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