Vascular reconfiguration

Vascular surgery covers a range of surgical procedures undertaken on veins and the lymphatic system (an important part of the body's immune system) – but the most important part of the vascular surgeon’s work is to reconstruct, unblock, or bypass arteries.

In many cases, when first diagnosed, blocked or narrowed arteries are treated with medication. Surgery only takes place when blood flow is dangerously restricted. As such vascular surgery is predominantly an urgent or emergency response service and must be organised so that patients can get timely access to effective care.

Often, patients receiving vascular surgery are frail, with the surgery urgently needed to repair an aneurysm, improve blood flow to an organ (e.g. the brain) to prevent a stroke, or to a limb to avoid the need to amputate.

Overall, the vascular service comprises the elements shown in the diagram.

The current vascular service in Lancashire and South Cumbria was commissioned in 2013.

The service is based on two vascular centres serving patients from across Lancashire and South Cumbria and some patients from Wrightington Wigan and Leigh NHS Foundation Trust.

Patients in Blackburn with Darwen and East Lancashire:

• Access a service from East Lancashire Hospitals NHS Trust (ELHT), for outpatient, day case, and diagnostic services.
  • The Trust sees 900-day case patients per year from a total population of 550,000 people served.
• If a person needs vascular inpatient services (e.g. serious surgery including amputation) they go to ELHT.
  • A small number may go to Lancashire Teaching Hospital NHS Foundation Trust (LTH).
  • ELHT has approximately 670 patient admissions per year.

Patients in Blackpool, South Cumbria, Wigan and the rest of Lancashire

• Access their local hospital for outpatient, day case, and diagnostic services.
  • These services are supported, in those hospitals, by staff employed by LTH.
  • LTH serves a total population of 1.4 million people.

• If a person needs vascular inpatient services, they go to LTH.
  • LTH has on average 1,200 patient admissions every year.

The new way of working includes:

1. The establishment of a Lancashire, South Cumbria, and Wigan (LSC&W) Vascular Network hosted by LTH, where all staff work together jointly.
2. The commissioning of a single dedicated specialist arterial centre for LSC&W hosted by LTH at Royal Preston Hospital.
3. Network hospital sites at the other partner Trust hospitals.

So, for patients:

• All patients would go to their local hospital for vascular outpatient, day case, and diagnostic services.
  • Patients would be seen by staff who are employed by one Trust – LTH.
  • Information about a patient’s care and treatment would be shared amongst all appropriate vascular staff.
• All patients who need vascular inpatient services (e.g. complex surgery such as amputation) would go to Royal Preston Hospital (LTH).
  • Patients living in areas such as South Cumbria and Wigan already attend Royal Preston Hospital under the current configuration - so they would see no change.
  • Patients living in East Lancashire or Blackburn with Darwen would travel to Royal Preston Hospital rather than to Royal Blackburn Hospital for their specialist surgery.
  • North West Ambulance Service NHS Trust and the Patient Transport Service will continue to support patients, as appropriate.

• Once the operation is over, and the patient is fit to be discharged, they would return to be supported by to their local hospital or community services.
  • Time away from home would be kept to as few days as possible. Rehabilitation and follow-up appointments would take place as near to home as possible - either in the community or at a Trust hospital that is part of the network and would be with staff who are fully connected to the network of consultants.

In March 2018, the national Getting it Right First Time (GiRFT) programme published a ‘National Specialty Report on Vascular Surgery.’ The pivotal recommendation made in the report was to ensure that all vascular units are operating within a network model, as defined by the National Service Specification (NHS England). This has been further reinforced in more recent national guidance (2021) from the Vascular Society for Great Britain & Ireland.

As a result, the main reasons for changing the current vascular services in Lancashire, South Cumbria and Wigan include:

• Population size does not meet minimum clinical requirements: The requirement is for each centre to serve more than 800,000 people; ELHT serves 550,000.

• Demand is increasing: From 2019/20 to 2022/23, LTH saw a 6.8 per cent increase, and ELHT saw an 18.3 per cent increase in patients requiring vascular care.
• The centres are not working within a recommended network configuration: They should have a single ‘hub’ hospital providing arterial surgery and complex endovascular interventions. Patients should travel to the arterial centre only for specific arterial and complex endovascular interventions. The pre- and post-procedure care related to these interventions should be delivered, whenever possible, at the network hospital local to them.
• Issues with repatriation home or to a suitable care setting: Patient discharge from acute settings can be highly complex given the nature of vascular surgery. There are various discharge pathways for both Trusts, which can be complicated, with varying processes and referral routes. Across Lancashire, South Cumbria and Wigan, there are no formal repatriation agreements for vascular patients, further adding to the discharge complexities and negatively impacting length of stay at LTH.

The clinical leads for vascular services have examined 17 other options.

Each option was then scored based on a set of criteria that was developed using patient and clinical feedback:

1. Maintains or improves quality
2. Contributes to the wider Integrated Care System priorities
3. Maintains or improves staff experience
4. Delivers value for money
5. Improves access to care
6. Prevents ill health and promotes a healthy lifestyle
7. Supports or promotes workforce education and/or research

The proposed option scored highest.

For most hospital appointments you will be seen at your nearest hospital. You will be seen by a healthcare professional that works as part of a network team across all hospitals.

If you need to have an operation requiring an in-patient stay you will go to Royal Preston Hospital for surgery and then go back to a hospital nearer to home as soon as you are recovered well enough to be moved.

Find out more about getting to Royal Preston Hospital

Ways to get to Royal Preston Hospital by public transport

​​​​​​​The amount of time you need to be in the arterial centre at Royal Preston Hospital will be as short as possible. You will be able to have people visit but they will have to make arrangements for transport. There are lots of ways to get to Royal Preston Hospital by public transport or private vehicle.

​​​​​​​Yes. All outpatient appointments will be with the same person and in the same place in a local hospital. While you are an inpatient at Royal Preston Hospital following surgery you may see one of the on-call team. If you do see someone else, they will have full access to your patient notes, so you won’t have to explain your circumstances again to them.

​​​​​​​They will be carried out at a local hospital in the same way they are now. If you receive this in a community setting, then this will not change.

​​​​​​​Yes, and only with the appropriate staff supporting your care. The staff will all be together when they discuss your case and treatment so everyone will be up to date on your progress and the next steps for you.

​​​​​​​The benefit of working in a network is that all staff will work together as part of one integrated team. They will all have access to your notes and treatment plan. They will also have regular meetings with professionals from all specialties coming together to discuss your case, so they all know what others are doing and what they need to do too.