1. Managed Clinical Networks Heart & Stroke Denise W Brown MCN Manager 8 th October 2009 - eScience Centre Edinburgh

2. Drivers for 2009 New Action Plan from Scottish Government June 2009 SIGN Guidelines QIS Standards NHS efficiency savings Long Term Conditions Patient Self Management

3. What are stroke challenges for 2009/10? Stroke Thrombolysis services / telemedicine Phased implementation of service – with 5 patients thrombolysed since June 09 at Ayr Hospital. Out of hours still go to Glasgow. Working with clinicians, operational managers, planners, SAS, West of Scotland Stroke Group and National telemedicine colleagues Acute Stroke measures to improve admission Working with clinicians, operational managers & QIS Standards measured by Scottish Stroke Audit Community involvement in early discharge, exercise for stroke and promotion of healthy lifestyles All requiring working across the pathways and with partners SAS – Leisure Services and Keep Well QIS Standards

4. What are challenges for heart in 2009 / 2010? New Heart Attack definition – troponin < 1 (400 plus for c rehab) Optimal Reperfusion Service for STEMI (started Jan 2009) Living and Dying Well - Palliative Care for Heart Failure (BHF 3 yr post) Improving Psychology for Heart Disease (BHF 3 yr post) 18 Referral to treatment (RTT) ICD follow up service QIS Draft Standards Pilot Site QIS Standards

5. 18week challenge: Real-time process mapping AngioIntervention Investigations Consultant clinic Rapid access CP clinic Post MI clinic Other cons referrals GP referrals In-patient admission Open access ETT Review

6. 1 st step Triaging GP Cardiology Referrals into appropriate pathway: Consultant clinic GPwSi Rapid Access Referred onto Consultant Clinic if appropriate GP referrals Advanced Specialist Nurse Cardiophysiology Led investigations Working with patients, clinicians, operational managers, planners, West of Scotland Tertiary Centres for onward referrals for surgery Palpitation / Arrthythmia Pathway

7. Implantable Cardioverter Defibrillator (ICD) follow up Service Patient influence and lobbying of Health Board for local service rather than travel to Glasgow MCN, planners and West of Scotland Group agreed this shift of care to A&A Cardiophysiologists were trained and the service supported by MCN This service is now at Ayr Hospital and we are delighted with the positive response from patients All new patients with ICD fitted in Glasgow will have their follow up visits at Ayr Hospital Currently 75 patients on books with 2 new patients a month

8. Patients at the centre of Psychology Service planning

9. Clinical Psychology Project for Stroke – Dr Luke Williams enabling staff & patients to recognise distress and agree a plan Distress Management System to highlight, monitor & manage distress Unfortunately no recurring Psychology service after March 2010

10. ☼ LIFE AFTER STROKE Self Support Group in the community for people, their families and carers who have come through a stroke and want to meet socially. Support by Chest Heart and Stroke Scotland, MCNs and PPFs. Meeting Monthly in the community setting. CHALLENGING YOUR CONDITION : A Self Management Generic Course in Community run by Arthritis paid for by Ayrshire & Arran. ♥ Ticker Talk Self support for people with heart failure, their families and carers PPFs

11. Influences Audit Data collection – knowledge is power Good Communications – quarterly reports/ Public Relations / Profile Patient Power – groups / open meetings Multidisciplinary / agency work / pathways Self Management philosophy National, Regional and Local involvement in planning Scottish MCN Managers for Heart Disease Group

12. Authority & Clout! Lead Clinicians for MCN are dedicated Operational Managers & patients on MCN Involvement in A&A Strategy – efficiency saving/ re-design & planning Shifting Balance (Benefits; Burden) of Care QIS / SIGN / Action Plan / Patient Involvement & Influence  We tick all the boxes