Written Statement: Update on vascular services

I am issuing this statement to ensure Members are aware of some changes which are necessary to ensure a sustainable and safe service provision in particular in relation to vascular services in North Wales.

Betsi Cadwaladr University Health Board implemented a hub and spoke model for delivery of vascular services in north Wales in April 2019; recommended and endorsed by external experts. This model included the provision of very specialised care for some patients in English trusts. A Service Review by the Royal College of Surgeons (RCS) was commissioned in 2020 to review the quality of the new networked service, the first report from this review being received by the Health Board in March 2021 and the second report being received in February 2022.

In February, I issued a written statement concerning the second report. The RCS reviewed 44 sets of notes and raised concerns about the care received by a number of the patients. I have subsequently kept Members updated on developments.

In response to the second report, the Health Board convened a Vascular Quality Panel (VQP) with an external chair and an external medical lead to review those notes and to make recommendations to the Board regarding the care of individual patients and any service improvements that could be made. That panel first met in April 2022 and provides regular escalation reports which inform the Vascular Improvement Plan.

There have also been two Never Events in the service and other concerns relating to safety and sustainability which have resulted in Healthcare Inspectorate Wales (HIW) designating the service a Service Requiring Significant Improvement in March 2022. Never Events are defined as serious incidents that are wholly preventable because guidance or safety recommendations are available at a national level and should have been implemented by all healthcare providers.

In response to these safety concerns a series of additional measures were introduced on 7 March 2022 to ensure safe delivery of care to patients. These measures were reviewed regularly, and two requirements (including dual consultant operating) were removed on 23 May 2022 following a review that showed they were not adding any safety benefits.

An extraordinary tripartite meeting was held on 26 May as part of the NHS Wales escalation framework and the NHS Wales Chief Executive has recommended that the targeted intervention status at Betsi Cadwaladr University Health Board should be extended beyond mental health and governance issues to incorporate Ysbyty Glan Clwyd, focusing in particular on the vascular service and emergency department in Ysbyty Glan Clwyd, I accepted this recommendation and announced it in the Senedd on 7 June.

The decision was made in line with the escalation framework and reflected serious concerns about the leadership, governance and progress at Ysbyty Glan Clwyd. 

During July, a number of patient safety quality concerns have been raised by the Vascular Quality Panel in relation to the management of aortic patients. These were escalated to the Board and a number of additional safety measures have been reinstated for aortic patients from 8 July.

In addition, there are immediate operational pressures due to consultant availability and nurse staffing in vascular services within the Health Board. The fragility of the service led to the Health Board to consider contingency plans should the service not be able to be delivered as currently configured with the primary concern being the ability to provide a safe service for the population of North Wales. As a result, meetings have taken place with the Health Board, Welsh Government officials and the national leadership team in NHS England to develop options for alternative service provision with English provider trusts.

BCUHB has established an operational planning group, which meets three times a day to ensure oversight of these arrangements and to ensure that any patients that may need care delivered in a different way are managed safely and in a timely fashion. As a result of the immediate service challenges and following wider discussion with English providers, an agreement has been reached that, during August, some patients may be transferred to Royal Liverpool University Hospital or, as already happens for North Wales residents with major trauma injuries, Royal Stoke University Hospital.

I am also pleased to inform Members that I have now received and accepted advice on the establishment of an All-Wales vascular network. The Welsh Government is providing funding to establish interim network arrangements for vascular including the appointment of an interim national clinical lead. During this period work can be undertaken to clarify the scope and role of a network for vascular services, as well as begin to introduce some quality improvement processes such as a peer review programme.

This network will work alongside health boards and support the newly established South East Wales Operational Delivery Network for Vascular services. I am sure Members will be reassured to hear that the first week of the new networked arrangements in South East Wales went well with no major issues identified. There are comprehensive review arrangements in place to ensure that any teething problems are addressed on a timely basis and a series of formal review forums over the coming months to track realisation of the envisaged benefits to patients and staffing.

This statement is being issued during recess to keep Members informed. Should Members wish me to make a further statement or to answer questions on this when the Senedd returns I would be happy to do so.