Transcript Safe and Sustainable Paediatric Cardiac Surgery Services

Safe and Sustainable
Paediatric Cardiac Surgery
Services Programme
Jeremy Glyde
Programme Manager
NHS National Specialised Commissioning Team
Scope
paediatric surgical services
 paediatric interventional cardiology
services
 interdependent services

… in England
Previous Reviews and Recommendations

Kennedy Report, 2001 (the Bristol Royal
Infirmary Inquiry)

Paediatric and Congenital Cardiac Services
Review Group, 2003 (the Monro report)

Professor Boyle and Dr Shribman workshop,
2006
“I am writing formally to request that
the National Specialised
Commissioning Group undertake a
review of the provision of paediatric
cardiac surgical services in England
with a view to reconfiguration”.
Professor Sir Bruce Keogh
NHS Medical Director
May 2008
NHS Levels of Commissioning
National
NCG
Supra-Regional
Specialised
Commissioning Groups
Regional
Specialised Commissioning
Group
Local
(PCT)
Practice
Practice-based
commissioning
National Specialised
Commissioning Group
Examples
• Transplants (except renal)
• Rare cancers
• Rare neuro-muscular
50 million people
• Paediatric cardiac/neuro-surgery
• Severe burn care
• Cleft lip & palate
5 – 50 million people
• Children & young peoples’ cancers
• Haemophilia
• Renal transplants
1 – 5 million people
• General acute medicine/surgery
(e.g. hip replacements)
100,000 – 1 million people
• Minor surgery
• Endoscopies
• District nursing
Less than 100,000 people
NSCG membership

Chaired by Chief Exec of London SHA

Chairs of 10 SCGs (Chief Execs of PCTs)

Lay representation

Department of Health

President, Royal College Pathologists

President, Royal College Physicians

Chair of National Commissioning Group

Director, National Specialised Commissioning

Observers from Scotland / Wales / NI
Safe and Sustainable
Paediatric Cardiac Surgery
Services
Why Now?

Sub-specialisation within field of surgery

Training and mentoring in surgical teams

Working time legislation (limits hours)

Critical mass of procedures
Why now?
Difference in surgical procedures
(largest centre measured against
smallest centre)
2002/03 = 434 procedures
2007/08 = 496 procedures
Steering Group membership

Children’s Heart Federation

British Congenital Cardiac Association

Association of Cardiothoracic Anaesthetists

Society for Cardiothoracic Surgery in Great Britain
and Ireland

Royal College of Paediatrics and Child Health

Paediatric Intensive Care Society

NHS commissioners

NHS in Scotland and Wales

NHS public health doctors
Principles

The NHS must provide only the very highest
standard of care for children and their families,
regardless of where they live or which hospital
provides their care.

Centres should provide care that is based
around the needs of the child and the family and
which takes account of the transition to adult
services.

All relevant treatment other than surgery,
including follow up, should be provided as locally
as possible to the family.

Clinical standards should be agreed and met by
all centres.
Terms of Reference

Develop criteria for the designation of specialist
paediatric congenital cardiac services

Agree a national quality framework via clinical
standards for paediatric congenital cardiac services

Identify and address the financial and workforce
implications of service reconfiguration

Identify cross boundary issues facing service
provision for the devolved administrations that are
affected by commissioning decisions in England

Who makes the recommendations?
SCG Collaboratives
SCG
NHS Trust
Collabor
ative
Northern Zone
1. The Newcastle-Upon-Tyne Hospitals NHS
Foundation Trust
2. Leeds Teaching Hospitals NHS Trust
3. Alder Hey Children's NHS Foundation Trust
Midlands Zone
4. University Hospitals of Leicester NHS Trust
5. Birmingham Children's Hospital NHS
Foundation Trust
South Eastern
Zone
6. Great Ormond Street Hospital For Children
NHS Trust
7.Royal Brompton & Harefield NHS Trust
8.Guy's And St Thomas' NHS Foundation Trust
South Western
Zone
9. Oxford Radcliffe Hospital NHS Trust
10. University Hospitals Bristol NHS Foundation
Trust
11. Southampton University Hospitals NHS Trust
The recommendations
Recommendations and viable options
for change
 Assessment of the options
 Impact to other services?
 Evidence base
 Financial case
 Implementation strategy
 Consultation strategy

Key project milestones
Draft standards circulated for comment
Sep 09
National stakeholder event
Oct 09
Final version of standards circulated
Nov 09
Assessment of centres against standards
Jan 10
SCGs submit recommendations
Jul 10
NHS Management Board considers
recommendations
Jul 10
Public consultation begins
Sep 10
Implementation of recommendations?
Jan 11
Draft standards
1.
2.
3.
4.
5.
6.
7.
8.
9.
Network approach
Prenatal screening
Making choices
Patient and family experience
Access to services
Age appropriate care
Excellent care
Team delivered
Safe and sustainable
How can you get involved?
CHF Federation Day 12/09/09
 Ipsos MORI survey
 NHS Stakeholder Event 22/10/09
 Comment on draft standards
 Talk to us ....
 Write to us ....


www.nscg.nhs.uk
Nationally designated children’s
services (cardiothoracic)

Heart and lung transplantation (2 centres)

Mechanical bridge to heart transplant (2 centres)

ECMO for respiratory failure (3 centres)

Pulmonary hypertension (1 “hub” centre and
6 regional centres)

Complex tracheal (1 centre)
NCG membership
Lay representation
Presidents of Royal Colleges of:
 Paediatrics
 Pathologists
 Physicians
 Psychiatrists
 Surgeons