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