Safe and Sustainable Paediatric Cardiac Surgery Services Programme

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Safe and SustainablePaediatric Cardiac Surgery
Services Programme
Jeremy Glyde Programme Manager NHS National
Specialised Commissioning Team
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Scope

• paediatric surgical services
• paediatric interventional cardiology services
• interdependent services
• in England

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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

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• 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

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NHS Levels of 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)

National NCG
Supra-Regional Specialised Commissioning Groups
Regional Specialised Commissioning Group
Local (PCT)
Practice Practice-based commissioning
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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

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Safe and SustainablePaediatric Cardiac Surgery
Services

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Why Now?

• Sub-specialisation within field of surgery
• Training and mentoring in surgical teams
• Working time legislation (limits hours)
• Critical mass of procedures

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Why now?

• Difference in surgical procedures (largest centre
  measured against smallest centre)
• 2002/03 434 procedures
• 2007/08 496 procedures

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Steering Group membership

• Childrens 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

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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.

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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

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• Who makes the recommendations?

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SCG Collaboratives
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The recommendations

• Recommendations and viable options for change
• Assessment of the options
• Impact to other services?
• Evidence base
• Financial case
• Implementation strategy
• Consultation strategy

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Key project milestones
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Draft standards

• Network approach
• Prenatal screening
• Making choices
• Patient and family experience
• Access to services
• Age appropriate care
• Excellent care
• Team delivered
• Safe and sustainable

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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

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Nationally designated childrens 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)

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NCG membership

• Lay representation
• Presidents of Royal Colleges of
• Paediatrics
• Pathologists
• Physicians
• Psychiatrists
• Surgeons

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