Vascular Services

21st May 2020

Today Betsi Cadwaladr University Health Board held a Board meeting virtually. Due to government guidance, it was not possible to hold the meeting in public, as is usual. Unfortunately, due to technical issues it was not possible to livestream this meeting as planned. We apologise to those who were unable to observe the meeting. We recorded the meeting and it will be available to view through our social media channels.

On the agenda was the Health Board’s review of the current provision and delivery of vascular services in North Wales following the implementation of a reconfigured service in April 2019. The new model is an integrated vascular network with Ysbyty Glan Clwyd as the single site for major arterial surgery. Vascular clinics, investigations, diagnostics, vascular access and varicose vein procedures are provided at all three district general hospitals.

The review paper was presented by Executive Medical Director Dr David Fearnley and Deputy Chief Executive and Executive Director of Nursing and Midwifery Gill Harris.

They explained how significant investment in additional staff and resources, including the development of a new £2.3m hybrid theatre at Ysbyty Glan Clwyd, has supported the establishment of a stable, fit-for-purpose, modern vascular service for the North Wales population.

Dr David Fearnley said: “We recognise that the reconfiguration of this service has caused concern amongst some and we have published a review and action plan to be open and transparent about the further improvements required. We are committed to addressing current challenges to ensure that North Wales residents receive an equitable, safe, high quality service.

“Our investment in this evidence-based new model, informed and supported by the Vascular Society for Great Britain and Ireland and the Royal College of Surgeons, has enabled us to recruit eight vascular consultants. This means we now have a sustainable 24/7 on-call rota for patients in need of emergency care, which we did not have before.

“Clinical pathways for a range of conditions have been implemented and improved, but we recognise that there is more to do, particularly for the management of patients with diabetic foot problems.

“Prior to the reconfiguration of the service, waiting times for some procedures including treatment for aneurysms were inconsistent across the Health Board as cases were discussed locally. There is now a North Wales-wide weekly multidisciplinary team meeting for the management of all complex cases, which meets the requirement from the Welsh Abdominal Aortic Aneurysm Screening Programme.”

Gill Harris added: “Establishing and embedding any new services and introducing new ways of working takes time and we are working hard to ensure that further progress is made. We are pleased to see evidence of multidisciplinary team training and the sharing of learning across the service with regular governance meetings being held to ensure that clinical issues and risks are discussed openly. This points to a change in culture within the service that is focused on patient and service needs.

“We value the feedback on the service that the Community Health Council compiled following their engagement events and acknowledge that their report highlights some issues which we take very seriously and are committed to addressing. We will continue to work closely with Community Health Council colleagues.

“We are actively engaging with staff and patients to listen and learn from their experiences and act upon them to make further improvements.”

The Board approved the establishment of a Task and Finish Group, to be chaired by Dr Fearnley, to oversee the implementation of the vascular services review recommendations and to consider the draft action plan to identify further actions and recommended key performance indicators.

The Board also agreed to commission an external, independent multi-disciplinary assessment of the North Wales Vascular Service provided across the Health Board to assess the quality and safety of the service and patient outcomes. The Board would like this work to begin as soon as possible and will explore timescales, which will be dependent on the availability of expert assessors during the COVID-19 pandemic.

The full review and appendices are available here.

24th February 2020

BCUHB Executive Medical Director Dr David Fearnley said:

“Significant investment in additional staff and resources, including the development of a new £2.3m hybrid theatre, means we now have a stable, fit-for-purpose, modern vascular service.

“Under the previous service model, patients who live in rural locations in Anglesey and Gwynedd had to travel to Wrexham for emergency vascular surgery for half of the week.

“It is widely recognised that the previous service model was too stretched and did not meet national guidelines. Without changing the service, we would not have been able to recruit doctors in the future, meaning we would lose the service in North Wales altogether.

“We have recruited seven vascular consultants since moving forward with the change in service, and now have a sustainable on-call rota which can care for patients in need of emergency care."

March 2019

From 10 April 2019, Glan Clwyd Hospital will become the arterial centre for the vascular network and will provide all emergency and elective arterial surgery and complex endovascular interventions. In order to support this the Health Board has appointed clinical staff, opened an additional ring fenced arterial ward and installed a state of the art hybrid operating theatre. 

The 24-hour-a-day, 7-days-a-week consultant vascular emergency rota will run from Glan Clwyd Hospital. It currently runs from Ysbyty Gwynedd and Wrexham Maelor Hospital on an alternating basis. In simple terms, at present for half of the week emergency care is available in Wrexham, and for half of the week it’s based in Bangor. By locating the small number of emergency cases in one site, it means everyone has equal access to the best expertise, regardless of where in North Wales they live.

The acute hospitals; Wrexham Maelor Hospital, Glan Clwyd Hospital and Ysbyty Gwynedd will continue to have a consultant surgeon presence and will provide the following clinical services: vascular clinics, diagnostics, interventions including renal access and varicose vein procedures, review of in-patient vascular referrals, and rehabilitation. Day-case peripheral angioplasty and simple stenting will also continue at all sites. 

Why is this service changing?

  • The service as it stands is too stretched and does not meet national guidelines
  • Evidence from elsewhere in the UK shows that clinical outcomes are improved at sites where there is a higher volume of procedures
  • Without changing the service, we would not be able to recruit doctors in the future, meaning we would lose the service in North Wales altogether
  • Having committed to a new service model, we have recruited six new vascular consultants, as well as many other clinical staff. This means that we will have a sustainable on-call rota for patients in need of emergency care

Are renal services moving?

  • Renal services, including acute dialysis, are not moving from the sites where they are currently delivered – Ysbyty Gwynedd, Ysbyty Alltwen, Glan Clwyd Hospital, and Wrexham Maelor Hospital.
  • In January, the Health Board announced a new multi-million pound investment in renal services across North Wales, which will also include the development of a new satellite unit in Mold.

Media reports have made reference to dangers if patients are not seen in “the golden hour”

  • The concept of the “golden hour” is not generally used in relation to patients in need of vascular emergency care
  • For patients who suffer a major vascular emergency such as rupture of a major aneurysm, without almost immediate specialist intervention the prospects of survival are not good, no matter how speedy the transfer to hospital.
  • If a patient is too unwell to travel, provision would be available for an on-call surgeon to travel to them to provide treatment.
  • All other emergency arterial patients would be stabilised at their nearest district general hospital before being transferred to Glan Clwyd Hospital for treatment.

Who has supported the decision the board made in January 2013?

  • The development follows guidance from, and is supported by:
    • The Royal College of Surgeons
    • Vascular Society of Great Britain and Ireland
    • Welsh Abdominal Aortic Aneurysm Screening Programme
    • North Wales Community Health Council
    • North Wales LMC

Useful resources    

Chronology of public discussion of Vascular Services 

View our Board Papers here