London Cardiac and Vascular Strategic Clinical Leadership Group (SCLG) Minutes 25 September 2014 1. Welcome, introductions, apologies In attendance Huon Gray National Clinical Director for Cardiac Care and Cardiologist, Chair Jenna Evans Senior Project Manager, NHS England (London region) Jay Nairn Project Manager, NHS England (London region) Paul Trevatt - Lead, CVD Strategic Clinical Network Olaf Wendler Cardiac Surgeon Michael Cooklin - Cardiologist Philip McCarthy Cardiologist Nicola Jones General Practitioner Stuart Rowe Specialised Commissioner, NHS England (London region) Nick Bunce Cardiologist Andrew Leatherland British Heart Foundation Apologies Obi Agu Vascular Surgeon Iqbal Malik Cardiologist Lucy Grothier Associate Director Paul Baskerville Vascular Surgeon Jane Fryer- Medical Director, NHS South-East London Jillian Riley Consultant Nurse Sotiris Antoniou - Pharmacist Helen Williams Pharmacist Andrew Chukwuemeka Cardiac Surgeon Mark Whitbread London Ambulance Service Andrew Archbold - Cardiologist Clare Dollery Cardiologist Sue Sawyer Specialised Commissioner Simon Woldman Cardiologist (Heart Failure) Matt Thompson Vascular Surgeon 2. Minutes of last meeting and matters arising The minutes were agreed as an accurate reflection of discussions. HG updated the SCLG on the progress of the group s work on Kawasaki Disease. A brief document has been drafted regarding service provision in London and is being reviewed by Kawasaki Disease experts in the US. A draft version will be circulated to the SCLG in due course for any final comments. Action HG to circulate finalised Kawasaki Disease guidance to the SCLG when available. PM suggested the SCLG identify any learning points from this process in anticipation of 1
other relatively rare diseases that require clinical input from the SCLG. Outstanding actions from the last meeting: o IHT SR updated the SCLG that Specialised Commissioning was to write to receiving trusts reminding them of the 3,000 required to support the IHT system and that they would be invoiced accordingly by Teleologic. This letter was expected to go out in the next week. o Membership HG again highlighted the TOR listed 50% attendance at the meetings. Action - HG to write to those members who had poor attendance. 3. Specialist Commissioning Update SR provided an update on cardiac and vascular specialised commissioning. Regional planning is beginning in October for the next commissioning round. The Specialised Commissioning Team is looking to develop position statements with each Trust to identify performance and funding issues across London. A review of vascular services across London has been suggested by Specialised Commissioning. The SCLG will be a key group to inform and guide the review. QIPP has now become a priority for Specialised Commissioning and the central NHS England team will be looking to regions for efficiency measures. Specialised Commissioning is looking to undertake work to produce line item funding splits to be able to better track spending by Trusts. NHS England is also looking to move commissioning responsibility for some services from Specialised Commissioning to CCGs. Such devolved services may include bariatric and renal services. JE outlined the suggested QIPP items that will impact cardiac services in London o Enhanced recovery post cardiac surgery o Remote monitoring of devices - EP 4. Clinical Commissioning Groups NJ provided an update on Clinical Commissioning Groups in London. Most CCGs have expressed interest in co-commissioning primary care. CCGs currently have responsibility for improving quality of primary care, but are lacking levers and incentives to do this. Co-commissioning will provide opportunities and challenges. CCGs are working with NHS England (London region) to finalise a joint response to the recommendations of the London Health Commission. CCGs are under significant pressure to reach RTT and 4 hour performance targets. CCGs will be looking to work with Trusts to reach these targets. Additional monies have been made available to CCGs to commission Trusts for this work. Members of the SCLG highlighted that this additional funding can be a risk for Trusts as it is hard to implement new processes to reduce RTT in such a short time period. HG provided an update on additional national priorities. Dementia will be a big national focus, with the Government planning to set new targets for increasing rates of diagnosis. Trusts will be notified shortly if they have been successful in becoming part of the Commissioning through Evaluation pilot (CtE). PT highlighted that there has been a push for SCNs to look at the whole of the patient 2
pathway especially prevention and primary care. The SCNs in London have been asked to support a CVD prevention workshop for GPs in March 2015. 5. Arrhythmia MC provided an update on the Arrhythmia Advisory Group. Triage for arrhythmia patients by London Ambulance Service (LAS) has gone live, but has not resulted in a large increase of patient numbers to arrhythmia centres. Action MC to get an update from Mark Whitbread on numbers of patients triaged by LAS. Benefits of the triage project includes delivery of 24 hour care by all arrhythmia centres. HG suggested that these benefits need to be quantified and suggested data should continue to be collected. MC reported that he had presented on the pilot at London s Clinical Senate and they had asked to be updated on patient numbers and outcomes in another year. It was suggested that LAS may be able to include a new data field in their reporting system to record triaging of arrhythmia patients. Action MC to discuss possibility of continued data collection with Mark Whitbread. MC has convened a group of clinicians to work on publishing results of the triage pilot. There is still some data missing from centres that took part in the pilot. HG suggested that he write a thank you letter to arrhythmia centres outlining the final date for them to send data. Action JE and JN to draft letter for HG to send to arrhythmia centres thanking them for taking part in the triage pilot and asking them to send any outstanding data through. 6. ACS MC discussed the LAS education event regarding arrhythmia taking place on Monday 29 September 2014. MC highlighted that Inherited Cardiac Conditions (ICC) and the need for standardised genetic testing and funding would be a focus of the new Arrhythmia Advisory Group. There is currently variation between regions on who funds and delivers genetic testing for ICC. London has a lot of expertise in genetic testing and ICC however there is a need for centralisation and specialisation by Trusts. HG suggested that this may be an opportunity for London to undertake a networked approach to ICC. MC also highlighted that the Arrhythmia Advisory Group would be looking at the potential process for designating pacing centres in London. PM updated the SCLG on the ACS Advisory Group. The Group will meet on November 14th. All designated heart attack centres will be attending. Other centres that provide NSTEACS services and their data will be invited to this meeting. The group will meet bi-annually. A requirement for attendance is the provision of annual data. The ACS Advisory Group will be supported in its work by an Out of Hospital Cardiac Arrest Group, a STEMI Group and a R&D Group. Two articles had already been published and had proven a good incentive for clinicians to be involved in the SCNs. Members of the SCLG suggested a group bibliography be set up to illustrate the work of the SCLG and the advisory groups. 3
Action JE and JN to organise a group bibliography to record publications and achievements. PM discussed the need for more data and at a better quality and hopes the ACS groups would improve this. Data for OHCA was especially important, with many trusts providing good service at the start of the patient pathway, but discharge and length of stay being an issue. HG suggested contacting Gavin Perkins in Warwick and Jonathan Benger from NHS England regarding OHCA data. HG also highlighted that the SCNs and NHS England had submitted a proposal for OHCA to be considered as part of the NCEPOD programme. If accepted, the audit would consider the in hospital management of OHCA 7. OHCA JE provided an update on behalf of the Chair of the OHCA Advisory Group. The OHCA Advisory Group will be looking to investigate data for the patient pathway. Data sources include LAS and HES data. The Group would also like to look at rehabilitation and neuro rehabilitation. HG suggested that it may be better to focus on rehabilitation at the NHSL CVD Outcomes meeting rather than by a specific advisory group. Action PT to include rehabilitation on the agenda for the next CVD Outcomes meeting. 8. Vascular JE provided an update on behalf of Obi Agu. The Vascular Advisory Group met on 10 July 2014, and has prioritised critical limb ischaemia as their focus. An app is in development for abdominal aortic aneurysm diagnosis and the group would like to see if a similar project can be undertaken for critical limb ischaemia. The group would also like to focus on data. 9. Cardiac Surgery Olaf Wendler provided an update on the Cardiac Advisory Group. The group will be meeting in October and part of its focus will be on activity and surgeon availability in London. Waiting lists have increased. The SCLG discussed possible reasons for waiting time increase, including complexity of surgery and a move to seven day services. NJ highlighted that the role of System Resilience Groups was to hold the system to account for increases in treatment times and any additional funding used to reduce treatment times. The SCLG asked for specialised commissioning to provide an update on investment in cardiac surgery. Action - JN and JE to seek a written update from Sue Sawyer on investment in cardiac surgery and distribute to the SCLG. 10. Heart Failure JE provided an update on the Heart Failure Advisory Group. Simon Woldman and Jill Riley had decided on priorities for the advisory group with the help of JE and HG. The Group has decided to focus on the HF pathway and variation of commissioned 4
services Members of the SCLG highlighted their interest in being involved in the Heart Failure Advisory Group. Action JE to circulate the Heart Failure Advisory Group s priorities proposal. Action JE to seek additional representatives for the group s membership. 11. Pharmacy update Update scheduled for next SCLG 12. AOB Andrew Leatherland provided an update on the British Heart Foundation Heart Failure nurses project. FH community nurses have now started at the Royal Brompton & Harefield Hospital. A launch for the programme is planned for the near future. Andrew Leatherland also provided an update on the Intravenous Diuretics pilot. It is UK wide and the evaluation of the pilot has been drafted and will be released soon. It looked at safe community provision of intravenous diuretics, and found some benefit for patient outcomes and cost savings. Next meeting: 10.00 13.00 5 December 2015 5