Agenda item

Michael Ridgwell (Programme Director, Kent and Medway STP), Nicky Bentley (Director of Strategy and Business Development, East Kent Hospitals University NHS Foundation Trust), Simon Brooks-Sykes (Senior Strategic Development Manager and Programme Manager for the Kent and Medway Vascular Clinical Network, East Kent Hospitals University NHS Foundation Trust) and Dr Anil Madhavan (Consultant Interventional Radiologist at Medway NHS Foundation Trust and Deputy Chair for the Kent and Medway Vascular Network) were in attendance for this item.

(1)       Mr Ridgwell began by introducing the guests and outlining the current service provision in Kent & Medway. Vascular services were currently delivered at the Kent & Canterbury Hospital and Medway Maritime Hospital; both sites were non-compliant with the national specification for vascular surgery particularly in relation to the number of procedures being undertaken. As part of the review process, the Kent & Medway Vascular Network was established by the two providers, Medway NHS Foundation Trust (MFT) and East Kent Hospitals University Foundation Trust (EKHUFT), to enable the future delivery of sustainable vascular services through a single arterial centre. The Network had undertaken an options appraisal which had indicated that the arterial centre would be best placed in East Kent with an enhanced non-arterial centre in Medway.

(2)       Members commented about recruitment, local care and consultation. Dr Madhavan explained that there was a national shortage of vascular surgeons and interventional radiologists. The two centres in Kent & Medway currently had seven vascular surgeons and seven interventional radiologists; the network model would require eight vascular surgeons and eight interventional radiologists. He stated that once the centralised model, which would be compliant with the national specification and be used to deliver the service for the next 15 – 20 years, had been finalised, it would attract staff to Kent & Medway. Mr Ridgwell noted that the provision of optimally configured health services improved recruitment; he gave the example of the Estuary View Medical Centre in Whitstable. Dr Madhavan stated that only a small proportion of patients were required to travel to an acute specialist centre for treatment. He confirmed that the majority of the service would continue to be delivered locally including pre-operative and post-operative assessments. Mr Ridgwell explained that a range of engagement activities had been undertaken including a survey, targeted listening events and workshops. He reported that when the review was presented to Stage 1 of the NHS England assurance process in June 2016, the assurance team advised that the change did not require formal consultation if adequate engagement was carried out. 

(3)       Members enquired about the financial gap which had been identified in the development of the business case. Ms Bentley confirmed that the business case was near completion and that financial investment would be required to consolidate the two services. In terms of the deficit, Mr Brooks-Sykes reported that there was a combined deficit of £4 million which took into account £2.2 million deficit at MFT, £.1.1 million deficit at EKHUFT and additional investment required to house the new facilities. He stated that the network board was in discussion with NHS England about the opportunities to attract a higher income and join the national procurement process to purchase high cost equipment.  Mr Ridgwell committed to providing the Committee with the total spend on vascular services. Mr Brooks-Sykes noted that the abdominal aortic aneurysm screening programme would remain unchanged. Dr M Madhavan highlighted that a significant proportion of the deficit was the cost of temporary staffing which would reduce with the implementation of the new model. He noted that whilst vascular services worldwide were loss making services due to the use of expensive technology; it was a speciality that supported other services which achieved an overall financial balance. Mr Ridgwell concluded by reminding Members that finance was one aspect of the business case.

(4)       RESOLVED that the Vascular Review Programme Board be requested:

(a)       to note the comments about recruitment, local care, consultation and the financial position;

(b)       to present the final model and key recommendations to the Committee prior to approval by NHS England Specialist Commissioning.