Coventry and Warwickshire Cardiovascular Network'' Adding Value

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Coventry and Warwickshire Cardiovascular
Network..Adding Value

• Rachael Rowe
• Cardiac Network Director

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Networks are

• A means by which a set of autonomous
  organisations interested in doing something about
  an issue can work together across boundaries to
  do something that a single person or organisation
  could not achieve in isolation.
• Cardiac networks combine clinical expertise with
  service redesign to transform care for patients

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National Perspective

• 28 cardiovascular/heart and stroke networks in
  England
• All cardiac networks assessed as fit for purpose
  in 2005
• CHD Collaborative merged with the networks in
  April 2005
• Following SHA Hosted programmes review funding
  to 2010
• Developing a vascular focus
• Now a cardiovascular network

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Coventry and Warwickshire Cardiac Network Vision

• Everyone in Coventry and Warwickshire
• will receive the highest level of
• cardiovascular care

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Organisations within Coventry and Warwickshire
Cardiovascular Network

• Warwickshire PCT (Host)
• George Eliot NHS Trust
• Coventry (Teaching) PCT
• University Hospitals Coventry and Warwickshire
  NHS Trust

• South Warwick Hospitals NHS Trust
• West Midlands Ambulance Service NHS Trust
  (Coventry and Warwickshire Locality)
• Coventry University
• PBC Consortia

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We are here to.

• Improve cardiovascular care for patients
• Develop evidence based care pathways
• Look at inequity across Coventry and Warwickshire
• Advise on commissioning and policy development
• Get things done quickly and efficiently
• Promote a shared way of working
• Add value and return on investment
• Networks are developed around patient pathways

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Network Structure
Strategic Health Authority
Coventry and Warwickshire Joint Commissioning
Board
Coventry and Warwickshire CardioVascular Network
Board
Local Specialised Commissioning Board
Network Commissioning Advisory Group
Stroke Strategy Group
Patient and Public group
Cardiac working groups
Practice Based Commissioning
Bespoke working groups
Bespoke Working Groups
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Who is in the network ?

• YOU!
• People who work in health care organisations in
  Coventry and Warwickshire and patients and the
  public

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Whos Who in the core team

• David Rose- Chief Executive
• Rachael Rowe- Network Director
• Dr Martin Been Clinical Lead
• Dr Anthony Kenton- Clinical Lead

• Juelene White- Service Improvement Manager
• Dr Padma Bhakta-Service Improvement Manager
• Teri Abbott- Network Administrator
• Peggy Coleman- project lead
• 1 vacancy

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Network priorities

• Sustainable patient pathways
• Patient and public involvement
• Reducing length of stay and preventing admissions
• Stroke
• Heart Failure
• Arrhythmias
• Emergency cardiac care
• Cardiac Rehabilitation
• Prevention

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Overview

• Portfolio of 30 projects within the team and
  externally managed
• Average of 40 50 requests for help and support
  each month
• Changing priorities relating to local, regional
  and national policy development

• Collaborated on 4 national projects and 2
  university collaborations
• Collaborating with other networks on several
  projects
• Developing a cost and resource saving programme
  with recorded benefits realisation

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The challenges of 2007

• All organisations in Coventry and Warwickshire
  were in financial turnaround
• Reconfiguration of PCTs and change of host
• National and local reviews of networks
• Inability to recruit to vacant posts

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KEY ACHIEVEMENTS IN 2007/08
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Opportunities of 2007/08

• The network began working with stroke
• Stronger links to commissioning via specialist
  team and practice based consortia
• Project leads for cardiovascular change in all
  practice based commissioning consortia
• Developing a commissioning network fcus
• Registered NICE stakeholders
• Links formed to WM Workforce Deanery
• Team centralised in Warwick

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Developing Sustainable Pathways

• Commissioning of a community based heart failure
  diagnostic service
• Pathway included BNP and community echo service
• 200 outpatient appointments prevented

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Acute Stroke

• A redesigned and recommissioned stroke pathway
  for acute stroke care in Coventry and
  Warwickshire that enables everyone to access an
  acute stroke unit, CT scanning and thrombolysis
  where appropriate on a 24 hour basis
• Acute stroke pathway being presented as part of
  the West Midlands SHA Vision of the Darzi Review
• Network is advising 15 other networks/
  commissioning teams on the pathway and process

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Acute Stroke

• A FAST bus poster campaign on buses in
  Coventry,Nuneaton and Leamington Spa
• Poster campaign spread to Black Country

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Chest Pain

• Network Wide distribution of heart attack cards
  to GP practices, libraries
• Radio interviews and press releases about chest
  pain and the importance of ringing 999

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Patient and Public Involvement

• 3 PPI workshops with stroke survivors and
  organisations to advise on the stroke pathway
• Patients working with the network on AF pathway
• Hosted a BHF Hearty Voices Programme
• Patient information leaflets on heart surgery and
  cardioversion produced
• Worked with the Nuneaton and Bedworth
  Multicultural centre to advise on healthy eating

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Reducing length of stay

•   Inter hospital transfer rates maintained to a
  minimum, saving 100-200k in resources for
  Warwickshire, Worcestershire and East Birmingham
  commissioners.
• Bed days for primary angioplasty patients reduced
  by 1 day on average in Coventry and Rugby
  compared to thrombolysed patients saving 35k in
  2007

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Primary Angioplasty

• Now running an 8am-8pm service for Coventry and
  Rugby
• Expanding to 24/7 for Coventry and Warwickshire
  in 2008
• Reduced length of stay for heart attack patients
  and less complications

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Arrhythmia Services

• Plans to develop a cardiac arrhythmia service in
  Coventry and Warwickshire
• Reviewing ICD pathways to develop a local service
• Standardising atrial fibrillation- national pilot
• Working on near patient testing for
  anticoagulation
• Redesigned cardioversion pathway

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Community first responders

• Working with a team of security guards and
  cleaners in a Nuneaton Shopping Centre to become
  community defibrillator responders
• Network team will become defibrillator responders
  in June 2008!

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Some of the added value

• 200 outpatient appointments saved
• 80 avoided arrhythmia admissions
• Shorter stays for PPCI
• Minimal inter hospital transfer times

• Organisations supported in meeting Standards for
  Better Health
• Sharing of good practice across networks
• INTRODUCING LIFE SAVING TREATMENT AND PREVENTING
  LONG TERM DISABILITY

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Next Steps

• Strengthening the stroke programme
• STROKE STRATEGY DAY- 8 July 2008
• Redesigning stroke rehabilitation
• Reviewing and redesigning arrhythmia and heart
  failure pathways with practice based
  commissioning

• Implementing CT scanning within Rapid access
  chest pain pathways
• Repatriating arrhythmia device activity
• Supporting PCTs with World Class Commissioning
• Prevention programme in targeted at risk
  population

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What would you like to see the network doing?

• Rachael.rowe_at_warkpct.nhs.uk
• 01926493491 ext 397