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					                             VASCULAR SERVICES REVIEW
          RECOMMENDATIONS OF THE TASK AND FINISH GROUP
                                        OCTOBER 2010


SUMMARY OF RECOMMENDATIONS
Recommendation A
Yorkshire and the Humber (and Bassetlaw) should adopt a partnership approach to the
provision of vascular services.

Recommendation B
All partnerships should include the following key functions:-
      A strong co-ordinating clinical leadership role to liaise with commissioners, consult
         with colleagues and protect the integrity of the partnership
      A commitment to mutual support, with reciprocal honorary contracts in place
      A joint approach to consultant workforce planning including joint consultant
         appointments and, where appropriate, training and development of all staff working
         within the service
      Standardisation of clinical practice across the partnership
      Shared clinical audit and regular routine review of outcomes

Recommendation C
The region should consult on a single vascular service in North & East Yorkshire and
Humberside, with two collaborating centres in Hull and York, with some elective non arterial
surgery being carried out at Harrogate, Scarborough, Scunthorpe and Grimsby, along with
local outpatient clinics.

Recommendation D
The AAA screening population for the ‘East’ screening programme should be revised to
include the catchment of Harrogate and York Trusts.

Recommendation E
North & Eastern Yorkshire and Humberside Commissioners and Providers, including YAS
and EMAS establish a working group, reporting to NEYHCOM, to produce an implementation
plan for safe transition to the proposed service model, with a view to full implementation by
April 2012.

Recommendation F
The region should consult on a single vascular service in West Yorkshire Central, with all
vascular emergencies and major elective vascular arterial surgery carried out on the LGI site,
with outpatients, daycases, intermediate cases (including renal access) and ward attenders
continuing to take place at Mid Yorkshire hospitals, through a unified partnership of the
existing clinical teams.

Recommendation G
The AAA screening population for the ‘Central’ screening programme should be reviewed by
local commissioners to ensure best fit with current referral pathways.




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Recommendation H
West Yorkshire Central Commissioners and Providers, including YAS, should establish a
working group, reporting to WYCOM, to produce an implementation plan for safe transition to
the proposed service model, with a view to full implementation by April 2012.

Recommendation I
The region should consult on a single vascular service in West Yorkshire West, with two
collaborating centres for Level 2, 3 and 4 activity in Bradford and Calderdale and
Huddersfield, with outpatient and daycase activity continuing to be provided in Airedale. Out
of hours care will alternate on a weekly basis between Bradford Royal Infirmary and
Huddersfield Royal Infirmary.

Recommendation J
The AAA screening population for the ‘West’ screening programme should be reviewed by
local commissioners to ensure best fit with current referral pathways.

Recommendation K
The Vascular Oversight Committee of the provider Trusts within West Yorkshire Central
should establish a working group, reporting to WYCOM, to agree the framework for a formal
review of the service at twelve months.

Recommendation L
The region should consult on a single vascular service in South Yorkshire, with two
collaborating centres in Doncaster and Sheffield delivering elective and emergency level 2
and 3 activities across both sites, with some non arterial surgery and outpatient clinics
continuing to be carried out in Barnsley, Rotherham and Bassetlaw. Complex Level 4 cases
would continue to be undertaken at Sheffield Teaching Hospitals.

Recommendation M
The South Yorkshire and Bassetlaw service establishes it’s Vascular Partnership Board and
works with commissioners and YAS, reporting to NORCOM, to agree the work priorities for
the coming year in order to ensure the functions set out in Recommendation B are delivered.
South Yorkshire and Bassetlaw commissioners align their commissioning and contracting
intentions to support this partnership.

Recommendation N
A full regional public consultation should take place on the recommendations set out above,
supported by regional consultation materials developed by the Specialised Commissioning
Group. This should be supplemented by local PCT consultation on specific local impacts and
BME groups should be specifically targeted.

Recommendation O
It is recommended that interim designation of vascular service partnerships takes place in
June 2011, with full designation in June 2012. As part of interim designation, each
partnership will need to produce an action plan to deliver against all of the designation
standards by June 2012.

Recommendation P
Data collection and performance targets should be incorporated into contracts for all vascular
surgery providers, to provide supportive evidence to the designation process. CQUINs may
be an appropriate mechanism for this. This should include all data submitted to the following
national databases:-
     The National Vascular Database
     The Carotid Endarterectomy Audit
     The Aortic Aneurysm Repair Audit
     Amputation Audit
     Reta Registry
     The British Society of Interventional Radiology BIAS databases.
     TEVAR
     IVC Filter Registry
                           1




1
    Yorkshire and the Humber Vascular Designation Standard 17

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1.      Introduction

The Vascular Services Review has considered a number of options for providing
resilient vascular services across the region, which meet the high standards we have
set for ourselves. There is no ‘one size fits all’ or obviously superlative solution that
delivers this. Vascular services also have links with a range of other services and this
needed to be carefully considered.

A detailed Impact Assessment setting out a range of options was shared with all
stakeholders in January 2010 and responses received back. Significant work was
then undertaken at a sub-regional level to seek to reach consensus on the best fit
locally. This has included: workshops; discussions at sub-regional commissioning
collaborative meetings; provider to provider discussions; GP events; OSC briefings;
patient and public surveys and focus groups; and presentations and briefings at
network meetings. From this, a preferred option for each sub-region has been
identified.

There is significant supporting evidence and analysis that sits behind these
recommendations. A full list of the documentation considered by the Task and Finish
Group is set out at Appendix One and is available on request.

These recommendations should be read in conjunction with Version 13.0 of the
Impact Assessment of Options to Deliver the Vascular Designation Standards,
September 2010 (enclosed), which sets out in detail the proposed service models
and assessment of their impact.

The Task and Finish Group met in June, July and September to consider the
proposed service models, including the key risks and impacts. They provided
feedback to PCTs and providers on the emerging models. Membership and
attendance was as follows:-

Member                                                                    June   July   Sept
                                                                                        emb
                                                                                        er
Chris Welsh, SHA Medical Director                                         D      A      N
Ian Holmes, SHA Associate Director, Economics and Systems                 A      A      A
Management
Kevin Smith, SCG Regional Medical Advisor                                 N      A      A
Jonothan Earnshaw, AAA Screening Director*                                N/A    N/A    N/A
Mike Pinkerton, Chief of Business Development, Rotherham FT               A      N      A
Garry Dyke, Deputy Dean, Yorkshire and the Humber Deanery                 A      A      A
Charles Collinson, GP Representative, NHS Rotherham                       N      N      A
Pia Clinton-Tarestad                                                      A      A      A
*Member for provision of external clinical advice as and when requested

A: Attended
D: Deputy
N: Not attended
N/A: Not Applicable




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2.        Recommendations – Service Models

2.1       Overarching Principles

The concept of partnership working emerged as an overarching theme from the sub-
regional discussions, driven by the acknowledgement that significant changes to
clinical practice and workforce within vascular services are anticipated over the next
5-10 years and a partnership over a larger population may be better placed to
respond to these changes. Commissioners in particular, but also several providers,
GPs and local authorities were keen for providers to explore opportunities for working
collaboratively as equal partners. As a result of these discussions, all of the
preferred service models involve partnership across two or more existing providers of
vascular services.

The view that partnerships over a larger population may be better placed to respond
to future changes is supported by the Task and Finish Group.

NORCOM commissioners, during their sub-regional discussions, identified a series of
principles for partnership working that would reinforce this resilience:-

         A single lead clinician
         A single clinical team working across the partnership
         A single workforce plan and training arrangements
         A single set of agreed protocols and pathways for patient treatment
         A single mechanism for reviewing outcomes and clinical decision making

These were supported in principle by the Task and Finish Group and consistent with
the approach already adopted in the emerging partnership between Calderdale &
Huddersfield and Bradford Teaching Hospitals. The function behind these principles
has required clarification, but is broadly supported by the emerging partnerships.
The following overarching principles are therefore recommended:-


Recommendation A

Yorkshire and the Humber (and Bassetlaw) should adopt a partnership approach to
the provision of vascular services.

Recommendation B

All partnerships should include the following key functions:-
     A strong co-ordinating clinical leadership role to liaise with commissioners,
        consult with colleagues and protect the integrity of the partnership
     A commitment to mutual support, with reciprocal honorary contracts in place
     A joint approach to consultant workforce planning including joint consultant
        appointments and, where appropriate, training and development of all staff
        working within the service
     Standardisation of clinical practice across the partnership
     Shared clinical audit and regular routine review of outcomes




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2.2       North & East Yorkshire and Humberside (p29-33)

The proposed model for North & East Yorkshire and Humberside is a single service
with two collaborating centres in Hull and York, with some elective non arterial
surgery being carried out at Harrogate, Scarborough, Scunthorpe and Grimsby,
along with local outpatient clinics.

This model complies with all the vascular designation standards. The Task and
Finish Group support the view that this is the safest and most sustainable model that
will maintain some local access in Scarborough, Scunthorpe and Grimsby and a
significant vascular presence in York. The Task and Finish group support this as the
preferred model.

This represents a significant change to services in Scarborough, Scunthorpe and
Grimsby, where non-elective and complex arterial surgery is currently carried out. It
also represents an expansion of clinical services in York to offer 24/7 interventional
radiology.

The AAA screening population will need to be revised to align itself with this service.

The Task and Finish Group have considered a number of risks inherent
recommending this service model and propose the following mitigating actions:


Risk                                                  Mitigation

         Ensuring robust and equitable                          Implementation plan to include
          patient pathways in place across                        timed pathways, to be incorporated
          the network for stroke, diabetes,                       into contracts with all Trusts in the
          renal, venous access and IR.                            sub-region.
         Ensuring sustainable general                           Implementation plan to include
          surgical on-call in SNEY and                            general surgery workforce plans
          NLAG.                                                   for in NLAG and SNEY and clear
                                                                  transition arrangements.
         Transition to 24/7 interventional                      Clear patient pathways for IR
          radiology in York.                                      patients out of hours during the
                                                                  transitional period.
                                                                 Consideration should be given to
                                                                  whether an on-site 1:4 rota can be
                                                                  put in place through support from
                                                                  HEY.
         Changes in capacity at all                             Implementation plan to include
          providers, with specific concerns                       detailed modelling of assumptions.
          regarding the impact on viability in                   NHS North Yorkshire and York to
          SNEY.                                                   include the impact of the vascular
                                                                  review in their ongoing work with
                                                                  SNEY.
         Impact on ambulance                                    Working group to include EMAS /
          management and transfer                                 YAS to identify ambulance
                                                                  management and transfer impacts
                                                                  and opportunities

The North & Eastern Yorkshire and Humberside model requires significant further
work prior to implementation, but it is essential that momentum is maintained and the
proposed model in place at the earliest possible date, to ensure equity of service

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provision across the region. The Task and Finish Group agree every effort should be
made to move to the new service model by April 2012.

During the consultation period, the Task and Finish Group recommends that work
continues within this sub-region to produce an implementation plan for safe transition
to the proposed service model.


Recommendation C

The region should consult on a single vascular service in North & East Yorkshire and
Humberside, with two collaborating centres in Hull and York, with some elective non
arterial surgery being carried out at Harrogate, Scarborough, Scunthorpe and
Grimsby, along with local outpatient clinics.

Recommendation D

The AAA screening population for the ‘East’ screening programme should be revised
to include the catchment of Harrogate and York Trusts.

Recommendation E

North & Eastern Yorkshire and Humberside Commissioners and Providers, including
YAS and EMAS establish a working group, reporting to NEYHCOM, to produce an
implementation plan for safe transition to the proposed service model, with a view to
full implementation by April 2012.



2.3     West Yorkshire Central (pp34-37)

The proposed model for West Yorkshire Central is a single service with all vascular
emergencies and major elective vascular arterial surgery carried out on the LGI site,
with outpatients, daycases, intermediate cases (including renal access) and ward
attenders continuing to take place at Mid Yorkshire hospitals, through a unified
partnership of the existing clinical teams.

This model complies with all the vascular designation standards. The Task and
Finish Group support the view that this is the safest and most sustainable model that
will maintain local access for many patients from the Mid Yorkshire catchment, whilst
realising the significant benefits of collaboration. The Task and Finish group support
this as the preferred model.

This represents a significant change to services in both hospitals and a significant
change for patients from the Mid Yorkshire catchment.

The ‘central’ AAA screening population does not need to be revised to align itself with
this service, however, may need to be revised to best align with existing patient
flows.

The Task and Finish Group have considered a number of risks inherent
recommending this service model and propose the following mitigating actions:




Risk                                                   Mitigation

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       Links with other services – ensuring                     Implementation plan to include
        robust and equitable patient                              timed pathways, to be incorporated
        pathways in place for stroke,                             into provider contracts.
        diabetes, renal, venous access and
        IR.
       Ward, Theatre and critical care                          Implementation plan to include
        capacity in Leeds                                         detailed modelling of assumptions,
                                                                  supported by the critical care
                                                                  network.
       Impact on ambulance management                           Working group to include YAS to
        and transfer                                              identify ambulance management
                                                                  and transfer impacts and
                                                                  opportunities
       Reduced local access to arterial                         Specific Consultation with patients
        and emergency surgery in Mid                              in Mid Yorkshire.
        Yorkshire
       Considerable amount of planning                          Working group to develop detailed
        work still to be undertaken.                              implementation plans



The West Yorkshire Central model requires significant further work prior to
implementation and the providers have highlighted potential interdependencies, such
as interventional cardiology in Mid Yorkshire. It is, however, essential that
momentum is maintained and the proposed model in place at the earliest possible
date, to ensure equity of service provision across the region. The Task and Finish
Group agree every effort should be made to move to the new service model by April
2012.

During the consultation period, the Task and Finish Group recommends that work
continues within this sub-region to produce an implementation plan for safe transition
to the proposed service model and supports the principle of strong clinical leadership
from both Trusts to ensure this happens.



Recommendation F

The region should consult on a single vascular service in West Yorkshire Central,
with all vascular emergencies and major elective vascular arterial surgery carried out
on the LGI site, with outpatients, daycases, intermediate cases (including renal
access) and ward attenders continuing to take place at Mid Yorkshire hospitals,
through a unified partnership of the existing clinical teams.

Recommendation G

The AAA screening population for the ‘Central’ screening programme should be
reviewed by local commissioners to ensure best fit with current referral pathways.


Recommendation H

West Yorkshire Central Commissioners and Providers, including YAS, should
establish a working group, reporting to WYCOM, to produce an implementation plan
for safe transition to the proposed service model, with a view to full implementation
by April 2012.
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2.3       West Yorkshire West (pp38-41)

The proposed model for West Yorkshire West is a single service with two
collaborating centres for Level 2, 3 and 4 activity in Bradford and Calderdale and
Huddersfield, with outpatient and daycase activity continuing to be provided in
Airedale. Out of hours care would alternate on a weekly basis between Bradford
Royal Infirmary and Huddersfield Royal Infirmary.

The service complies with all the vascular designation standards, provided local
activity data for the first four months of 2010/11 is used to assess minimum numbers
and shared on-call is deemed to provide 24/7 cover. The Task and Finish Group do
not support the view that this is the safest and most sustainable model for vascular
services but acknowledge the significant work undertaken by the provider Trusts to
develop this model and the associated governance, the local PCT and GP support
for this as the preferred model and the lack of robust evidence that this model would
not deliver the outcomes of the review. The Task and Finish group therefore support
this model as the preferred model, subject to formal review after twelve months.

This represents a significant change to services in both hospitals and a significant
change for all patients requiring emergency vascular services out of hours.

The ‘central’ AAA screening population does not need to be revised to align itself with
this service, however, may need to be revised to best align with existing patient
flows.

The Task and Finish Group have considered a number of risks inherent
recommending this service model and propose the following mitigating actions:


Risk                                                  Mitigation

         Care of complex elective patients                      Second on-call system to run for
          out of hours                                            an initial period of 6 months to
                                                                  assess risk.
         Low numbers per centre and per                         Formal review of volume and
          individual                                              outcomes at twelve months.
         Impact of critical mass on                             Formal review of volume and
          assessment of outcomes                                  outcomes at twelve months.
         Long term sustainability                               Formal review of volume and
                                                                  outcomes at twelve months.

The West Yorkshire Central model has been the subject of detailed planning
between the two collaborating centres and they are in a position to put the proposed
model in place immediately following consultation, if appropriate. The Task and
Finish Group agree the preferred model should be implemented from early 2011 if
there are no major changes following consultation.

During the consultation period, the Task and Finish Group recommends that the
Oversight Committee, reporting to WYCOM, works with commissioners and YAS to
agree the timing and nature of the twelve month review.



Recommendation I

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The region should consult on a single vascular service in West Yorkshire West, with
two collaborating centres for Level 2, 3 and 4 activity in Bradford and Calderdale and
Huddersfield, with outpatient and daycase activity continuing to be provided in
Airedale. Out of hours care will alternate on a weekly basis between Bradford Royal
Infirmary and Huddersfield Royal Infirmary.

Recommendation J

The AAA screening population for the ‘West’ screening programme should be
reviewed by local commissioners to ensure best fit with current referral pathways.

Recommendation K

The Vascular Oversight Committee of the provider Trusts within West Yorkshire
Central should establish a working group, reporting to WYCOM, to agree the
framework for a formal review of the service at twelve months.




2.4       South Yorkshire and Bassetlaw (pp42-45)

The proposed model for South Yorkshire and Bassetlaw is a single service with two
collaborating centres in Doncaster and Sheffield delivering elective and emergency
level 2 and 3 activities across both sites, with some non arterial surgery and
outpatient clinics continuing to be carried out in Barnsley, Rotherham and Bassetlaw.
Complex Level 4 cases would continue to be undertaken at Sheffield Hospital.

This model complies with all the vascular designation standards. The Task and
Finish Group support the view that this is the safest and most sustainable model that
will maintain some local access in Barnsley, Rotherham and Bassetlaw and a
significant vascular presence in Doncaster. The Task and Finish group support this
as the preferred model.

This does not represent a significant change to existing services.

The ‘South’ AAA screening population does not need to be revised to align itself with
this service.

The Task and Finish Group have considered a number of risks inherent
recommending this service model and propose the following mitigating actions:



Risks                                          Mitigation

         Low population base for                      Vascular Partnership Board to work
          Doncaster                                     together to ensure a resilient population
                                                        base for each of the centres within the
                                                        service
         Increased system costs                       Vascular Partnership Board to adopt a
          through increased workforce                   joint approach to workforce planning to
                                                        maximise efficiency
         Long term sustainability                     Vascular Partnership Board to work
                                                        together to ensure sustainability for each

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                                                        of the centres within the service

The South Yorkshire and Bassetlaw model does not require significant planning as
no major changes to service are required and the centres are in a position to put the
proposed model in place immediately following consultation, if appropriate. The Task
and Finish Group agree the preferred model should be implemented from early 2011
if there are no major changes following consultation.

During the consultation period, the Task and Finish Group recommends that the
Vascular Partnership Board, reporting to NORCOM, works with commissioners and
YAS to establish their terms of reference and agree the priorities for the coming year
in relation to population sustainability, workforce planning and training, and
standardisation of clinical practice.


Recommendation L

The region should consult on a single vascular service in South Yorkshire, with two
collaborating centres in Doncaster and Sheffield delivering elective and emergency
level 2 and 3 activities across both sites, with some non arterial surgery and
outpatient clinics continuing to be carried out in Barnsley, Rotherham and Bassetlaw.
Complex Level 4 cases would continue to be undertaken at Sheffield Teaching
Hospitals.


Recommendation M

The South Yorkshire and Bassetlaw service establishes it’s Vascular Partnership
Board and works with commissioners and YAS, reporting to NORCOM, to agree the
work priorities for the coming year in order to ensure the functions set out in
Recommendation B are delivered. South Yorkshire and Bassetlaw commissioners
align their commissioning and contracting intentions to support this partnership.




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3.         Recommendations – Delivery

The Task and Finish Group identified a number of overarching risks to the successful
implementation of these recommendations and propose mitigation as follows:-



Risk                                                    Mitigation

          The future commissioning landscape                    Respond to White Paper
           and commissioner capacity to                           consultation to support National
           implement changes                                      Commissioning of Vascular
                                                                  Services.

                                                                 Implement service models as early
                                                                  as possible.

                                                                 Regional support for consultation
                                                                  and implementation.

          The ongoing commitment of provider                    Commissioning and contracting to
           organisations to work together                         be aligned to ensure ongoing
                                                                  commitment to partnership working

                                                                 Seek views of patients and the
                                                                  public on partnership working as part
                                                                  of the consultation.

                                                                 Ensure the designation process
                                                                  embeds partnership working.




Recommendation N

A full regional public consultation should take place on the recommendations set out
above, supported by regional consultation materials developed by the Specialised
Commissioning Group. This should be supplemented by local PCT consultation on
specific local impacts and BME groups should be specifically targeted.2


Recommendation O

It is recommended that interim designation of vascular service partnerships takes
place in June 2011, with full designation in June 2012. As part of interim designation,
each partnership will need to produce an action plan to deliver against all of the
designation standards by June 2012.




2
    Appendix 2 summarizes the consultation requirements by PCT

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Recommendation P

Data collection and performance targets should be incorporated into contracts for all
vascular surgery providers, to provide supportive evidence to the designation
process. CQUINs may be an appropriate mechanism for this. This should include
all data submitted to the following national databases:-
      The National Vascular Database
      The Carotid Endarterectomy Audit
      The Aortic Aneurysm Repair Audit
      Amputation Audit
      Reta Registry
      The British Society of Interventional Radiology BIAS databases.
      TEVAR
      IVC Filter Registry3



Chief Executives are asked to:-

          Review the recommendations of the Task and Finish Group
          Provide assurance to the SHA and SCG that the relevant impacts have been
           considered within the recommendations.



Pia Clinton-Tarestad
Assistant Director of Commissioning
Yorkshire and the Humber SCG

On behalf of:-

The Vascular Task and Finish Group


22 September 2010




3
    Yorkshire and the Humber Vascular Designation Standard 17

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Appendix One

   SUPPORTING DOCUMENTATION CONSIDERED BY THE VASCULAR TASK
                      AND FINISH GROUP

Ref       Description

TF1       Vascular Services Review – Background Information
TF2       Vascular Services Review – Criteria
TF3       Vascular Assessment V8
TF4       Vascular Assessment Appendices V8
TF5       Task and Finish Group Report One from 17.06.10
TF6       Data Pack
TF7       Feedback from Stroke Networks
TF8       Renal Letter
TF9       Renal Position Statement
TF10      DH Interventional Radiology Paper
TF11      Statement re concerns about shared rotas
TF12      Vascular Assessment V10
TF13      Letter to West Yorkshire Central
TF14      Letter to West Yorkshire West
TF15      Letter to North East Yorkshire and Humberside
TF16      Letter from South Yorkshire Trusts
TF17      Letter to South Yorkshire
TF18      Populations Work
TF19      Statement on vascular as single specialty status
TF20      E-mail re Trauma Review
TF21      Bradford, Airedale and Calderdale Strategy Document and supporting docs
TF22      Task and Finish Group Report Two from 23.07.10
TF23      Equality Impact Assessment V1
TF24      E-mail re Workforce Planning
TF25      Recommendations for Specialty Training
TF26      NPSA Advice
TF27      Vascular Assessment V12
TF28      Recommendations V1 Aug 10
TF29      West Yorkshire West submissions
TF30      South Yorkshire submissions
TF31      Northern and East Yorkshire and North Lincolnshire submissions
TF32      West Yorkshire West submissions
TF33      Comments from all Stakeholders – Final Sept 10
TF34      Vascular Impact Assessment – Summary of Comments
TF35      Vascular Services Engagement Report – Final
TF36      Vascular Impact Assessment V13
TF37      Vascular Impact Assessment Appendices V13
TF38      Recommendations V2 Sep 10
TF39      Vascular Designation Standards V6




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Appendix Two

 SUMMARY OF SERVICE CHANGE AND CONSULTATION IMPLICATIONS FOR
                  EACH PRIMARY CARE TRUST




                                                             Significant service change?




                                                                                                                                                    Specific local consultation?
                                                                                                                      Local media/comms plan?
                                                                                               Part of regional
                                                                                                consultation?
               Primary Care Trust




Barnsley                                                 N                                 Y                      Y                             N
Bassetlaw                                                N                                 Y                      Y                             N
Bradford & Airedale                                      Y                                 Y                      Y                             Y
Calderdale                                               Y                                 Y                      Y                             Y
Doncaster                                                N                                 Y                      Y                             N
East Riding                                              Y                                 Y                      Y                             Y
Hull                                                     Y                                 Y                      Y                             Y
Kirklees                                                 Y                                 Y                      Y                             Y
Leeds                                                    N                                 Y                      Y                             N
North East Lincolnshire                                  Y                                 Y                      Y                             Y
North Lincolnshire                                       Y                                 Y                      Y                             Y
North Yorkshire and York                                 Y                                 Y                      Y                             Y
Rotherham                                                N                                 Y                      Y                             N
Sheffield                                                N                                 Y                      Y                             N
Wakefield                                                Y                                 Y                      Y                             Y




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Appendix A

Summary of the Draft Recommendations of the OGC Gateway Review


Colour                                       Criteria Description

            Successful delivery appears feasible but issues require management attention. The issues
  A         appear resolvable at this stage of the programme/project if addressed promptly.




         The SRO should ensure that the programme reviews and learns
          lessons from the process used to identify and develop the preferred
          sub regional vascular service models so that they can be applied to
          inform future reviews of a similar nature.

         The SRO needs to decide how best to describe the sub regional
          vascular service proposals prior to consultation.

         The SRO should ensure that a workforce plan is developed to support
          the delivery of the service.

         As the programme moves from development into consultation and
          implementation the Specialised Commissioning Group should take the
          opportunity to reassess its existing risk management arrangements.

         The SRO should clarify the date on which consultation will commence
          and ensure that all key stakeholders are aligned.

         The SRO should ensure that the programme identifies the high risk
          areas in the consultation and ensures that local plans are appropriate
          and that adequate resources are available to support their delivery.

         The SRO should ensure that an implementation plan is available to the
          Specialised Commissioning Group which assures delivery of the new
          vascular services from April 2011.




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