Coronary Heart Disease and Stroke: STRATEGY FOR SCOTLAND
APPENDIX 3 SCOTTISH CARDIAC INTERVENTION NETWORK (SCIN)
Terms of Reference:
to take responsibility for the delivery, on a Scotland-wide basis, of:
cardiac surgery;
percutaneous coronary intervention (but not diagnostic coronary angiography);
all other therapeutic cardiac interventions, including balloon valvuloplasty and device closure;
specialist electrophysiology services (diagnostic EP studies, RF ablation, implantation of ICDs); and
the development of proposals for a National Heart Failure Centre in Glasgow.
to identify priorities for new investment.
to promote a quality assurance programme by:
continuous audit, supported by the national CHD database;
the development of agreed protocols and guidelines on eligibility for interventions; and
promoting appropriate revascularisation rates and equity of access, and investigating anomalies in those rates.
to monitor the effectiveness of the regional planning arrangements in relation to cardiac interventions across Scotland as a whole, and to provide the single and definitive source of advice to the Executive and Regional Planning Groups on all matters relating to cardiac interventions and, through its Policy Sub-Group, to the Executive on policy relating to CHD generally.
to advise the Executive on referral patterns for cardiac surgery patients, including their allocation to the National Waiting Times Centre.
Constitution and Method of Working
The Network would consist of a main group, which would meet 2/3 times a year and an Executive Group, which would meet on a monthly basis once the development phase was over (see below for details of membership).
It would establish a range of sub-groups, dealing with:
general policy on all aspects of CHD, including primary prevention;
percutaneous coronary intervention;
cardiac surgery;
IT, data collection and analysis; and
electrophysiology.
SCIN will be responsible in future for commissioning data on revascularisation, building on the existing machinery developed by the Scottish Cardiac Society.
The membership of the CHD Policy Sub-Group should have the breadth needed to make sure that the full spectrum of interests, covering every aspect of CHD, is represented, including patients, primary care, District General Hospital clinicians and public health.
The structure of the Network is shown in diagrammatic form as follows:
The Network would be headed by a Lead Clinician, who would be assisted by a Network Manager, with robust administrative and IT support.
Membership
The following interests should be represented on the main group:
patients;
local MCNs (the type of representation being left to the discretion of each Network);
Scottish Cardiac Society;
nursing;
AHPs;
interventional cardiology;
cardiac rehabilitation;
cardiac surgery;
cardiac anaesthesia/perfusion;
DGH cardiology;
primary care;
pharmacy;
data collection/IT;
Scottish Ambulance Service; and
public health/health promotion.
The main group should also contain proper geographical representation. The Group should make as much use as possible of video conferencing, but should also hold its meetings in different parts of Scotland. Meetings should be held on different days of the week and at different times.
The Executive Group would consist of:
the Lead Clinician of SCIN;
the chair of each Sub-Group;
the Network Manager; and
three/four members of the main Group, who would be elected by the main Group.
It would also have the option of co-opting other members of the main Group when specific issues were under consideration.
Links to Other Bodies
The Network would need to develop strong links to a range of other bodies:
the Regional Planning Groups;
the Quality Standards Board for Health in Scotland;
NHS Education for Scotland;
Regional Workforce Groups and the National Workforce Committee;
the CHD National Learning Network;
the CSO focus group on CHD research; and
the Scottish Medicines Consortium.
Funding
Dedicated funding would be needed for the following elements of the Network:
the sessional commitment of the Lead Clinician and the sub-group chairs;
the salary of the Network Manager and administrative support;
locum and back-fill costs;
IT services;
data collection, in particular the development of the national CHD database; and
travel expenses.
Transitional Arrangements
A Project Group should be formed from the CHD component of the Reference Group to draw up a development plan and then take forward implementation of that plan. It would probably wish to set up sub-groups to look at specific issues such as patient involvement, IT, etc. The main tasks facing the Project Group would include drawing up:
The Project Group approach would ensure that the process of establishing SCIN was fully inclusive, and would also offer an opportunity to educate NHSScotland about the function of the Network.
The transitional phase should not be allowed to inhibit the taking of key decisions about CHD services. The Executive would therefore need to recognise the Project Group as the source of authoritative advice pending the establishment of SCIN. That would mean in particular making clear that existing machinery, such as the cardiac surgery purchasing consortia, no longer had a role to play, and that all proposals regarding CHD should be referred to the Project Group (as they would be referred to SCIN once it was operational).
The role of the Chair of the Project Group is crucial to achieving the key goals of the Group and will therefore require a sessional commitment.