South East Coast Complex Cardiology Services

Transcription

1 South East Coast Complex Cardiology Services Dr Adam Jacques Clinical Director SEC CVD SCN June 4 th 2014

2 SEC Cardiovascular SCN Vision Cardiovascular Centres of Excellence Patients being diagnosed as early as possible Patients being given prompt treatment for high risk conditions Those with chronic conditions being managed appropriately in primary and community care with greater self management and empowerment 2 Transforming urgent and emergency care services in England

3 The Future of Urgent & Emergency Care Services in England Better support for people to self-care Enhance the NHS 111 service Provide highly responsive urgent care services outside of hospital, 7 days a week Introduce two levels of hospital emergency department; Emergency Centres and Major Emergency Centres Develop emergency care networks, led by Major Emergency Centres 3 Transforming urgent and emergency care services in England

4 Major Emergency Centre 4 Transforming urgent and emergency care services in England

5 Principles For Change Emerging principles for urgent and emergency care in England outline a system that: 1. Provides consistently high quality and safe care, across all seven days of the week; 2. Is simple and guides good, informed choices by patients, their carers and clinicians; 3. Provides access to the right care in the right place, by those with the right skills, the first time; 4. Is efficient and effective in the delivery of care and services for patients. 5

6 6 Shifting care closer to home

7 7 Transforming urgent and emergency care services in England

8 Major Emergency Centres Larger units, capable of assessing and initiating treatment for all patients; providing a range of specialist services. - Consistent levels of senior staffing - Access to specialist equipment - Transfer from MECs will be rare (with the exception of discharge to the community) 8 Transforming urgent and emergency care services in England Emergency Centres Capable of assessing and initiating treatment for all patients - Suitable patients will be managed by local hospital - Many patients directed to ECs for initial assessment (particularly in remote and rural settings) Emergency Care Networks Principles of major trauma networks extended to the whole emergency care system, ensuring a consistent approach to the delivery of services and formally linking the community and hospital components of the urgent and emergency care system. MECs will have a lead responsibility for the quality of care and operational performance of service across the network they support Critical care transfer and retrieval system Ensure that patients with specialist needs reach the best possible care in a timely fashion through the introduction of formal transfer and retrieval systems in remote and rural areas. These will be modelled on the best existing services for critically ill and injured patients

9 Urgent Care Centres Community-based urgent care facilities Full range of primary and community care services Open at least 16 hours per day (8am to midnight) every day 24/7 access to the urgent care network Co-located with every Emergency Department Accept patient referrals from other sources (e.g. ambulance) Access to senior and specialist support, and diagnostics Universal referral rights 9

10 Emergency Centres Receive all patients Include an Emergency Department and inpatient beds Open 24/7, 365 days a year 24 hour access to blood products 24 hour access to radiology (including CT and pathology) 24 hour access to specialist support through the network Transfer and retrieval protocols 10

11 Major Emergency Centres An Emergency Centre plus extended ED and inpatient facilities, including at least two of: Major trauma management including neurosciences, plastic surgery, burns Primary percutaneous angiography for myocardial infarction Stroke thrombolysis Emergency vascular surgery Specialist paediatric facilities Critical care Interventional radiology 11

12 Major Emergency Centres The Starting Point Vascular Stroke Trauma Heart Attack Critically ill children Co dependencies Cancer Renal Mental Health Neurology Interventional Radiology Rehabilitation Maternity and paediatrics Critical Care Specialised Services 12 Transforming urgent and emergency care services in England

13 SEC CVD SCN Complex Cardiology Review Requested by specialised commissioning to undertake baseline of where complex services are currently delivered, activity, workforce, etc Review against compliance with national service specifications and understand impact for CCGs Identification of outcomes e.g. call to balloon time, 30 day mortality, readmission rates Sharing with Cardiac CAG at focus meeting in June for discussion Identification of best practice and key issues with recommendation of way forward Next steps extending to include other cardiology services including NSTEMI etc,

14 Working with the Strategic Clinical Networks and Clinical Senate Use of SCNs to identify and advise on critical co-dependencies for both Major Emergency Centres and Emergency Centres (depending on definition) Linking with existing SCN work streams and areas of good practice to build the layers to support the development of Major Emergency Centres Use of Clinical Senate to take the SCN advice and provide an overall view on the specific critical co-dependencies for both Major Emergency Centres and Emergency Centres (as discussed by the Clinical Senate Council on 3 rd April) 14 Transforming urgent and emergency care services in England

15 Commissioner led service change Based on population needs, designed to achieve best outcomes Must be affordable, deliverable and sustainable Strong public and patient engagement Change must be clinically-led and underpinned by a clear clinical evidence base with support for proposals from clinical commissioners Effective partnership working between commissioners and providers Link closely with other work streams and geographies. E.g. Thames Valley/Wessex/London, stroke, specialised commissioning strategy, trauma ODN 15 Approach to planning and change Transforming urgent and emergency care services in England

16 SOUTH EAST COAST COMPLEX CARDIOLOGY DATA

17 Caveats The Data presented is subject to the following MINAP 11/12 data is the latest version available to NHS England arm s length bodies (i.e. SEC CVD SCN) Previous data sharing arrangements with local cardiac networks have been lost Based upon HES data via SUS reliant upon the Trusts coding behaviours Local interpretation of OPCS codes Timing of data availability for decision making No access to out of area activity codes i.e. London tertiary centres 17

18 ABLATIONS

19 Number of Patients Total number of ablation procedures per Trust ASHFORD AND ST PETER'S HOSPITALS NHS FOUNDATION TRUST BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST EAST SUSSEX HEALTHCARE NHS TRUST FRIMLEY PARK HOSPITAL NHS FOUNDATION TRUST MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST 16 ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST 1 WESTERN SUSSEX HOSPITALS NHS TRUST

20 110, , , , , , , , , , , , , , , , , , , ,052, Total Ablation Cost per CCG ,200, ,000, , , , ,

21 Cost in Total ablations- Average cost per head of population per SEC CCG NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

22 Number of patients Number of ablations for atrial flutter and atrial fibrillation per Trust Ablation for atrial flutter Ablation for atrial fibrillation ASPH BSUH EKHT ESHT FPH MTW RSCH WSHT

23 Total ablation & AF ablation costs to SEC CCGs ,200,000 1,000, , , ,000 Total ablation costs ( ) AF ablation costs ( ) 200,000 0

24 36, , , , , , , , , , , , , , , , , , Cost to CCG for AF and atrial flutter ablation patients , , , , , ,

25 Total ablation spend per SEC CCG split into percentage for provider Trusts % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Other Oxford Radcliffe RSC FPH ASPH Imperial UCL S'ton BSUH Barts St George's RBH MTW Kings GSTT ESHT EKHT

26 Provider Trusts- percentage make up of SEC CCG costs % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% West Kent Thanet Swale Surrey Heath Surrey Downs South Kent Coast North west Surrey Medway Horsham & Mid Sussex High Weald Lewes & Havens Hastings & Rother Guildford & Waverley Eastbourne Hailsham & Seaford East Surrey Dartford Gravesham & Swanley Crawley Coastal West Sussex Canterbury & Coastal Brighton & Hove Ashford

27 PACING

28 No of procedures Total number of all pacing procedures per Trust ASPH BSUH DGH EKHT ESHT FPH MTW Medway RSC SASH WSHT 28 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

29 No of procedures Number of pacemaker system procedures per Trust Cardiac pacemaker system NEC Single chamber cardiac pacemaker system 50 Dual chamber pacemaker system 0 ASPH BSUH DGH EKHT ESHT FPH MTW Medway RSC SASH WSHT 29 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

30 No of procedures Total number of single and dual chamber procedures per Trust Single chamber cardiac pacemaker system Dual chamber pacemaker system 50 0 ASPH BSUH DGH EKHT ESHT FPH MTW Medway RSC SASH WSHT 30 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

31 No of procedures Total number of ICD and CRTD procedures per Trust Biventricular pacemaker system (CRTD) Cardioverter defibrillator (ICD) 10 0 ASPH BSUH DGH EKHT ESHT FPH MTW Medway RSC SASH WSHT 31 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

32 STEMI/NSTEMI

33 minutes MINAP 12/13- Median Call to balloon and Door to balloon times Median call to balloon times mins Median Door to balloon mins 20 0

34 minutes MINAP 12/13- Median Call to balloon and Door to balloon times SEC Primary PCI Centres Median call to balloon times mins 40 Median Door to balloon mins ENGLAND Conquest Eastbourne BSUH FPH William Harvey

35 Percentage of patients MINAP 12/13- Percentage of patients achieving 120/150 minutes direct admission to Primary PCI centres call to balloon direct admission 150 mins % pts call to balloon direct admission 120 mins % pts ENGLAND Conquest Eastbourne BSUH FPH William Harvey QA Portsmouth St George's

36 Percentage of patients MINAP 12/13- Percentage of patients receiving Primary PCI within 90 minutes of arrival at Primary PCI Centre ENGLAND Conquest Eastbourne BSUH FPH William Harvey QA Portsmouth St George's

37 MINAP nstemi Indicator England Overall St Frimley Georges Park Epsom Royal Surrey County St Peter's East Surrey Eastbour Conques Brighton ne t St Worthing William Princess Harvey Richards Royal Ashford Darent Valley Medway Maritime Tunbridge Wells Maidsto ne Kent & Canterbury QA Portsmouth QEQN nstemi patients seen by a cardiologist or member of the team 94% 100% 96% 100% 99% 100% 92% 97% 96% 96% 97% 93% 93% 89% 99% 89% 93% 99% 79% 100% 76% nstemi patients admitted to cardiac unit or ward 53% 71% 29% 73% 56% 95% 26% 44% 89% 73% 78% 65% 88% 61% 64% 20% 53% 42% 75% 18% 57% nstemi patients that were referred for or had angiography 73% 72% 85% 63% 69% 88% 97% 74% 29% 0% 99% 81% 72% 62% 67% 77% 72% 66% 24% 82% 49% Colour Coding Key Within 10% < England overall % 10%-20% < England overall % >20% less than England overall % 37

38 38

39 Median call to ppci time for STEMI patients, 2011/12 39 Transforming urgent and emergency care services in England

40 The percentage of non-stemi patients seen by a cardiologist, 2011/ Transforming urgent and emergency care services in England

41 Total Number of Patients STEMI & NSTEMI patients- total numbers for whole SEC Total Number of Patients NSTEMI STEMI Total Cost ,000, ,000, ,000, ,000, ,000, ,000, ,000, ,000, NSTEMI STEMI 41 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

42 No of patients STEMI & NSTEMI patients- total number per Trust Total STEMI patients Total NSTEMI patients 0 ASPH BSUH D&GH EKHT ESHT FPH MTW MEDWAY RSCH SASH WSHT 42 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

43 No of procedures Total number of PCI procedures per Trust ASPH BSUH DGH EKHT ESHT FPH MTW Medway SASH WSHT 43 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

44 PCI procedures per SEC Trust Percutaneous transluminal balloon angioplasty of one coronary artery Angiocardiography of left side of heart NEC Percutaneous transluminal balloon angioplasty and insertion of 1-2 drug-eluting stents into coronary artery Percutaneous transluminal balloon angioplasty and insertion of 3 or more drug-eluting stents into coronary artery Percutaneous transluminal balloon angioplasty and insertion of 1-2 stents into coronary artery Percutaneous transluminal balloon angioplasty and insertion of 3 or more stents into coronary artery NEC 0 44 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

45 45 Transforming urgent and emergency care services in England

46 No of patients Total number of STEMI Patients per SEC Primary PCI Trust Conquest Eastbourne BSUH FPH EKHT (William Harvey) St George's 46 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

47 Number of Patients STEMI patients- 30 day mortality at SEC Primary PCI centres STEMI 30 Day Mortality Brighton and Sussex Frimley Park East Kent Eastbourne Hastings 30 Day Mortality Population Total STEMI Population NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

48 Percentage of Patients (%) STEMI patients- 30 day mortality percentage rate at SEC Primary PCI centres Brighton and Sussex Frimley Park East Kent Eastbourne Hastings 48 NHS SEC Strategic Clinical Networks February 2014 Further info: Tel:

49 No of patients STEMI patients- total number per SEC Trust ASPH BSUH D&GH EKHT ESHT FPH MTW MEDWAY RSCH SASH WSHT

50 No of patients NSTEMI patients- total number per SEC Trust ASPH BSUH D&GH EKHT ESHT FPH MTW MEDWAY RSCH SASH WSHT

51 No of days STEMI patients- average length of stay per episode in SEC Trusts ASPH BSUH DGH EKHT ESHT FPH MTW Medway RSC SASH NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

52 No of days NSTEMI patients- average length of stay per episode in SEC Trusts ASPH BSUH DGH EKHT ESHT FPH MTW Medway RSC SASH WSHT 52 NHS SEC Strategic Clinical Networks February 2014 Further info: england.adminscn-senate@nhs.net Tel:

53 TAVI

54 BSUH No of patients Cost per Pt Total cost EA53Z 77 23,376 1,799,952

55 Staffing Numbers BSUH Royal Surrey County East Sussex Frimley Park ASPH EKHUFT MTW Darent Valley Number of cardiology consultants Number of cardiac physiologists Number of Specialist Cardiology Nurses and subspecialities Notes Info is for one dept across two sites. We are in the middle of increasing our establishments.

56 Physiologists BSUH Royal Surrey County East Sussex Frimley Park ASPH EKHUFT MTW Darent Valley Band Band Band Band Band 4 1 Total Number of cardiac physiologists who can provide 24/7 cover for Intervention Device programming 8 (intervention only) PCI is the only 24/7 cover given. The remainder is 9-5pm 24/7 for intervention ppci currently, not for others currently device only not echo or intervention Echo imaging SpR provide 24/7 echo Band 8 Band 7 Band 6 Band 5 Band 4 Unknown 25 Number BSUH Royal Surrey County East Sussex Frimley Park ASPH EKHUFT MTW Darent Valley Trust

57 Services Offered Number of cardiology beds (Per Trust) Number of Cath Labs (per Trust) 24/7 Cardiology Service Currently provided Brighton and Sussex University Hospitals NHS Trust. Royal Surrey County East Sussex Frimley Park ASPH EKHUFT Maidstone and Tunbridge Wells NHS Trust Darent Valley Yes Yes CCU, cardiology wards, temporary pacing, PCI Yes N-stemi/ on call ppci 24/7 No No Daily consultant ward rounds Yes All post take are seen by consultant. All patients discussed by consultant on daily board round. Patients seen by their consultant twice a week and seen by their SpR on the other days. Yes Yes Yes Yes Yes mon fri, sat/sun cardiac reg Yes Yes 24/7 cardiology consultant on call 24/7 interventional consultant cardiologist on call 24/7 access to cardiac cath lab for intervention/pacing Note Yes Yes Same as below Yes Yes No Yes No Yes 2 Yes Yes Yes Yes No No Yes YES Pacing Frimley PCI Info is for one dept across two sites. Yes Yes (ppci centre) Yes Yes We also help cover Epsom cardiology On call. All our clinicians do 1:4 on call No done in theatres out of hours No

58 Points for consideration Centralisation of services aka Keogh and Specialised Commissioning Strategy Number of centres delivering complex cardiology services Variation in work force numbers and availability (cons cardiologists) SECAmb concerns ESHT rota for primary PCI Variance in Primary PCI Centre acceptance of patients Responsibility for commissioning Primary PCI pathway and performance management NSTEMI patients: Potential delay in transfer Need for double procedure for patient Data Coding practice TAVI and external review of BSUH Up to date MINAP/ Call to balloon time specifically-do Trusts have access to own? Potential ablation outliers and associated CCG spend 58 NHS SEC Strategic Clinical Networks February 2014 Further info: Tel: