Review of Children’s Congenital Cardiac Services in England
description
Transcript of Review of Children’s Congenital Cardiac Services in England
Review of Children’s Congenital Cardiac Services in England
Safe and Sustainable
1
Principles of the Review
The NHS must provide only the very highest standards 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, including 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
2Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Standards
A set of national standards has been developed as part of this review
The standards were developed in partnership with healthcare professionals, parents and patient groups and are endorsed by professional associations and national patient groups
There are over 150 standards and they stand at the heart of the review aiming to achieve the best possible care and outcomes for children
3Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Children’s Heart Surgery Centres in England
1. The Newcastle-Upon-Tyne Hospitals NHS Foundation Trust
2. Leeds Teaching Hospitals NHS Trust3. Alder Hey Children's NHS Foundation
Trust4. University Hospitals of Leicester NHS
Trust5. Birmingham Children's Hospital NHS
Foundation Trust6. Great Ormond Street Hospital For Children
NHS Trust7 Royal Brompton & Harefield NHS Trust8 Guy's And St Thomas' NHS Foundation
Trust9. Oxford Radcliffe Hospital NHS Trust10. University Hospitals Bristol NHS
Foundation Trust11. Southampton University
Hospitals NHS Trust4Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in
England, October 2010
Devolved Administrations
The review does not include Scotland and Northern Ireland but representatives of these administrations were invited to the steering group
Wales is materially affected, but the Welsh NHS has decided to have observer status in the review. Safe and Sustainable will fully consult with the Welsh population
5Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Why is there a need for the review?
Experts are concerned that smaller centres are not sustainable into the future and cannot provide the best possible care
Services have developed on an ad-hoc basis and as a result the current care pathway does not deliver the best possible care for children and their families
To ensure the national standards are met and the best service is delivered
6Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How could the service be improved?
Of the 11 heart surgery centres in England some have fewer than four paediatric surgeons. This means that in some centres there will be times when a surgeon is not available to deal with routine cases or with emergencies
We need enough surgeons in each centre to meet the day-to-day demands of each centre, these include:
Being on call for emergencies Undertaking ward rounds Running outpatient clinics Training Annual Leave
7Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Risks of Current Staffing Levels
Smaller centres may not see the same volume and variety of caseload that colleagues in a larger centre will see
A significant risk of smaller centres with fewer staff is that there may be times when cardiac surgery teams are not available. This can result in:
Lack of 24/7 care Small case loads Occasional practice Cancelled operations Low availability of staff in emergencies
8Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
The need for review
Surgeon Surgical
numbers (2009) procedures (2007)
Newcastle 2 244
Leeds 3 290
Liverpool 4 380
Birmingham 3 464
Leicester 3 201
Bristol 2 285
Oxford 1 130
GOSH 4 516
Brompton 4 414
Evelina 3 368
Southampton 2 227
The new standards require a minimum of 4 surgeons in each centre, each performing a minimum number of surgical procedures each year to maintain their expert skills.
Experts agree that surgeons should each be performing 100 to 125 procedures per year.
This suggests that each centre should be performing 400 to 500 procedures a year.
9Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Who says we need change?
The 2001 Kennedy public enquiry into deaths at the Bristol Royal Infirmary recommended that quality standards be developed for children’s heart surgery centres and that there be fewer, larger centres of expertise
The Monro Review (2003) recommended fewer centres, but this recommendation was not implemented
The Summit of experts (2006) concluded that the current configuration of child heart surgery services was not sustainable and called for fewer centres
The Royal College of Surgeons (2007) report ‘Delivering a First Class Service’ also called for fewer, larger cardiac surgery centres
The National Clinical Advisory Team (2010) reviewed the Safe and Sustainable ‘case for change’ and endorsed the need for fewer cardiac surgery centres
10Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Who says we need change?
All of these organisations have expressed public support for the rationale for change:
Royal College of SurgeonsSociety of Cardiothoracic Surgery in Great Britain and IrelandRoyal College of Paediatrics & Child Health Royal College of NursingBritish Congenital Cardiac AssociationChildren’s Heart Federation Specialised Healthcare AlliancePaediatric Intensive Care Society Council
11Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How will children benefit?
Surgeons, nurses and wider clinical teams should learn from each other. We also need to think about the next generation of clinicians so that the services are sustainable in the years to come
Working in teams exposes junior surgeons to the full range of surgical techniques necessary to deal with the complex and varied caseload of congenital heart disease
Surgeons, nurses and clinicians need to deal with a sufficient volume and range of complex operations if they are to offer a truly excellent and comprehensive service
12Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How will children benefit?
Surgeons should be operating together on rare or complex cases
Smaller centres struggle to recruit and retain surgeons, as naturally they will want to work in centres that give them exposure to a large range of procedures
This will ensure that the services we deliver are fit for the future
13Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
What are the benefits for children and families?
Improved diagnostic services and follow up treatment delivered as close to home as possible
Better access to 24/7 care
Better access to surgical centres with expertise in complex procedures
Better clinical outcomes (mortality and morbidity)
Stronger communication between services and parents
14Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
What are the benefits for children and families?
Surgeons will mentor and learn from each other
An effective network that improves planning, delivery and communication
Strengthened Specialist Children’s Liaison Team
A national network of surgical centres collaborating in the interests of patients
NHS workforce that is highly trained and expert
15Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
What Will Change Look Like?
Fewer, larger centres of excellence providing surgery A minimum of four consultant congenital cardiac surgeons at each centre Enough doctors and nurses to provide 24/7 care for children and parents A minimum of 400 paediatric heart surgeries per centre each year Ideally 500 paediatric heart surgeries will take place each year at each
centre The tertiary surgical centres will provide clinical leadership throughout their
networks Better training for surgeons and their teams to ensure the sustainability of
the service
The location of children’s heart surgery centres cannot be ‘local’ to all people in England. However, services that don’t involve surgery or interventional procedures can be provided more locally.
16Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
What Will Change Look Like?
Our vision is a network of linked hospitals working together, pooling expertise and experience to ensure the best results for children and young people.The new model aims to deliver better and more consistent care for children and young people with heart disease. Continual review will ensure the service provides the best care and support for parents and their childrenThe new service will strengthen the delivery of assessment and follow up care in local hospitals so that children and families do not have to travel long distances Current surgical centres that are not recommended for designation under Safe and Sustainable will become specialist paediatric cardiology centres, though not providing interventional servicesA network of specialist centres collaborating in research and clinical development, encouraging the sharing of knowledge across the network
17Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
The new model aims to deliver better and more consistent care for children and young people with congenital heart disease. Continual review will ensure the service provides the best care and support for parents and their children
18Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Will larger centres produce better outcomes?
Yes - research carried out by independent experts found evidence that suggests a link between larger centres and better clinical outcomes
The research evidence on which Safe and Sustainable relies is published at www.specialisedservices.nhs.uk
19Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Governance
A Joint Committee of Primary Care Trusts (JCPCT) is responsible for producing recommended options for a new national service and making a final decision following the public consultation
‘The governance structure has been robust and fit for purpose …
great care has been taken to consider the most suitable governance
vehicle and a joint committee of PCTs is being specially established
… NHS Operations Board and Secretary of State for Health
endorsement has been secured for this approach … NHS Specialised
Services is commended for this ground-breaking work’Office Government Commerce ‘Gateway’ report on Safe and Sustainable (September 2010)
Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
20
Joint Committee PCT (JCPCT) Membership
Chaired by Sir Neil McKay, Chief Executive of East of England SHA
Chairs of 10 SCGs (Chief Executives of PCTs)
Teresa Moss, Director NHS Specialised Services
The National Assembly for Wales and Welsh Health Specialised Services Committee were invited to join the JCPCT and have elected to take observer status to ensure the continued consideration of the interests of the population of Wales
21Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Role of the Steering Group
Develop and communicate the clinical ‘Case for Change’ Consider the available research evidence around the relationship
between larger surgical centres and clinical outcomes Develop clinical standards that surgical centres must meet in the
future Develop a proposed model of care for regional paediatric cardiology
networks Oversee stakeholder engagement and communication Endorse the process for the assessment of the current surgical
centres The steering group provides advice to the JCPCT about the clinical
viability of potential options
22Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Steering Group MembershipChildren’s Heart Federation and lay representationBritish Congenital Cardiac AssociationAssociation of Cardiothoracic Anaesthetists Society for Cardiothoracic Surgery in Great Britain and IrelandRoyal College of Paediatrics and Child Health Paediatric Intensive Care SocietyRoyal College of NursingNHS Commissioners NHS Strategic Health AuthoritiesNHS Public Health DoctorsNHS in Scotland and Wales
Dr Patricia Hamilton is Chair of the Steering Group and is Immediate Past President of the Royal College of Paediatrics and Child Health. Dr Patricia Hamilton sits on the JCPCT in an advisory capacity.
23Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
24
Expert Review Panel
The expert review panel that visited the 11 centres in May comprised:
Chair Professor Sir Ian KennedyLay Maria Von HildebrandSurgery Mr James MonroCardiology Dr Mike GodmanAnaesthesia Dr Neil MortonPaediatrics Dr David MabinNursing Sally RamsayCommissioning Julia Stallibrass MBE
All panel members are independent of current centres.
Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Safe and Sustainable National secretariat for the review – working on behalf of and in partnership with SCGs
Joint Committee of PCTs Decision making body, includes representation from each area
Steering Group
clinical leadership,development of standards, overseeing engagement, clinical advice to JCPCT
Standards Working Group
Developed Standards
Independent expert review panel
Led by Sir Ian Kennedy, assessed each surgical centre against standards
How will we get to a shortlist of options?
Phase 1 (April to June 2010) In May 2010 an independent panel of experts, led by Professor Sir Ian
Kennedy, visited each of the centres to assess their ability to meet the new standards. The outcome of these visits and other relevant evidence was reviewed by the JCPCT
A series of regional engagement events were held during May and June to understand the priorities of parents, patients and staff. Feedback from attendees was compiled and a summary report provided to the JCPCT.
26Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How will we get to a shortlist of options?Phase 2 (July to December 2010)The JCPCT will formulate options for reconfiguration considering:
The May assessments of centres Clinical networks Populations Travel times for parents and children Impact to other services (including paediatric intensive care,
children’s heart transplantation and children’s ECMO) Workforce implications Affordability
The outcome of this work will be a small number of potential configuration optionsThese options will form the basis of a public consultation in January 2011
27Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How will we get to a shortlist of options?
Phase 3 (December 2010) Before the recommendations for configuration are agreed the Steering
Group will advise the JCPCT on the clinical viability of the short-listed options so that the JCPCT is assured that the potential options are clinically safe
An independent group will review mortality cases from three centres currently performing surgery following analysis conducted earlier this year as part of South Central SHA’s review of the John Radcliffe Hospital
Phase 4 (2011) A public consultation will take place in early 2011 At this stage, all centres apart from the John Radcliffe Hospital, Oxford
form part of the options under consideration
28Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
John Radcliffe Hospital, Oxford
The JCPCT has not yet made any decisions about any options
The review team will recommend to the JCPCT that the Oxford service does not appear in any potential options
Initial work to date suggests that the Oxford service would have the greatest difficulty in meeting the proposed new standards in the future by a ‘significant margin’
No decision about the Oxford service, or any other service, will be made by the JCPCT until the outcome of public consultation has been considered in 2011
29Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How we will consult
From early 2011 a formal consultation will be held with the populations of England and Wales
You will have the opportunity to comment on which centres should remain designated surgical centres and how regional care should be managed
HOSCs, parents, clinicians, young people and professional bodies will all be encouraged to take part
There will be a number of recommendations to consider, including a ‘preferred’ option if appropriate
We intend to ensure all key stakeholder groups are notified of the consultation process
30Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How we will consult
We will use the following channels to reach the various audiences: A series of face to face events around the country Newsletters, written briefings and promotional materials Online updates
We are also working with media to ensure information about the process appears locally and nationally
The Safe and Sustainable website will also carry materials on the consultation process, including an online version of the consultation document
31Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Stakeholders
The public Parents and children Patient groups Charities and the voluntary sector NHS clinical staff NHS Executive staff Unions NHS Commissioners Strategic Health Authorities Local authorities / Overview and Scrutiny Committees Royal Colleges and professional associations Devolved administrations (Scotland / Wales / Northern Ireland) Department of Health Local MPs Media
32Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
How we have engaged with stakeholders
‘Stakeholder engagement to date has been robust and impressive,
and there is widespread support for the new standards and the case for reconfiguration from clinicians and commissioners’
Office Government Commerce ‘Gateway’ report on Safe and Sustainable (September 2010)
National stakeholder event October 2009 (every OSC and LINk in England was invited) discussions from the day made available as videos on our website
Held 10 engagement events across England in spring of 2010 Comments sought and received from stakeholders on the draft standards; the
comments were placed on our website so that stakeholders can see how their comments have influenced the ‘final product’
Quarterly newsletters Presentations at parent and patient group meetings Have worked with the Children’s Heart Federation to canvass the views of parents
and patients We have published the research evidence around volumes and outcomes on our
website
33Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Engagement and consultation with HOSCs We have sought advice from the Centre for Public Scrutiny
We invited all HOSCs and LINks in England to the national stakeholder event in October 2009
In August 2010 we issued a communique to all HOSCs in England in advance of formal public consultation
The 2003 Direction from the SoS requires HOSCs to convene a joint HOSC when two or more HOSCs consider proposals affecting a population larger than a single HOSC to be ‘substantial’
We have asked HOSCs to let us know how they would like to be consulted in advance so that we all make the best use of the consultation period
34Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
What we need from HOSCs
Although some HOSCs have let us know that they do not anticipate that future recommendations will constitute a substantial variation for their local populations, or that they have joint arrangements in place for consultation, some HOSCs have not yet let us know how they would wish to be consulted.
Please let us know:
1.Your proposed arrangements for scrutiny (for example, whether or not you think that existing arrangements for regional joint scrutiny can be used and how much time you would need to put these arrangements into place - how often does the regional network meet?)
2.Contact details so that we can start to confirm dates and venues for presentations to HOSCs (we suggest that we set dates now so that we can start to work with you in developing a consultation that meets your needs)
3.Any other questions that you may have
35Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Timeline
January 2011 – JCPCT meets to consider shortlist of potential options for configuration
February 2011 – JCPCT agrees final set of options for consultation
February 2011 – formal consultation commences
May 2011 – formal consultation ends
May-June 2011 – analysis of consultation by independent third party
July 2011 – JCPCT considers outcome of consultation and makes a decision
2013 - implementation
36Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
Summary of achievements to date
Excellent clinician, patient and key stakeholder engagement
New standards and a robust assessment process created
Breaking new governance ground
An appropriately resourced programme
A supportive National Clinical Advisory Team review
Office Government Commerce ‘Gateway’ report on Safe and Sustainable (September 2010)
37Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010
www.specialisedservices.nhs.uk/safeandsustainable
More information?
38Slides on the Safe and Sustainable Review of Paediatric Congenital Cardiac Services in England, October 2010