The NCL CardioVascular & Stroke Network has now taken on a vascular workstream
The document Cardiovascular Project: The case for change; an analysis of London’s provision of Cardiac Surgery, NSTEACs and Vascular services, was published in August 2010, based on the London review. This detailed the conclusions arrived at by a working party led by Prof Matt Thompson, Vascular Surgeon at St Georges Healthcare Trust.
According to the working party, UK patients have significantly worse mortality outcomes after an abdominal aortic aneurysm repair compared with other European countries, are less likely to be treated using new technologies and have among the longest lengths of stay in hospital in western Europe.
In London, the standard of care for patients with acute cardiovascular disease varies across the capital. Some patients are being treated in hospitals that do not regularly perform complex surgical procedures, despite clinical evidence showing this does not give the best outcomes. The Vascular Society also recently published recommendations around emergency vascular provision. They stated that the best outcomes are achieved in specialist vascular units with dedicated vascular teams available 24 hours a day, seven days a week. The documents also emphasised that it is in the best interests of patients that hospitals should come together to provide high volume units and that the NHS in London needs to guarantee patients equal access to the treatment in order that they get the highest possible standard of care for their condition.
Consequently, the North Central London Network has been tasked to help to facilitate this process to improve treatment, care and outcomes for the local population who suffer vascular disease. According to data collected by NCL in 2010, (see Appendix 3) the sector is already achieving good standards of care e.g. Crude in-hospital mortality rate of 2.7% (Target = 4%). However, in order to further improve all measures, a strategic approach is now needed to further prioritise and implement measures to continue to improve the service.
NCL is therefore planning to consolidate the majority of complex vascular surgery onto one site within the NCL area. Public responses to the Case for Change Cardiovascular project engagement consultation indicates broadly based public support for such an initiative. The measurable improvements achieved by the proposed reorganisation are summarised as follows:
- All emergency and elective vascular surgery will be undertaken by a consultant vascular specialist or by staff under their supervision. All vascular surgeons will undertake sufficient operations per annum to maintain competence.
- A vascular specialist and support staff with competences in interventional radiology will be available for all elective and emergency vascular radiology procedures.
- There will be a reduced aortic aneurysm repair length of stay, due to increased uptake of endovascular aneurysm repairs.
- There will be a reduced mortality rates for Vascular Surgery
- There will be an increased commitment to research
- There will be an improved patient experience