Monthly Archives: August 2016

Vascular Services

Open letter to HASC

Dear Cllr Roberts,

Further to my email dated 15th June, I wondered what progress had been made for halting the removal of Buckinghamshire’s Vascular Services? At the last HASC meeting, you mentioned that they would be discussed in September however that will be TOO LATE as services are due to leave Buckinghamshire’s hospitals then.

You are being asked to ensure the further removal of Vascular Services is halted. Moreover, the services moved in April 2016 should be restored.
I was told by Dr Gamell that Carotid endarterectomies were highlighted in Better Healthcare in Bucks (BHiB) in 2012 to be reviewed. When will the public consultation be held with regards to these? A full open honest public consultation is needed, with retaining vascular surgery at Wycombe as an option.

The four key tests are:
1)Demonstrate public and patient engagement
2)have the support from GP commissioners
3) be based on clinical evidence
4) and consider patient choice.
Clinical evidence shows that vascular services are performing well in Buckinghamshire, in fact back in 2012 the outcomes were better here than at Oxford. The public haven’t been properly consulted and patient choice is being removed.

HASC is fully expected to refer this to the Secretary of State for Health, as mentioned in the debate (https://www.theyworkforyou.com/debates/?id=2013-01-14d.708.0)

Considering the suspension of a surgeon who designed the changes to the Vascular surgery network by the GMC, shouldn’t the removal of Vascular services from High Wycombe be suspended too? And services removed in April 2016 returned?
Other areas are fighting to retain services in the interest of their hospitals and importantly patients/potential patients, e.g. Royal Brompton, Leeds, Judicial review (https://www.theguardian.com/society/2016/jul/08/nhs-england-plan-shut-child-heart-surgery-units-skills-outcry-royal-brompton-leicester-manchester- As is the case in Wycombe, these hospitals site good clinical outcomes. HASC is fully expected to do the same.

As stated in my previous email, vascular services in Wycombe performed well without need for mass centralisation. Population growth means that in time, a comprehensive 24/7 service should be possible locally. Wycombe Hospital has highly regarded Stroke and Cardiology services. Vascular services are very closely related to these 2 services, with patients often needing input from all 3 specialties. Therefore it makes sense for Wycombe Hospital to continue to expand Vascular Services, not lose them. In Key Performance Indicators published by the SHA in 2012, which compared the merged services in Oxford with Bucks. Bucks Vascular Services easily outperformed Oxford on all these performance indicators. It is currently performing well. This clinical evidence must not be disregarded. . Attempts to centralise vascular services have caused confusion and wasted money across the country, Simon Stevens, CEO of NHS England, stated that centralisation of Vascular Services should be a low priority for the NHS.

I truly hope you will champion Buckinghamshire’s patients on this, in fact we demand that you do. As per my email in June, welcome to your new post.
We look forward to hearing from you soon and learning about the action you are taking to ensure the best Healthcare provision for Buckinghamshire patients.
Kind regards,
Ozma

Miss Ozma Hafiz

SaveWycombeHospital

 

Response

Dear Ms Hafiz

Vascular Services reconfiguration

 Thank you for your email regarding the above.  Just to clarify and summarise the Select Committee’s involvement to date in this decision.

·         The previous Chairman of HASC met with Geoff Payne to better understand the background to the vascular services reconfiguration.  It was then discussed at the HASC Select Committee meeting on 10 May and a briefing note was circulated to Members and also attached to the minutes of the meeting.  The Chairman confirmed her support for the change and sought comments from Members but no further feedback was given.

·         As the new Chairman of HASC, I met with Geoff Payne and asked that the item be brought back to the September HASC meeting with more details around the communications and engagement plan and a detailed patient pathway before and after the change.

The Committee understands that the decision to reconfigure the service is based on clinical evidence provided by the Clinical Senate with patient safety at the heart of the decision.  The HASC will continue to monitor this service and if patient outcomes start to be affected, then we will bring this back to the Committee for further scrutiny to review the service in more detail.

We are not qualified to make Clinical decisions but as a Select Committee we can question the Clinicians to ensure that what they are doing is not detrimental to the well being of our residents.

I am willing to work together with anyone on a mutual basis to the benefit of our residents and to ensure the best possible outcomes for all, I do not respond to those that ‘demand’.

Further to your open letter, please find below the response from Andrea Collins at NHS England which I understand you have already received. I have added this reply so that all the recipients of your open letter have full knowledge of the facts:

“Dear Ms Hafiz

 

Thank you for your questions regarding vascular services in Buckinghamshire.

 

Please find below responses to your questions, the first of which you will have already received from a similar question sent to Dr Geoff Payne.

 

When will the consultation on Vascular Services be held? ‘Carotid endarterectomies were highlighted in Better Healthcare in Bucks (BHiB) in 2012 to be reviewed’. A full open honest public consultation is needed, with retaining vascular surgery at Wycombe as an option.

 

You may be aware that clinical evidence has shown that the current model of vascular care at Buckinghamshire Healthcare NHS Trust (BHT) is not compliant with the nationally defined service specification for vascular surgery (2013) and Provision of Vascular Services (POVS 2012 – 15). 

 

The Vascular Society of Great Britain and Ireland (VSGBI) and the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) state that the best outcomes for patients are achieved in specialist vascular units with dedicated vascular teams available 24 hours a day, 7 days a week.  The strong recommendation is that all specialist vascular procedures that require in‐patient stay should be done at a centre where there is 24/7 consultant cover. This is an issue of patient safety.

 

Consequently, the commissioning of a non-compliant service cannot be supported by NHS England specialised commissioning when capacity exists at a compliant service.  Some of the arterial surgical work from BHT is being performed at Oxford University Hospitals NHS Foundation Trust (OUH FT) already and vascular surgeons from the BHT are participating in the on-call rota at the OUH FT.  The scope for providing options to consult is therefore not available where a decision has to be made on clinical grounds. 

 

Discussions to this effect have been held with the Buckinghamshire Health and Adult Social Care Select Committee (HASC) and Health Overview and Scrutiny Committee (HOSC), clinicians, Steve Baker MP and patient representatives.  Agreement has been reached that, as set out by the Buckinghamshire HOSC recommendations in 2012, where there is clear clinical evidence to centralise services, this will be done.  The consultation in 2012 was significant and combined with clinical evidence and more recent stakeholder and patient discussions, there is no case to re-consult.  This view is held by NHS England specialised commissioning and has been reinforced recently by Steve Baker MP and the and the previous and current Buckinghamshire HASC Chairs, all of whom had separate meetings with Dr Payne to discuss this. 

 

Please note that an associated paper was recently submitted to the Buckinghamshire HASC and is available here under the 10.00am agenda item.

 

On 1 September 2016, the final branch of complex vascular surgery, Carotid Endarterectomy procedures will move to Oxford University Hospitals NHS FT. Pre and post-operative surgery will be carried out in Wycombe, to reduce the need to travel.

 

Arrangements have been put in place to monitor the move to providing complex vascular surgery at Oxford University Hospitals NHS FT with patient experience gathered and regularly analysed.

 

 

Considering the suspension of a surgeon who designed the changes to the Vascular surgery network by the GMC, shouldn’t the removal of Vascular services from High Wycombe be suspended too? And services removed in April 2016 returned?

 

The decision to suspend the surgeon is not relevant to the reconfiguration of a service or consolidation of complex vascular surgery in the Thames Valley (or other area), which is based on the nationally defined service specification for vascular surgery.

 

Please note that a suspension is a neutral act in order to facilitate a thorough investigation.  Any decision to suspend a surgeon is taken by an individual organisation and is a matter for that organisation to investigate with qualified experts where relevant. 

 

NHS England consider there to be a good working relationship between vascular surgeons and interventional radiologists in the Thames Valley Vascular Network.

 

 

If you would like to discuss these responses further, please let me know if you would like to meet with Dr Ahmed and his clinical colleagues.”

 

Best regards

Councillor Brian Roberts

County Councillor for Aylesbury South East Division
Chairman of Health and Adult Social Care Select Committee
Deputy Chairman Development Control Committee
Chairman of Greater Aylesbury Local Area Forum
Member of Environment and Transportation Select Committee

 

 

Reply

Dear Cllr Roberts,
Thank you for including the NHS England response in your email. I did indeed receive both after sending you the open letter and await a meeting date. You will be aware that Geoff Payne has now left. He failed to respond to my email earlier this year asking when the public consultation will be held, it is clear that vascular services are being moved at all costs. I must say I’m somewhat disappointed to learn that the HASC chair mentioned in the response was in fact yourself after all, but thank you for clarifying.
HASC has vascular services on the agenda for 6th September, they are due to leave Wycombe Hospital on the 1st. Surely the first thing that HASC would request in the interest of Buckinghamshire’s patients is that this was delayed, at the very least until the item is fully discussed and investigated. HASC may not have the qualifications to make clinical decisions but you do have referring to the Secretary of State for Health within your remit. Given that in 2012, Oxford’s outcomes were shown to be lagging years behind, commonsense would dictate that the data for vascular services needs to be properly looked at, scrutinised and independently verified.
You mention that HASC would bring the service back for scrutiny if patient outcomes were affected, however this sentence is somewhat worrying, each patient is a real person, with a life, a family/friends/colleagues etc. HASC and others should be fully reassured that this is the best move for Bucks’ patients before the move.
Also can the loss of ?£1m from Bucks’ hospitals once vascular services leave really be justified when the service works well locally? To the public the loss will be greater as they will now have to incorporate costs of travel and potential loss of revenue in transporting their loved ones to Oxford. Not to mention the health impact on patient’s loved ones when they have their own pre-existing conditions. As a member of the Environment and Transportation select committee, I am sure you are aware of the issues surrounding distance to services. The recent fire at Wexham Park again demonstrates an important flaw in the mass centralisation of services.

If this was truly a matter of clinical safety, how would you explain the better clinical outcomes in Wycombe in 2012 (with less staff) and the fact that Vascular services have been allowed to remain in Wycombe all this time?

HASC is fully expected to refer the matter to the Health Secretary, to call for a suspension in the move of vascular services whilst it is properly investigated and submitted to a public consultation, with retaining vascular services at Wycombe as an option.  I don’t believe I made demands in my first email which you didn’t respond to. I can’t apologise if this email is taken as being somewhat demanding, this is for the health of the Buckinghamshire population, including yourself.

Kind regards,
Ozma

……………………………………………………………………………………………………………….

Questions for HASC

Dear Cllr Roberts,

I hope you are well. I fully appreciate that it must be difficult to have come into a new role with such a huge issue to greet you (vascular surgery losses in Buckinghamshire).

I have located the 2012 document in the hope it will help: https://www.buckscc.gov.uk/media/132778/better_healthcare.pdf

There is more in the document but here are a quick couple of points.

I would also like to ask the following questions of HASC and would ask that if HASC via their own scrutiny do not have all the answers immediately to hand, that you request an immediate suspension of the removal of further vascular surgery from Wycombe Hospital so that the issue can be scrutinised fully.

p22 have all the recommendations been met? ‘We therefore recommend that:
16. The following information should be provided urgently to the HOSC
prior to any proposals being fully agreed to by the HOSC in anything
other than in principle :
Benefits Realisation Plan; Implementation Plan, including key milestones;
Full Financial Business Plan;
Transport Impact Assessment;
An integrated plan detailing the future role of community hospitals;
A statement on how and when the outcomes of changes (if implemented) will be monitored. ”I would rather Also has an equality impact assessment been received?  Can all these documents be put into the public domain immediately as of today’s date? If not, why not?

p26 ‘Day surgery, diagnostics, outpatients and surgery to prevent strokes caused by carotid artery disease would remain unchanged.’

Carotid surgery at Wycombe doesn’t appear to have been an issue of clinical safety in 2012, why is it suddenly now? If it was a given that it would have to be moved, shouldn’t this have been made clear in the 2012 consultation document? Will patients get to see the same team at Wycombe pre-op (and post-op) which will perform their surgery in Oxford? If not won’t there be issues to do with consent?

There have been issues in the past with concerns about data entry at Oxford. What has been done to address this? Has the data been independently scrutinised? Has Oxford met all of the recommendations made by the external review in 2014? Why is outcome data for patients at Wycombe being ignored? We had a good service locally.

What impact has the move in April and now on 1st September had on staff morale? Did a Dr not leave Wexham Park when their services were moved to Oxford? Did he not raise concerns about practises in Oxford?

Where is economic analysis to see if centralisation saves money? Isn’t there in fact, evidence it increases costs by making staff travel between multiple sites? Has Wycombe’s arrangement of services at the start of the year been looked at to see if it is more cost-effective than the move of services to Oxford? Does it not make it more difficult for frail, vulnerable elderly patients who would previously been treated at Wycombe?

………………………………………………………………………………………………………………

 

Further to the questions already provided, I would like some clarification. The documents provided by Geoff Payne have a much smaller number of procedures than those conducted on the link: https://www.vsqip.org.uk/ Are we able to explain the discrepancy? What are the patient pathways for those not included?

Also I want to emphasize that since 2012 more procedures have been conducted at both Oxford and Wycombe. Surely we should be able to compare like with like? (comment about different complexities/outcomes)

I would like to refer you to the comment about the suspension definition. Please ask for one here. We need time to scrutinise and get our questions answered. With so many documents outstanding, I would have serious concern if HASC let this go tomorrow.

 

 

 

Documents

2012 BHiB doc: https://www.buckscc.gov.uk/media/132778/better_healthcare.pdf

2016 Vascular services briefing doc: https://democracy.buckscc.gov.uk/ieListDocuments.aspx?CId=137&MId=6919&Ver=4 (under 10.00)

25 Aug 16 Doc FINAL Stakeholder briefing – vascular services

An Open letter to HASC chair Cllr Roberts – re. Vascular Services

Dear Cllr Roberts,

Further to my email dated 15th June, I wondered what progress had been made for halting the removal of Buckinghamshire’s Vascular Services? At the last HASC meeting, you mentioned that they would be discussed in September however that will be TOO LATE as services are due to leave Buckinghamshire’s hospitals then.

You are being asked to ensure the further removal of Vascular Services is halted. Moreover, the services moved in April 2016 should be restored.
I was told by Dr Gamell that Carotid endarterectomies were highlighted in Better Healthcare in Bucks (BHiB) in 2012 to be reviewed. When will the public consultation be held with regards to these? A full open honest public consultation is needed, with retaining vascular surgery at Wycombe as an option.

The four key tests are:
1) Demonstrate public and patient engagement
2) have the support from GP commissioners
3) be based on clinical evidence
4) and consider patient choice.
Clinical evidence shows that vascular services are performing well in Buckinghamshire, in fact back in 2012 the outcomes were better here than at Oxford. The public haven’t been properly consulted and patient choice is being removed.

HASC is fully expected to refer this to the Secretary of State for Health, as mentioned in the debate (https://www.theyworkforyou.com/debates/?id=2013-01-14d.708.0)

Considering the suspension of a surgeon who designed the changes to the Vascular surgery network by the GMC, shouldn’t the removal of Vascular services from High Wycombe be suspended too? And services removed in April 2016 returned?
Other areas are fighting to retain services in the interest of their hospitals and importantly patients/potential patients, e.g. Royal Brompton, Leeds, Judicial review (https://www.theguardian.com/society/2016/jul/08/nhs-england-plan-shut-child-heart-surgery-units-skills-outcry-royal-brompton-leicester-manchester-As is the case in Wycombe, these hospitals site good clinical outcomes. HASC is fully expected to do the same.

As stated in my previous email, vascular services in Wycombe performed well without need for mass centralisation. Population growth means that in time, a comprehensive 24/7 service should be possible locally. Wycombe Hospital has highly regarded Stroke and Cardiology services. Vascular services are very closely related to these 2 services, with patients often needing input from all 3 specialties. Therefore it makes sense for Wycombe Hospital to continue to expand Vascular Services, not lose them. In Key Performance Indicators published by the SHA in 2012, which compared the merged services in Oxford with Bucks. Bucks Vascular Services easily outperformed Oxford on all these performance indicators. It is currently performing well. This clinical evidence must not be disregarded. . Attempts to centralise vascular services have caused confusion and wasted money across the country, Simon Stevens, CEO of NHS England, stated that centralisation of Vascular Services should be a low priority for the NHS.

I truly hope you will champion Buckinghamshire’s patients on this, in fact we demand that you do. As per my email in June, welcome to your new post.
We look forward to hearing from you soon and learning about the action you are taking to ensure the best Healthcare provision for Buckinghamshire patients.
Kind regards,
Ozma

Miss Ozma Hafiz
SaveWycombeHospital