title: Remodelling of vascular (surgical) services in the UK.
abstract: The last few years have seen major changes in the delivery of vascular services in the UK. An increasingly elderly population with greater expectations from their medical services has challenged established methods. It also became apparent that outcomes for low volume, high risk index vascular interventions such as abdominal aortic aneurysm repair were poor in the UK compared to the rest of Europe. Other ongoing challenges were the introduction of a national aortic aneurysm screening programme and the development of vascular surgery as a separate speciality. This article details the approach taken to modernise vascular services in the UK, using a quality framework agreed by vascular specialists, which drove the structural change to move vascular interventions into fewer, higher volume centres. The introduction of modern networks is designed to maintain services in surrounding hospitals without on site vascular inpatient services. The initial effects of this service remodelling are positive, with elective aortic aneurysm mortality rates falling nationally from 7.5 to 2.4 per cent.
authors.affiliation: Department of Vascular Surgery, Gloucestershire Royal Hospital, Gloucester, UK. jjearnshaw@tiscali.co.uk
authors.forename: J J
authors.initials: JJ
authors.lastname: Earnshaw
authors.forename: D C
authors.initials: DC
authors.lastname: Mitchell
authors.forename: M G
authors.initials: MG
authors.lastname: Wyatt
authors.forename: P M
authors.initials: PM
authors.lastname: Lamont
authors.forename: A R
authors.initials: AR
authors.lastname: Naylor
mesh_terms: D017544:Aortic Aneurysm, Abdominal / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration*; D017146:Models, Organizational; D018579:Patient Selection; D011237:Predictive Value of Tests; D019984:Quality Indicators, Health Care / Q000458:organization & administration; D018570:Risk Assessment; D012307:Risk Factors; D013043:Specialties, Surgical / Q000458:organization & administration; D013222:State Medicine / Q000458:organization & administration*; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000458:organization & administration*