1. National Review of Congenital Cardiac Services
Carin van Doorn
Chair Congenital Subcommittee

2. New National Review Congenital Cardiac Services
Started
Commissioning Nov 2017
Completion ???2021
Covers England and Wales
Not applicable to Scotland and Ireland -Scotland: amalgamation of paediatric services in Glasgow -Ireland: all Ireland service in Dublin for paediatric cardiac surgery

3. Based of Standards of Service
Covers whole patient pathway: antenatal diagnosis – end of life care
Separate standards for adults and children
Important standards: - Need for co-location of services - Minimal 125 operations/surgeon/yr (averaged over 3 yrs) - Minimum of 4 surgeons/unit (by 2021)
( No standards for training or research)

4. Service delivery via a Network approach
Level 1 (surgical centre)
Level 2 (cardiology centre)
Level 3 (local hospital)

5. Commissioned services
Paediatric All existing paediatric cardiac surgery centres remained open Special measures for Leicester, Newcastle, and Brompton
ACHD Closure of Manchester as congenital surgical centre New surgical services to start at Liverpool (commenced Sept 18) with services provided in Leeds, Newcastle and Birmingham in mean time.

6. Progress over last year
Establishment of regional congenital cardiac networks
On-going work to achieve the many standards for commissioning
Concerns that with all 10 paediatric centres currently active, it is not possible for each centre to do 500 cases/yr with 4 surgeons ( Nicor submissions annually for 10 English centres plus Scotland and Ireland)
Concerns about practicalities to deliver the prescribed activity - lack of PICU beds / adult ICU beds - lack of surgical manpower (> 15 new surgeons required over next 10 years)
Development of more collaborative approach between centres, esp for multicentre research

7. Steps taken to address problems
SCTS stakeholder participation in new national PICU review
Work in progress for peri-CCT congenital cardiac fellowship
Ongoing discussions on how to ‘count’ number of cases - ? Counting double scrubbing - ? Are all cases counted equal
Agreement for controlled randomised trial on cardioplegia through first round of BHF funding