A WAR of words has broken out over hospital vascular services provision in Bangor.

Arfon AM Siân Gwenllian has accused Betsi Cadwaladr University Health Board and the Welsh Government of “managerial incompetency” and “ineptitude” over failings in the consultation process regarding removal of vascular services from Ysbyty Gwynedd.

Questioning Cabinet Secretary Lesley Griffiths, standing in for First Minister Mark Drakeford at the Senedd, Mrs Gwenllian sought clarity as to when the decision was taken to remove emergency vascular services from Ysbyty Gwynedd after being reassured they would stay at Bangor.

Lesley Griffiths said: “A paper did go the board on March 1, 2018 which stated that ‘patients with diseases of the lower limbs relating to circulation will be managed at both Ysbyty Glan Clwyd and the limb salvage unit at YG with provision for elective and emergency admissions and in-patient treatments at both sites.

I think it’s that sentence that has given rise to the confusion. The Paper should have made it more explicit that the provision for elective and emergency admissions to Ysbyty Gwynedd related to diabetic foot and non-arterial cases.

"Arterial cases will go to Ysbyty Glan Clwyd…You ask about the letter that was sent to GPs and again that letter was sent with the same wording and hence I’m guessing the same confusion was caused.”

Mrs Gwenllian said: ‘The Government has admitted that the public were misled over the future of the world-renowned emergency vascular services at my local hospital in Bangor, conceding that mistakes were made in communicating their intention. Further evidence of the complete ineptitude of the Welsh Government to manage a public consultation of such significance.”

In response a letter from BCUHB chairman Mark Polin and chief executive Gary Doherty said they wanted to “reassure readers” that changes to vascular services will provide “better outcomes for patients.”

See full letter below:

Open letter on changes we are making to vascular services in North Wales

We want to reassure readers the changes we are making to vascular services will provide better outcomes for patients in North Wales.

Our decision was made following full public consultation considered by the Board in 2013, which was extensively documented and reported at the time.

Our current plan is fully in line with our decision in 2013. As has been seen across the NHS, changing vascular services is a long, complex process, but we have now built a state of the art vascular operating theatre with £2.3M investment from Welsh Government and have been able to attract six new vascular surgeons.

The decision to change is in line with guidance from the Vascular Society of Great Britain which the whole of the NHS is required to implement, and reflects the national development of vascular surgery into a specialist, hi tech service that is provided in fewer, bigger centres. The majority of vascular services will remain locally. About 300 complex cases per year will take place in our specialist centre at Ysbyty Glan Clwyd, representing 20% of all the vascular activity. Outpatient appointments, diagnostic tests, less complex surgical procedures and support for renal dialysis patients will not change and will continue to be provided locally.

Bringing the specialised surgery into one place allows us to invest in the latest equipment and technology and to attract new staff. Most importantly, this investment allows us to create a team who are doing the most complex cases every day and the evidence from elsewhere where this change has already taken place shows that patients get better outcomes as a result.

Our current vascular service achieves world-class results for some of our procedures, but this is not the case for all of our vascular surgery. By developing a specialist centre of excellence we want all our vascular surgery to have the very best outcomes and to ensure we have a viable, modern vascular service for the future.

Some correspondence has made reference to a ‘golden hour’. This is a clinical phrase that is used in trauma surgery, not vascular surgery, but we appreciate there are rightly concerns around emergency access and while new screening services mean we can spot many vascular conditions and treat them in a planned way, some of the 300 cases will be emergencies.

Our current service is too stretched, individual hospitals cannot provide 24/7 emergency vascular care so out-of-hours it is provided at either Ysbyty Gwynedd or Wrexham Maelor Hospital on an alternating basis. This means emergency patients either travel to the site which is on call (so emergency patients from Gwynedd and Anglesey are travelling to Wrexham right now) or if they are too unwell to do so the on-call surgeon travels to them. This will continue to be the case with the new service – if patients are too unwell to travel to the specialist centre at Glan Clwyd Hospital the specialist will come to them.

The Health Board is committed to providing services as near to patients as we can, but like the rest of the NHS we must change and develop in this speciality. Vascular surgery is now a recognised, highly specialised service and like other highly specialised services such as cancer and heart services it is provided in a smaller number of bigger specialist centres. We have invested millions of pounds in new equipment and have been able to attract new surgeons to North Wales who would not have come here if we did not have a modern, specialist vascular centre. The vast majority of patients will be seen and treated locally. North Wales patients (including emergency patients) are already travelling for treatment. Travelling to a specialist, centre of excellence will allow us to give the best outcomes to patients right now but will also make sure we have a vascular service in North Wales for future generations.

Yours sincerely,

Mark Polin Chairman (Betsi Cadwaladr University Health Board)

Gary Doherty Chief Executive (Betsi Cadwaladr University Health Board)