A strategy for vascular services--testing the 600,000 population model.
BACKGROUND
Vascular services' delivery has been criticised, and re-organisation based on a 600,000 population model suggested. We assessed the feasibility of this model in three geographically disparate English regions.


METHODS
Surgical arterial activity by Trust was analyzed using 1994/95 data from Hospital Episode Statistics. A postal survey of acute Trusts was used to assess vascular facilities and personnel. Distances between hospitals and enumeration districts were mapped using a Geographical Information System.


METHODS
Number (proportion) of Trusts performing over 100 arterial procedures a year. Number (proportion) of Trusts with a vascular on-call rota. Proportion of population likely to live more than 40 km away (equivalent to 1 h blue-light ambulance travel time) from a vascular unit under the proposed model.


RESULTS
Twelve of the 32 Trusts (38%) performed over 100 arterial procedures annually; 23 Trusts completed the survey. Of these, five (22%) had a vascular on-call rota. Under the 600,000 model, in East Anglia a further 16.5% of the population would live > 40 km from a vascular unit. In Wessex, a further 0.4% of the population would live > 40 km from a vascular unit. Impact on access in North West Thames was negligible.


CONCLUSIONS
A 600,000 population model could be feasible in urbanized regions, but not in geographically remote ones.
Arora
S
S
Department of Public Health, Kensington & Chelsea and Westminster Health Authority, London, UK.
Wolfe
J
J
Maheswaran
R
R
Grossinho
A
A
Darke
S
S
Colin
J
J
Hargreaves
S
S
D003695:Delivery of Health Care / Q000458:organization & administration*; D004739:England; D005240:Feasibility Studies; D006297:Health Services Accessibility; D006801:Humans; D017146:Models, Organizational; D011156:Population Density; D014656:Vascular Surgical Procedures / Q000458:organization & administration*; D000078329:Workforce