Vascular Surgery in Thames Valley Dr Will Orr Clinical Lead CVD Thames Valley NHS England 1

Thames Valley SCN “Improving outcomes for the population of Thames Valley through engaging, empowering and enabling our partners to underpin the delivery of evidence-based high quality care” 2 June 2005 – Thames Valley Cardiac Network April 2007 – South Central Cardiovascular Network April 2013 – Thames Valley Strategic Cardiovascular Network

SCN way of working  How does quality vary across TV? what are we not doing that evidence tells us we should be doing? are there things that we should no longer be doing?  What & where do we need to improve? are we using guidelines? – NICE, national societies, national service specifications can we be innovative?  How can we bring about change? work on large scale, cross organisational strategic challenges improve patient outcomes by influencing the commissioning process (“guardians of the patient pathway”)

All work must map to NHS Outcomes Framework Domains 1.Preventing people from dying prematurely 2.Enhancing Quality of Life for people with long term conditions 3.Helping people to recover from periods of ill health or following injury 4.Ensuring people have a positive experience of care 5.Treating people in a safe environment and protecting them from avoidable harm 4

National Guidance Cardiac Stroke Renal Diabetes  Treat as a family of diseases 5 …and Vascular Surgery

Vascular Surgery Centres in South Central 2008

Report into the Provision of Emergency Vascular Surgery for People Living within the South Central Area - SCCVN 2008 Key elements of good emergency vascular care: Patients with emergency vascular problems should have access to treatment at all times by a team that includes consultants with both surgical and interventional radiology expertise. There should be appropriate access to vascular imaging and ITU/HDU facilities. Patients with conditions requiring vascular surgery do better with specialist care than with a general surgeon even when transfer times are taken into consideration. Outcomes are better in services offering a high volume service. On call rotas should be sustainable: 1 in 6 is recommended Services to all patients should be protocol driven Lamont et al (2007). The Provision of Emergency Vascular Services. Vascular Society

Recommendations for Future Actions 2008 A.There is scope for further development of existing networks based on the following criteria: With no less than 6 participants Regular MDT meetings Freeing of participants from the general surgery rota Covering the weekend period Preferably with either an extended period of on call (one week at a time) or with set days With a written protocol for the ambulance services regarding transfers and the operation of the network Agreeing explicit arrangements for inpatient follow up With one consultant job plan identifying coordinator duties for the network

Recommendations for Future Actions 2008 B.In the Thames Valley area, out of hours cover needs to be rationalised and formalised across the patch. C.Should providers find it difficult to agree local PCTs could co-operate, via the PCT alliance to tender for vascular surgical services D.The network, working with the vascular surgery group can provide a tender specification for commissioners E. PCTs should be aware however of the consequences for other services withina hospital of removing interventional radiology services and vascular surgery

Dr Foster Data 2007/2008 Abdominal Aortic Aneurysm Repair – Elective & Emergency VolumeOutcome

Dr Foster Data 2007/2008 Carotid Endarterectomy – Elective & Emergency VolumeOutcome

Dr Foster Data 2007/2008 Infra-Inguinal Bypass – Elective & Emergency VolumeOutcome

Service Reorganisation

Networks!

Safe & Sustainable Report 2011

South Central Vascular Surgery Reorganisation 2010 Hub and Spoke model agreed to satisfy agreed SS Working group focus on emergencies & major vascular surgery being done at Hub Complex politics between organisations & surgeons – some Spokes continued to do major vascular surgery Lack of planning for provision of service in Spokes once surgeons leave

External Review of Service 2012

Specialised Commissioning 2013

Where are we in 2014?

External Review Aims

TVSCN Vascular Group 1 st Meeting 19 th Sept 2014 Good representation from all Acute Trusts in TV Broad agreement with recommendations of External Review Network of “Nodes” rather than “Hub & Spokes” Clinical Leadership Need to move all major vascular surgery to High Volume Centre Greater participation by all vascular surgeons in emergency rota Ongoing provision of Interventional Radiology at all Nodes Define & deliver high quality minimum level of vascular surgery care in all acute trusts

Any questions please? 26