Agenda item

The Chairman introduced those in attendance for this item and asked Mr Phil Davey, Clinical Lead and Vascular Consultant, CDDFT to give an update presentation in relation to the NHS England Review of Specialised Vascular Services (for copy see file of minutes).

Mr P Davey noted the background in terms of the NHS England Review and previous attendance at the Committee.  He reminded Members of similar reviews in Manchester and Yorkshire and that the aim was for good staff and facilities to deliver good outcomes, while still helping locally in terms of repatriation after surgery.  Members noted the proposed hub and spoke model as described at a meeting of the Committee on 6 July 2018 with the reduction from 4 to 3 specialised vascular services centres in the North East, those being Middlesbrough, Newcastle and one other.  It was reiterated that the review had not been critical of services, however, the case for Sunderland had been made in terms of capacity and infrastructure, including theatres, imaging and its Integrated Critical Care Unit (ICCU).  Mr P Davey added that in terms of geography and population travel times from secondary care were shown to be less than one hour, and also it had been noted the networks in place at Sunderland were felt to be superior to those at Durham.  He added that the co-location of services at Sunderland, renal and interventional cardiology, also counted in Sunderland’s favour.

Members noted: the data in terms of vascular in-patient activity had been refreshed for 2017/18; the outcomes of the work carried out by NHS England regarding travel times; the outcome of the travel impact assessment and modelling carried out by the North East Ambulance Service (NEAS); and the outcome of the rapid self-assessment undertaken by CDDFT and City Hospitals Sunderland (CHS) on how they would be the third arterial centre.  Mr P Davey referred Members to slides showing the relevant postcodes within the County, travel times and in-patient activity for 2017/18, including heat maps for elective and non-elective admissions. 

Members noted the national standards and service specification “emergency access to vascular interventional radiology must be within 1 hour from initial consultation to intervention”, not 1 hour from a patient’s postcode to a centre.  Members were given further information in terms of Abdominal Aortic Aneurysm (AAA) for 2018 by postcode, in-patient length of stay for 2016/17, and travel time differences between the University Hospital of North Durham (UHND) and Sunderland Royal Hospital (SRH) for key postcodes. 

Mr P Davey referred Members to modelling carried out by NEAS in terms of impact from the proposed reconfiguring of vascular services, noting that there was effectively no impact in terms of category C1 or C2 patients, those most seriously ill. 

The Committee were reminded of the rationale in terms of the interdependencies with renal and interventional cardiology, and their existing co-location at Sunderland.  Members were referred to information in terms of the self-assessment and the differences in terms of costs, including capital, with the total for Sunderland being around £4million, and for Durham being around £35 million.

Members noted in summary: infrastructure was already in place at Sunderland to provide key interdependencies; current networking arrangements in place at Sunderland; the majority of care would continue to be delivered in Durham, out-patient, diagnostics and day cases; the service in Sunderland would be fully compliant including travel times for emergencies; work by NEAS showed minimal impact on emergency travel times; and self-assessments had shown a significant impact on moving services to Durham in terms of finance and impact, for example renal services.

Mr P Davey noted that following the additional analysis since the July meeting of the Committee, the view had been confirmed that: clinical consensus had been reached in terms of a 3 centre model to provide the best possible care/outcomes for patients; the only viable clinical option was for the third centre to be located at Sunderland for the reasons stated, this being supported by commissioners, both Trusts and the Vascular Network; the proposals fit with NHS England’s national service specification; and that travel impact assessment demonstrated some additional travel time for patients and carers, but this was mitigated as lengths of stay were relatively short and patients would be repatriated where clinically appropriate to do so.

The Chairman asked the Medical Director, NHS England, Mr Chris Gray to speak in relation to the report and presentation.  Mr C Gray noted NHS England were reassured in terms of the service change, with the solution proposed meeting the outcomes now and for the future.  He added it was shown that Sunderland had the capacity and services needed and added that importantly there was commitment from both Durham and Sunderland to make the proposals work.

The Chairman thanked the speakers, and also all those involved in the additional work in bringing further information to the Committee.  The Chairman noted that it was the role of Overview and Scrutiny and Elected Members to represent the people of County Durham and to ensure the viability of UHND for the future.  He asked Members of the Committee for their questions and comments on the presentation.

Councillor R Bell noted the strong clinical case for Sunderland to be the third specialist vascular services centre, and noted the small proportion of emergency cases from those key postcodes as set out.  He added that he disputed that the difference between UHND and CHS from those postcodes as being an additional 10 minutes and noted that this was proposed to be mitigated by NEAS by “an adjustment in resources levels”.  He asked what this adjustment would be, for example faster response time from NEAS.  The Director of Commissioning and Development, North Durham CCG, Michael Houghton noted this did not mean an additional resource, rather NEAS would look at how resources were utilised operationally and adjust accordingly. 

Councillor R Bell added that he felt that the Committee should formally ask for follow up information from NEAS, with a mind to a formal agreement in terms of this.

Councillor A Patterson noted she felt the proposals represented a significant change with significant impacts.  She added she would also challenge the accuracy of some of the travel times quoted, feeling it had been a desktop exercise, not taking into account the actual geography, traffic levels or road infrastructure.  She referred to the heat maps relating to elective patients, as set out in the presentation, and noted that many from the west of the County could be considered to be closer in travel time to Newcastle or Middlesbrough and they may elect to go to those hospitals rather than Sunderland or indeed Durham.  Mr P Davey highlighted that the heat maps referred to in-patient activity and added that for around every 4,000 patients only one-sixth required to be in-patient.  He noted that for the 60 patients that had attended Bishop Auckland for example that this would equate to in terms of the proposed model that only 10 patients would need to be admitted to Sunderland, with the remaining 50 patients being treated in the same way they would be now, via services at Bishop Auckland or UHND.  The Regional Director of Specialised Commissioning North, NHS England, Robert Cornall added that the pathway for those needing surgery was proposed to be via Sunderland, and if not requiring surgery they would remain to be treated locally at Durham. 

R Hassoon noted concerns, from experience, in terms of proposed repatriation after surgery and asked as regards assessments carried out before this process.  Mr P Davey noted that such repatriation would only be once a vascular care episode had been completed, patients would not be moved if further care was required.

Councillor H Smith noted the additional information had been useful and agreed that the clinical case for Sunderland had been made overwhelmingly, as had the financial case.  She noted however that from the perspective of the DL12 and DL13 postcodes that the travel times stated were hopelessly optimistic, especially when factoring in car parking issues and the public transport provision in those areas.

Councillor A Hopgood agreed as regards the clinical case, and added that indeed Members had understood this at the July meeting.  She noted that she was not convinced in terms of the travel time issues, with an apparent change in definition of where the emergency was considered from.  Councillor A Hopgood noted recent closures of the A19 over the summer period, at least one time every week, and asked if these incidents had been taken into account.

Councillor S Quinn noted issues previously discussed in terms of ambulance waiting times when dropping off at Accident and Emergency and whether this would also impact.  The Chairman noted this was an issue being looked at by Chief Executive Officer, CDDFT.

Councillor R Crute asked whether there was a particular reason for the recommendation in terms of endorsement from the Committee prior to engagement.  The Chairman noted that the issue was regional and the Regional Director of Specialised Commissioning North added that the programme of engagement would inform on the process to help ameliorate impact.  Councillor A Hopgood noted that informing was not the same as engagement. 

The Regional Director of Specialised Commissioning North noted that through the engagement process if points were raised then where possible some changes could be made.

The Principal Overview and Scrutiny Officer noted that the review was region-wide and that the North East Joint Health Scrutiny Committee had asked that information be provided to Durham County Council’s Adults, Wellbeing and Health Overview and Scrutiny Committee.  He noted the information in terms of the clinical case, the costs, the impact assessment from NEAS and the options in terms of the Committee.  Councillor R Crute noted he felt there was no requirement for Members to endorse the proposals as set out, with the recommendation within the report asking for the Committee to receive the report and note and comment upon the presentation in terms of the proposals and associated communication and engagement plans.  He added that he felt the comments from Members had been made clearly and could be added and taken forward.  Councillor A Hopgood agreed that there was no recommendation to endorse the proposals, noting she accepted the clinical case, accepted the financial case, however did not accept the case in terms of travel times.

Resolved:

(i)        That the Committee receive the report.

(ii)        That the comments made on the report are communicated to NHS England’s North Region Specialised Commissioning Team in respect of the proposals to reconfigure specialised and some non-specialised vascular services in the North East and the associated communications and engagement plans.

Councillor J Robinson left the meeting at 11.00am

Councillor J Chaplow Vice-Chair in the Chair