Bundle Health Board 21 May 2020 Public Session 2.30pm Via Webex 1 20.60 Sylwadau Agoriadol y Cadeirydd / Chair's Introductory Remarks - Mr Mark Polin 2 20.61 Ymddiheuriadau am Absenoldeb / Apologies for Absence 3 20.62 Datgan Buddiannau / Declarations of Interest 4 20.63 Gwasanaethau Fasgwlaidd / Vascular Services - Dr David Fearnley Recommendations: The Board is asked to: 1. Approve the establishment of a Task and Finish Group, chaired by the Executive Medical Director, to oversee the implementation of the vascular services review recommendations. 2. Request the Task and Finish Group to consider the draft action plan to identify any further required actions and recommended key performance indicator. 3. Agree progress reporting arrangements are via the Quality, Safety and Experience committee. 4. 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. 20.63 Vascular Review report v0.8 reformatted.docx 20.63 Appendix 1 Healthcare in North Wales is Changing.pdf 20.63 Appendix 2 Vascular Model V5.doc 20.63 Appendix 3 GIRFT Vascular Surgery Report 2018.pdf 20.63 Appendix 4 Analysis of Bed Requirements.docx 20.63 Appendix 6 WAAASP Feedback.pdf 20.63 Appendix 7(i) Simulation and anaesthetic training.doc 20.63 Appendix 7(ii) Simulation and anaesthetic training.docx 20.63 Appendix 7(iii) Simulation and anaesthetic training.docx 20.63 Appendix 8 Vascular Staff Nurse Portfolio of Competency.docx 20.63 Appendix 9 Agenda of vascular nurse training days.docx 20.63 Appendix 10 Vascular admissions.docx 20.63 Appendix 11 Vascular Society – A Best Practice Clinical Care Pathway for Peripheral Arterial Disease.pdf 20.63 Appendix 12 Vascular outliers.docx 20.63 Appendix 13 Theatre cancellations.docx 20.63 Appendix 14 Emergency theatre activity.docx 20.63 Appendix 15 Readmissions within 30 days.docx 20.63 Appendix 16 Major procedures.docx 20.63 Appendix 18 Amputations.docx 20.63 Appendix 19 Outpatient attendances new and review.docx 20.63 Appendix 20 PTL.docx 20.63 Appendix 21 Activity lost due to consultants not participating in the on-call rota April to September 2019.docx 20.63 Appendix 22 RTT and FUWL review and actions.docx 20.63 Appendix 23 Follow up waiting list.docx 20.63 Appendix 24 Concerns.docx 20.63 Appendix 25 Patient feedback.pdf 20.63 Appendix 26 - MDT SOP.docx 20.63 Appendix 27 Rapid improvement event feedback and actions.docx 20.63 Appendix 28 North Wales response from Vascular society May 2020.pdf 20.63 Appendix 29 BCUHB North Wales Joint Vascular Surgery and Vascular Imaging COVID-19 Pathway.pdf 20.63 Appendix 30 BCUHB Vascular Network Action Plan v0.2.docx 20.63 Appendix 31 CHC Report Final Vascular Events Report - Final version 2.1.pdf 5 20.64 Dyddiad y Cyfarfod Nesaf / Date of Next Meeting 18.6.20 @ 10.30am 4 20.63 Gwasanaethau Fasgwlaidd / Vascular Services - Dr David Fearnley 1 20.63 Vascular Review report v0.8 reformatted.docx 1 Cyfarfod a dyddiad: Health Board Meeting and date: 21st May 2020 Cyhoeddus neu Breifat: Public Public or Private: Teitl yr Adroddiad Update on North Wales Vascular Service Report Title: Cyfarwyddwr Cyfrifol: Dr David Fearnley, Executive Medical Director Responsible Director: Awdur yr Adroddiad Dr Kate Clark, Secondary Care Medical Director Report Author: Joanne Garzoni, Vascular Network Manager Craffu blaenorol: Supported by the Executive team and reviewed by the Vascular Prior Scrutiny: Society Atodiadau Appendix 1 Healthcare in North Wales is Changing – Public Consultation Appendices: Appendix 2 Vascular Model Appendix 3 GIRFT Vascular Surgery Report 2018 Appendix 4 Analysis of bed requirements Appendix 5 Pathways http://howis.wales.nhs.uk/sitesplus/861/page/75714 Appendix 6 WAAASP feedback Appendix 7 Simulation and anaesthetic training Appendix 8 Society of Vascular Staff Nurse Portfolio of Competency and competency record for ward 3 Appendix 9 Agenda of vascular nurse training days Appendix 10 Vascular admissions Appendix 11 Vascular Society – A Best Practice Clinical Care Pathway for Peripheral Arterial Disease Appendix 12 Vascular outliers Appendix 13 Theatre cancellations Appendix 14 Emergency theatre activity Appendix 15 Readmissions within 30 days Appendix 16 Major procedures Appendix 17 Carotid Endarterectomy pathway http://howis.wales.nhs.uk/sitesplus/861/page/75714 Appendix 18 Amputations Appendix 19 Outpatient attendances – new and review Appendix 20 PTL Appendix 21 Activity lost due to consultants not participating in the on-call rota April to September 2019 Appendix 22 RTT and FUWL review and actions Appendix 23 Follow up waiting list Appendix 24 Concerns Appendix 25 Patient feedback Appendix 26 MDT SOP Appendix 27 Rapid improvement event feedback and actions Appendix 28 North Wales response from Vascular society May 2020 Appendix 29 BCUHB North Wales Joint Vascular Surgery and Vascular Imaging COVID-19 Pathway Appendix 30 BCU Vascular Service Improvement Plan Appendix 31 North Wales CHC Vascular Services Final Report March 2020 2 Argymhelliad / Recommendation: The Board is asked to: 1. Approve the establishment of a Task and Finish Group, chaired by the Executive Medical Director, to oversee the implementation of the vascular services review recommendations. 2. Request the Task and Finish Group to consider the draft action plan to identify any further required actions and recommended key performance indicator. 3. Agree progress reporting arrangements are via the Quality, Safety and Experience committee. 4. 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. Please tick one as appropriate (note the Chair of the meeting will review and may determine the document should be viewed under a different category) Ar gyfer Ar gyfer Ar gyfer Er penderfyniad √ Trafodaeth sicrwydd gwybodaeth /cymeradwyaeth For For For For Decision/ Discussion Assurance Information Approval Sefyllfa / Situation: Following the centralisation of the service in April 2019, the Board received an update in July 2019. It commented on the lack of outcome data available due to the early stages of the service implementation. It was therefore agreed that a report be prepared for the Board around 12 months from implementation. At its meeting in November 2019 the Board received an update on the planned service review of the centralised vascular services. The service review was expected to be completed by March 2020 following additional executive and clinical team discussion, analysis of new national data and external specialist clinical advice to help prepare actions arising from the review. The principle objective of the review was to assess the impact of the vascular services provided across the North Wales Vascular Network and incorporated the following: a) A review of the current provision and delivery of vascular surgery services in North Wales following the implementation of a centralised service in April 2019. b) The safety and accessibility of vascular services for all patients in the North Wales Vascular Network. c) The risk management and clinical governance arrangements of the North Wales Vascular Network. d) To identify lessons that can be learnt from these events: both examples of good practice and areas where improvement is required e) Clear recommendations for the consideration of the Health Board as to possible courses of action which may be taken to address any specific areas of concern which have been identified. 3 Cefndir / Background: The formation of the new North Wales Vascular Network is designed to make the service safe and sustainable, reducing the risk of the loss of local vascular services from North Wales. The detail of the review and its findings is set out in the following pages. The review identifies six areas for further work as follows:- Alignment of vascular inpatient bed base Pathways of care Engagement and Communication Quality and Safety Access to the Service External Review The specific actions for each area are detailed in the Action Plan which is attached as Appendix 30 Additional Note: The original timeline for conclusion of this review was March 2020. The March deadline was extended to align with the anticipated Community Health Council’s own report which is now attached at Appendix 31 and then the unprecedented pressures of the COVID-19 pandemic. During this pandemic the vascular service has reviewed activity in line with national guidance to ensure that it continues to deliver life and limb threatening interventions. A chronology of events has been compiled to support the content of the report. (Reference 1). Feedback on the review has been received from the Vascular Society of Great Britain and Ireland and is attached (Reference 2). Asesiad / Assessment & Analysis Strategy Implications This review examines the centralisation of vascular service at Ysbyty Glan Clwyd (YGC) to deliver a clinically approved safe service for complex and major arterial work at the hub supported by appropriate localised services at Bangor and Wrexham. Financial Implications The scope of this review did not include financial implications. Risk Analysis Risk assessments have been undertaken as part of the governance framework of the vascular network and are recorded within the report. 4 Legal and Compliance The report reviewed compliance with national benchmark standards and has also been shared