1. Surgical update

5. Commissioning

7. Specialised commissioning – service specification for thoracic surgery
Minimum of three full time general thoracic surgeons leading thoracic surgical services.
24/7 on call cover should be provided by either general thoracic surgeons or mixed cardiothoracic surgeons only.
Thoracic centres must undertake 70 lung resections for primary cancer per annum. This figure rises to 150 lung resections per annum by the end of 2018/19.
Providers will need to ensure they have protocols in place to facilitate the provision of a second opinion as to the patient’s suitability for surgery for patients with early stage disease who are turned down for surgery.
Surgical job plans should support the organisation of the service (includes 95% MDT attendance).

8. Scrutiny of practice and outcomes
LCCOP
NLCA
GIRFT

16. Recommendations
More efficient bed management by ensuring surgery on day of admission is delivered routinely
Ring-fencing beds on ICU and general wards
Sub-specialisation for certain critical procedures
Use of VATS for lung resection surgery

17. % randomised of eligible
VIOLET study
Centre
January
February
March
Number randomised
% randomised of eligible
% of CRFs missing
Brompton 2 1 75
58% 3%
Liverpool 55
40% 5%
Bristol 4 3 88 1%
Middlesbrough 63
78% 8%
Harefield 23
12%
Oxford
11% 2%
Hull 5
100%
18%
Birmingham
50%
22%
Overall 9
316
48%

18. Aspirations Consolidate good practice: Care closer to home:
VATS
ERAS
Care closer to home:
95% MDT attendance
Virtual POAC
Shorter pathway
Patient outcomes
Sublobar resections (CALGB, JCOG)
Robotic surgery