THE resignation of a senior surgeon, along with the findings of an independent review, raised several concerns about a controversial shake-up of vascular surgery in the Thames Valley.
Certain complex vascular procedures, for patients with disorders of the arteries and veins, are set to be moved out of Wycombe and Royal Berkshire hospitals - with the work centralised at the John Radcliffe Hospital in Oxford.
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Phase 1 of the changes, involving the transfer of vascular surgery out of Wexham Park Hospital near Slough, was completed this year.
But documents obtained by the Bucks Free Press under Freedom of Information laws reveal how the surgeon leading this phase resigned to take a position at another hospital trust - after criticising the facilities and working methods in Oxford.
The centralisation, recommended by the South Central Cardiovascular Network, is aimed to increase the level of consultant cover and expertise, thereby improving patient outcomes.
But Peter Rutter, a senior vascular surgeon, raised concerns about "patient safety issues", 'antiquated equipment' and poor lighting in the operating theatres within the vascular department at the John Radcliffe.
He also complained of operations being cancelled due to a lack of ward and critical care beds, ‘impossible’ logistics for transferring patients and a lack of rehabilitation for amputees.
These criticisms triggered a review of Phase 1 before the phases involving the Royal Berkshire [Phase 2] and Wycombe Hospital [Phase 3] are implemented.
The findings of this external review say most of Mr Rutter’s concerns have since been addressed by Oxford University Hospitals NHS Trust [OUH] - which runs the John Radcliffe.
The reviewers do not challenge the decision to centralise arterial surgery in Oxford, saying as a major trauma centre, the presence of vascular surgery on site is "inevitable".
But the report adds: "Vascular surgery at OUH seems to be safe, but has not developed in the way that it has in other hospitals in the United Kingdom. It seems to be positioned about ten to fifteen years behind the best."
The reviewers say OUH practices vascular surgery more like a ‘district general hospital’ than an ‘important teaching hospital’, while several of the surrounding hospitals "probably provide a better endovascular service".
They add: "The impression is given that OUH had not properly thought through the implications of centralisation.
"There was apparently no business case to support the vision, and it is suggested that management had embarked on a shrinkage of vascular surgery, but was forced into an expansion."
Following the transfer of complex vascular surgery from Wexham Park, the reviewers said an ‘us and them situation’ emerged between consultants, with claims that Oxford University Hospitals was "empire building".
The ‘established’ vascular surgeons from Oxford had not agreed to do sessions in the surrounding district hospitals, according to the review, whereas the consultants coming into Oxford for their complex procedures would also have to look after less complex cases in their district hospital.
The review recorded several comments made by staff and found: "Several stakeholders commented that OUH vascular surgery lacks leadership, particularly in the endovascular arena, and that the existing vascular surgeons were individuals rather than team players. The reviewers agree with these views."
One stakeholder also said an "Oxford Senior Surgeon threatened to make Bucks Vascular Surgeons redundant unless they toed the line".
Earlier this year Wycombe MP Steve Baker raised questions about the clinical case for selecting Oxford as the regional centre – following an anonymous ‘tip off’ that Wycombe achieves better patient outcomes.
But after meeting the vascular team at Wycombe Hospital, Mr Baker said the stats were based on numbers sufficiently small that it was "difficult to make an absolute comparison", whereas the evidence from a broader perspective is that "if you centralise you get better outcomes".
OXFORD University Hospitals NHS Trust, which runs the John Radcliffe, said in a statement:
"Centralisation of vascular surgery into larger dedicated centres has been initiated by vascular surgeons of the Vascular Society and supported by Vascular Networks.
"Oxford was chosen as the site to provide vascular surgery after extensive research and consultation by the South Central Cardiovascular Network.
"This decision has been endorsed by the external review and recommends that the centralisation of services at the John Radcliffe Hospital should go ahead as planned.
"Clinical outcomes were considered in the process and Oxford was chosen after extensive consultation and bidding processes with a national panel including commissioners, clinicians and public health professionals.
"The Trust’s outcomes for vascular surgery are excellent and reflect the complex emergency case load. There has been no data presented to suggest that other services have demonstrably superior case mix adjusted outcomes."
The South Central Cardiovascular Network, which made the recommendation to the regional NHS to centralise complex vascular surgery in Oxford, said:
"Outcomes were part of the consideration... Outcomes for all providers, including Oxford University Hospitals NHS Trust, have continued to improve since the original review panel."
Charles Waddicor, the Network’s chairman, added there are plans already in place to refurbish Oxford’s vascular surgery theatre facilities by 2014, including a purpose-designed endovascular theatre by January 2015.
And he said work is already underway to expand the vascular department with a second interventional radiology suite and a hybrid theatre – which the external reviewers said should be in place before the transfer of vascular surgery from Wycombe goes ahead.