that SECAmb would have resolved these. He stated that the review had a good working relationship with SECAmb and was working closely with them as pathways and models of care were being developed.

(8)       A number of comments were made about workforce. Dr Thallon explained that in order to be competitive, integrated fit for purpose facilities were required to attract staff. Dr Wilson noted that vascular services had been radically changed following the General Medical Council’s decision to make it a specialist service. He stated that the majority of vascular services across the country had been centralised and Kent and Medway was lagging behind. He stated that he was optimistic that the model with all care being provided locally, with complex cases being provided as part of a single centralised hub, would attract and strengthen the vascular workforce.  He explained that the workforce model and skills required with being reviewed; it was proposed that allied and non-medical staffing, such as nurse practitioners, would help to support consultant-delivered care. He stressed the importance of junior doctors being trained rather than be responsible for the delivery of care.

(9)       In response to a question about finance, Dr Thallon stated that the aim of the review was about reducing the amount of vascular activity. He acknowledged that there would be a capital cost attached to modernising the service and it was recognised by NHS England that capital was in short supply.  He noted that the STP was looking at capital requirements for the whole system and the vascular services review was looking at an element of that. He stated that the next step was for the development of business case which would include the cost of the collaborative service. He suggested that the next update to the Committee should include the presentation of the business case and the feedback from the engagement events with the timing dependent on purdah. Ms Windibank noted that the engagement events were scheduled to be held at the end of February and the feedback would be incorporated into the business case.

(10)     Members enquired about the sustainability of the proposed model of care and centralisation. Dr Wilson explained that he had been appointed as a vascular surgeon in 1995 and his passion had been to develop better care and services since then. He acknowledged that previous reviews had not got the model right and this review provided the opportunity to implement the best model of care which had been successfully implemented and delivered across the country.  He stated that the greatest success of the review had been the development of the collaborative Network to implement and deliver the new model of care. In regards to centralisation, Dr Thallon explained that care would be localised as much as possible and only complex care would be centralised. He stated that there was a good evidence base which showed that centralisation improved the outcomes for patients but this needed to be balanced against the patients’ access to their families. Mr Stevens stated that the engagement events would focus on the families to ensure that their needs and concerns were included as part of the business case.

(11)     RESOLVED that NHS England South (South East) and the Kent & Medway Vascular Clinical Network Board be requested:

(a)       to note the comments about workforce, finance and sustainability;

(b)       to present an update to the Committee following the engagement events and the development of the business case.