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NORTH WEST CONGENITAL
HEART DISEASE
PARTNERSHIP
Dr Vishal Sharma
Congenital Heart disease Implementation Lead
OUTLINE
• Background to ACHD in North
West
• Future Model for CHD
Hub and Spoke
• Level 1 Surgical centre at Alder Hey
• Paediatric CHD Interventions at Alder
Hey
• Paediatric EP supported by Liverpool
Heart and Chest
• Outpatient services across North West
provided by Alder Hey outreach
• Fetal Screening at 2 centres
CURRENT SERVICES - PAEDIATRIC
CURRENT SERVICES -ACHD
Adult Hub - (CMFT)
• ACHD Surgery - CMFT
• ACHD interventions at 2 sites
- provided by Alder Hey cardiologists
- EP Service at LHCH
• Outpatient services
- provided by CMFT Outreach
- supplemented at LHCH by Alder Hey
• Obstetric Care provided on a risk matrix
- Moderate Risk Transferred to
Arrowe/Whiston
- High Risk ACHD transferred to CMFT
• Non Cardiac surgery/Medical Admissions
- Local DGH’s
- Complex cases transferred to CMFT
ACTIVITY AND OUTCOME
Liverpool is a high volume centre:
• Performed 83% of Congenital Surgery
for the North West (NICOR 2009-13)
• Performed 81% of Congenital
Intervention for the North West (NICOR
2009-13)
• Performed 41% of Northern Region’s
Congenital Surgery
Liverpool achieves excellent outcomes:
• Paediatric CHD Surgical Mortality
<1.0% since 2013 North West Surgical and Interventional Activity 2009-2013
(NICOR)
CURRENT CONFIGURATION
UNSUSTAINABLE • Paediatric CHD Service compliant
• Unsustainable Adult Surgery
• Surgical activity <80 cases/surgeon
• 1:1 surgical on call rota
• No ACHD interventional cardiologists at CMFT
• Service provided by Alder Hey
• Difficulties managing transition from paediatric services
• Inability to provide sustainable on call rotas (40 miles)
• Surgery
• Intervention
• ACHD medical on call
Logistics of the M62
NHS ENGLAND CHD REVIEW
ASSESSMENT AGAINST STANDARDS
>125 cases / surgeon
1:3 surgical on-call rota
1:4 interventional cardiology rota
Seven congenital cardiologists
Paediatric co-dependencies
Specialist cardiac nurses
PICU capacity
Paediatric cardiac anaesthetists
ECMO
~80 cases / surgeon
1:1 surgical on-call rota
No interventional cardiology rota
Two congenital cardiologist
Adult co-dependencies
Specialist cardiac liaison nurses
ICU capacity
Dedicated adult congenital
anaesthetist
No Paediatric Service
Alder Hey- Paediatric Service CMFT – Adult Service
NHS ENGLAND DECISION
• Decided to Commission Liverpool to provide Level 1
Services
• Decommissioning of Level 1 surgery at Manchester
Royal Infirmary
• Specialist medical care and some interventional activity
may continue at Manchester as Level 2 centre
• During the consultation, ACHD services at Manchester
collapsed
• Interim arrangements in place with Newcastle and
Leeds.
LIVERPOOL – ALL AGE LEVEL 1 CHD
CENTRE
AIMS
• Provide specialist CHD care
24/7
• Sustainable on call rotas
• Surgery/Intervention
performed in high volume
centres by highly experienced
operators
• Achieve world leading
outcomes
• Work with providers across
the North West to provide all
age CHD Network
Newcastle
Leeds
Manchester
Liverpool
Wrexham
Blackpool
NORTH OF ENGLAND CHD NETWORK
Level 1 Centres:
• Liverpool
• Leeds
• Newcastle
Good access to Level 1 centres
• North England
• North Wales
North West Level 2/3 Centres
• Manchester
• Wrexham
• Blackpool
Level 1 Surgical Centre
Level 2/3 Centres
Sustainable rotas
1:4 surgery
1:4 Intervention
24/7 care delivery
Call to bedside <30mins
Seamless integration across
organisations
Host all age CHD Network
Compliance with standards
• Adult Level 1 surgical centre • Adult interventions • Shared Adult Services with Royal • Transition services with Alder
Hey
• Medical/cardiac admissions for ACHD
• Non- cardiac surgery for ACHD • Delivery of high-risk cardiac patients
with LWH • Provide adult co-dependencies for
LHCH • ACHD cardiology on call
• Paediatric Level 1 Surgical Centre
• Paediatric co-dependencies • Common surgical rota with LHCH • Support LHCH anaesthesia • Surgery for neonates with CHD
together with LWH
• Manage high risk deliveries at Royal
• Pre pregnancy counseling • Foetal Screening • Coordinate delivery/intervention
for neonates with CHD
TRANSITION PLAN
• Currently Interim arrangements in place
• Specialist ACHD advice/support accessed through Manchester Foundation Trust (MRI)
• Surgical and interventional activity delivered at Leeds/Newcastle
• Services to transition to Liverpool over 12-18 months
• Phase 1- Intervention
• Phase 2 - Congenital Surgery
• Phase 3 - Specialist medical care
• Phase 4 - Responsible for compliant services across North West.
SUMMARY
• Been a long and difficult process
• Significant challenges remain
• For now access to ACHD care remains through Manchester
• Services will transition to Liverpool over next 12-18 months
• Ultimately will achieve a high quality service fully compliant with the
standards
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