society for cardiothoracic surgery in great …below is bb’s response to the president’s email...
TRANSCRIPT
UNAPPROVED
Pag
e1
SOCIETY FOR CARDIOTHORACIC SURGERY
IN GREAT BRITAIN AND IRELAND
Minutes of the Executive Committee meeting held on 5th June 2015
at the Royal College of Surgeons of Edinburgh in Birmingham.
The meeting opened at 10.30am
Present:
Mr Tim Graham President TG
Mr Graham Cooper President-Elect GC
Mr Jonathan Afoke Joint Trainee Representative JA
Mrs Christina Bannister Nursing & Allied Health Professionals Representative CB
Mr Clifford Barlow Meetings Secretary CWB
Mr Sion Barnard Chair of the SAC & Co-opted Revalidation Lead SB
Mr David Barron Elected Member DB
Mr Ben Bridgewater Invited Member & Member of Clinical Audit Committee BB
Mr Andrew Chukwuemeka Elected Member AC
Mr David Jenkins Elected member DJ
Prof Marjan Jahangiri Elected Member MJ
Mr Simon Kendall Honorary Secretary SK
Ms Juliet King Elected Member & Co-opted Trustee JK
Mr Kulvinder Lall Treasurer KL
Mr Mike Lewis Joint Education Secretary ML
Mr Heyman Luckraz Perfusion Representative HL
Ms Sarah Murray Lay Representative SM
Mr Andrew Owens Elected Member & Co-opted Trustee AO
Mr Rajesh Shah Joint Education Secretary RS
In attendance:
Prof Dion Morton Royal College of Surgeons DM
Ms Jasmina Dvordjevic ACSA JD
Ms Isabelle Ferner Society Administrator IF
Miss Tilly Mitchell Exhibition and Finance Administrator TM
Mr Murray Robertson Education Administrator MR
Ms Katharine Owen Minute Taker KO
Apologies:
Mr Jon Anderson Chair ICEB Cardiothoracic surgery JA
Mr Sunil Ohri Meetings Treasurer SO
Mr Amir Sepehripour Joint Trainee Representative AS
Mr Doug West Thoracic Surgery and Audit Lead DW
UNAPPROVED
Pag
e2
1. Welcome
1.1 TG welcomed everyone to the meeting, thanking them for attending. Apologies for absence
were as noted above.
2. Minutes of the meeting held on 6th February 2015 in London and matters arising
2.1 Standing Report from the President: Update on visit to Mr Ionescu – December 2014 (Min
4.3, p.3.)
Agreed: ML would discuss with TG, outside the meeting, the appointment of a Society
Historian/Archivist who was likely to be Mr John Dark or Mr John Smith. ACTION ML/TG
2.2 Report from the Clinical Audit Group including a presentation by Ralph Tomlinson (Min 7.8,
p.5)
Noted: GC would report later in the meeting on proposed funding by SCTS of the process of
responding to divergence in surgical outcomes depending on the number of cases involved.
2.3 Summing up of Action Points (Min 9.1, p.6)
Noted: TG had written to Professor Sir Bruce Keogh as agreed.
2.4 NACSA and post BORS Plan (Min 10, p.7-8)
Agreed: That Mr Ben Bridgewater pass details of amendments together with his response to the
President’s email of 8 February 2015 to IF for inclusion in the minutes.
ACTION BB/IF/KO
Post meeting note: The amendments are included in the reissued minutes of 6 February 2015.
Below is BB’s response to the President’s email of 8 February 2015; both emails are included for
clarity. The response has also been added to the minutes of the meeting held on 6 February 2015.
Subject: Re: Identification of individual positive outliers in the NACSA for the COP next round.
From: BB to the President
Date: Wed, 11 Feb 2015 09:56:47 +0000
Dear Tim,
Thanks for your email. I have discussed the issues with Jane Ingham and Danny Keenan at HQIP and
also with John Deanfield at NICOR. We are pleased the decision of the executive on Friday was not to
reject the directive to publish positive outliers for named surgeons, but I agree the reservations about
this came through strongly in the discussions and I have reflected that to HQIP and NICOR
colleagues. I also note from your email that you are asking for support in your communication with
the membership of SCTS. I think it is worth considering the following:
There is a clear directive from NHS England to publish positive outliers at individual clinician level
across the whole of the Consultant Outcomes Publication programme for this year’s round. So this is
programme-wide and SCTS is not being singled out in any way.
My understanding is that moving to publishing positive outliers is reverting to the SCTS policy
between 2005 and 2010.
Congenital and Thoracic surgery are currently not being asked to publish data at individual surgeon
level. As such the positive outlier issue does not apply to them at this stage.
UNAPPROVED
Pag
e3
The SCTS will be in a position to work with NICOR to develop the methodology for publication and will
be able to contextualise the data on the SCTS.org site, allowing full ability to raise any issues felt to be
important to patients and the public to go out alongside the data.
Alongside publishing positive outliers, SCTS has a good opportunity to focus on the issues that came
out strongly at the exec about organisation results, and can put in place a strategy to define and
celebrate best practice, learn from it and disseminate it widely. I know that RCS England and HQIP
would be very supportive of any initiative along this line.
With respect to the other points you raise, I note your concern about the process of communication
and I apologise if you feel that this should have been more formal and directly to SCTS. In my HQIP
and NICOR roles I was aware of the issues as they developed and I did try to make every effort to keep
SCTS informed through detailed conversations with David Jenkins, Graham Cooper and yourself and I
forwarded the relevant email, to sit alongside Bruce's reply to your letter, to that group and Simon
Kendall in preparation for Friday’s meeting. This email did contain the clear directive that you
describe in your message. I have, however, raised your point about mode of communication
with both HQIP and NICOR and they are copied in to this reply.
The issues about how you identify positive outliers at this stage is planned to be using two-tailed
statistical processes testing the hypothesis as the 'is the mortality rate after adjusting for patient risk
significantly different from the national average?'. This would apply to
both positive and negative outliers. When this was done on data in the past it identified about eight
surgeons with mortality rates better than expected at the 95% limit. There is a 'power' issue here in
the way the stats work, so that low volume surgeons could not be identified as positive outliers. The
model used to adjust for risk to ensure that case mix is appropriately reflected in the analysis would
be the same model used for all analyses, and we have had much discussion and there has been
significant external scrutiny on this over the last year or so. I think the model we use
is acknowledged to discriminate well across the full spectrum of risk and as such is 'fit for purpose' for
identifying positive outliers. This can obviously be discussed in detail at the NACSA meeting on Friday.
With respect to previous publication of positive outliers in the COP programme, the BCIS audit did
identify positive outliers on risk adjusted MACCE which were published on their website in the last
round. I do not have access to the exact number of outliers identified at this point but I have asked
HQIP to look into things in more detail. All other COP audits are being asked to use methodology for
this year to do the same.
Finally the issue of positive outliers and the COP audits is on the agenda for the COP wash-up
meeting on the 23 February and I am sure that you and other members of SCTS will be in attendance,
as will Bruce and other representatives of NHS England and HQIP. There will be patient representation
there also. This was really the forum for this all to be discussed prior to this COP round, but because
the SCTS publishes slightly ahead of the other audits this was raised with you for discussion on Friday
prior to the wash up. This meeting will allow discussion of the perceived benefits of the approach and
give the professional societies, RCS and other stakeholders the opportunity to raise any issues they
have.
With best wishes, Ben
UNAPPROVED
Pag
e4
On 8 Feb 2015, at 13:19, Tim Graham wrote:
Ben
Thankyou for coming to the SCTS on Friday and advising us of the above. As you stated this is a higher
political issue and we acknowledge that as an active clinical cardiac surgeon and a member of SCTS
you are in a difficult position.
We have reflected on the whole discussion/debate on Friday . The SCTS executive supported the plan
to identify unit positive outliers and can see the potential benefits but had concerns about doing this
at an individual surgeon level - this would be a significant change for all the adult cardiac surgeons
contributing to the NACSA via NICOR. The executive feel that this change in public outputs from the
NACSA should therefore be transparent and has to be clearly explained for all the SCTS members.
We would be grateful if you could help us with this in the following way -
We are concerned that the communication regarding this is by word of mouth and the copying in of
second hand e mails - we would like to have a clear directive in writing from HQIP and/or even the
powers that are instructing HQIP.
Identify the perceived benefits of this approach from the HQIP perspective
Explain how the statistical methodology would identify high volume full range of clinical practice/risk
surgeons rather than low volume low risk surgeons
Estimate how many surgeons might be identified at each round of data release on your data to date
Provide us with the information from the last COP outputs in November of specialties and number of
surgeons who were identified as positive outliers ( we have been unable to find this information )
Explain how positive individual surgeon outliers are going to be identified in the congenital cardiac
surgical audit and how this will be taken forward with thoracic surgery.
Thank you for your help with this in anticipation. As you explained the timeline for this is tight with
imminent release of the next round of adult cardiac data and a general election in May.
We have the NACSA meeting next Friday and perhaps it will be possible to get this information then
so we can widely disseminate this proposed change as soon as possible
Best wishes
Tim
T R Graham
President SCTS GB&I
2.5 Report from the Meetings Secretary (Min 22.2, p.12)
Agreed: That the minute be amended to read, line 3, “...planned for Birmingham, Dublin or Belfast.”
ACTION KO
2.6 Signing of minutes
Agreed: The minutes were approved as a true and accurate record of the meeting, subject to
typographical amendments and the insertion of BB’s response to the President (Min 10, pp.7-8).
Following this they would be signed by TG and loaded onto the Society’s website. ACTION IF/TG
3. Report from the President
3.1 Received: Standing Report from the President, T Graham (Paper 5.i, Appendix 1).
3.1.1 Reports
UNAPPROVED
Pag
e5
Noted: A list of reports produced since the last Executive Committee meeting in February was
attached, together with the President’s upcoming article for inclusion in the SCTS Bulletin.
3.1.2 Awards
Noted: Of particular note was an update on the current, complicated ACCEA process. No new
awards were being funded - they are from renewals and retirements this year. The Society was
allowed to nominate members for awards every year. Particularly strong applications had been
made for the silver awards. Compared with other specialities, there was a relatively high rate of
return for SCTS nominations but the number of recommendations was fixed for the size of specialty.
The number of awards made for surgery at a national level was poor generally, but when they were
made, the SCTS did well.
3.1.3 National Clinical Audits
Noted: NHS Choices was committed to publishing individual outliers. This would be discussed in the
course of the meeting.
3.1.4 Mr Ionescu and Scott Prenn
Noted: KL would speak about the continued support received from Mr Ionescu and would report on
Scott Prenn.
3.1.5 Governance of SCTS
Noted: This was now a key issue and it was proposed to establish an SCTS Professional Standards
Committee. Post meeting note: this will be called the Professional Standards and Governance
Committee and there will also be an SCTS Research Committee.
4. Report from the Clinical Audit Group
4.1 Received: Standing Report from the Chair of the Clinical Audit Committee, David Jenkins
(Paper 5.ii)
4.2 Noted: The table at the end of the paper indicated important differences between the three
main speciality audits. In summary, the main reported measure for Adult cardiac was survival at
surgeon and unit level. For Thoracic, it was 30/90 day mortality at unit level and resection rate. For
Congenital, it was survival at unit level.
4.3 Noted: Thoracic benign surgery was not well represented at NHS Choices. Congenital
cardiac surgery was not part of the NHS England COP agenda.
4.4 Noted: Following the Board of representatives meeting to discuss Adult cardiac audit, the 13
point plan had been agreed. Specifically:
4.4.1 Noted: It had been agreed to present data as survival rather than mortality.
4.4.2 Noted: The June 2015 update of data for publication (2011-2014) would show positive
outliers. One practising surgeon and two units were significantly worse than expected, triggering
alarms. However, 19 surgeons and five units were significantly better than expected. It was
anticipated that the media would take an interest in the one practising surgeon and two units who
were significantly worse than expected. However, the President-Elect had the media team alerted; it
was working on this within RCS Eng.
4.5 Noted: It had been requested at the NHS Choices meeting the previous day that unit level
outcomes be at the forefront of the published data/website and have consultant level data
subservient to unit level data with a “health warning” attached regarding the nature of cardiac
surgery.
UNAPPROVED
Pag
e6
4.6 Noted: There were other factors to be taken into account when reporting on outcomes – not
just mortality. Risk scoring had been critical in the past. There is a forthcoming SCTS/NICOR meeting
on 3 July to discuss and agree the definition of risk factors.
4.7 Noted: Discussions related to other outcome measures will also occur at the meeting on 3rd
July.
4.8 The outcome of the risk factors and other outcomes meeting on 3rd July needed to be
communicated to the Members at the earliest opportunity.
4.9 Noted: The concerns of the Clinical Audit Group regarding the publication of positive
individual outliers had been conveyed to HQIP and NHS England but this would go ahead in the COP
release in June/July.
4.10 Noted: Primary lung cancer surgery would be included in the COP programme. Three
measures had been chosen, 30 and 90 day mortality by unit and resection rate by MDT Resection
rate. Methodology for determining this from NCLA data had not yet been clarified. It was not known
how this would work out and there was no complete analysis for benign thoracic surgery Risk
adjustment was poor. Dendrite collected the data but had yet to be validated. The Nottingham
group hoped to obtain a more accurate picture in the future.
4.11 Noted: Congenital surgeons had kept data at unit level; it may be appropriate for Thoracic to
do the same. The difficulty lay in obtaining accurate data.
4.12 Noted: Funding was available for Dendrite – however this was not ideal. DW would report
back to the Executive in October 2015. For benign surgery support was required and the Society may
need to self fund or find corporate partners.
4.13 Noted: The establishment of a Governance Committee would be considered later in the
meeting (see Min 9.2). Post meeting note: It was agreed to establish a Professional Standards and
Governance Committee.
4.14 Agreed: That the membership of the Clinical Audit Committee be adjusted to include JK and
Andrew (Chuck) McLean. All three of the specialty clinical audits should be discussed every six
months.
4.15 Agreed: Thanks were extended to DJ for his extensive work and for his report.
5. Report from the President-Elect
5.1 Received: Standing Report from the President-Elect, Graham Cooper (Paper 5.iii)
5.2 Blue Book Proposal (Paper 5.iii B Appendix 1)
Noted: The work should go ahead and be ready for March next year. However, it had not yet been
resolved whether it would be available only in electronic form as a pdf or in hard copy also. The
latter depended on funding.
5.2.1 Agreed: GC to head up a project team and arrange discussions with Dendrite and NICOR and
Database managers. ACTION: GC
5.2.2 Noted: Re Surgeons’ profiles on SCTS website: of interest to patients were pictures of
members, details of training and other information. To date, where profiles were included on the
website, total hits included 322,891, of which 191,758 were unique hits (different devices). Any
missing profiles from the Executive Committee weakened the project. Profiles could include
anonymised feedback and the kind of information declared at an appraisal. Details should be within
the bounds of GMP.
5.3 Invited Review Mechanism (Paper 5.iii B Appendix 2)
UNAPPROVED
Pag
e7
5.3.1 Received: A proposal that the SCTS Executive Committee and the RCS Invited Review Team
work together to develop a Cardiac Peer Review (CPR) scheme.
5.3.2 Noted: Preliminary costing of the resources required to provide the scheme estimated that
with good levels of engagement the scheme could be delivered on a four year cycle for an annual
cost of approximately £5000 per unit per year (or a one off charge of £20K every four years).
5.3.3 Noted: The scheme was intended to be IRM light. It was key that the Executive Committee
be seen to be working with units and surgeons to help them in the face of publication of outliers and
supporting individual members and units to become better at addressing performance issues earlier.
In this way the SCTS could work towards “preventing the next car crash”. This was the potential
strength of this proposal.
5.3.4 Noted: An analyst at NICOR had looked at the revised scheme of alarms and alerts.
5.3.5 Noted: There was a view that it may not be necessary to have reviews every four years;
however, whilst this could not be made obligatory for Trusts, it could be given as an example of good
practice. There was some concern that, when the SCTS Executive changed, the initiative would be
dropped and would therefore not be value for money. Conversely, the view was that it could only be
tried and that pilots would give a good idea of future success. A lot of the work could be undertaken
online and it was suspected that the uptake would be quite strong.
5.3.6 Noted: The Perfusionists had a successful similar initiative, based on a five year cycle.
5.3.7 Noted: The initiative would not be possible without major funding.
5.3.8 Agreed: After discussion, to support the proposal in principle and to support the President-
Elect and Mike Lewis in approaching Ralph Tomlinson (Head of RCS Invited Reviews) to ask him to
draw up a formal plan for the proposed scheme, with the aim of delivering a series of “trial sites”
from Spring 2016 onwards. ACTION: GC/ML/RT
5.4 Governance (Paper 5.iii Appendices A and B)
5.4.1 Agreed: The policy relating to Thoracic Surgery would be adapted and disseminated at the
next Executive ACTION: GC
5.5 SCTS Best Practice Guidance: Monitoring Individual and Team Outcomes and Supporting
Early Action in Response to Divergence in Performance (Paper 5. iii Appendix 3)
5.4.1 Received: A proposal on Best Practice.
5.4.2 Agreed: That CUSUM plots be formally reviewed by the consultant surgeons at least every
three months to ensure that individual and unit performance was within expected norms and action
taken if this were not the case. ACTION: GC
5.6 SCTS Outlier Policy 2015 Adult Cardiac Surgery Draft (Paper 5.iii Appendix 4)
5.6.1 Received: A proposal on Outlier Policy.
5.6.2 Noted: There had not been a standardised outlier policy in place in the past. There were
three important differences from previous policies. SCTS had traditionally defined three levels of
outlier; yellow, amber and red. In keeping with the other specialities publishing consultant level
outcome data and on the advice of the external statistical review of the audit last year, for 2015, the
SCTS was moving to two levels: alert which represented the old yellow and amber levels and alarm
which represented the old red level.
5.6.3 Noted: The President-Elect had drafted template letters following the triggering of an alarm
or an alert which would go to Individual Surgeons, Medical Directors, and Audit Leads. However,
NICOR had declined to sign these as they contained areas of advice that was not within their
responsibility.
UNAPPROVED
Pag
e8
5.6.4 Noted: It may not be helpful to send two lots of letters – and that a shorter letter agreed by
NICOR would be preferable.
5.6.5 Noted: Medical Directors would get a phone call prior to the letters going out and there
would be appropriate details placed on the website.
5.6.6 Agreed: There was substantial support for the original draft letters; detail such as the tables
with crude mortality and other details should be retained. The introductory paragraph could be
modified. The President-Elect would adjust the original letters outside the meeting and put them to
NICOR next week (week commencing 8 June) with a view to their being sent out on 16/17 June. The
Trustees would then be asked for their approval. ACTION: GC
5.7 Notes on Divergence in the Lung Cancer Surgery Consultant Outcomes Publications (LCCOP)
(Paper 5.iii Appendix 5)
5.7.1 Agreed: Discussion of this paper would be postponed until DW could be present at the
October Executive. ACTION: IF/DW
6. Presentation by Dion Morton, RCS: Speciality Contribution to Research
6.1 Received: A presentation on Speciality Contribution to Research (ppt)
6.2 Noted: Following the presentation a brief discussion highlighted the wish of SCTS to make
use of an opportunity which had arisen, for a Thoracic lead post with RCS Eng.
6.3 Noted: that the RCS had substantial funding and yet had suggested that the SCTS contribute
funding to the 2 research lead posts in one years time..
6.4 Agreed: SCTS would write to Professor Morton regarding the new Thoracic Research lead
post for the next three years. ACTION TG
7. Presentation by Simon Kendall: Proposal for SCTS Research Committee
7.1 Received: A presentation on Terms of Reference June 2015 for the proposed Cardiothoracic
Surgical Academic and Research Committee Society for Cardiothoracic Surgery Great Britain and
Ireland (Paper 6. Appendix 2)
7.2 Agreed: There was a significant need for this Committee
7.3 Agreed: The Executive Committee did not wish to exclude potentially good candidates who
might not have an academic appointment from the proposed Research Committee. A Research
Nurse should be added to the proposed structure, providing he/she was a member of the SCTS. This
structure could apply to other sub-committees. On this basis, the proposal was agreed.
ACTION SK to confirm structure of committee and arrange appointment of chair.
7.4 Agreed: That a trainee representative should be on the SCTS Research Committee.
8. Standing Report from the Treasurer
8.1 Received: A report from the Treasurer, Kulvinder Lall (Paper 5.iv)
8.2 Noted: Funds held as of 31.5.15:
SCTS Education £48,186
SCTS £205,000
Ionescu Account £190,302
Cardiac & Thoracic Surgery UK £145,000
8.2.1 Noted: The SCTS meeting generated a surplus of £74K this was being invested wisely
through financial advisors. All deposits and withdrawals were accompanied by receipts.
8.3 Ionescu Fund
UNAPPROVED
Pag
e9
8.3.1 Noted: Mr Ionescu continued to be extremely supportive. All cheques received are
deposited in the Ionescu Education & Quality Trust Fund Account. These monies are then
redistributed to Education at €50,000pa to ensure the long term success of the education
workstream. There was a potential further donation of €100,000 this summer.
8.3.2 Agreed: The €50K pa payments including timings referred to above would be discussed
outside the meeting with ML and RS (Education Committee). ACTION: ML/RS/KL/TG
8.4 Scott Prenn
8.4.1 Noted: The London based marketing company’s contract had come up for renewal in June.
It was the Treasurer’s recommendation that the contract be extended for one year in order that
certain projects could be completed. The relationship was, however likely to be finite.
8.4.2 Noted: The Company charged £45K pa and had agreed to fund 2 further showcase days and
had been given specific metrics to achieve. Key was the exposure they could achieve, which saved
the time of members of the SCTS Executive . However, the argument could be made for appointing a
full time communications specialist; in this sense there was some question as to whether such a
dedicated resource was being received in terms of the time given by Scott Prenn. Profit and
influence against the monies paid out was sought., There had been some aspects of their
professional interaction which had been strained. There had been a double approach to Ethicon and
there had been certain notable absences at the AGM showcase day. However, there had been a
growing collaboration with TM in particular. The February 2016 meeting of the SCTS Executive
should discuss any future contract
8.4.3 Agreed: After discussion, it was agreed that the advice of KL should be taken and it was
agreed to renew Scott Prenn’s contract to 31st May 2016. There should be a showcase day in London
as soon as possible – most likely before the October Executive meeting. An analysis/position
document would be carried out by KL and two members of the Executive Committee.
ACTION: KL/AO/RS to provide a discussion document on future of Scott Prenn contract at the SCTS
February executive including discussion on alternative publicity / partnerships strategy may 2016
onwards.
9. Standing Report from the Secretary
9.1 Received: A report from the Secretary, Simon Kendall and a Question from Richard Steyn
(Paper 5.v)
9.2 Proposal for SCTS Professional Standards and Governance Committee (Appendix 1)
9.2.1 Agreed: The name of the proposed committee be amended as shown in 9.2.
9.2.2 Agreed: There should be a non-medical/lay member in the structure of the committee. Any
external industry representatives should be invited on a case by case basis to specific meetings.
ACTION: SK to confirm membership of committee and arrange appointment of Chair.
9.3 Cardiothoracic Workforce Report for SAC/SCTS
9.2.1 Agreed: That the section on joint cardiothoracic practice be made more robust; the trauma
section had not yet been delivered. ACTION: SK
9.2.2 Agreed: A significant amount of work had gone into the drawing up of this proposal and
should be disseminated as a Joint Report with the SAC. The SCTS should check the Report, in tandem
with the SAC and be joint authors. ACTION: SK
The document would be available online to be released by 1 August 2015. A good quality pdf which
was potentially printable was acceptable. Some hard copies would probably be helpful.
UNAPPROVED
Pag
e10
9.2.3 Agreed: To approve the document, which showed the SCTS’ status at present, not how it
would be in ten years. Any updated information could be included in a second volume. ACTION SK
9.2.4 Agreed: Prior to dissemination, the document should be edited; job plans could restrict
members; indicative numbers could be given. Medical workforce planning would be needed. SM
would read the document carefully. Following this, SK for SCTS and SAC would forward it to the FSSA
and NHS England. The timeline involved was next week for the SAC, with feedback to be given to the
chapter writers. It was to be noted that the SCTS had funded the secretarial support of this
document. ACTION: SM/SK
Post meeting note: There should be a three yearly annual review of the terms of reference of all
SCTS Executive committees. ACTION: SK
9.3 Question from Richard Steyn
9.3.1 Noted from the AGM March 2015 : The President has today received an email from Richard
Steyn at the ABM regarding the role of the SCTS in supporting individuals. In the email he (President
of SCTS) noted that the Society (as a body) cannot intervene or act on behalf of an individual member
(beyond providing advice and information relating to good standards or practice).
9.3.2 Noted: Mr Steyn asked, essentially, that the Society confirm that it had not, to date, acted in
breach of its constitution.
9.3.3 Agreed: The SCTS had given pastoral support to its members. It was not believed that the
Society had acted in breach of its constitution. This holding reply would go to Richard Steyn and then
to the new Professional Standards and Governance Committee. ACTION: SK
10. Standing Report from the Chair of the Thoracic Sub-Committee
10.1 Received: A Report from the Joint Chair of the Thoracic Sub-Committee, Juliet King (Paper
5.vi)
10.2 Minutes of the teleconference meeting held on 28 May 2015
10.2.1 Noted: The minutes of the teleconference meeting held on 28 May 2015. It had been
reiterated what had happened to the lung cancer COP for last year. It may be possible to adjust the
alert and alarm figures; these had not yet been robustly analysed. Data entry for all surgery into
Dendrite had fallen off since LCCOP had been introduced and the future of the relationship with
Dendrite was currently uncertain. HQIP would clarify whether they would support data collection for
non-lung cancer surgery – this was essential. SR was sending out a new survey and had had new
discussions. BTS guidelines on pneumothorax were currently being reviewed; if there were not
enough evidence currently to support earlier intervention then a national trial may be appropriate.
10.2.2 Agreed: There were vacancies for three new members on the Thoracic Sub-Committee; these
would be advertised for next week. ACTION: JK/IF
10.2.3 Noted: SK was of the view that JK as the new co-Chair had a good vision.
10.2.4 Noted: The Thoracic returns had been received, showing the number of deaths per unit.
Dendrite oversees this process together with COPS. It was planned to phase out this system and to
have only one dataset.
10.2.5 Agreed: At least two of these systems should be merged; the advantage of Dendrite was that
there was one dataset. It was important to understand whether the problem with the Thoracic audit
lay in the funding, the informatics or the workload involved.
UNAPPROVED
Pag
e11
10.2.6 Noted: The views that, whilst it may be valuable to return to the previous system, ensuring
that everyone used Dendrite, this was not possible in practice. BB agreed to try and come up with a
solution using HESDATA for benign surgery; this may be a good starting point.
10.2.7 Agreed: BB would provide an update at the next meeting of the Executive Committee,
through the Clinical Audit Committee. ACTION: BB
10.3 Update on Communications Survey (Agenda item 7.v)
10.3.1 Noted: Two surveys had been carried out across unit representatives; about 90 returns in all
had been received. Those who responded tended to be those who already engaged and tended to
support the content of BORS meetings being put onto the website.
10.3.2 Agreed: However, it was agreed that, given that the survey had been run twice, a third
survey was not appropriate. It was noted, however, that people had requested more emails,
reminders in terms of what was happening and there was, post BORS, a need to update the website
quickly. A one page record of the BORs and list of attendees would be produced. Also, a one page
summary of the highlights of each executive meeting was agreed would be helpful to be e mailed to
all members soon after each Executive meeting. ACTION: JK/SK
11. Standing Report from the Joint Chair of the Congenital Sub-Committee
11.1 Received: A Report from the Joint Chair of the Congenital Sub-Committee, David Barron
(Paper 5.vii)
11.2 NHSE Congenital Heart Services Review
11.2.1 Noted: The Standards had now been approved and would go to the NHS in July. These were
4 surgeons and 500 cases per unit. The view of the SCTS and of the Congenital Sub-Committee had
remained in support of a standard for three surgeons as being acceptable and that proposals to
enforce a minimum of four surgeons per unit could be impractical and destabilising. There would be
a five year lead in, with the Standards not going live until 2021. There would be no double counting
of cases. The NHSE Standards would be published on the SCTS Website. ACTION: DB/IF
11.3.2 Agreed: A representative from each of the current congenital units should join the Congenital
Committee (they are required to be a member of the Society). The Terms of Reference of the
Congenital Sub-Committee must be amended to reflect this. DB would contact all units regarding
this and feed back to main Executive Committee. ACTION: DB /IF
11.3.3 Agreed: That there be a three yearly annual review of the terms of reference of all sub-
committees. ACTION: SK
12. Standing Report from the Joint Chair of the Cardiac Sub-Committee
12.1 Received: A Report from the Joint Chair of the Cardiac Sub-Committee, David Jenkins (Paper
5.viii)
12.1.1 Noted: The “Safe Surgery” proposal led by MJ had been accepted as a project by ACSSC. It
was not a joint project between ACSSC and St Georges. There had been a brief discussion with BB.
The project would go to NIHR for funding and NICOR had agreed an extra analyst; details of this
would be agreed with Adult Cardiac Surgery. ACTION: DJ
12.1.2 Noted: The Sub-Committee had been asked to comment on the ICU reconfiguration
document/proposal. ACTION MJ to arrange a response.
12.1.3 Agreed: The Sub-Committee would respond to NICE on behalf of the Society regarding
endocarditis prophylaxis. The response should be joint with the British Heart foundation BCVS and
UNAPPROVED
Pag
e12
British Heart Valve Society. Deadlines had been missed in terms of commenting on CRG and NICE
specifications. ACTION:N Briffa/ACSC
13. Standing Report from the Nursing and Allied Health Professionals Representative
13.1 Received: A Report from the Nursing and Allied Health Professionals Representative,
Christina Bannister (Paper 5.ix)
13.2 Annual Meeting
13.2.1 Noted the Nursing and Allied Health Professional Cardiothoracic Forum at the Annual
Meeting, was well attended.
13.3 Ionescu Fellowships
13.3.1 Noted: This year SCTS Education had advertised the opportunity for two Ionescu Nursing and
Allied Health Practitioner Fellowships worth £2,500. These had been offered and the reports of the
two successful applicants were awaited.
13.4 BUPA/SCTS Patient Information Website Portal
13.4.1 Noted: There was currently a nursing project running to create patient information pages for
the SCTS and BUPA websites.
13.5 SCTS Education, Band 5&6 nurses
13.5.1 Noted: Work towards creating SCTS 5&6 nursing training course and competencies had
begun. The course Core Principles of Cardiothoracic Surgery and Care of the Patient following
Surgery was currently being created.
13.6 SCTS Nursing & AHP Website Pages
13.6.1 Noted: These had been amalgamated into one page, with links to useful subpages and
websites.
13.6.2 Noted: Thanks were extended to CB for all her hard work.
13.7 SCP Exam/ACSA (Jasmina Dvordjevic)
13.7.1 Noted: JD was welcomed to the meeting.
13.7.2 Noted: At present, SCP members could join ACSA, gaining joint membership of ACSA and
SCTS; they could also join SCTS separately. This had worked well for the last two years and ACSA
membership had increased. Two years ago it had been agreed that that the yearly fee would be
shared. Five SCPs had just joined SCTS out of choice.
13.7.3 Noted: The fee could be raised to £50 for all SCPS for SCTS membership and joint
membership of ACSA would be included. Educational courses could not be attended without the
attending SCP being a member of the SCTS.
13.7.4 Agreed: Post meeting proposal by ML – all SCP members must pay a fee of £50. Any SCP
may have joint membership of SCTS and ACSA. Other associate members, for example nurses
should pay £30 pa. ACTION: IF/ML
14. Report from the Meeting Secretary
14.1 Received: A Report from the Meeting Secretary, Clifford Barlow (Paper 5.x)
14.1.1 Noted:. Attendees were attracted by a large and varied programme but this had to be
balanced. There were several ways in which future meetings could be improved. One major change
was that the educational aspect of the meeting and university would be better coordinated with the
SCTS Education Chairs to ensure no overlap occurred. There were too many simultaneous sessions at
the University which would be addressed. Sub-consultant rates would be looked at.
UNAPPROVED
Pag
e13
14.1.2 Agreed: The Executive Committee would reflect on the programme and indicate what they
needed in terms of satellite meetings and administrative sessions and business meetings .
ACTION: ALL EXEC MEMBERS
14.1.4 Agreed: The Annual Meeting was the SCTS’ major showcase event; feedback was required.
The Meetings team’s officers should attend the Executive Committee meetings as required.
ACTION: CB/SK/TG/IF
15. Standing Report from the Chair of the SAC
15.1 Received: A Report from the Chair of the SAC, Sion Barnard (Paper 5.xi)
15.1.2 Noted: Congenital appointments to a combined London/London consortium post and a
Liverpool/Newcastle Consortium post were hoped to be made at National Selection. However, these
had stagnated and would be brought up again at the next SAC meeting. Some other Consortia were
at risk of breaking up due to logistical problems. However, the North West/Mersey consortium
worked well.
15.1.3 Agreed: In terms of curriculum change and the Shape of Training, there was a steer from the
SAC that the speciality should pursue the 1:5 option (5 years in chosen speciality, 1 year in the other),
but it would not be easy to obtain GMC approval. There was a requirement for a wider speciality
input with this issue which is the future of the speciality. This could be done in a combined way with
the wider membership via the SCTS. The President would have discussions on this with SB outside
the meeting. He thanked SB for all his work. ACTION: TG/SB
16. Standing Report from the Joint Trainee Representative
16.1 Received: A Report from the Joint Trainee Representative, Jonathan Afoke (Paper 5.xiv)
16.1.1 Agreed: To reinforce the request that only invited consultants attend the Trainee meeting.
16.1.2 Noted: Preparation work for work experience projects had already begun locally in Leeds and
Plymouth.
16.1.3 Agreed: With regard to funding of work experience projects and any requirement for a
website, discussions should be held with RS and KL. ACTION: JA/RS/KL
17. Standing Report from the Chairman of the Intercollegiate Examination Board
17.1 Received: A report in the absence of the Chairman of the Intercollegiate Examination Board,
Jon Anderson
17.1.1 Noted: There had been no change in the cardiothoracic curriculum and therefore no change
in the format of the exam. The focus of the exam board this year was to review question banks for
quality assurance. Examiner recruitment was keeping pace with retirements and more examiners for
diverse backgrounds were being appointed.
18. Standing Report from the Perfusion Representative
18.1 Received: A Report from the Perfusion Representative, Heyman Luckraz (Paper 5.xv, including
Appendix 1: Letter dated 18th February 2015 from Patrick Campbell, Honorary Secretary,
representing the Perfusion College Council)
18.1.1 Noted: The Perfusion Representative expressed gratitude that agreements across the UK
regarding those units which were accredited could now be published.
18.1.2 Noted: The “N+1 Criterion” was recommended by the College of Perfusion. Under this
criterion, for each cardiac theatre list in operation (N) there should be an additional Clinical Perfusion
UNAPPROVED
Pag
e14
Scientist who would act as back up across the theatre area and provide emergency Clinical Perfusion
support to ICU/Cath lab etc. This individual must not be scheduled to supervise trainees and must be
free of scheduled duties. Adherence to the N+1 criterion was commonplace across Clinical Perfusion
departments within the UK and Ireland to ensure safe practice – but was noted by executive
members not in the private sector
18.1.3 Noted: There was discussion as to whether all private units had been told they had to
provide N+1.
ACTION: HL to seek further clarification in writing regarding this from the College of Perfusion.
18.1.4 Noted: At Basildon and Thurrock Trust there had now been 16-19 allegations of professional
misconduct against the Perfusion Team. There had been two meetings with the Perfusion legal
team; prior to the meeting in which the allegations had been made, there had been discussions with
an employment lawyer who had made it clear that the Professional Standards document of the
College would not stand up to scrutiny. As a result, the document had been redacted, but had been
remodelled on the Royal College of Nursing Standards.
18.1.5 Agreed: That HL provide a half page summary (see post meeting note below) of the above,
requesting formally a copy of the new Professional Standards of Practice from the College of
Perfusion. This must be put to the SCTS’ Professional Standards and Governance Committee. TG and
HL would write to the College of Perfusion; the SCTS was linked to this Association as was duty bound
to decide on its stance on this matter.
ACTION: TG/HL
Post meeting note, as per 18.1.5 above:
1. HL referred to the letter sent to Mr S Kendall (SCTS Secretary) from the Secretary of the Council
for the College of Clinical Perfusion Scientists. The letter provided details of the revalidation visits
which the College carries out to assess and revalidate the various Perfusion departments across the
UK.
2. The Council for the College of Clinical Perfusion Scientists is grateful to SCTS for agreeing to link-
in the list of accredited Perfusion units to the SCTS website.
3. The letter also provided some explanation as to why there is an "N+1" rule for perfusion cover.
4. HL also gave an update on the revalidation of the Basildon Perfusion Unit as detailed underneath.
1. As a new centre they were given a couple of years’ grace, to put all systems and paperwork in place.
2. All requests for a college visit to accredit the unit were continually refused / blocked by the General manager and Chief Perfusionist, even though the CEO agreed to a visit.
3. The Hospital launched an investigation into fraud and suspended the entire perfusion team from duty for alleged (now proved) fraud. A new team was employed to staff and manage the service.
4. The college arranged an urgent accreditation visit of Basildon with the support of the new Perfusion manager and his team, this happened in May 2013.
5. The college report gave Basildon 5 years accreditation as a centre and also accredited them as a training centre with the proviso that an action plan was drawn up and the work was completed within a set timeline.
5. Professional Practice Committees (PPC) were set up by the Council for the College of Clinical
Perfusion Scientists to review the professional conduct of the 6 Perfusionists at Basildon who were
prosecuted for fraud (4 convicted, 2 acquitted). Once the PPC panel was constituted, a meeting was
held on the 6/2/15 and NHS Protect gave a summary of the facts but could only release a limited
UNAPPROVED
Pag
e15
amount of evidence due to a legal injunction from the convicted perfusionists. After appeal from the
legal representative of the Council for the College of Clinical Perfusion Scientists, some further
evidence was made available. A second PPC meeting was held on the 9/4/15 in the presence of a
legal expert in Employment Law with a view to start interviewing the relevant Perfusionists on the 20-
22 April 2015. However, the legal expert felt that the current Council for the College of Clinical
Perfusion Scientists Disciplinary Policy and Procedure and Fitness to Practice was not clear and
required redrafting. Hence the PPC has been put on hold until the "Policy" is redrafted.
6. Mr Thasee Pillay (SCTS Rep at the Council for the College of Clinical Perfusion Scientists) is not
planning to take a long sabbatical as initially planned.
End post meeting note.
19. Report on Current Processes to Review Consultant Job Descriptions and to allocate College
Representatives to Consultant Appointments Committee
19.1 Received: A verbal report by Andrew Chukwuemeka.
19.1.1 Noted: It was essential to work with the RCS to improve processes. The RCS employed staff
to manage these and, even if the SCTS has its own “house in order”, there are some things outside its
control which require review. There is concern regarding the standard of SCTS and de facto RCS
representation at AAC consultant interviews in the specialty.
19.1.2 Agreed: Enough time must be allowed to carry out reviews of submitted consultant posts job
specifications. AC would oversee the overall processes; specifically, DB would be responsible for
Congenital; AC for Cardiac; JK/Richard Page for Thoracic; SK/AC/JK for Cardiothoracic posts.
ACTION: AC/DB/JK/RICHARD PAGE/SK
19.1.3 Agreed: TG and AC would meet with Lee Honeyball, Professional Support Manager at the RCS
and also the Manager of Professional Standards at RCS with AC to discuss the above issues.
ACTION: TG/AC/IF
20. Standing Report from the Education Secretaries
20.1 Received: A Report from the Education Secretaries, Mike Lewis and Rajesh Shah
20.1.1 Noted: Ethicon Scholarships, the Ionescu Consultant and Student Travelling Fellowships. The
latter was aimed at getting prospective students interested at a young age. The fellowship structure
was going from strength to strength.
20.1.2 Noted: The discussion regarding NTNs in Ireland had been resolved. Following discussions
with Ethicon and the programme director of Ireland Irish trainees would be eligible for SCTS
Education courses as long as they were members of the SCTS.
20.1.3 Noted: Every SCP would receive free training, funded by Ethicon if an SCTS member.
20.1.4 Noted: The SCTS was developing an operative video library.
20.1.5 Noted: A primary objective was now to test the principle of the proposed SCTS
Education/VATS lobectomy Programme; a presentation would be made at the SCTS/Ethicon
Consultant symposium in June 2015. It was now important that outcome measures of the
educational programme with Ethicon be developed in order to justify and maintain the investment.
20.1.6 Noted: With regard to the term of the SCTS Education Chairs which was three years, to
March 2016, this should now be extended a further two years given that their Vision/Plans are
predicted to take a minimum of five years.
20.1.7 Agreed: This discussion would continue outside the committee; the question should be
revisited in the next six months. Ideally the chairs would continue to run for a further two to three
UNAPPROVED
Pag
e16
years, to enable succession planning. It was recommended that they consider completing their terms
at different times to facilitate this. They were asked to present a plan at the October Executive.
ACTION: TG/ML/RS
21. Other Business: Lifetime Achievement Award
21.1 Noted: The Lifetime Achievement Award had previously been agreed to be bestowed on Mr
Lincoln at the AGM in Birmingham in 2016.
21.1.1 Agreed: MJ would forward contact details to the President and that she would present the
citation for Mr Lincoln at the AGM. ACTION: MJ/TG/IF
22. Dates of Next Meetings RCS England in London
22.1 Noted: Meetings Team 8th October 2015
Showcase 8th October 2015 (provisional )
Executive Committee 9th October 2015
The meeting closed at 4.30pm.
T R Graham
President SCTS
SIGNED DATE
KATHARINE OWEN
BA(Hons) French, LLM Employment Law (Distinction)
for and on behalf of Owen Business Services Ltd
First draft 13th June 2015
Final draft 3rd July 2015