Surgeon’s fears for patient care

Consultant vascular and general surgeon Mark Tomlinson outside the Royal Lancaster Infirmary.
Consultant vascular and general surgeon Mark Tomlinson outside the Royal Lancaster Infirmary.

A top Lancaster surgeon has said patient health could be compromised by plans to move vascular services out of the district.

Consultant vascular surgeon Mark Tomlinson has been backed by more than 100 medical experts following the decision to centralise the service.

Vascular services cater for conditions where there is not enough blood reaching an organ or parts of the body such as the arms, legs or head, caused by a partial or total blockage, or the bursting of a large artery.

It also includes treatment for aneurysm, other types of abnormal blood vessels and supporting other medical treatments such as kidney dialysis or chemotherapy access.

Routine and planned vascular treatment will continue to be provided for patients at the Royal Lancaster Infirmary (RLI), as well as outpatient and day case vascular surgery.

But specialist inpatient care – including interventional surgery such as aneurysm surgery, leg bypass procedures and amputations – will now take place at one of the new vascular intervention centres.

The decision was made by the North of England NHS Specialised Commissioning Board and the newly established NHS National Commissioning Board.

The University Hospitals of Morecambe Bay NHS Foundation Trust (UHMBT) failed in an appeal against the decision not to choose the RLI as a specialist centre.

Mr Tomlinson, who relayed his concerns in a letter to the Joint Overview and Scrutiny Health Committee for Lancashire and Cumbria, said the public needed to know the potential effects of the move. More than 100 clinical colleagues, including consultants, senior medical staff and GPs, have acted as co-signatories to his letter.

“Clinical colleagues are concerned that to remove a well-functioning inpatient service to such remote centres will jeopardise the populations we provide for if they develop such problems and leave some services more exposed and create greater risk,” Mr Tomlinson said.

“This is going to leave a large void and there’s already a well functioning unit here.”

Mr Tomlinson said the move contradicts currently recommended assessment and transfer times for vascular conditions, and will leave patients and other surgeons very exposed with increased risk.

As a result, it is likely that other patients will no longer be offered some procedures or treatments currently available within UHMBT and will also have to travel further. The decision is likely to have a significant effect on the trust’s ability to maintain emergency staffing, he said.

“Whilst clinicians do understand the need for some centralisation of services as newer treatments become available, the lack of provision of some of these services within UHMBT will deplete the staffing, experience and morale of clinicians to such a point that a nadir of insufficient key services will remain, and this will compound already challenging recruitment issues within the area,” he added.

Under the new plans, patients needing emergency treatment will initially be taken to the RLI for assessment. Depending on their scan results and the time scale involved, they would then be transferred to the specialist centre.

“You can give some treatment to patients while you are transferring them but if the distance gets too large they can miss their window of opportunity,” Mr Tomlinson said. “Transfer times are there for a reason.”

There are also fears of job losses for the five consultant vascular surgeons, two middle grade surgeons and two interventional radiologists who work across the trust.

John Abraham, clinical director of surgery and critical care at UHMBT, said: “We appreciate the clinician’s concerns regarding the decision by commissioners to remove an element of specialist vascular work, including emergency interventions, from our trust.

“We were disappointed that our formal appeal against the decision was not upheld, and we understand that the Cumbria Health Overview and Scrutiny Committee has since referred the case to the Health Minister.

“We await the outcome of this referral but would like to reassure the public that whatever happens, we will continue to work with our commissioners in the best interest of our patients.”

Dr Jim Gardner, Lancaster GP and medical director for NHS Lancashire, who has been leading the commissioning of the new Vascular Network, said: “The Vascular Network aims to deliver improved and consistent pathways for patients with vascular disease, and the majority of services, such as screening, outpatient clinics, day case surgery, diagnostic tests and rehabilitation services will be enhanced and continue to be delivered locally.

“Patients will be supported in the community to manage their condition and to prevent the development of more serious disease. These patient-centred services will be delivered across the whole of Cumbria and Lancashire, including rural areas.

“However, if patients have more serious arterial problems, the aim will be to refer them to their GP, local hospital, or to one of the three specialist Arterial Centres.

“The specialist centres will allow Vascular Teams to collaborate across the region to provide patients with the best possible care using the latest surgical advances and technology.”