NORTH OF SCOTLAND PLANNING GROUP CARDIAC PLANNING EVENT 24 th February 2010 Aberdeen

Cardiac Activity NOS Start 1975 Last 15 years Range = Average : 600 cases/Year All types of Adult Cardiac Surgery, except cardiac transplantation All types of Adult Thoracic Surgery, except transplantation

For every 1 million population CABGs are required... NOS 1.2 million = Approx CABGs

CABG and the Age Trends Over the last 4 years 1791 cabg cases were performed in NOS: Grampian= 1009 Highlands = 323 Tayside = 352 Orkney = 41 Shetland = 28 Fife = 23 England =7 Western Isles = 4 Wales / Forth Valley =1 > 70 Year old = 39 % > 80 Year old = 5 % Can we deny treatment on basis of age?

North of Scotland CT Surgery Unit 2 Dedicated Operating Theatres 6 Bed Cardiac ITU (5 Staffed beds 24x7) (CITU) 6 Bed High Dependency Unit (W51) 32 Bed WARD (W50)

NOS –CTH Surgery Unit Staffing 5 CONSULTANTS SURGEONS 5 WTE CONSULTANTS ANAESTHETISTS 2 SPECIALITY DOCTOR (STAFF GRADE) 7 SpR/ CLINICAL FELLOW/ STA 3 FY2 5 MEDICAL SUPPORT NURSES 3 SURGICAL SUPPORT PRACTITIONER (TRAINEE) 4 PERFUSIONISTS/ +1 TRAINEE

The Scottish Coronary Revascularization Register ERIGJNHNOSScotland% CABG % C+V % Valve C+V+O % C+O % Other % TOTAL

The Scottish Coronary Revascularization Register Observed and predicted in-hospital mortality (CABG) MortalityERIGJNHNOSScotland Alive572 (98.3%)691(96.6%)358(98.9%)1621(97.7%) Died10 (1.7%)24(3.4%)4 (1.1%)38 (2.3) EuroSCORE Additive – Mean (SD) 3.6(2.9)3.5(2.6)4.1(3.1)3.6(2.8) EuroSCORE Logistic – Mean(SD) 4.1(7.3)3.7(5.2)4.9(7.7)4.1(6.6)

The Scottish Coronary Revascularization Register Observed and predicted in-hospital mortality (CABG) (Elective ) ERIGJNHNOSScotland Alive427 (98.6%)574(98.0%)239(99.2%)1240(98.8%) Died6(1.4%)12(2.0%)2(0.8%)20(1.6%)

The Scottish Coronary Revascularization Register Observed and predicted in-hospital mortality (CABG) (Urgent) ERIGJNHNOSScotland Alive129(97.7)113(90.4%)113(99.1%)355(95.7%) Died3(2.3%)12(9.6%)1(0.9%)16(4.3%)

Keeping up with New Techniques As a whole: Sensible open-minded approach to new techniques and treatments - Off-pump Revascularization -AF Ablation -Minimally Invasive MV Surgery (2 patients from Highlands and Tayside) -Antegrade Cerebral Perfusion for aortic surgery

ECMO AND VAD Only Scottish Centre which has experience in Extra Corporeal Membrane Oxygenator in Adults Ahead in experience with Ventricular Assist Devices Most of the complex aortic surgery including aortic arch are performed in Aberdeen

Full compliance with WTG

Recruitment Pressures Medical Middle Grade Staff : Training/Non training (SpR –STA-Core Trainee- Clinical Fellow – Research Fellow –Trust Doctors).. EWHD – Immigration restrictions.. Image of bleak future. Anaesthetic Medical Staffing... Improvement Nursing.. Specialist training, turn over, retention etc. Most of the above are problems at NATIONAL LEVEL

Solutions Non training :Speciality Doctors “Staff Grade/Associate Specialist” (2WT) MMC: Medical Support Nurses (5 WT) along with 3 FYD2 (FY2 cover only 30% of rota requirements) Surgical Practitioners (3 Trainees) graduating Aug 2011

Sustainability Expanding the non-training grade (SpD) Replacement of some medical middle-grade posts with Surgical Practitioners posts. Redesign rota structures and roles taking into accounts the limitations imposed by CC - AFC- EWHD- Professional bodies –Unions...etc A transitional period of higher PayRoll during training and replacement ( About 3 Years)

Plans/Future Using telemedicine (PACS already)- SCI.. Extending clinical database to region MD Meeting revival with Raigmore and Ninewells using technology Promotion of managerial and administrative collaboration to achieve clinical effectiveness. This event today is another step in the efforts to support regional integration... Best wishes!