Meeting Overview
To mark the end of Vascular Awareness Month, the VVAPPG hosted an open meeting to discuss the CQUIN indicator: Achievement of revascularisation standards for lower limb ischaemia. The meeting was hosted by the APPG’s Chair Jim Shannon and included a presentation by Jonathan Boyle, President of the Vascular Society of Great Britain and Ireland, on the background, aims and objectives, and examination of success to date of the CQUIN that has been running this year. The meeting facilitated a conversation between healthcare professionals, representatives of industry, and policy makers on the success of the CQUIN in improving quality standards and the benefits of having a continued focus on this important area of medicine.
Agenda
Introduction from Secretariat
Welcome remarks from Jim Shannon MP, Chair, VVAPPG
Discussion on the CQUIN, Jonathan Boyle, President, Vascular Society of Great Britain and Ireland
The background of the CQUIN and its introduction
The aims and objectives of the CQUIN
Current awareness within clinical community
Uptake and adherence
Examination of success to date
Next steps with the CQUIN
Break and departure of Jim Shannon MP
Questions from the floor and open discussion on the CQUIN, including gathering feedback from stakeholders
Closing remarks from Secretariat
Meeting closed
Event Summary
Presentation on the CQUIN from Jonathan Boyle, President of the Vascular Society of Great Britain and Ireland
Jonathan provided an overview of the background to the development of the CQUIN, including the Getting it Right First Time programme, and the attempt to remove unwarranted variation in care.
He noted that the 2018 GIRFT report on vascular disease highlighted variation in practice around lower limb ischaemia, and sought to increase availability of revascularisation and improve case ascertainment for lower limb procedures.
Jonathan discussed the PAD-QIF, which was written in 2018/19 by the Vascular Society along with a team including external stakeholders, patients, and specialists. Based on the feedback from the document, an application was submitted for the CQUIN.
The PADQIF focused on patients admitted with emergency critical limb ischaemia (CLI), and aimed to ensure that treatment was delivered as early as possible. Based on the fact that the earlier you treat patients, the more likely they are to keep their affected limb, the target for treatment was set as 5 days.
Targets were also set at a rate which was achievable, otherwise units would be unlikely to engage with the framework and deliver against its aims.
The benefits of the CQUIN have included reduced mortality; reduced major amputations; raising awareness and an increased focus within Hospital leadership on vascular disease and people who are at risk of losing limbs; and improving the understanding of the need to submit correct HES and NVR data.
Jonathan showed some evidence using NVR to show that treatments were taking place more quickly, in general, suggesting that the PADQIF and the CQUIN have had an impact on increasing the number of patients who have been seen quicker.
He also used HES data to demonstrate the Trusts which have been performing particularly well following the introduction of the CQUIN and the PADQIF.
There is clear evidence that delaying re-vascularisation leads to worse outcomes for patients, longer stays in hospital, more amputations, and more deaths. As well as changes to the way that Trust leadership thinks about the importance of vascular surgery, the 5 day target has had a significant impact on improving outcomes for patients.
Jonathan discussed applying for the CQUIN for 2022/23, and the potential benefits of having a continued focus on this important area of medicine.
The event included Q&A. Details available on request