Changes to Carotid Endarterectomy Surgery

I am proud that Wycombe Hospital continues to be a specialist centre for two of the biggest killers – heart attack and stroke – and that there has been recent investment in these services. From 1st September 2016, carotid endarterectomy  surgery moved from Wycombe Hospital to the John Radcliffe Hospital. Some campaigners have opposed the change. It has been done to ensure patients have the best possible clinical outcomes.

A carotid endarterectomy is a surgical procedure to unblock a carotid artery, which, if left untreated, can lead to a stroke. It is an elective procedure – one carried out at a chosen time – not an emergency procedure.

To understand the clinical reasoning behind this change, I asked Buckinghamshire Healthcare NHS Trust why this decision had been taken by the NHS.

The key points are:

  • The move of carotid endarterectomy surgery will not impact stroke or interventional radiology services at Wycombe Hospital.
  • Patients will only be asked to travel for procedures where there is clear evidence of benefit in doing so – namely for complex procedures.
  • All other services will continue to be delivered locally with patients receiving their pre-operative care and follow-ups at Wycombe Hospital, reducing the need for travel.
  • Vascular surgeons will continue to offer day surgery at Wycombe Hospital with outpatient clinics at Wycombe, Stoke Mandeville, Amersham and Chalfont Hospitals.
  • These changes are based on national clinical guidance and best practice and are important to ensure the safety of patients and ongoing provision of these services.

Here is the detail:

  1. To what extent is Carotid Endarterectomy an elective procedure? i.e. not used in an emergency.

If there is clear clinical evidence that a patient requires Carotid Endarterectomy this will be conducted at the John Radcliffe Hospital in Oxford from 1 September with pre-operative and post-operative care for Buckinghamshire patients at Wycombe Hospital. This is expected to affect 60 to 100 patients per year. The average length of stay for this procedure is one to two days. If a patient is identified as needing this procedure, clinical guidelines state this should be conducted within two weeks and is an elective procedure, unless more urgent surgery is required.

Arrangements have been put in place to monitor the move to providing complex vascular surgery at the John Radcliffe Hospital with patient experience gathered and regularly analysed. 

Based on clinical evidence, The Vascular Society recommend that all specialist vascular procedures that require in-patient stay should be done at a centre where there is 24/7 consultant cover (including six vascular surgeons and six interventional radiologists and specialist nurses).  This enables the provision of better quality care and means a better chance of survival as patients are treated by specialists who see a large number of patients and so develop and maintain significant expertise in this area.

In order to provide specialist services, a hospital Trust needs to meet a number of criteria, one of which is the consultant cover described above.  Buckinghamshire Healthcare NHS Trust does not meet these criteria.  In addition, over the next five years, hospitals will move to seven day working, which will increase pressure on having enough qualified staff to cover rotas.

The Buckinghamshire surgeons are participating in the on-call rota at the John Radcliffe Hospital where they are currently performing other arterial surgery.

We need to ensure doctors see enough patients to maintain their expertise. This means hospital staff working together as one team – with one hospital providing all the inpatient surgery while other hospitals provide outpatient and diagnostic tests and in some cases day surgery, as is the case at Wycombe Hospital. The national service specification says that a centre providing arterial surgery, such as carotid endarterectomy, should serve a minimum population of 800,000.

To meet the requirements of this national service specification and to deliver resilient and sustainable vascular services, NHS England has been re-organising vascular services into networks with the last phase of the Thames Valley Vascular Network due to go live on 1 September 2016.


  1. What impact is there on stroke care at Wycombe Hospital?

The Buckinghamshire Healthcare NHS Trust (BHT) stroke unit is a high performing unit and has good working relationships with the vascular surgeons at the John Radcliffe Hospital, Oxford.

The new arrangements will not impact stroke services as the quality of this interaction and referral pathway would be unchanged.

The move of CEA surgery will not impact on interventional radiology either.  Surgery to prevent stroke caused by carotid artery disease (carotid endarterectomy – CEA) is provided by vascular surgeons, not interventional radiologists. Interventional radiologists provide a wide range of elective and emergency interventional procedures; only a proportion of these are vascular.

Abdominal aortic aneurysm (AAA) screening continues to be provided as before. There is no change to this service.

Furthermore, vascular surgeons will continue to offer day surgery at Wycombe Hospital (such as for varicose veins) and run outpatient clinicsfrom Wycombe, Stoke, Amersham and Chalfont Hospitals, including diabetic foot clinics.

The sustainability of district general hospitals is important for the delivery of high quality care locally. Discussions have taken place with the Thames Valley Clinical Senate to address this and ensure that acute hospital services are designed to maximise safety, patient outcomes and experience and sustainability.

Retention of some specialised services does not help deliver sustainability of a district general hospital. The cost of providing specialist consultant cover 24 hours a day, 7 days a week for a smaller than proposed population base reduces the ability to provide high quality secondary care services .

Attempting to retain or develop ‘sub specification’ specialist services at Wycombe Hospital will not help the sustainability of the hospital; in fact in the long term it may well hinder it.

The NHS have assured me that they will monitor the move to provide complex vascular surgery at the John Radcliffe Hospital including gathering and analysing the patient experience. I remain committed to the highest quality NHS healthcare for Wycombe residents and will want to see that this move is benefiting constituents.

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