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
SCG Collaborative NHS Trust
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
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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
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
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Draft standards

1. Network approach
2. Prenatal screening
3. Making choices
4. Patient and family experience
5. Access to services
6. Age appropriate care
7. Excellent care
8. Team delivered
9. 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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