Dear Northampton General Hospital NHS Trust,

With regards to your vascular services and its annual self-assessment (2019/2020) submission l request electronic copies of the following information.

1. The 2019/2020 annual self-assessment that was submitted via the Quality Surveillance Programme relating to the Specialised Vascular Services (Adult) Specification 170004/S.

2. If the Main Arterial centre declared a positive result (stated Yes)/compliance with indicator 170004S-001 - "There is an agreement outlining the network configuration", then l request copies of the evidence documents: operational policy (or part of) that supported this positive declaration.

3. If the Main Arterial centre declared a positive result (stated Yes)/compliance with indicator 170004S-017 - "There are patient pathways in place", then l request copies of the evidence documents: operational policy (or part of) including pathways that supported this positive declaration.

In order to reduce the scope of this part of the request, l include part of the indicator description that highlights my main interest:

Descriptor:
The AC should agree with the relevant service providers and relevant commissioners, network wide patient pathways for:

Peripheral Arterial Disease including:
- The management of acute limb ischaemia.

The pathway should include the following specifics;
- that emergency admissions should be reviewed by a consultant vascular surgeon within 12 hours

All the pathways should specify:
- the specific responsibilities of the involved providers, including the AC, the NAVCs and other providers;
- the indications for referral between providers (compatible with the levels of care model in the introduction to these indicators);
- the arrangements for transfer between providers for emergency surgery or interventions;
- any indications for case discussion at the weekly network MDT meeting;
- the relative responsibilities of the endovascular and open surgical specialists;
- referral pathways to other relevant specialties;
- the essential communications between professionals—what information should pass between which providers by which timelines;
- arrangements for patients who are turned down for vascular intervention and require palliative admission;
- locally relevant items including named providers and contact points.

Notes:
Pathways specify how the different Centres and groups of professionals should interact at defined stages of the patient journey, for diagnosis, assessment, management or follow up, as relevant.

4. If the Main Arterial centre declared a positive result (stated Yes)/compliance with indicator 170004S-021 - "There are clinical guidelines in place", then l request copies of the evidence documents: operational policy (or part of) including guidelines that supported this positive declaration.

In order to reduce the scope of this part of the request, l include part of the indicator description that highlights my main interest:

Descriptor:
The AC should agree with relevant service providers and relevant commissioners, network wide clinical guidelines for patients with:

- peripheral arterial disease including amputation;
- vascular injury

The guidelines should cover diagnosis, assessment, treatment and follow up.
Notes:
Clinical guidelines cover guidelines, protocols, ‘SOPs’ which describe how to manage a patient in a given clinical situation or specified point on the pathway. Examples include assessment checklists, surgical procedures, treatment protocols, key investigations at follow-up visits etc.
The Centre may wish to agree additional clinical guidelines to those specified in the indicators.
Network guidelines should be compliant with current national guidelines where relevant.

If any part of this request is unclear then please do not hesitate to contact me for clarification.

Yours faithfully,

Mr. Kent

Dear Northampton General Hospital NHS Trust,

Thank you for the update regarding the FOI entitled "Specialised Vascular Services Assessment" submitted to you on the 25th June 2021.

I now hope to be in receipt of your response by Friday 20th August 2021.

Yours faithfully,

Mr. Kent

Dear Northampton General Hospital NHS Trust,

Thank you for you response, however you are completely mistaken with your response of:

"Due to the Covid pandemic, there was national guidance suspending the submission of the 19/20 annual self-assessments. We therefore do not have an annual self-assessment for 19/20 to share."

The 2019/2020 self-assessments that were submitted in 2019 were not affected by COVID-19, the submissions for 2020/2021 and 2021/2022 are affected.

I have asked NHS England and they have confirmed that your overall score for the 2019/2020 assessment was: 92.60% so you obviously submitted your 2019/2020 .

Here are two examples of such assessments submitted in 2019 for the 2019/2020 Quality Surveillance Programme by other trusts in your the same NHS Region (Midlands).

https://www.whatdotheyknow.com/request/7...

https://www.whatdotheyknow.com/request/6...

Given your response, l must request that you conduct an Internal Review for your Trust to realise its error and to then to provide all of the requested information.

A full history of my FOI request and all correspondence is available on the Internet at this address: https://www.whatdotheyknow.com/request/s...

Yours faithfully,

Mr. Kent

Dear Northampton General Hospital NHS Trust,

Thank you for your response and the results of your Internal Review, however you have still not satisfied this request, failing to answer one question completely.

Please find below the questions asked, your responses and my comments to them so you can understand why l believe you have not satisfied this request.

I asked for the following:

1. The 2019/2020 annual self-assessment that was submitted via the Quality Surveillance Programme relating to the Specialised Vascular Services (Adult) Specification 170004/S.

Your response: "Please see the attached as requested".

My response : Thank you for the attached "Specialist Vascular Service.pdf" which is the Trusts self-assessment for 2019/2020, however it is missing the indicator descriptors?

Although l do believe that all Trust's received the same indicator descriptors, without seeing these l can not be 100% certain.

These descriptors are important because they are the requirements that are being assessed, and without seeing these then myself and any other viewer will not know exactly what the Trust has given its positive declarations to?

Unless there is a technical problem preventing the Trust from an intact assessment via the Quality Surveillance Programme Portal, would it be possible to re-send the assessment with all information intact i.e. the descriptors and any notes/comments that were entered. If you feel that you have satisfied this question and will not resend the assessment intact as part of this FOI request, l would be more than happy to submit another request if necessary?

Please see one for Worcestershire Royal Hospital with all items intact.

https://www.whatdotheyknow.com/request/7...

Question pending clarification / self-assessment re-send.

2. If the Main Arterial centre declared a positive result (stated Yes)/compliance with indicator 170004S-001 - "There is an agreement outlining the network configuration", then l request copies of the evidence documents: operational policy (or part of) that supported this positive declaration.

Your response: "Please see the attached as requested. Please note that policy NGH-PO-781 Northamptonshire Vascular Service Operational Policy is currently under review. We attach the current copy and expect the new one to be available by the end of October 2021."

My comments: Thank you for the attached document "NGH PO 781 Vascular Service Operational Policy review Mar 2017.doc"

Question answered in full.

3. If the Main Arterial centre declared a positive result (stated Yes)/compliance with indicator 170004S-017 - "There are patient pathways in place", then l request copies of the evidence documents: operational policy (or part of) including pathways that supported this positive declaration.

In order to reduce the scope of this part of the request, l include part of the indicator description that highlights my main interest:

Descriptor:
The AC should agree with the relevant service providers and relevant commissioners, network wide patient pathways for:

Peripheral Arterial Disease including:
- The management of acute limb ischaemia.

The pathway should include the following specifics;
- that emergency admissions should be reviewed by a consultant vascular surgeon within 12 hours

All the pathways should specify:
- the specific responsibilities of the involved providers, including the AC, the NAVCs and other providers;
- the indications for referral between providers (compatible with the levels of care model in the introduction to these indicators);
- the arrangements for transfer between providers for emergency surgery or interventions;
- any indications for case discussion at the weekly network MDT meeting;
- the relative responsibilities of the endovascular and open surgical specialists;
- referral pathways to other relevant specialties;
- the essential communications between professionals—what information should pass between which providers by which timelines;
- arrangements for patients who are turned down for vascular intervention and require palliative admission;
- locally relevant items including named providers and contact points.

Notes:
Pathways specify how the different Centres and groups of professionals should interact at defined stages of the patient journey, for diagnosis, assessment, management or follow up, as relevant.

Your response: "Please see the attached as requested."

My comments: "Thank you for the attachments 'Peripheral Arterial Disease update.xls', 'Emergency major amp draft.xls' ,'Non emergency AAA.xlsx', ''Acute Limb Ischaemia 15 Dec 2015.xlsx' in conjunction with 'NGH PO 781 Vascular Service Operational Policy review Mar 2017.doc'"

Question answered in full.

4. If the Main Arterial centre declared a positive result (stated Yes)/compliance with indicator 170004S-021 - "There are clinical guidelines in place", then l request copies of the evidence documents: operational policy (or part of) including guidelines that supported this positive declaration.

In order to reduce the scope of this part of the request, l include part of the indicator description that highlights my main interest:

Descriptor:
The AC should agree with relevant service providers and relevant commissioners, network wide clinical guidelines for patients with:

- peripheral arterial disease including amputation;
- vascular injury

The guidelines should cover diagnosis, assessment, treatment and follow up.
Notes:
Clinical guidelines cover guidelines, protocols, ‘SOPs’ which describe how to manage a patient in a given clinical situation or specified point on the pathway. Examples include assessment checklists, surgical procedures, treatment protocols, key investigations at follow-up visits etc.
The Centre may wish to agree additional clinical guidelines to those specified in the indicators.
Network guidelines should be compliant with current national guidelines where relevant.

Your response: ?

My comments: May l ask where are your network wide clinical guidelines or the list of those that your network members have all agreed to follow, even if it is just a simple document with a list of pointers to nationally recognised clinical guidelines?

Regarding annual vascular assessments, l am sure you know that if your Trust did not implement all of the requirements set against each quality indicators then a negative response of "NO" to the appropriate indicator should have been indicated along with an appropriate comment.

From both discussions with and documentation obtained from the Specialised Commissioning Team I believe that the Quality Surveillance Team (QST) monitor assessments and as such can act on negative returns where and when appropriate, but obviously without accurate assessments the QST would be none the wiser. I also believe that in most cases a negative response is handled internally with an action plan put in place to rectify the non-compliance at some point in time.

The reason l mention the above is because it may be that the Trust has found an error with its official 2019/2020 submission given the complete omission of a response to question four of this FOI. Please note if errors have been detected with this submission then l would not expect the Trust to release documentation that may now be in progress etc.

Presently, NHS England, when l last contacted them were not aware of any errors with your 2019/2020 submission.

Please can you either provide the requested documents that the Trust declared as having / used to support its positive declaration or advise if the Trust has found errors with its submission?

Given the time that has elapsed, and that the ICO in general allow a maximum of 40 days for an Internal Review could you please provide a response no later than the 5th October 2021.

Thank you

Yours faithfully

Mr Kent

Dear Northampton General Hospital NHS Trust,

With regards to my FOI request, your ref FOI 21/22_10760.

Please be advised that given the Trusts failure to respond to my comments regarding its Internal Reivew and the missing information for question four, l have now contacted the ICO for assistance.

I will of course withdraw my complaint with the ICO if the Trust decides to provide anwser/complete a thorough review which obvisiously it did not given the complete ommission regarding question four.

Yours faithfully

Mr. Kent

Dear Sarah / Northampton General Hospital NHS Trust,

Thank you for your response and the re-send of the self-assessment with the indicators intact.
Question one - Answered in full
Question Two - Answered in full
Question Three - Answered in full

Question four is still missing the requested clinical guidelines/documented list of agreed clinical guidelines that are to be followed by all network members. There is a subtle difference between a pathway and a clinical guideline and thus far the Trust has only provided its pathways which were for question three.

Your Trust has declared that there are agreed (documented)/network wide clinical guidelines in place.
Please review your Trusts submission as to what it officially declared as implemented.

As the Trust may not be using its own defined evidenced based guidelines, then the agreed guidelines may be a documented list of "Named" external reference materials that all network partners have agreed that will be used/followed where when appropriate; for example regarding PAD this could be NICE CG147.

Presently it appears from the information provided thus far that there is NO policy and/or documented list of the agreed clinical guidelines that are to be referenced by all parties despite your Trust declaring that there is - please correct me if l am wrong?

Yours faithfully,

Mr. Kent

Dear NORTHAMPTON GENERAL HOSPITAL NHS TRUST,

At present without your confirmation I believe that there are three hospitals that work together to provide vascular services to residents in your catchment area with the Northampton General Hospital being the main arterial centre and as such would suggest that your comment of "We are not part of a wider vascular network" is somewhat ludicrous.

Your hospital/Trust has declared as having documented network wide clinical guidelines in place i.e. each hospital should have some sort of document with a list of clinical guidelines that are to be followed - Where is this simple list/document of the clinical guidelines?

You either have the document(s) or you do not, please which is it?

Yours faithfully

Mr. Kent

Dear (Northampton General Hospital NHS Trust,

Thank you for your response and for stating that your Trust believes that it has not made any errors in its submission.

I believe your Trust is mistaken as I believe it has erred in its submission given it cannot produce the documents it declared as having AKA the evidence documents.

If your Trust did not have these required documents then I believe your Trust should have simply declared "NO" to the quality indicator being assessed with a simple comment such as "We do not currently have network wide documents in place, but follow national guidelines" ... etc.

Sheffield (one of the largest vascular networks/centres in England) do not have network wide documents in place and simply stated as much:

https://www.whatdotheyknow.com/request/7...

Your Trust has not provided any clinical guidelines only pathways which we both know are different to guidelines. The guidelines which tend to be external are used due to the extensive research/trials gone into producing them, so unless your Trust was the developer of such guidance then external sources are most definitely used, however, I believe (in order to satisfy the requirements) there still needs to be a document in place that states which guidelines are to be followed by all network members/service providers.

With regards to your comments about a wider network, I have never expressed any notion of it being regional, the network as of the documentation regarding the vascular services refers to providers that work together to provide the vascular services, typically in a Hub and Spoke manor with one hospital being the Hub/Main Arterial Centre (AC) and any other hospitals that are a part of this network being classified as spokes. With regards to your Trusts configuration I believe there is one Hub and two spokes that make up your vascular network - Is this not the case?

The annual assessment/quality indicator in question clearly states the following:

"The AC should agree with relevant service providers and relevant commissioners, network wide clinical guidelines for patients with:"
....
"Network guidelines should be compliant with current national guidelines where relevant"
...
"Evidence Documents: Operational policy including guidelines"

Where is this operational policy that lists which internal or external clinical guidelines that any spokes and the hub have all agreed will be followed?

I am sorry you find my FOI/these questions vexatious, you are not the first Trust to cite section 14, for your information to date the ICO has never found any of my FOI requests to be vexatious.

Yours faithfully

Mr. Kent

Dear FOI (NORTHAMPTON GENERAL HOSPITAL NHS TRUST),

Thank you for the response, however, I believe at this stage it may be more beneficial to all if the Trust
contacted NHS England and explained to them why the Trust submitted FALSE information, as it cannot produce the required documents that it declared as having, a requirement that was being measured.

Yours sincerely,

Mr. Kent