Health for north east London – complex vascular surgery
A major public consultation was held between November 2009 and March 2010 to hear
people’s views on ideas for improving hospital services. To read more about the analysis and
results of the consultation please click here.
Clinicians are now reviewing and considering the feedback from consultation and are working
closely with other GPs, local authorities, doctors, midwives and other health professionals to
further develop our proposals.
Recommendations on complex vascular surgery
As part of the consultation, Health for north east London proposed performing complex vascular
surgery at The Royal London and Queen’s Hospital which will lead to better, safer care. Most
respondents agreed with the proposal; 61% of individuals and organisations who responded to
the consultation questionnaire supported consolidated complex vascular surgery.
Following further local discussion, clinicians in north east London believe that the proposal for
vascular surgery will result in the best outcomes for patients – saving lives and reducing
disability. Following further engagement with local GPs and local authorities, a joint committee
of primary care trusts in outer north east London is expected to consider the recommendations
on complex vascular surgery, and all the feedback received during the consultation, at a
meeting held in public in October 2010. This meeting would only consider changes to complex
Frequently asked questions
Q. What are the changes proposed to vascular surgery?
A: Currently four centres in north east London provide complex vascular surgery – The Royal
London, Queen’s, King George and Whipps Cross. However, only The Royal London performs
the recommended volume of surgery to achieve the best patient outcomes. Currently there are
around 400 complex vascular operations a year across north east London so our clinical
advisors proposed concentrating services onto two sites – The Royal London and Queen’s
During consultation we recommended that Barking, Havering and Redbridge University
Hospitals Trust (BHRUT) centralise the service from King George to the vascular centre on the
Queen’s Hospital site; and that the service at Whipps Cross transfer to The Royal London.
Q: What would this mean for patients in north east London?
A: There is strong evidence to show that vascular patients have better survival rates, recover
quicker, and have reduced disability when they have surgery at specialist hospitals by surgeons
who perform higher volumes of vascular surgery.
Currently patients in inner north east London (Tower Hamlets, the City and Hackney, and
Newham) already receive complex vascular surgery at The Royal London so there would be no
change to these services.
Under the proposals, patients in outer north east London would receive complex vascular
surgery at The Royal London or Queen’s Hospital, these services would no longer be provided
at Whipps Cross or King George Hospitals.
Q. Would this mean patients have to travel further?
A: Clinicians believe that providing specialist vascular care in fewer centres will be better for
patients, even if this means travelling further.
During the consultation we spoke with vascular surgery patients who agreed with the benefits of
centralising care and travelling further to receive the highest quality care available.
Q: When and how will decisions be made?
A: A joint committee of primary care trusts (JCPCT) in outer north east London is expected to
consider the proposals for concentrating vascular surgery in October 2010. The committee will
consider all the feedback received during consultation, as well as the views of the inner north
east London JCPCT.
Clinicians are still reviewing and considering consultation feedback on the other proposals and
no decisions will be made on other proposed changes to hospital services until this work is
Q: Why are you making decisions about vascular services ahead of the other
A: There is a strong and pressing case for change and clinicians believe that introducing more
specialist vascular surgery would lead to better, safer care for people in north east London. The
proposal has strong support from clinicians in north east London and more than 60% of people
who responded to the consultation agreed with the proposed change to complex vascular
Following further engagement with local GPs and local authorities, we believe that a joint
committee of primary care trusts will be in a position to make decisions on complex vascular
surgery in October 2010.
For all other proposals, clinicians are undertaking more work to consider all the feedback
received during the consultation and to further develop the proposals for improving health
services for people in north east London.
Q: Should any changes to vascular surgery be agreed and implemented, would this
impact on other proposed changes to hospital services in north east London?
A: No, any decisions to perform complex vascular surgery at The Royal London and Queen’s
would not pre-empt or depend on other proposed changes to hospital services.
Over the coming months doctors, nurses, GPs, healthcare professionals, patient and public
representatives and other partners will be discussing the responses to the consultation and
further developing proposals that will improve the health of the local population.
Q: Do GPs and clinicians support the proposals?
A: The Health for north east London proposals were developed by local clinicians with the input
of nearly 200 doctors, nurses and other health professionals. There is a strong clinical
consensus in favour of the proposed changes to services.
Patient outcomes following complex vascular surgery are poorer in the UK in comparison to
other western European countries. Evidence shows patients recover better and more quickly
when they are treated by a surgeon, and in a centre, that performs high numbers of that
procedure. Clinicians in north east London want to save lives, reduce disability and significantly
improve the health of thousands of people. Primary care trusts (PCTs) will be seeking formal
support from GP commissioners for the proposed changes to services.
Q: What did the public say about the proposals during consultation?
A: Many individuals and organisations responding to the consultation supported the change.
61% of individuals and organisations who responded to the consultation questionnaire agreed
with this proposal. In all boroughs the balance of opinion was in favour of the change (i.e. the
number saying that they agreed or strongly agreed with the proposals exceeded the number of
people saying they disagreed or strongly disagreed).
Overall for the other proposals;
There was more support than disagreement for;
• providing surgery for children under two only at The Royal London
(and not at Whipps Cross, Newham or King George Hospital);
• providing urgent surgery and complex surgery for children under
15 at The Royal London and Queen’s Hospital (and not at Whipps
Cross, Newham or King George Hospital);
• providing care for children with more complex needs at The Royal
London and Queen’s (not at Homerton, Whipps Cross, Newham
or King George Hospital);
• moving uncomplicated planned surgery from Queen’s Hospital to
King George Hospital; and
• The Royal London and Queen’s becoming the two major acute
hospitals in north east London.
However there was more disagreement than support from respondents about;
• changing the number of A&Es and maternity delivery departments
in the area from six to five; and
• moving A&E and maternity delivery services from King George
Around a third of respondents did not support the above proposals.
However, a majority of organisations representing views from numerous
groups of people supported these two proposals.
Q: How are you addressing issues raised during consultation?
A: Over the coming months doctors, nurses, healthcare professionals, patients, the public and
other partners will be discussing the responses to the consultation and the issues raised. Many
of the responses suggested helpful suggestions about how improvements could be made to the
proposals and these are being considered by expert groups.
Health for north east London will consider the recommendations made in the impact
assessment report to ensure we grasp the opportunities to improve the health of local people
and access to services, and address any concerns. You can read a full list of the issues raised
during consultation here.
Q: Will Queen’s and The Royal London be able to cope with the increased workload?
A: Currently only a small amount of complex vascular surgery is performed at King George and
Whipps Cross hospitals. Evidence shows that better quality care for patients can be achieved
by concentrating services at fewer hospitals so that teams and surgeons can see and treat
more patients. Hospital trusts are confident they can provide specialist care for the population of
north east London and are developing detailed plans for how the additional workload would be
managed and, if the proposals are agreed, steps for implementing any new services.
Q: Where can I read about all the other proposals?
A: You can see a list of the proposals here. Or you can read the full consultation document here
Q: Can I still get involved?
A: We are continuing to work with clinicians, local authorities, Local Involvement Networks
(LINks) and People’s Platforms. If you would like to attend a clinical or stakeholder meeting in
September please contact email@example.com to register your interest.