HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST
VASCULAR STRATEGY UPDATE
Trust Board
date
Director
11th September 2012
Reference
Amanda Pye
Number
Author
Nicky Murphy
(Trust Strategy Lead)
Kerry Higgins
(Divisional Manager)
Karen Jessop
(Divisional Nurse Manager)
(Chief Operating Officer)
Reason for
the report
Type of report
1
The purpose of this paper is to provide the Trust Board with an update
on the vascular strategy and to detail the future steps required to
ensure long-term sustainability.
Concept paper
Strategic
Business
options
case
Information 
Performance
RECOMMENDATIONS
Review

The Trust Board is requested to:
2
 Receive this report and appendices
 Decide if any further information and/or actions are required
 Provide its support for initiating discussions regarding long-term financing
Key purpose
Decision
Information
3
4
5
Approval

Assurance
Discussion


Delegation
STRATEGIC OBJECTIVES
 Safe, high quality effective care
 Strong, high performing FT
 Creating and sustaining purposeful partnerships
 Efficient economic use of resources – targeted and prioritised
 effectively
Delivery against our priorities and objectives
 Capable, effective, valued and committed workforce
 Strong respected impactful leadership
LINKED TO
CQC Regulation(s)
All Essential Standards of Quality and Safety
Assurance Framework
Ref:
No
BOARD/BOARD COMMITTEE REVIEW
Legal advice
No
The draft version of this report was presented to and has been discussed by:
Monthly Vascular Meeting (via minutes): 13th August 2012




HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST
VASCULAR STRATEGY UPDATE
1. PURPOSE OF THE PAPER
The purpose of this paper is to provide the Trust Board with an update on the
vascular strategy and to detail the future steps required to ensure long-term
sustainability.
2. BACKGROUND
Nationally, Specialised Commissioning Groups commission vascular services. In
2008 – 2011, the Yorkshire and Humber Specialised Commissioning Group
conducted a regional review of vascular services, with extensive patient and clinician
consultation. The main proposal from this review was that hospitals work in
partnership to deliver vascular services, with complex and emergency operations
carried out in fewer, specialist centres, with the remainder of care continuing to be
provided locally.
As a result of this review, a partnership alliance to provide a Vascular Network for the
populations of North and East Yorkshire and Humber has been formed from:

York Teaching Hospital NHS Foundation Trust

Hull & East Yorkshire Hospitals

Scarborough Hospital

Harrogate Hospital NHS Foundation Trust

North Lincolnshire and Goole Hospitals NHS Foundation Trust
Outpatient activity and investigations will continue to be provided across all hospital
sites as listed above. However Level 2, 3 and 4 vascular services will be delivered
from the two sites at York Teaching Hospital and Hull Royal Infirmary, operating as a
single centre. Patients can choose which site to attend, or will be sent to the nearest
one in the case of an emergency.
The North East Yorkshire and Humber Clinical Alliance (Vascular) will provide
comprehensive, 24/7 vascular services for a population size of 1.8 million. Although a
large proportion of the vascular activity will be undertaken at the two centres in York
and Hull, the Consultant Vascular Surgeons will also provide outreach services to the
surrounding hospitals in Harrogate, Scarborough, Bridlington, Goole, Grimsby and
Scunthorpe.
Timescales
It is anticipated that the twin-site, single Centre will be accredited by the Specialised
Commissioning Group before December 2012. The operation as a twin-site, single
Centre has already commenced.
3. CURRENT STATUS
Compliance with standards
The Vascular Centre has self-rated as compliant with all 40 designation standards.
The Specialised Commissioning Group have indicated that they are generally positive
towards the Centre, however, clarification is being sought regarding formal
accreditation.
The Specialised Commissioning Group have identified ‘eight products’ which they will
be progressing to further enable delivery of high quality patient care across the
Centre. The Centre is committed to working with the Specialised Commissioning
Group to develop these ‘products’, which are:
1)
Commissioning scope: this will describe what is being commissioned. It is
expected that all vascular services (including surgery and interventional
radiology) with the exception of varicose veins will be included within the scope.
2)
Single Service Specification: this will be included in all contracts. The
specification will describe acceptable service models of which there is likely to
be 2 options:
a. A network with a single centre undertaking all the inpatient surgery and
interventions providing outreach services to neighbouring hospitals in the
network.
b. A network with a single centre undertaking all the major arterial work with
formal arrangements to other hospitals to provide some inpatient
care/surgery and outreach services.
3)
Quality Measures: these will be closely linked to the National Vascular
Database.
4)
QIPP: the focus for phase 1 will be amputation specifically prevention case
selection and rehabilitation.
5)
Innovation Fund: this will be a nationally available fund which providers can bid
against.
6)
CQUIN: to be developed for inclusion in 2014/15 plans
7)
Identification Rules: this relates to data and coding to define what is and what is
not included.
8)
Commissioning Policy: this is a national policy to provide clarity on patient
eligibility and clinical criteria for undertaking some vascular procedures.
Governance Framework
A Vascular Programme Implementation Group has been set up with regular meetings
to facilitate the move to the Vascular Centre in accordance with the above standards.
In addition, a Vascular Clinical Expert Group has also been set up to provide clinical
input into establishing policies and pathways for this single, twin-site centre. It is
intended that in the future, the Vascular Clinical Excellence Group will continue to
review activity and outcomes data in conjunction with national documentation and
audits.
Discussion regarding the management of difficult clinical cases takes place at a
quarterly multidisciplinary team meeting. Following the Specialised Commissioning
Group stocktake, it was considered that quarterly meetings would not be sufficiently
frequent for urgent case discussion. A joint monthly multidisciplinary team meeting
between HEY and York Teaching Hospital Foundation Trust has therefore been
established. This multidisciplinary team will review all highly complex patients and
those presenting with an aneurysm. A process for reviewing urgent cases outside of a
multidisciplinary team meeting has also been developed.
Pathways
A number of care pathways for different vascular conditions have been identified and
these will be applied throughout the Vascular Centre. A protocol has also been
identified for repatriating patients to their local hospital where this would be a more
appropriate place of care following vascular treatment or intervention.
Activity
An analysis of the elective, non-elective and new outpatient activity from 2010 is
shown below, by Primary Care Trust:
Elective activity:
PCT
North Lincolnshire
North Yorkshire and York
East Riding of Yorkshire
Hull Teaching
North East Lincolnshire
Non-elective activity:
2010/11
2011/12
93
156
42
46
608
626
788
706
72
114
2012/13
(to May 2012/13
2012)
(extrapolated)
21
126
5
30
95
570
95
570
19
114
PCT
North Lincolnshire
North Yorkshire and York
East Riding of Yorkshire
Hull Teaching
North East Lincolnshire
2010/11
2011/12
35
60
21
8
92
130
128
161
16
47
2012/13
(to May 2012/13
2012)
(extrapolated)
5
30
0
0
18
108
26
156
17
102
2010/11
2011/12
119
98
32
28
984
983
1,398
1,314
61
51
2012/13
(to May 2012/13
2012 )
(extrapolated)
13
78
3
18
164
984
285
1710
8
48
New outpatient activity:
PCT
North Lincolnshire
North Yorkshire and York
East Riding of Yorkshire
Hull Teaching
North East Lincolnshire
Finance
The long-term financing arrangements for the twin-site, single Centre remain unclear.
There are a number of potential options. HEY’s position is well placed as the regional
centre for specialist services, particularly with its accreditation as a major trauma
centre. Discussions have yet to take place with York regarding this arrangement.
The Board is requested to provide support for the initiation of these discussions with
York Teaching Hospital NHS Trust and the Specialised Commissioning Group.
4. NEXT STEPS

Development of a joint workplan, to be signed off at the next North and East
Yorkshire and Humber Clinical Alliance (Vascular) meeting in September
2012. As part of this, joint leads have been identified for therapies, nursing
and management across the Centre.

Development of an options paper considering joint vascular laboratories and
specialist nurses between HEY and North Lincolnshire and Goole Hospitals
NHS Foundation Trust. Pursuing this option would enable cross-cover
between the sites and a more robust service.

Provide feedback from the Centre to the Specialised Commissioning Group
regarding the minutes ‘confirm and challenge’ session. Some clarification is
required regarding a number of actions, such as the frequency of joint multidisciplinary team meetings.

Regular discussions have been set up through a Clinical Alliance with York
Teaching Hospitals NHS Trust. These meetings will occur on a quarterly basis
and the Vascular Centre will be a standing item on the agenda. It is
anticipated that the ongoing review process for this model will follow a similar
format to the pre-existing cancer peer review process.

The Health Group will ensure that there is a capacity plan in place to manage
the actual workload faced by vascular. At present, workload is close to
contract and referrals have increased in the first quarter of 2012/13.
The Board will receive quarterly updates on this strategy, and will also receive papers
if a decision is required at another date.
5. RECOMMENDATION
The Trust Board is requested to receive this report and decide if any further
information, actions and/or assurance is required. The Board is requested to provide
its support for the initiation of long-term financing discussions with providers and
commissioners and the development of a ‘next steps’ programme to ensure
accreditation.
Appendices
Appendix 1 - Mapping to Designation Standards
Standard
Description
Source
Type Met
1
2
Surgeons seeking
appointment to vascular
specialist posts must be
appointed through a
consultant appointment
committee, including
representation from the
Royal College of Surgeons,
to ensure the individual has
had adequate and
appropriate training in their
field.
VSGBI 2009 (22)
Surgeons should abide by
the professional standards
set down by the Royal
College of Surgeons and
undertake clinical practice
appropriate to their training
and experience.
VSGBI 2009 (22)
Core
√
Amended following
discussion at clinical
event regarding
“recognized training
unit”
Evidence
Documentation
Trust
recruitment
policies
On call rotas
External advice
received
Honorary
contracts
Core
√
Amended to reflect
comments from
clinical event
regarding who can
set standards.
4
Specialists seeking to carry
out interventional vascular
radiology should comply
with the training
requirements set out by the
Royal College of
Radiologists.
Original Service
Specification
Vascular Centres are not
required to be centres for
training but should ensure
they have the appropriate
infrastructure (as defined by
the Royal Colleges) in place
Original Service
Specification
Royal College
of Surgeons
Honorary
Contracts
Core
√
RCS and RCR
professional
standards
Core
√
Hull And East
Yorkshire
Hospitals NHS
Trust and York
hospitals
Foundation
Supported at clinical
event, amended to
reflect comment that
the standard should
apply to all clinicians
Supported at clinical
event, amended to
reflect comments
Section 4
Evidence
Folder
Joint workforce
plan
External advice
received
3
Found in:
Section 4
Evidence
Folder
to support training in
vascular surgery and
vascular radiology.
from clinical event
regarding number of
training centres
required.
trust are both
key members of
the Hull York
Medical School
(HYMS)
Amended following
final consultation to
explicitly include
vascular radiology.
5
6
7
Education, training and staff
development should be an
integral part of service
provision. Centres should
collaborate to ensure
consistency across the
region, whilst tailoring needs
to individuals.
Original Service
Specification
All staff should receive
appropriate training in
patient care and support for
adults with vascular
disease, in accordance with
current professional
guidelines. This should
include the availability of
vascular surgeons and
radiologists to see patients
within outpatients and on
wards.
Original Service
Specification
Vascular Centres should
participate, as required, in
regional and postgraduate
training programmes with
other designated
specialised vascular
providers.
Original Service
Specification
Core
√
Workforce
committee TOR
Appendix 3
Operating
framework
Core
√
Hey/York
recruitment
policies
Section 4
Evidence
Folder
Supported at clinical
event, amended to
reflect comments
from clinical event
that regional
consistency required
Supported at clinical
event, amended
following clinical
event to provide
further rigour/clarity
Professional
guidelines,
royal college of
surgeons and
royal college of
radiologists
Amended on
recommendation of
clinical standards
sub-group, to clarify
‘appropriate’
Supported at clinical
event, amended to
include ‘as required’
to reflect comments
from clinical event
regarding potential
future training need
Core
√
HYMS Student
teaching
Yorkshire Post
graduate
deanery school
of surgery core
and specialist
trainees.
North
Yorkshire, East
Coast
Foundation
training
8
9
10
11
Surgeons and radiologists
involved with vascular
surgery should be core
members of the MDT and
commit a substantial
proportion of their clinical
practice to the care of
vascular patients in order to
maintain their expertise.
VSGBI 2009 (21)
There is a need for renal
services to have timely
access to vascular
specialists, through formal
pathways and protocols.
Vascular services should be
coordinated with renal
access in provision, training
and audit.
VSGBI 2009 (21),
Joint Working Party
2006 (19)
Core
√
Amended to reflect
comments from
clinical event to
focus on specialism
and MDT input
rather than absolute
% of time spent
Core
√
Amended to reflect
comments from
clinical event
regarding need for
services to work
together
Vascular specialists must
monitor their practice to
ensure they stay within the
acceptable limits of
performance stipulated by
the Royal College of
Radiologists, Royal College
of Surgeons and all other
extant professional
guidance.
RCR 2007 (6)
Each Vascular Centre
should have a named Lead
Original Service
Specification
MDT TOR
Chapter 7
Operating
framework
Vascular
surgeon/interve
ntional
radiologist job
plans
Section 4
Evidence
Folder
Trust
Operational
policies
Section 1
Evidence
Folder
Chapter 8
Clinical
pathways
(Vascular
Centre
operating
Framework)
Core
√
Amended to reflect
comments from
clinical event that
this should apply to
all vascular
specialists carrying
out interventional
radiology
Core
√
National
Vascular
database
Section 2
Evidence
folder
Job plans
Section 4
Evidence
Folder
Detailed in
Vascular
12
13
Clinician (surgeon or
radiologist) and Lead
Manager with overall
responsibility for
governance, performance
and development of the
service.
Supported at clinical
event, amended to
reflect comments
from clinical event
Lead Clinician could
be surgeon or
radiologist and
overall responsibility
for governance
Vascular surgeons and
radiology specialists should
operate as a single team. In
the case of acute work, the
surgeon and radiologist
should be on-call from the
same site.
VSGBI 2009 (22)
Care of all but the most
urgent patients should be
managed through regular
multidisciplinary team
meetings, which should
occur at least once a week.
Vascular specialists should
contribute to other related
services including renal,
diabetes and interventional
radiology.
VSGBI 2009 (22)
Centre
operating
framework
Core
√
Job plans, on
call rotas
Section 4
Evidence
Folder
Core
√
MDT policy
Vascular
Centre
Operating
Framework
Chapter 7
Amended to reflect
comments from
clinical event that the
system/infrastructure
for acute work is on
the same site.
Amended to reflect
comments from
clinical event that
urgent patients may
not have MDT
discussion and the
need for the MDT to
work with related
Operational
policy
Services
Amended specific
reference to
contribution to other
MDTs following
feedback on final
standards.
Chapter 4
MDT
coordinator Job
description
Section 1
Evidence
Folder
Section 4
Evidence
Folder
14
MDT Meetings should be
underpinned by established
care pathways for problems
requiring more rapid
consideration, e.g. ruptured
AAA
Original Service
Specification
NonCore
√
MDT Meetings
Supported at clinical
event
No change
Operational
policies
15
Vascular Centres must
enter data onto the following
databases / audits:- The
National Vascular Database
The Carotid Endarterectomy
Audit
The Aortic Aneurysm Repair
Audit Amputation Audit Reta
Registry
The British Society of
Interventional Radiology
BIAS databases.
TEVAR IVC Filter Registry
Vascular
Centre
Operating
Framework
Chapter 7
VSGBI 2009 (28),
NAASP, RCR 2007
(97)
Core
√
Section 1
Evidence
Folder
Data submitted
and reports
generated
Amended to reflect
comments at clinical
event regarding
additional databases
to include and
consensus that a
common dataset
should be developed
Section 2
Evidence
Folder
Amended to reflect
comment at Viva
that Fibroid
Embolism no longer
open
Centres will be expected to
report on a range of
outcome measures,
including those from the
AAA screening programme.
These are under
development.
16
Vascular Centres should
have access to vascular
beds that are specifically for
the use of vascular patients
VSGBI 2009 (24)
No change
Core
√
Trust
operational
policies
Section 1
Evidence
Folder
and staffed by an
appropriate skill mix of
nurses, in accordance with
current professional
guidelines.
No response from
consultation with
Society of Vascular
Nurses
Amended in
accordance with the
recommendation of
the clinical standards
sub-group
18
a
Vascular Centres should
have access to dedicated
radiographers.
New standard
NonCore
√
Section 4
Evidence
Folder
Workforce
information
19
Vascular patients should
have access to specialist
physiotherapy and
occupational therapy; in
particular amputees should
have access to specialist
facilities.
VSGBI 2009 (26)
19
a
Every Vascular Centre must
have a physiotherapist
specialised in the
management of amputee
patients.
New Standard
19
The centre should ensure
New Standard
√
British Association of
Chartered
Physiotherapists in
Amputee
Rehabilitation
(BACPAR) and
Chartered Society of
Physiotherapy
consulted with.
Standards 19a – 19d
developed in place
of Standard 19
Core
Core
Therapies
pathway
Vascular
Centre
Operating
Framework
Appendix 4
Therapies
pathway
Vascular
Centre
Operating
Framework
Appendix 4
√
√
b
that all vascular patients
requiring rehabilitation have
a personalised treatment
plan in place, which is goal
based and focussed on the
needs of the individual.
19
c
The centre should have
written pathways and
protocols in place for the
transition of vascular
patients to rehabilitation
settings, which demonstrate
high-quality transition of
care.
New Standard
19
d
Vascular Centres must
comply with the guidelines
set out by the British
Association of Chartered
Physiotherapists in
Amputee Rehabilitation
(BACPAR) and the British
Society of Rehabilitation
Medicine (BSRM)
New Standard
19
e
Every Vascular Centre must
have facilities including
treatment areas and
equipment to enable early
rehabilitation
New Standard
Core
√
Therapy room
Hey/York
20
Outpatient clinics should
have access to nurses
experienced in ulcer and
wound care and duplex
ultrasound machines, with
appropriately trained
operators, should be
available. There should be
in clinic access to Doppler
machines. Vascular
Centres should offer onestop services wherever
practicable.
VSGBI 2009 (24)
Core
√
Vascular
Centre
operating
framework
ITU and HDU facilities with
VSGBI 2009 (25;26)
21
Non
Core
√
Core
√
Amended to reflect
comments from
clinical event that
one-stop services
should be offered
where possible and
to correct typo re
duplex (previously
written as ‘Doppler
ultrasound’)
Therapies
pathway
Vascular
Centre
Operating
Framework
Appendix 4
Therapies
pathway
Vascular
Centre
Operating
Framework
Appendix 4
Therapies
pathway
Vascular
Centre
Operating
Framework
Appendix 4
Section 1
Evidence
Folder
Trust
Operational
policies
Minor amendment to
wording following
feedback on final
version.
Core
√
Trust
Section 1
22
23
24
full haemofiltration and/or
haemodialysis support must
be available on-site
Amended to reflect
comments from
clinical event that
haemofiltration or
haemodialysis
acceptable
Vascular Centres must
ensure their patients have
access to an appropriate
multidisciplinary limb fitting
service, which meets the
standards set by BACPAR
and BSRM.
VSGBI 2009 (26)
The Vascular Centre should
have shared care protocols
and patient information for
common vascular
procedures and should
ensure all patients are
provided with information
regarding their intervention
at the point at which surgery
is offered to ensure
informed consent.
Original Service
Specification
Vascular Centres must be
able to demonstrate that
systematic, proactive and
effective mechanisms are in
place for the capture of user
feedback and the
Original Service
Specification
Operational
Policies
Evidence
Folder
Vascular
Centre
Operating
Framework
Appendix 6
Core
√
Therapies
pathway
Core
√
Circulation
Foundation
leaflets in use
in the Single
Centre service
Core
√
In-patient
surveys
collected on
both sites
Amended to reflect
comments at clinical
event to change
local for appropriate
and to reflect extant
professional
guidelines
Supported at clinical
event
No change
Amended to reflect
recommendation of
clinical standards
sub-group re
informed consent.
Supported at clinical
event
incorporation of this
Amended to reflect
feedback into service design comments from
and planning.
clinical event that
this needs to be
systematic and
proactive
25
26
27
28
Vascular Centres will
routinely review their cases
(significant event audit /
M&M) to continually improve
clinical practice. This should
be a learning opportunity for
junior staff and should be
joined between surgical,
radiology and other relevant
colleagues (e.g. critical
care).
Original Service
Specification
In addition to regular local
audit, the Vascular Centre
will take part in ad-hoc
audits related to NICE
guidance or appropriate
local topics identified via the
Significant Event Audit,
commissioning lead or other
sources.
Original Service
Specification
Vascular Centres will
provide to commissioners
routine performance
monitoring. In addition,
centres will routinely monitor
their medium and long-term
outcomes from treatment
against agreed outcome
measures, to be developed.
Original Service
Specification
Where a Vascular Centre is
spread across more than
one hospital site, this must
Original service
specification
√
Vascular
operating
centre
framework
√
Participation by
single centre as
required
Core
√
Vascular
Centre
operating
framework
Core
√
Vascular
Centre
operating
Core
Supported at clinical
event
Amended to reflect
comments from
clinical event that
other specialties
need to be involved
Supported at clinical
event
No change
Supported at clinical
event
Amended to reflect
comments from
clinical event that
outcomes need to be
defined
Supported at clinical
Vascular
Centre
Operating
Framework
Chapter 7
29
30
act as a single service, with
written protocols for the
transfer of patients between
sites and centre around a
single multi-professional
MDT.
event
framework
Amended to reflect
comments that
single multiprofessional MDT
essential
Evidence
Folder
The centre should perform a
minimum of 32 aortic
aneurysms per year and
perform a minimum of 35
carotid endarterectomies /
stents per year. Each centre
should carry out a minimum
of 20 elective aneurysm
repairs per year (60 over 3
years).
Holt et al. 2007
(94;4); Holt et al.
2007 (646e654)
Each centre must be able to
offer the full range of
surgical and interventional
radiological vascular
procedures 24/7, including:
Brazier et al. 2000
(4;11)
Non-invasive diagnostic
imaging MR angiography /
CT angiography
Catheter angiography for
occlusive disease, bleeding
and trauma
Open aneurysm repair
Endovascular aneurysm
repair Carotid Surgery
Angioplasty / stenting for
peripheral arterial occlusive
disease
Distal bypass and
amputation surgery,
including vascular
reconstruction
Tibial artery angioplasty in
Core
√
Annual report
Core
√
Vascular
Centre
operating
framework
Amended to
incorporate further
guidance from the
NAASP programme
Amended to reflect
comments that some
procedures should
be supra-regional
and the need to
define pathways for
supra-regional
procedures
Amended following
final consultation to
include CT
angiography
Vascular
Centre
Operating
Framework
Chapter 4
critical limb ischaemia
Vein bypass surgery
Caval filter insertion
Treatment of renal artery
disease. Treatment of
thoracic outlet syndrome
Management of vascular
trauma and bleeding,
including stent grafting and
embolisation
Thrombolysis and
thrombectomy for acute limb
ischaemia Elective and
acute embolisation for
bleeding Venous access
Management of failing /
failed dialysis access,
including insertion of
tunnelled central venous
catheters Management of
lymphodoema and wound
care
A small number of
procedures may need to be
carried out on a supraregional basis and do not
therefore need to be done in
every centre:-
Treatment of thoracoabdominal aneurysm
Treatment of vascular
anomalies Carotid Stenting
Central venous bypass
surgery Management of
massive pulmonary
embolus Treatment of
mesenteric vascular disease
Endovascular management
of variceal bleeding
Where a procedure is
carried out supra-regionally,
each centre must have clear
pathways in place to refer
on these patients and
access to the supra-regional
MDT.
31
32
Vascular Centres must have
access to vascular
laboratory services for the
diagnosis and assessment
of arterial and venous
disease. A vascular
laboratory service should
employ vascular
technologists, accredited by
the Society of Vascular
Technology (SVT) or
appropriately trained
sonographers.
VSGBI 2009 (24)
The emergency vascular
service should serve a
minimum population of
500,000 as a whole.
VSGBI 2007
Core
√
Trust
operational
policies
Section 1
evidence
folder
√
Vascular
Centre
operating
framework
Vascular
Centre
Operating
Framework
Chapter 2
√
Evidence
Folder
Amended following
comments at clinical
event to reflect need
to consider service,
rather than physical
location.
Need for 24/7
service removed
following advice from
national screening
lead.
Not supported at
clinical event
Removed
33
Vascular Centres should be
consultant delivered and
provide safe, sustainable
24/7 consultant surgeon and
interventional radiologist
cover for emergency
vascular surgery and
emergency vascular
interventional radiology
procedures. Rotas should
be safe and sustainable.
VSGBI 2009 (21)
Consensus not
reached at clinical
event regarding 24/7
interventional
radiology
Amended following
Viva event. 1:6 rota
not clinically
supported as a
standard.
NonCore
Section 4
Job plans
Rotas
Consensus reached
at Viva event that
24/7 on-site vascular
interventional
radiology should be
in place, but some
time needed to get in
place, hence
included as noncore.
34
35
Vascular Centres should
have access at all times to a
24-hour NCEPOD theatre
and interventional radiology
room, to undertake
emergency vascular
procedures, with access to
the appropriate equipment
and specialist consumables.
VSGBI 2009 (25)
Vascular Centres should
have written protocols in
place to deal with elective
vascular patients, which
become emergencies.
Original service
specification
Core
√
Available at
York and Hull
Core
√
Vascular
Centre
operating
framework
Core
√
Compliant
Core
√
AAA screening
policy
Amended to reflect
need for
interventional
radiology room,
rather than x-ray carm specifically
Supported at clinical
event
Vascular
Centre
Operating
Framework
Chapter 8
No change
36
37
Vascular Centres providing
post screening AAA repair
must be part of an NAASP
network
NAASP 2009
Vascular Centres providing
post screening AAA repair
must be responsible for
quality control of screeningrelated activity within the
centre and ensure failsafe
procedures are operated in
accordance with the agreed
policy for the local, and
national screening
programme
NAASP 2009
Supported at clinical
event
Supported at clinical
event
Amended wording to
reflect ‘centre’ not
‘unit’
Section 8
Evidence
Folder
38
39
40
Vascular specialists within
designated centres must:
hold an NHS consultant
post; regularly manage
patients with aortic
aneurysm disease, and its
associated conditions;
participate in an on-call
emergency rota (except
where specific
arrangements have been
agreed for clinicians as part
of their retirement planning)
and participate in vascular
audit, clinical governance
and appraisal at Trust level.
NAASP 2009
Vascular teams within
designated centres must:
counsel patients with an
AAA 5.5 cm or larger
according to standard
guidelines and offer a full
range of interventions,
including EVAR, as
appropriate; submit data on
all aortic procedures done
by them or under their care,
and outcomes where they
are known, to the National
Vascular Database within
60 days of the intervention;
and attend regular multidisciplinary team meetings
for treatment planning with
other members of the
service.
NAASP 2009
Endovascular aneurysm
repair should only be
performed in specialist
centres by clinical teams
experienced in the
management of abdominal
aortic aneurysms. The
NICE 2009
Core
√
Workforce
information
Section 4
Evidence
Folder
Core
√
AAA screening
policy
Section 8
Evidence
Folder
Core
√
Vascular
Centre
operating
Framework
Vascular
Centre
Operating
Framework
Chapter 4
Supported at clinical
event
Amended to reflect
need to consider
individuals who may
come off the
emergency rota as
part of retirement
planning
Supported at clinical
event
Amended to reflect
requirement for all
disciplines, not just
surgeons
New Standard
teams should have
appropriate expertise in all
aspects of patient
assessment and the use of
endovascular aortic stent–
grafts including the
necessary interventional
radiology expertise to
manage complications
encountered during these
procedures.