Presentation on theme: "New congenital heart disease review"— Presentation transcript:
1New congenital heart disease review ConsultationSeptember – December 2014
2What is congenital heart disease ? New Congenital Heart Disease ReviewWhat is congenital heart disease ?Congenital heart disease is a general term for a range of birth defects that affect the normal workings of the heart.The term congenital means the condition is present at birth.The human heart1. Pulmonary valve 5. Left ventricle 2. Left atrium 6. Right ventricle 3. Mitral valve 7. Tricuspid valve 4. Septum 8. Right atrium
3New Congenital Heart Disease Review Key FactsAround eight out of every 1,000 babies born have some form of congenital heart disease (CHD).More babies with CHD are now surviving into adulthood.NHS cardiac surgery for children is carried out in 10 hospitals in England.
4The Case for Change Survival rates are good. New Congenital Heart Disease ReviewThe Case for ChangeSurvival rates are good.But other factors are important too, including:Quality of careQuality of lifeVariations in careHow can we improve the service?
5The “new CHD review” The review aims to help the service: New Congenital Heart Disease ReviewThe “new CHD review”The review aims to help the service:Secure the best outcomes for all patients (not just lowest mortality)Tackle VariationImprove patient experience.
6Objectives The new CHD review has six objectives: New Congenital Heart Disease ReviewObjectivesThe new CHD review has six objectives:Develop best practice standardsAnalyse current and future demand for servicesMake recommendations on function, form and capacity of services neededMake recommendations on the commissioning and change management approachEstablish a system for the provision of information about the performance of CHD servicesImprove antenatal and neonatal detection rates.
7New Congenital Heart Disease Review StandardsOur standards cover all aspects of running a service with the aim of improving care.For the first time there will be:a single set of standards and specifications for children and adultsa single national commissioner (NHS England) for congenital heart services.
8New Congenital Heart Disease Review Areas coveredSection A: The network approach Section B: Staffing and skills Section C: Facilities Section D: Interdependencies Section E: Training and education Section F: Organisation, governance and audit Section G: Research Section H: Communication with patients Section I: Transition Section J: Pregnancy and contraception Section K: Fetal diagnosis Section L: Palliative care and bereavement Section M: Dental
9New Congenital Heart Disease Review What next ?The Consultation is due to run until the middle of DecemberThe aim is to have approved standards and specifications by March 2015.Once agreed all providers will be expected to meet the standards.Some of the changes will not happen immediately.
10How do I get involved? You can engage with the review further by: New Congenital Heart Disease ReviewHow do I get involved?You can engage with the review further by:Watching the YouTube videosReading the consultation document, easy read version or the complete standards and service specificationsAttending a consultation eventCompleting our online questionnaire.(Links to all resources referred to above are included in the description section of this video)
11New congenital heart disease review Networks, Staffing and Skills, Interdependencies and Fetal DiagnosisConsultation September – December 2014
12New Congenital Heart Disease Review Model of CareThe standards are based on having three levels of CHD services for children and adults. These are:specialist surgical centres (level 1);specialist cardiology centres (level 2); andlocal cardiology centres (level 3).
13Section A: The Network Approach Sets out how all hospitals treating people with congenital heart disease will work together to deliver the best possible outcomes within existing resources. Networks include all congenital heart services, both adult and paediatric, at all three levels of the service.New Congenital Heart Disease Review
14What we heard A good network should: be clearly defined Section A: The network approachWhat we heard A good network should: be clearly definedinclude all elements of congenital heart disease carecomprise high quality servicesbe large enough to be sustainable, but small enough to managehave adequate resourcingdevelop consistent care pathwaysinvest in developing individual relationshipsacross the network.
15What we are proposing The creation of networks. Section A: The network approachWhat we are proposingThe creation of networks.That congenital heart surgery is only undertaken in specialist surgical centres.Networks will consist of:specialist surgical centres (level 1);specialist cardiology centres (level 2); andlocal cardiology centres (level 3).
16What we are proposing The shape of networks will vary. Section A: The network approachWhat we are proposingThe shape of networks will vary.Formal working relationships with other centres and specialisms.Weekly specialist multi-disciplinary team meetings.New standard health records summary.
17Section A: The network approach What this will meanHospitals and clinicians working together locally, regionally and nationally.Better experience for patients, their families and carers.More joined-up services.Quality is improved and standards are improved consistently across networks.
18Section B: Staffing and Skills New Congenital Heart Disease ReviewSection B: Staffing and SkillsSets out the staff and skills needed in teams to deliver a world class service across all parts of the network to deliver excellent outcomes within existing resources. This covers all three tiers of the service.
19What we heard The emotional needs of patients need to be addressed. Section B: Staffing and SkillsWhat we heardThe emotional needs of patients need to be addressed.Patients and their families need help to understand the health system as well as areas like benefits and education.There is a concern about current and future staffing levels.
20Section B: Staffing and Skills What we are proposingThe staffing and skills needed to ensure that a world-class service is provided across the country.The arrangements needed to ensure that there is consistent high quality care all year round.Minimum staffing and activity levels for surgeons, interventional cardiologists and other members of the multi- disciplinary team.
21Section B: Staffing and Skills What this will meanAll centres will have the right staffing with the right skills.Where necessary centres will refer patients to another unit or bring in expert support.We expect an increase in the number of some staff groups at some centres.
22Section D: Interdependencies Sets out the relationship congenital heart disease services (children’s and adults) have with each other and with other services to deliver the best possible outcomes within existing resources. This covers all three levels of the service.New Congenital Heart Disease Review
23Interdependencies Three types of interdependency described: Section D: InterdependenciesInterdependenciesThree types of interdependency described:paediatric cardiac services with other paediatric services;adult congenital heart services with other adult services; andpaediatric cardiac services with adult congenital heart services.Triple co-location is the ideal.There were different views about the importance of each type of interdependency.
24Section D: Interdependencies What we heardSpecialist congenital heart services need to work with other services that are used by CHD patients, but are notCHD-specific.
25Section D: Interdependencies What we heardSometimes patients with CHD will need support from another specialist very quickly.Patients often have other problems as well as congenital heart disease and so need care from many specialists; not just heart specialists. Sometimes the different teams of doctors do not work closely together.
26What we heard about co-location Section D: InterdependenciesWhat we heard about co-locationSome people told us that while responsiveness is important, it is not the only thing that matters: daily interaction between teams is also important in building relationships and ensuring the best care.Other people argued that as long as the other children’s services could meet the required response times it was not necessary for all the children’s services to be on the same site.
28Section D: Interdependencies What we are proposingSpecialist children’s cardiac services should only be delivered in settings where a wider range of other specialist children’s services are also present on the same site (co-location).This brings the standards for CHD services into line with expectations in other specialist children’s services.Triple co-location is the ideal, but where this is not possible, we say which services must be on the same site, and what is the required level of responsiveness for all the other services.
29Section D: Interdependencies What this will meanAll the experts patients are likely to need are on site, or available very quickly.Centres will need to consider how to arrange services to ensure that they meet these standards.
30Section K: Fetal diagnosis New Congenital Heart Disease ReviewSection K: Fetal diagnosisSets out the importance of providers working together in networks to ensure that national standards are consistently applied and results reported.
31Section K: Fetal Diagnosis What we heardDetection is not as good as it could be and rates vary across the country. We have heard that national standards introduced in to test for CHD at weeks have not been fully implemented.
32What we heard The following areas were also thought important: Section K: Fetal DiagnosisWhat we heardThe following areas were also thought important:adequate and continuous training for sonographers a national fetal anomaly register;more funding for ultrasound; andmore coordinated working as part of a fetal network.The time between the first suspicion of a problem and confirmed diagnosis needs to be reduced.
33Section K: Fetal Diagnosis What we are proposingArrangements to ensure that all women with a suspected fetal cardiac anomaly are seen more quickly by a specialist.Where there is a concern that a baby in the womb may have abnormalities of the heart, a firm diagnosis will be made as quickly as possible.At diagnosis, a plan will be developed that gives information about arrangements for delivery of the baby.
34How do I get involved? You can engage with the review further by: Watching the YouTube videosReading the consultation document, easy read version or the complete standards and service specificationsAttending a consultation eventCompleting our online questionnaire
35New congenital heart disease review Facilities, Communication with patients, Transition, Pregnancy and contraception and Palliative care and bereavement.Consultation September – December 2014
36Section C: FacilitiesSets out what facilities and equipment are needed to deliver care and treatment to people with congenital heart disease, to support families and carers, to deliver the best possible outcomes within existing resources. This covers all three tiers of the service.New Congenital Heart Disease Review
37What we heard A booklet on ‘How to find us/About Us’ would be useful Section C: FacilitiesWhat we heardA booklet on ‘How to find us/About Us’ would be usefulFacilities need to be welcoming, age appropriate and wheelchair friendly.People need facilities where they can make their own mealsWi-Fi needs to be availableParking charges need to be reasonable or removed
38Section C: FacilitiesWhat we are proposingWe set out what facilities and equipment will be required in the different centres and say what information needs to be provided.
39Section C: FacilitiesWhat this will meanFacilities that will improve the overall experience of patients, their families and carers.Patients, families and carers will be able to live as normally as possible during times spent in hospital.
40Section H: Communication with patients New Congenital Heart Disease ReviewSection H: Communication with patientsSets out the importance of ensuring that patients of all ages, family and carers are able to participate actively in decision making at every stage in their care to deliver the best possible outcomes within existing resources. This covers all three tiers of the service.
41What we heard The importance of sensitive and caring communication. Section H: Communication with patientsWhat we heardThe importance of sensitive and caring communication.Centres need to explain what is happening at all times.There needs to be a better way of sharing information across servicesPatients, families and carers would like information about living with CHD and what this means outside hospital.
42Section H: Communication with patients What we are proposingPatients, their families and carers need to be told about what is happening at all times.Each patient will have an individualised care plan.Communication will be two way.Patients will be supported if they request a second opinion.The standards also set out processes for sharing information across services.
43Section H: Communication with patients What this will meanPatients, families and carers will have a better understanding of CHD, the care provided and what the options are.Networks and centres will give them the information they need in a form that makes sense.
44New Congenital Heart Disease Review Section I: TransitionSets out the importance of ensuring that young people can move smoothly from children’s to adult services in a way that respects individual circumstances, to deliver the best possible outcomes within existing resources. This covers all three tiers of the service.
45What we heard Transition can be difficult for young people. Section I: TransitionWhat we heardTransition can be difficult for young people.Transition needs to be planned carefully and personalised.People have suggested having young people’s wards and young people’s services.
46Section I: TransitionWhat we heardWe have heard that that there are a number of things that help young people transition well:Dedicated transition nurses;Young adult clinics;Transition days;Being able to speak to someone who has already gone through it (buddy system); andMeeting the new consultant and ward staff before transition.
47Section I: TransitionWhat we are proposingYoung people and their families will receive more support as they move between services.Children’s CHD services and adult CHD services to work more closely together to manage the transfer.Appropriate arrangements to ensure a seamless pathway of care, led jointly by paediatric and adult congenital cardiologists.Young people, parents and carers will be fully involved and supported in discussions about their care.
48Section I: TransitionWhat this will meanYoung people have the help and support they need as they move from children’s into adult services.Young people experience a seamless transition and those young people who need ongoing support and treatment continue to receive it.
49Section J: Pregnancy and contraception New Congenital Heart Disease ReviewSection J: Pregnancy and contraceptionSets out the importance of appropriate discussions about family planning and describes the management of pregnancy to deliver excellent outcomes within available resources. This covers all three tiers of the service.
50Section J: Pregnancy and contraception What we heardPregnancy in women with CHD is becoming more commonplace.A close relationship between maternity and ACHD services is important
51Section J: Pregnancy and contraception What we are proposingDiscussions with a consultant cardiologist and specialist nurse.Access to genetic counselling and information about contraception and recurrence risks.Each Specialist ACHD Surgical Centre (level 1) must be staffed by Specialist ACHD cardiologists with expertise in pregnancy.Individualised care plans that cover the antenatal and postnatal periods as well as pregnancy.
52Section J: Pregnancy and contraception What this will meanPatients will be able to make informed choices in relation to contraception, termination, pregnancy and maternityPregnant women will be cared for in the most appropriate setting
53Section L: Palliative care and bereavement New Congenital Heart Disease ReviewSection L: Palliative care and bereavementSets out the support to be provided at end of life and how to manage communication with families at this difficult time.
54Section L: Palliative care and bereavement What we heardFamilies and carers depend on psychological, social, spiritual and practical support at this very difficult time.Excellent and open communication is key.We have heard that staff need to be trained in how to break bad news.
55Section L: Palliative care and bereavement What we are proposingHow CHD services should support patients and families at this time with the help of other existing teams.A lead doctor and named nurse to be chosen by the multi- disciplinary team and the patient and their family/carers.The development of an individual end of life care plan.The support that must be given to bereaved families and carers at the time of death and afterwards.
56Section L: Palliative care and bereavement What this will meanPatients, families and carers receive all the support they need at the end of life whether that be in the hospital or in the community, including at home.Networks and centres will work together to agree and deliver appropriate care and support.
57How do I get involved? You can engage with the review further by: Watching the YouTube videosReading the consultation document, easy read version or the complete standards and service specificationsAttending a consultation eventCompleting our online questionnaire
58New congenital heart disease review Training and education, Organisation, governance and audit, Research and DentalConsultation September– December 2014
59Section E: Training and Education New Congenital Heart Disease ReviewSection E: Training and EducationSets out the requirements for continuing training and education for healthcare professionals involved in the care of those with congenital heart disease, in order to deliver the best possible outcomes within existing resources. This covers all three tiers of the service.
60What we heard Communication and listening skills are very important Section E: Training and EducationWhat we heardCommunication and listening skills are very importantHelp is needed in maintaining skills. All members of MDTs should learn from each other.
61Section E: Training and Education What we are proposingAll healthcare professionals involved in the care of people with CHD to stay up to date through continuing training and education.CHD networks will promote education and training in, and across, local centres.Standardised, competency based training and education across all networks.
62Section E: Training and Education What this will meanPatients, families and carers will be cared for by staff who are appropriately trained in the skills needed to perform their jobs.Networks and centres will have the right processes in place to train staff appropriately.
63Section F: Organisation, governance and audit New Congenital Heart Disease ReviewSection F: Organisation, governance and auditSets out systems to ensure good decision making and quality improvement, including learning from local data and experience to deliver the best possible outcomes within existing resources. This covers all three tiers of the service.
64Section F: Organisation, governance and audit What we heardThe way information is collected and used varies across centres.Too many operations were cancelled at short notice.It is important that information sharing between agencies is handled appropriately.
65Section F: Organisation, governance and audit What we are proposingSurgical centres have a dedicated management group for the internal management and coordination of service delivery.A robust and documented clinical governance framework.Regular Network meetings.Information about activity and results to be submitted to the national audit run by NICOR.
66Section F: Organisation, governance and audit What this will meanClearly organised systems focused on patient care and improved outcomes.Close monitoring of the outcomes from surgery and interventional cardiology.Networks and centres have the right processes in place to deliver quality outcomes based on robust information and audit systems.
67New Congenital Heart Disease Review Section G: ResearchSets out a requirement for networks to have and regularly update a research strategy and research programme to deliver the best possible outcomes within existing resources. This covers all three tiers of the service.
68Many hospitals have close ties with Universities. Section G: ResearchWhat we heardMany hospitals have close ties with Universities.What we are proposingA new commitment to research that ensures that all services are continually focused on improvement, development and innovation.Each Network will have close links with one or more academic department(s) in Higher Education Institutions.
69Section G: ResearchWhat this will meanPatients, families and carers will benefit from research.Networks and centres will be able to keep adding to their knowledge and understanding.
70New Congenital Heart Disease Review Section M: DentalSets out how to ensure that congenital heart disease patients receive good dental care, to deliver the best possible outcomes within existing resources. This covers all three tiers of the service.
71Section M: DentalWhat we heardIt is important for people with CHD to receive appropriate dental care because of the risk of endocarditis (infection of the lining of the heart and valves, or both which can start as an infection of the gum).
72Section M: DentalWhat we are proposingClear referral pathways for urgent dental assessments for certain patients.All patients admitted and diagnosed with infective endocarditis must have a dental assessment within 72 hours.Centres must be able to provide access to theatre facilities and appropriate anaesthetic support for dental procedures, or refer patients to the Specialist Surgical Centre.
73Section M: DentalWhat this will meanPatients who are at risk because of dental problems are identified and treated.Networks and centres will have the facilities to undertake dental surgery on CHD patients where needed.
74How do I get involved? You can engage with the review further by: Watching the YouTube videosReading the consultation document, easy read version or the complete standards and service specificationsAttending a consultation eventCompleting our online questionnaire