NORTH WEST CONGENITAL

HEART DISEASE

PARTNERSHIP

Dr Vishal Sharma

Congenital Heart disease Implementation Lead

OUTLINE

• Background to ACHD in North

West

• Future Model for CHD

Hub and Spoke

• Level 1 Surgical centre at Alder Hey

• Paediatric CHD Interventions at Alder

Hey

• Paediatric EP supported by Liverpool

Heart and Chest

• Outpatient services across North West

provided by Alder Hey outreach

• Fetal Screening at 2 centres

CURRENT SERVICES - PAEDIATRIC

CURRENT SERVICES -ACHD

Adult Hub - (CMFT)

• ACHD Surgery - CMFT

• ACHD interventions at 2 sites

- provided by Alder Hey cardiologists

- EP Service at LHCH

• Outpatient services

- provided by CMFT Outreach

- supplemented at LHCH by Alder Hey

• Obstetric Care provided on a risk matrix

- Moderate Risk Transferred to

Arrowe/Whiston

- High Risk ACHD transferred to CMFT

• Non Cardiac surgery/Medical Admissions

- Local DGH’s

- Complex cases transferred to CMFT

ACTIVITY AND OUTCOME

Liverpool is a high volume centre:

• Performed 83% of Congenital Surgery

for the North West (NICOR 2009-13)

• Performed 81% of Congenital

Intervention for the North West (NICOR

2009-13)

• Performed 41% of Northern Region’s

Congenital Surgery

Liverpool achieves excellent outcomes:

• Paediatric CHD Surgical Mortality

<1.0% since 2013 North West Surgical and Interventional Activity 2009-2013

(NICOR)

CURRENT CONFIGURATION

UNSUSTAINABLE • Paediatric CHD Service compliant

• Unsustainable Adult Surgery

• Surgical activity <80 cases/surgeon

• 1:1 surgical on call rota

• No ACHD interventional cardiologists at CMFT

• Service provided by Alder Hey

• Difficulties managing transition from paediatric services

• Inability to provide sustainable on call rotas (40 miles)

• Surgery

• Intervention

• ACHD medical on call

Logistics of the M62

NHS ENGLAND CHD REVIEW

ASSESSMENT AGAINST STANDARDS

>125 cases / surgeon

1:3 surgical on-call rota

1:4 interventional cardiology rota

Seven congenital cardiologists

Paediatric co-dependencies

Specialist cardiac nurses

PICU capacity

Paediatric cardiac anaesthetists

ECMO

~80 cases / surgeon

1:1 surgical on-call rota

No interventional cardiology rota

Two congenital cardiologist

Adult co-dependencies

Specialist cardiac liaison nurses

ICU capacity

Dedicated adult congenital

anaesthetist

No Paediatric Service

Alder Hey- Paediatric Service CMFT – Adult Service

NHS ENGLAND DECISION

• Decided to Commission Liverpool to provide Level 1

Services

• Decommissioning of Level 1 surgery at Manchester

Royal Infirmary

• Specialist medical care and some interventional activity

may continue at Manchester as Level 2 centre

• During the consultation, ACHD services at Manchester

collapsed

• Interim arrangements in place with Newcastle and

Leeds.

LIVERPOOL – ALL AGE LEVEL 1 CHD

CENTRE

AIMS

• Provide specialist CHD care

24/7

• Sustainable on call rotas

• Surgery/Intervention

performed in high volume

centres by highly experienced

operators

• Achieve world leading

outcomes

• Work with providers across

the North West to provide all

age CHD Network

Newcastle

Leeds

Manchester

Liverpool

Wrexham

Blackpool

NORTH OF ENGLAND CHD NETWORK

Level 1 Centres:

• Liverpool

• Leeds

• Newcastle

Good access to Level 1 centres

• North England

• North Wales

North West Level 2/3 Centres

• Manchester

• Wrexham

• Blackpool

Level 1 Surgical Centre

Level 2/3 Centres

Sustainable rotas

1:4 surgery

1:4 Intervention

24/7 care delivery

Call to bedside <30mins

Seamless integration across

organisations

Host all age CHD Network

Compliance with standards

• Adult Level 1 surgical centre • Adult interventions • Shared Adult Services with Royal • Transition services with Alder

Hey

• Medical/cardiac admissions for ACHD

• Non- cardiac surgery for ACHD • Delivery of high-risk cardiac patients

with LWH • Provide adult co-dependencies for

LHCH • ACHD cardiology on call

• Paediatric Level 1 Surgical Centre

• Paediatric co-dependencies • Common surgical rota with LHCH • Support LHCH anaesthesia • Surgery for neonates with CHD

together with LWH

• Manage high risk deliveries at Royal

• Pre pregnancy counseling • Foetal Screening • Coordinate delivery/intervention

for neonates with CHD

TRANSITION PLAN

• Currently Interim arrangements in place

• Specialist ACHD advice/support accessed through Manchester Foundation Trust (MRI)

• Surgical and interventional activity delivered at Leeds/Newcastle

• Services to transition to Liverpool over 12-18 months

• Phase 1- Intervention

• Phase 2 - Congenital Surgery

• Phase 3 - Specialist medical care

• Phase 4 - Responsible for compliant services across North West.

SUMMARY

• Been a long and difficult process

• Significant challenges remain

• For now access to ACHD care remains through Manchester

• Services will transition to Liverpool over next 12-18 months

• Ultimately will achieve a high quality service fully compliant with the

standards