here - Little Hearts Matter

2122 LHEARTS 20PP:NewsletterNo2 2009.qxd 05/11/2009 10:06 Page 6FeatureSafe and Sustainable ServicesChildren’s Cardiac Surgery Services Review and ServicePlanning.What this means for Little Hearts Matter’s members.“I am writing formally to request that theNational Specialised CommissioningGroup undertake a review of theprovision of paediatric cardiac surgicalservices in England with a view toreconfiguration”.Professor Sir Bruce KeoghNHS Medical DirectorLittle Hearts Matter has been involved withthe work to improve congenital heartdisease surgical services since the review andreport compiled following the crisis at BristolChildren’s Hospital in 1998.The aims of the report and subsequent reviews andservices recommendations have been discussedby cardiac teams throughout the country.• Kennedy Report, 2001 (the Bristol RoyalInfirmary inquiry).• Paediatric and Congenital Cardiac ServicesReview Group, 2003 (the Monro report).• Professor Boyle and Dr Shribman workshop,2006.To date only a few of the recommendations madehave been taken forward.Minimum StandardsThis was a nationally recognised set of surgicalmedical and care standards worked on by theBritish Congenital Cardiac Association, CongenitalCardiac Nurses Association, Children’s HeartFederation (LHM input) and the British CardiacSociety. These were supposed to form the basis ofall audit and service improvements.Central Cardiac Audit Database - CCADThis is a national audit of surgical results that has,for the first time, allowed comparisons to be madebetween units. The results are available toprofessionals and the general public.Unit’s results are measured against the nationalstandards and results are policed by the CCADteam and BCCA.So why do national services need to bereviewed and surgical provision rationalised?Who are the review team?• Sub-specialisation is increasing. This means that there aremore specialist doctors needed to provide top class care in eachhospital team.• Training and mentoring of doctors requires large centreexperience.• Working time legislation - European directive requires largernumbers of doctors.• Critical mass of procedures - there is evidence that larger units,with lots of experience, provide higher surgical success rates.Children’s Heart Federation - the voice of the user (LHM is oneof the voices)British Congenital Cardiac AssociationAssociation of Cardiothoracic AnaesthetistsSociety for Cardiothoracic Surgery in Great Britain and IrelandRoyal College of Paediatrics and Child HealthPaediatric Intensive Care SocietyNHS CommissionersNHS in Scotland and WalesHow is the NHS medical service funded? - each team of commissioners budget for their area of workExamplesNationalCommissionSupra RegionalSpecialistCommissioningRegional SpecialistCommissioningLocal Based Commissioning• Transplants (not Renal) • Rare Cancer • Rare NeuroMuscular Disorder.50 million people• Paediatric Cardiac and Neuro-muscular Services •Severe Burns Care • Cleft Lip and Palate.5 to 50 million people• Children’s and Young People’s Cancer • Haemophilia •Renal Transplant1 to 50 million people• General Acute Medicine and Surgery100,000 to 1 million people6Practice Based Commissioning• Minor Surgery • Endoscopies • District Nurses100,000 people