Impact of centralisation on vascular surgical services

Studies showing a volume-outcome relationship in vascular surgery have led to a drive towards centralization of vascular surgical services. This has led to these services being transferred from the district general hospital (DGH) to a central 'network' hospital. An unintended consequence of this is that the tariff funding stays with the operating hospital. Patients who are transferred back to the DGH for rehabilitation following treatment at the network hospital do not receive funding to cover their inpatient stay. We present data showing that since centralisation there has been a drop in overall income in a DGH along with sicker patients being repatriated. These patients also stay longer. This has implications for funding of rehabilitation tariffs and fo rthe viability of district general vascular services.