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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. - PowerPoint PPT Presentation
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Safe and SustainableSafe and SustainablePaediatric Cardiac Paediatric Cardiac Surgery Services Surgery Services
ProgrammeProgramme
Jeremy GlydeJeremy GlydeProgramme Manager Programme Manager
NHS National Specialised Commissioning TeamNHS National Specialised Commissioning Team
ScopeScope
paediatric surgical servicespaediatric surgical services paediatric interventional paediatric interventional
cardiology services cardiology services interdependent servicesinterdependent services
… … in Englandin England
Previous Reviews and RecommendationsPrevious Reviews and Recommendations
Kennedy Report, 2001 (the Bristol Royal Kennedy Report, 2001 (the Bristol Royal Infirmary Inquiry)Infirmary Inquiry)
Paediatric and Congenital Cardiac Services Paediatric and Congenital Cardiac Services Review Group, 2003 (the Monro report)Review Group, 2003 (the Monro report)
Professor Boyle and Dr Shribman Professor Boyle and Dr Shribman workshop, 2006 workshop, 2006
““I am writing formally to request that I am writing formally to request that the National Specialised the National Specialised Commissioning Group undertake a Commissioning Group undertake a review of the provision of review of the provision of paediatric cardiac surgical services paediatric cardiac surgical services in England with a view to in England with a view to reconfigurationreconfiguration”. ”.
Professor Sir Bruce KeoghProfessor Sir Bruce KeoghNHS Medical DirectorNHS Medical DirectorMay 2008May 2008
National NCG
Supra-Regional Specialised
Commissioning Groups
Regional Specialised Commissioning
Group
Local(PCT)
PracticePractice-based commissioning
Examples• Transplants (except renal)• Rare cancers• Rare neuro-muscular50 million people
• Paediatric cardiac/neuro-surgery• Severe burn care• Cleft lip & palate5 – 50 million people
• Children & young peoples’ cancers• Haemophilia• Renal transplants1 – 5 million people
• General acute medicine/surgery(e.g. hip replacements)
100,000 – 1 million people
• Minor surgery• Endoscopies• District nursingLess than 100,000 people
National SpecialisedCommissioning Group
NHS Levels of Commissioning
NSCG membershipNSCG membership
Chaired by Chief Exec of London SHAChaired by Chief Exec of London SHA
Chairs of 10 SCGs (Chief Execs of PCTs)Chairs of 10 SCGs (Chief Execs of PCTs)
Lay representationLay representation
Department of HealthDepartment of Health
President, Royal College PathologistsPresident, Royal College Pathologists
President, Royal College PhysiciansPresident, Royal College Physicians
Chair of National Commissioning GroupChair of National Commissioning Group
Director, National Specialised CommissioningDirector, National Specialised Commissioning
Observers from Scotland / Wales / NIObservers from Scotland / Wales / NI
Safe and Safe and SustainableSustainablePaediatric Cardiac Paediatric Cardiac Surgery ServicesSurgery Services
Why Now?Why Now?
Sub-specialisation within field of surgerySub-specialisation within field of surgery
Training and mentoring in surgical teamsTraining and mentoring in surgical teams
Working time legislation (limits hours)Working time legislation (limits hours)
Critical mass of proceduresCritical mass of procedures
Why now?Why now?
Difference in surgical procedures Difference in surgical procedures (largest centre measured against (largest centre measured against smallest centre)smallest centre)
2002/03 = 434 procedures2002/03 = 434 procedures
2007/08 = 496 procedures2007/08 = 496 procedures
Steering Group Steering Group membershipmembership
Children’s Heart FederationChildren’s Heart Federation British Congenital Cardiac AssociationBritish Congenital Cardiac Association Association of Cardiothoracic Anaesthetists Association of Cardiothoracic Anaesthetists Society for Cardiothoracic Surgery in Great Society for Cardiothoracic Surgery in Great
Britain and IrelandBritain and Ireland Royal College of Paediatrics and Child Health Royal College of Paediatrics and Child Health Paediatric Intensive Care SocietyPaediatric Intensive Care Society NHS commissioners NHS commissioners NHS in Scotland and WalesNHS in Scotland and Wales NHS public health doctorsNHS public health doctors
PrinciplesPrinciples
The NHS must provide only the very The NHS must provide only the very highest standard of care for children and highest standard of care for children and their families, regardless of where they their families, regardless of where they live or which hospital provides their care.live or which hospital provides their care.
Centres should provide care that is based Centres should provide care that is based around the needs of the child and the around the needs of the child and the family and which takes account of the family and which takes account of the transition to adult services.transition to adult services.
All relevant treatment other than surgery, All relevant treatment other than surgery, including follow up, should be provided as including follow up, should be provided as locally as possible to the family.locally as possible to the family.
Clinical standards should be agreed and Clinical standards should be agreed and met by all centres.met by all centres.
Terms of ReferenceTerms of Reference
Develop criteria for the designation of specialist Develop criteria for the designation of specialist paediatric congenital cardiac servicespaediatric congenital cardiac services
Agree a national quality framework via clinical Agree a national quality framework via clinical standards for paediatric congenital cardiac standards for paediatric congenital cardiac servicesservices
Identify and address the financial and workforce Identify and address the financial and workforce implications of service reconfigurationimplications of service reconfiguration
Identify cross boundary issues facing service Identify cross boundary issues facing service provision for the devolved administrations that provision for the devolved administrations that are affected by commissioning decisions in are affected by commissioning decisions in EnglandEngland
Who makes the Who makes the recommendations?recommendations?
SCG CollaborativesSCG Collaboratives
SCG SCG CollaborCollaborativeative
NHS TrustNHS Trust
Northern Zone 1. The Newcastle-Upon-Tyne Hospitals NHS Foundation Trust
2. Leeds Teaching Hospitals NHS Trust3. Alder Hey Children's NHS Foundation Trust
Midlands Zone 4. University Hospitals of Leicester NHS Trust5. Birmingham Children's Hospital NHS
Foundation Trust
South Eastern Zone
6. Great Ormond Street Hospital For Children NHS Trust
7.Royal Brompton & Harefield NHS Trust8.Guy's And St Thomas' NHS Foundation Trust
South Western Zone
9. Oxford Radcliffe Hospital NHS Trust10. University Hospitals Bristol NHS Foundation
Trust11. Southampton University Hospitals NHS Trust
The recommendationsThe recommendations
Recommendations and viable Recommendations and viable options for changeoptions for change
Assessment of the optionsAssessment of the options Impact to other services?Impact to other services? Evidence baseEvidence base Financial caseFinancial case Implementation strategyImplementation strategy Consultation strategyConsultation strategy
Key project milestonesKey project milestones
Draft standards circulated for commentDraft standards circulated for comment Sep Sep 0909
National stakeholder eventNational stakeholder event Oct Oct 0909
Final version of standards circulatedFinal version of standards circulated Nov Nov 0909
Assessment of centres against standardsAssessment of centres against standards Jan 10Jan 10
SCGs submit recommendationsSCGs submit recommendations Jul 10Jul 10
NHS Management Board considers NHS Management Board considers recommendationsrecommendations
Jul 10Jul 10
Public consultation beginsPublic consultation begins Sep Sep 1010
Implementation of recommendations?Implementation of recommendations? Jan 11Jan 11
Draft standardsDraft standards
1.1. Network approachNetwork approach
2.2. Prenatal screeningPrenatal screening
3.3. Making choicesMaking choices
4.4. Patient and family experiencePatient and family experience
5.5. Access to servicesAccess to services
6.6. Age appropriate careAge appropriate care
7.7. Excellent careExcellent care
8.8. Team deliveredTeam delivered
9.9. Safe and sustainableSafe and sustainable
How can you get How can you get involved?involved?
CHF Federation Day 12/09/09CHF Federation Day 12/09/09 Ipsos MORI surveyIpsos MORI survey NHS Stakeholder Event 22/10/09NHS Stakeholder Event 22/10/09 Comment on draft standardsComment on draft standards Talk to us ....Talk to us .... Write to us ....Write to us ....
www.nscg.nhs.ukwww.nscg.nhs.uk
Nationally designated Nationally designated children’s services children’s services
(cardiothoracic)(cardiothoracic) Heart and lung transplantation (2 centres)Heart and lung transplantation (2 centres)
Mechanical bridge to heart transplant (2 Mechanical bridge to heart transplant (2 centres)centres)
ECMO for respiratory failure (3 centres)ECMO for respiratory failure (3 centres)
Pulmonary hypertension (1 “hub” centre Pulmonary hypertension (1 “hub” centre and and 6 regional centres)6 regional centres)
Complex tracheal (1 centre)Complex tracheal (1 centre)
NCG membershipNCG membership
Lay representationLay representation
Presidents of Royal Colleges of: Presidents of Royal Colleges of: PaediatricsPaediatrics PathologistsPathologists PhysiciansPhysicians PsychiatristsPsychiatrists SurgeonsSurgeons