Dear University Hospitals of Derby and Burton NHS Foundation Trust,

Regarding your annual self-assessment for the specialised vascular surgical services via the Quality Surveillance Programme survey/self-declaration (form) "Arterial at Royal Derby Hospital". I would like to request electronic copies of the evidence documents regarding the following indicators, all of which you answered "YES" to in your submission and as such declared that you met the outlined requirement.

Below are the indicators and your declarative responses in respect to the aforementioned completed declaration form, along with my requests for the declared evidence documentation.

1. With regards to indicator: 170004S-001- There is an agreement outlining the network configuration.
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"

I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

2. With regards to indicator: 170004S-005 - "There is a weekly MDT Meeting".
You stated "YES" in the self-declaration, Evidence documents: "Annual report including attendance record"

I would like electronic copies of these evidence documents/annual report including attendance record.
Nb. If you have concerns for personal information i.e. names of consultants that are not publicly listed in GMC records/web sites, your own website/NHS consultant lists etc. then you can exclude/redact the attendance record part.

3. With regards to indicator: 170004S-012 - "There is an vascular outpatient clinic"
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"

I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

4. With regards to indicator: 170004S-016 - "The hospital has a policy whereby patients are managed in line with the Seven Day Services Clinical Standards policy."
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"

I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

5. With regards to indicator: 170004S-017 - "There are patient pathways in place"
You stated "YES" in the self-declaration, Evidence documents: "Operational policy including pathways"

I would like electronic copies of these evidence documents/operational policy that was in place/use during the time period of the self-assessment including the pathway(s) for Peripheral Arterial Disease.

6. With regards to indicator: 170004S-021 - "There are clinical guidelines in place"
You stated "YES" in the self-declaration, Evidence documents: "Operational policy including guidelines"

I would like electronic copies of these evidence documents/operational policy that was in place/use during the time period of the self-assessment including the guideline(s) for vascular injuries only.

Yours faithfully,

Mr. Kent

Dear University Hospitals of Derby and Burton NHS Foundation Trust,

Just a reminder that the statutory response time for this request (Ref: FOI.19.787) has now elapsed; presently you have neither provided answer nor advised of any delays regarding my request.

Can l expect a response in the next few days or at least an update as for the delay?

Yours faithfully

Mr. Kent

Dear University Hospitals of Derby and Burton NHS Foundation Trust,

You have just responded to my FOI request in which l requested to see documentation in connection with your annual self-assessment for the specialised vascular surgical services that you completed and submitted in June 2019. In this self-assessment you declared that you complied with all of the service indicators, some of which requiring various forms of documentation to have been produced. I believe it is also a requirement that if requested for external review that you are able to provide appropriate evidence documents such as Operational Policies, Patient/Care Pathways, Clinical Guidelines, Annual Reports and/or Work Programmes that would demonstrate your compliance.

You have now just stated:

"Further to your email below and other FOI applications received from you regarding a vascular network, our Trust has responded to you on several occasions explaining that we do not hold the information you are looking for; we have responded to the ICO communication; and invited you along to the Trust offering to meet with you to try and satisfactorily resolve this matter for you.

Unfortunately, whilst you have not found acceptable answers in our communication and have declined the Trust's offer to meet, we feel that we have exhausted all possible avenues to rectify this for you; therefore, we are unable to take this matter any further and are exempting from answering this and any other requests from you relating to vascular networks, pursuant of Section 14 of the Freedom of Information Act; vexatious/repeated requests."

Could you please offer explanation as to how you are unable to provide the requested documentation given that you submitted to NHS England a completed self-assessment indicating your compliance to the service specification or provide clarification as to exactly what it is you do not hold by answering the following question.

Can you confirm that despite declaring compliance with the specialised vascular service specification as indicated in your last submitted self-assessment form (June 2019) that YOU HAVE NOT PRODUCED THE REQUIRED DOCUMENTATION (for the appropriate indicators) and/or that YOU DO NOT HAVE ANY EVIDENCE DOCUMENTS that demonstrate your compliance and as such have nothing that would satisfy this request. Is this correct Yes Or No?

Failure to provide explanation or confirmation will leave me no other option but to contact the ICO for assistance as l believe given all of the information received to date from NHS England, the NHS Specialised Commissioning Team, your completed self-assessment form etc. that without sufficient explanation, that this may indicate that you are purposely concealing information which l believe is a criminal offence as explained in Section 77 of the FOI Act.

Your faithfully

Mr. Kent

Dear University Hospitals of Derby and Burton NHS Foundation Trust,

Thank you for you response of:

"Further to your email below, I attach our response of 9 December; which states the Trust are unable to answer your questions."

You have still failed to provide explanation and/or clarification as to what information it is that you feel you do not have and as such can not provide.

If indeed you do not have the requested information then surely it would be no problem for you to confirm it. If you could confirm it then l would have no need to pursue this matter any further with you, and/or to seek assistance from the ICO.

So will you confirm/answer the following:

Can you confirm that despite declaring compliance with the specialised vascular service specification as indicated in your last submitted self-assessment form (June 2019) that YOU HAVE NOT PRODUCED THE REQUIRED DOCUMENTATION (for the appropriate indicators) and/or that YOU DO NOT HAVE ANY EVIDENCE DOCUMENTS that demonstrate your compliance and as such have nothing that would satisfy this request. Is this correct Yes Or No?

Yours faithfully

Mr. Kent

Dear University Hospitals of Derby and Burton NHS Foundation Trust,

Seasonal greetings to you all and l wish l could have been more cheerful for you but ...

It appears that you do not wish to release the requested information and will not even clarify/explicitly state that you do not have the requested information, which seems very odd if you do not have it?

Yet again you claim that a simple, valid and legal request is vexatious in the hopes that this will somehow negate your public duty to provide the requested information. Given the correspondence received from NHS England, the NHS Specialised Commissioning Team, your own declarations in the Quality Surveillance Programme assessment, l believe that you are illegally withholding information.

As you have said that this request is vexatious and will not answer any more questions about it then this would preclude myself from asking you to conduct an internal review.

Please be advised that a report has now been sent to the ICO for both the failure to respond to this FOI in a timely manner and for what l believe is the illegal withholding of information that is suitable for public release.

Sadly just a lump of coal this year, bah humbug

Curmudgeonly yours

Mr. Kent

Dear Jane/ UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST,
Thank you for your response; may l suggest that you go and have a chat with both your legal team, NHS England and the NHS Specialised Commissioning team as you are currently being commissioned to provide Specialised Vascular Services by NHS England and to the best of my knowledge it is a contractual requirement as outlined in the service specification that "All Trusts that provide a vascular service must belong to a vascular provider network"; therefore l believe whilst being commissioned by NHS England you are a in fact part of a Vascular Network.

With regards to Mr. Timothy Rowlands being the Clinical lead, you publicly stated that Mr Tim Rowlands is the Clinical Lead for Vascular Services (including Derbyshire Vascular Services/Network) in April 2019, some two months before the self-assessment was submitted.

Please can you clarify your response by answering the following:

1. Despite being commissioned (funded) to provide Vascular Services which is subject to the the Specialised Vascular Services (Adults) Specification No. 170004/S; are you categorically stating that you are NOT part of a Vascular Network as outlined in the specification document. Yes or No?

2. NHS England recently and publicly stated that you are the Hub of a Vascular Network with Chesterfield being a Spoke in this network (hub and spoke model) are you categorically saying that this statement made by NHS England who fund you to provide these services were incorrect with their public statement. Yes or No?

3. Do you have a special arrangement with NHS England that allows you to be funded (currently) to provide Vascular Services but without being part of a vascular network (in this case the "Hub" Main arterial centre). Yes or No?

4. Have you contacted NHS England to explain that you have made the mistakes in the self-assessment submitted in June 2019. Yes or No.

I am sure the above will pose no problem for you to anwser given your response and these would probably conclude the matter, I look forward to your response.

Yours Sincerely

Mr. Kent

Dear Jane,

Thank you for your response, with regards to clarification 4 l have now contacted NHS England about this and await there response.

With regards to this request ref: FOI.19.787, your comments and/or (claimed) mistakes in the self-assessment make no difference other than you saying that you cannot anwser that one because of this (claimed) mistake with respect to indicator 170004S-001

There are 6 questions in this FOI request, so that leaves 5 others that do not ask about any formal network arrangements nor about any clinical lead, so l shall await those 5 answers as well as communications from NHS England.

I look forward to your response.

Yours sincerely,

Mr. Kent

Dear Jane,
Thank you for posting your previous responses it was helpful to re-read everything you have stated. If you do the same you may realise that you have not answered 5 of the questions, your statements about vascular networks and clinical leads have no bearing on them.

May l ask if you are now claiming that you also made mistakes with other declarations in you submission to NHS England, specifically with regards to questions 2 - 6 in this FOI which map to the following indicators
170004S-005,
170004S-012,
170004S-016,
170004S-017,
170004S-021

Should all of the above also have been declared as "NO" indicating further non-compliance to the specialised vascular specification.

Any chance of letting me know when you think your action plan outlining the steps that your Trust needs to take to become compliant will be ready, and do you envisage being actively monitored?
Yours sincerely,

Mr. Kent

Dear Jane,

May l ask why your Trust has tried to mislead both myself and the ICO?

Information just received.

"However, outside of the act NHS England can confirm that we have contacted the Trust and they have confirmed that their June 2019 position is correct and that there is an agreement network in place between University Hospitals of Derby and Burton NHS Foundation Trust and Chesterfield underpinned by a signed SLA. There is also a named clinical lead. This seems to be in conflict with the information you have received. "

Yours faithfully

Mr. Kent

Dear Jane (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST,

The information was provided to me by NHSE in an FOI (i did not request an FOI, only an enquiry, afterwards l then contacted the specialised commissioning team and provided them with all of YOUR statements/clarifications).

The FOI reply from NHS England was:

NHS England does not hold recorded information in relation to your request.

However, outside of the act NHS England can confirm that we have contacted the Trust and they have confirmed that their June 2019 position is correct and that there is an agreement network in place between University Hospitals of Derby and Burton NHS Foundation Trust and Chesterfield underpinned by a signed SLA. There is also a named clinical lead. This seems to be in conflict with the information you have received.

We are happy to discuss this further and PERSON NAME AND CONTACT DETAILS REMOVED is the direct contact within Specialised Commissioning.

I do not know if the person (who's name l have removed) is the person who contacted your trust.

As I have forwarded the email received to the ICO, if you contact them, may be they will feel that it is appropriate to release this name to you. I would hazard a guess that as you fall under region 6 (l think) it may have come from the Midlands Commissioning Team?

I will not provide nor publicly publish the persons name as the persons name was in text which as stated is outside of the act, and as mentioned, l do not know if this was the person who contacted you. All l know is that NHSE said they contacted your Trust and l very much doubt they were mistaken.

Yours Sincerely

Mr. Kent

Dear Jane (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

Thank you for your response.

Whilst l await your Trust and NHSE to figure out what your status/compliance is with regards to service indicators 170004S-001 & 170004S-002 with 170004S-001 only affecting question 1 of this FOI, may l remind you that you have not yet provided answers for questions 2 through 6 which are not actually reliant on your claimed mistake for service indicator 170004S-001.

Can l also remind you that questions 2 through 6 are regarding your own affirmations of compliance to service indicators
170004S-005,
170004S-012,
170004S-016,
170004S-017,
170004S-021

with respect to the Quality Surveillance Programme assessment regarding specialised vascular services.

May l ask the reason why you are not providing answer for these questions as affirmation also affirms that evidence documents are available on request and l have requested them?

Question 4 which maps to 170004S-016 should be most interesting as l believe you also submitted a self-assessment regarding this particular topic as well.

Yours sincerely

Mr. Kent

Dear Jane,
Thank your for your response.
With regards to my request being unclear, l believe both of my requests were/are crystal clear and in any event you could of asked for clarification if necessary as you did when enquiring as to who in NHSE had supplied information to me (that l do not know the answer to).

With regards a meeting, l think you are somewhat mistaken as you have not offered any meeting with regards to this FOI request.

You did send an offer of a meeting for my previous request, however you gave just 48 hours notice, do you honestly believe that anyone could have attended this meeting given the notice period, l think not.

One quick question, may l ask why you were even asking me as to who in NHSE provided the information regarding service indicators 170004S-001 & 170004S-002 as If you are non compliant and made mistakes then surely given the affect this may have on PATIENT SAFETY (which l am now investigating) then should your Trust not have immediately contacted NHSE providing details of this non-compliance and your action plan so they would have already known, negating this conversation?

I did ask NHSE about non-compliance and YOUR self-assessment and post part of the reply here for you:

The action taken by NHS England regional teams when a Trust has been found to be non-compliant with the requirements of the indicators described above is set out in the ‘Specialised Commissioning Standard Operating Procedure for the Annual Assessment Quality Assurance Process’ and is summarised below.

A negative return as part of the self-assessment would be considered as part of the annual surveillance process. Where a Trust reports non-compliance it would also be expected to report any action being taken to mitigate areas with a negative response. It is expected that any actions taken, or required to resolve the identified issues, will be managed through the provider organisation’s internal governance processes.

Following commissioner review a non-compliant Trust would be placed under enhanced surveillance or be subject to peer review. In either case additional action may be taken, which may be:

* Provider Action – where it is agreed the non-compliance is amenable to a short-term action plan (6/12 months), the provider will be required to submit a Service Development Improvement Plan (SDIP). This will be specified within the contract and monitored via contractual processes;

* Commissioner Action – where it is identified that the non-compliance is not amenable to a short-term action plan, the commissioner will notify the provider, within six months of the discussion, of the action that they intend to take to ensure a sustainable compliant service in the future; or

* Provider and Commissioner Action - where it is identified that the non-compliance in one service is amenable to both a short term and longer-term action plan.

Yours sincerely

Mr. Kent

Dear Jane / FOI (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

I have just received some documents sent to my personal email address, please could you remove my name and email address from these documents (that you emailed) and then post them to thread so the general public can view the result.

I will go these these shortly and provide comments.

Yours sincerely,

Mr. Kent

Dear Jane / (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

Thank you for your quick response / resending the documents that were previously sent to my personal email address to this thread thereby allowing the general public access to this information, it is appreciated.

With regards to your latest response, as much as l appreciate it, l believe you may have forgotten to include some of the requested documents. I would be grateful if you can either specify which exemptions you are using in order not to release them or as the case may be, to simply clarify if your Trust has discovered further errors in its submission negating the release of these documents?

Please find below the questions asked, your responses and my comments that either acknowledge the relevant part of the request as complete, or ask for clarification with regards to documents that appear to be missing.

1. With regards to indicator: 170004S-001- There is an agreement outlining the network configuration.
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"
I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

Your response: “As previously advised the response of ‘YES’ was an error as we are not in a formal network with Chesterfield. We work in partnership with Chesterfield. We have noted to ensure future submissions are responded as ‘NO’. We therefore do not have any evidence documents to support our response of ‘yes’ as this is an error. “

My comments: Agreed you should have responded NO to indicate non-compliance with service indicator 170004S-001 and as such you may not have had the appropriate/required documents in place at that time - Completed.

2. With regards to indicator: 170004S-005 - "There is a weekly MDT Meeting".
You stated "YES" in the self-declaration, Evidence documents: "Annual report including attendance record"
I would like electronic copies of these evidence documents/annual report including attendance record.

Nb. If you have concerns for personal information i.e. names of consultants that are not publicly listed in GMC records/web sites, your own website/NHS consultant lists etc. then you can exclude/redact the attendance record part.

Your response: “Enclosed; (3 relevant documents prefixed Item A)”.
My comments: Thank you for the 2 relevant documents (2 excluding your SD) – Completed.

3. With regards to indicator: 170004S-012 - "There is an vascular outpatient clinic"
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"
I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

Your response: “The Trust does not have individual operational policies per outpatient clinic – we will endeavour to add comments into the self-declaration to clarify that we have an overarching outpatient policy but not an individual one.”

My comments: if you have used this overarching outpatient policy as evidence to support your positive declaration then can you please provide it, as requested.

If you cannot provide the operational policy/evidence document that supported your positive declaration then can you either specify which exemption you are using in order not to release it, or can you please clarify if you also made a mistake with regards to this service indicator as otherwise I believe you should be able to produce the required/requested documents? – Pending Clarification

4. With regards to indicator: 170004S-016 - "The hospital has a policy whereby patients are managed in line with the Seven Day Services Clinical Standards policy."
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"
I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

Your response: “The Trust does not have operational policies for national standards. We will endeavour to add comments into the self-declaration to clarify that we follow the national 7 day services guidance.”

My comments: If you do not have an operational policy in place then how do your staff know what guidelines to follow? In this instance l assume you mean the Seven Day Services Clinical Standards policy (Gateway Ref – 06408), however, without this reference, policy document and/or a local copy of the aforementioned document in place then who knows?

If you cannot provide the operational policy/evidence document that supported your positive declaration then can you either specify which exemption you are using in order not to release it or can you please clarify if you also made a mistake with regards to this service indicator as otherwise I believe you should be able to produce the required/requested documents? – Pending Clarification.

5. With regards to indicator: 170004S-017 - "There are patient pathways in place"
You stated "YES" in the self-declaration, Evidence documents: "Operational policy including pathways"
I would like electronic copies of these evidence documents/operational policy that was in place/use during the time period of the self-assessment including the pathway(s) for Peripheral Arterial Disease.

Your response: “The VSQIP is the Vascular Services Quality Improvement Programme (joint venture with Vascular Society and Royal College of Surgeons) and is accessible for professionals and members of the public.
This is the web link https://www.vsqip.org.uk/
There are several reports and resources available on the website. The Trust uses the guidelines stated on the VSQIP website as default.”

My comments: I have requested to see the evidence documents/operational policies that were in place during the time period of the self-assessment including the pathway(s) for Peripheral Arterial Disease. Do you have an operational policy that direct staff to the appropriate information and/or have local copies of all of the appropriate pathways?

If you cannot provide the operational policy/evidence document that supported your positive declaration then can you either specify which exemption you are using in order not to release them, or can you please clarify if you also made a mistake with regards to this service indicator as otherwise I believe you should be able to produce the required/requested documents? – Pending Clarification.

6. With regards to indicator: 170004S-021 - "There are clinical guidelines in place"
You stated "YES" in the self-declaration, Evidence documents: "Operational policy including guidelines"
I would like electronic copies of these evidence documents/operational policy that was in place/use during the time period of the self-assessment including the guideline(s) for vascular injuries only.

Your comments: “Enclosed; (22 relevant documents prefixed Item B).”

My comments: Thank you for supplying the requested guidelines, l noticed that there are none for Chesterfield, one Spoke within your Hub and Spoke Vascular Services Model. May l ask how Chesterfield staff know which guidelines they should be following to ensure continuity of service for patients that may attend outpatient appointments across centres – do they have copies of these?

I also requested to see operational policies which appear not to have been included with your response. Without standard operational procedures/polices how would staff know what policies to adhere to/guidelines to follow when managing patients in given clinical situations or at specified points on YOUR pathway's; which as of your response to question 6 equally appear not to be in place?

If you cannot provide the operational policy that supported your positive declaration then can you either specify which exemption you are using in order not to release it or can you please clarify if you also made a mistake with regards to this service indicator as otherwise I believe you should be able to produce the required/requested documents? – Pending Clarification.

Again l thank you for your time and look forward to your response, hopefully we will be able to conclude this FOI without further ICO intervention.

Yours faithfully

Mr. Kent

Dear Jane / (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

With regards to your latest response l believe there are documents still missing in order to fulfil this request.

I would be grateful if you can either specify which exemptions you are using in order not to release them or as the case may be, to simply clarify if your Trust has discovered further errors in its submission negating the release of these documents?

Please find below the previous un-completed questions , your responses to these and my comments that either acknowledges the relevant part of the request as complete, or ask for clarification with regards to documents that appear to be missing.

3. With regards to indicator: 170004S-012 - "There is an vascular outpatient clinic"
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"
I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

Your current response: "Please see attachment 'UHDB_Patient_Access_Policy-Final_V1.2-RM-271119(2) - Q3'"
My comments: Thank you for releasing your Trusts policy in relation to indicator 170004S-012 - Completed.

4. With regards to indicator: 170004S-016 - "The hospital has a policy whereby patients are managed in line with the Seven Day Services Clinical Standards policy."
You stated "YES" in the self-declaration, Evidence documents: "Operational Policy"
I would like an electronic copy of this evidence document/operational policy that was in place/use during the time period of the self-assessment.

Your current response: "Please see attachment ‘seven-day-service-clinical-standards-september-2017 (Q4)’. The attached is what the Trust refers and responds to."

My comments: Thank you for sending me the Seven Day Services Clinical Standards policy (Gateway Ref – 06408) that l previously referred to. As l am sure you aware it contains a set of standards to be implemented/followed, some of which require governance/protocol documentation which would form part of your operational policies, aiding delivery of these services.

It is your evidence/operational policy regarding indicator 170004S-016 that supported your positive declaration that l have requested.

If you cannot provide the operational policy/evidence document that supported your positive declaration then can you either specify which exemption you are using in order not to release it or can you please clarify if you also made a mistake with regards to this service indicator as otherwise I believe you should be able to produce the required/requested documents? – Pending Clarification.
 
5. With regards to indicator: 170004S-017 - "There are patient pathways in place"
You stated "YES" in the self-declaration, Evidence documents: "Operational policy including pathways"
I would like electronic copies of these evidence documents/operational policy that was in place/use during the time period of the self-assessment including the pathway(s) for Peripheral Arterial Disease.

Your current response: "Vascular surgery is not a surgical speciality that lends itself to pathways. The training and examination process for vascular surgeons provides them with the working skills to manage very complicated scenarios which have to be bespoke for individual patients as and when the patient presents. The Vascular Society QIP and Guidance, along with other sources such as Royal College of Surgeons www.rceng.ac.uk is there for clinicians to refer to as and when; as part of keeping knowledge updated. Therefore, The Trust does not have specific operational policies in place for vascular surgery."

My comments: The service indicator 170004S-017 descriptor is quite explicit with regards to what is required and clearly states what pathways should be in place. I list a fragment of the service indicator descriptor below (relevant to my request) for your convenience.

Descriptor:
. . .

Peripheral Arterial Disease including:
- The management of acute limb ischaemia.
- The investigation and management of chronic vascular insufficiency.
- The vascular service’s contribution to the management of the diabetic foot.

The pathway should include the following specifics;
- that emergency admissions should be reviewed by a consultant vascular surgeon within 12 hours
- the arrangements for vascular service input into each of the diabetic foot teams across the network.

A patient pathway for vascular injury, including complications of angiography.
A patient pathway for emergency presentations.
The pathways should include the following specifics;
- that the initial referral regarding a vascular emergency should be directed to the vascular specialist consultant on call at the AC
- that emergencies presenting to hospitals other than the AC, deemed to require admission or urgent assessment should be transferred
to the AC unless contraindicated

- that emergencies presenting to hospitals other than the AC, who cannot be transferred should be dealt with by a vascular surgeon
working at the non-arterial Centre if available or by a visit by a vascular surgeon from the AC
- emergency transfer protocols agreed with the relevant ambulance services.

The emergency presentation pathways should be distributed to all providers in the AC catchment who admit emergencies.

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.

If you cannot provide the operational policy/evidence documents including pathways that supported your positive declaration then can you either specify which exemption you are using in order not to release them, or can you please clarify if you also made a mistake with regards to this service indicator as otherwise I believe you should be able to produce the required/requested documents? – Pending Clarification.

6. With regards to indicator: 170004S-021 - "There are clinical guidelines in place"
You stated "YES" in the self-declaration, Evidence documents: "Operational policy including guidelines"
I would like electronic copies of these evidence documents/operational policy that was in place/use during the time period of the self-assessment including the guideline(s) for vascular injuries only.

Your current response: “As stated we have a partnership arrangement with Chesterfield and are not part of a network, Chesterfield would have their own policies as a separate organisation to UHDB, please contact Chesterfield directly for their policies"

My comments: Thank you for reminding me that you had previously admitted to making mistakes on your submission with regards to service indicator 170004S-001 "There is an agreement outlining the network configuration" and service indicator 170004S-002 "There should be a single named vascular lead clinician and lead manager for the vascular network.", my apologies it had slipped my mind.
I have however requested to see your operational policy and not Chesterfield's, that supported your positive declaration/clinical guidelines..

If you cannot provide the operational policy that supported your positive declaration then can you either specify which exemption you are using in order not to release it or can you please clarify if you also made a mistake with regards to this service indicator as otherwise I believe you should be able to produce the required/requested documents? – Pending Clarification.

I hope to be in receipt of the aforementioned documents and/or clarifications if additional mistakes with your submission have been detected, then we will be able to conclude this FOI.

Yours faithfully

Mr. Kent

Dear Jane/FOI (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

May l ask if you are planning to respond and/or to provide the requested documents or clarifications?

If you do not provide an update regarding this matter by Friday 5th February 2021 then l shall assume you are not going to respond and as such will again need to contact the ICO for assistance.

Yours faithfully,

Mr. Kent

Dear Jane /FOI (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

Thank you for the update and given the current environment l do understand the difficulties.

As a side note in order to better communicate with you, could you please just clarify which Division you are referring to and the name of the clinical team involved?

I am sure Mr. Quarmby and Mr. Rowlands given their roles (as you previously disclosed) would most likely be able to assist/already know which documents supported the declarations and/or documents missing due to additional errors with the submission?

I await your confirmation on Friday 5th February 2021 as to whether your Trust is going to complete or refuse to complete this FOI.

Yours faithfully

Mr. Kent

Dear Jane / (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

With regards to your latest response you have not provided the documents requested.
You declared YES in your submission which means 100% compliance, l believe if you do not have the documentation then you should have declared NO and added comments as to why you were not 100% compliant and what steps you are taking to become fully compliant etc.

I believe NO does not mean you do not provide the services, it means you are not 100% compliant i.e missing documents and some actions are needed such as document creation (in this case maybe?).

Without all of the correct documentation and governance of service then errors could creep in and patient safety could be put at risk. YOU should have asked this question of NHS many years ago as you also declared 100% compliance in the submission before the one in question.

Either state that you made mistakes with your submission or provide the requested documents by the end of today or the ICO will be contacted as it is not my fault that your Trust cannot manage its own governance/service contracts/assessments. I am sorry but given all of the things you have said in the past about not having documents and then providing some, for all l know, this may be more of the same.

Your faithfully

Mr. Kent

Dear Jane / (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

I did not/have not received any of the requested documents advised as missing, nor have l received the exemptions that you may be applying to them, nor simple clarification that the reason for not being able to release these documents may be due to making mistakes with your submission, which would clearly explain their absence and conclude this FOI.

It is public knowledge that you declared positive responses of “YES” against the quality indicators in question, in fact to all 27 of them. I believe a positive response of “YES” is not only a declaration that you are delivering the service but also that you are 100% compliant to ALL of the requirements outlined by the associated indicator descriptor. This in turn, indicator dependant, l believe maps to relevant parts of the Specialised Vascular Services Specification (Adults) 170004/S.

In this instance delivery of service is not in question (no matter the quality), however, both governance (and safety?) of the service and ensuring staff have to hand (if needed?) documentation regarding all of the appropriate procedures, protocols & any specific pathways (and directions to those formally used by your Trust, if externally provided) are in question.

Being able to produce the required documents and/or declaring a negative response “NO” (in the assessment) would elevate this questioning as it would show that you either (on paper at least) met all the requirements (implementation of) or that you were both actively working on and/or monitoring the situation, ensuring both quality and safety of service. Having neither in my humble opinion is like burying your head in the sand hoping that no one will notice.

Your statements to all of my comments regarding the requested documents still missing are all worded such as:

"As a Trust, we clearly adhere to . . ."
"We are in conversation with NHS England (NHSE) as the indicator only allows us to enter ‘yes’ or ‘no’ and we have . . ."

My single comment is about all of yours:

It is NOT clear to me that you adhere to the requirements that the quality indicator is reporting as you have not provided the requested/required documents as of your own declaration, nor admitted mistakes were made.

As a side note, I asked via FOI every organisation that l knew of involved with auditing hospital services if any audit had been carried out against the vascular services offered by yourselves and your partner hospital “Chesterfield Royal”. To date l do not know of any such audit being completed, the only information on record regarding your vascular services are those made by yourselves?

You stated you were are in conversation with NHS England and previously explained that Mr. Quarmby's team and the Medical Director's Office were to have a meeting on Thursday 4th February 2021 about the requested documents. Given your statement of being in conversation with NHSE may l ask did they fail to explain the self-assessment process/requirements as surely a quick 15 minute conversation would have cleared things up, leaving ample time in which to respond to this request?

I must admit l am somewhat confused by the fact that you did not contact NHSE during the self-assessment if anything was unclear rather than just guessing, no matter how educated a guess?

I most likely already explained to you that NHSE had provided information to me regarding the assessment process, which seemed quite clear, you can view that FOI request here: https://www.whatdotheyknow.com/request/r...

For your convenience l have include the relevant parts below (my questions to NHSE did not ask about all 27 indicators):

"NHS England holds information relevant to this question.

The annual self-assessment requires Trusts that provide specialised vascular surgical services to say whether they have documentation that includes some of the information outlined in earlier questions. The relevant indicators are:

Indicator Code: 170004S-001 / Indicator Name: There is an agreement outlining the network configuration
Indicator Code: 170004S-017 / Indicator Name: There are patient pathways in place"

Later in their response they also provided answer regarding non-compliance i.e a NO response to an indicator:

"A negative return as part of the self-assessment would be considered as part of the annual surveillance process. Where a Trust reports non-compliance it would also be expected to report any action being taken to mitigate areas with a negative response. It is expected that any actions taken, or required to resolve the identified issues, will be managed through the provider organisation’s internal governance processes."

They go on to explain that actions taken by NHSE regional teams regarding non-compliance/negative indicator responses are contained/taken from the "Specialised Commissioning Standard Operating Procedure for the Annual Assessment Quality Assurance Process".

I wish l could provide more information for you but sadly some may say coincidently that despite asking for this document in October 2020 via FOI, l am yet to receive it or even a response regarding it. The ICO issued a decision notice regarding breach of section 10(1) of the FOIA to NSHE on the 28th January 2021: https://ico.org.uk/media/action-weve-tak....

Hopefully when l have that document, unless exempt from release, then l may be better qualified to discuss this topic further with you.

The reason l mention the above is due to your kind offer of a meeting this time without it being posted to the wrong FOI or only giving 48 hours notice in which to attend (on premises).

As l have spent two years chasing answers on this topic, may l ask what additional advice you feel would benefit me from attending such a meeting, when it appears you are not sure of your own assessment. Given all of the above then yes l would be happy to meet with you, after you have completed this FOI.

If you feel it would be beneficial for me to discuss this issue before you complete this FOi then may be Mr. Quarmby or Mr. Rowlands would like to call me to discuss this matter further.

Given my own notion of Seven Day Services l give you the weekend and until the end of Monday 8th February 2021 in which to provide adequate responses, after which l will seek the assistance of the ICO.

Yours faithfully / now On-call (including Sunday)

Mr. Kent.

Dear Jane / (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

Thank you for your update this morning advising that you had forwarded the content of my email to the Medical Directors Office and to the response just received.

You have still not provided adequate response, the requested documents as of your own declaration/submission, the exemptions that you may be applying to exclude their release and/or simple clarifications against the appropriate indicators where you may have now discovered additional mistakes with your self-assessment/submission which would explain the absence of these documents?

Until you provide adequate response then l must go by your official declaration of having the documents, if you do not have them, what is the problem in declaring that you made mistakes to conclude this FOI appropriately?

As a side note l also believe that declaring NO is important as without a negative response where appropriate then the Quality Surveillance Team will be unable to know what actions where/when appropriate to take as they would not know of any non-compliance issues etc

I also note that Mr. Quarmby nor Mr. Rowlands called to discuss this matter, although l am sure this was due to being busy with patients, their primary concern, which is to be expected, but neither did l receive any additional information regarding the offered meeting from your Trust/Medical Directors Office so l guess in hindsight you feel it may not be too beneficial?

At present given that you have not admitted DIRECTLY to additional errors in your submission which would explain the absence of the requested documents then at present there can not be any mistakes and as such you must have the documents as of your own declaration, l am sure you can see the dilemma.

As another side note, in the past when l spoke with the Specialised Commissioning Team and explained that l felt you did not have the required documents they advised that you must have given your 100% compliance, and explained that l should contact you in order to see them (which is what l have done). Given 100% compliance in your self-assessments may be one reason/explain why nobody had brought it to your attention why would they, you advised as being 100% compliant?

With regards to getting in touch with NHSE/Specialised Commissioning Team, l had no problem and the commissioning team gave me mobile numbers in order to contact them, do you not have them?

ICO contacted as advised.

Yours faithfully

Mr. Kent

Dear FOI (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

I cannot release to you mobile numbers as l do think that prudent on a public forum, but the information below is in the public domain (from the NHS Website)

NHS Midlands
Specialised Commissioning
Fosse House
6 Smith Way
Grove Park
Enderby
Leicester
LE19 1SX

Tel: 0116 206 0185

Yours faithfully

Mr. Kent

Dear Jane / FOI (UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST),

Thank you for your response.

There is something you can do, you can release the requested documents, those that are detailed in the indicator descriptor that you gave a positive response to, thus declaring compliance, thus you must have them (unless mistakes were made).

As l have explained if you do not have them, the reason can only be that you should not have declared as having them a mistake in your submission perhaps. All that is needed to conclude this FOI is just acknowledgement/clarification against the indicators in question that you have found mistakes in your submission i.e. you should have declared NO instead of Yes as you do not meet all of the indicator requirements, which in this case is operational policies/pathways.

You have some more time to reflect on this as l have had to issue a new complaint to the ICO given a decision notice had already been issued.

Yours faithfully,

Mr. Kent