- 1. Annual Business Meeting 1 Chairman The President Mr Patrick
Magee
2. Apologies for Absence
3. Announcement of members deaths
4. Minutes 2005 ABM 1 & 2
- Matters arising not considered elsewhere
5. Report from the Hon. Secretary James Roxburgh 6. Attendance
at the 4 Executive Committee meetings of 2005-2006
- 4- Magee, Keogh, Sethia, Roxburgh,Hamilton, Kendall, Munsch,
Nashef, Nicol ,Page
- 3 Cooper ,Hunter ,Hyde ,Lewis ,Livesey ,Ohri ,Taggart
,Venn
7. Retiring Executive members
8. Candidates for President-Elect & 2 Elected members of the
Executive
-
- 168 votes out of 344 members 49%
9. Results of Ballot
10. SCTS representation on other organisations
- Important as SCTS will pay expenses of members who are
officially representing the profession on behalf of SCTS.
- List posted on agenda/Registration area
- If you think you represent SCTS please check this list and let
us know of errors & omissions.
11. Ratification of new members
- The list of proposed new members has been posted on the web
agenda and will be available for viewing in the registration
area.
- Unless there are any objections they will be considered as
ratified from the end of the second ABM
12. Prizes for 2005 Annual Meeting
- Ionescu Scholarship - D Pagano
- Thoracic Surgery Scholarship S Stamenkovic
- St Jude Scholarship P Hayward
- Ronald Edwards Medal E Soo
13. The Bulletin
14. CTSNet
- 70% increase in sessions and100% increase in page views. Google
search engine.
-
- AATS/STS/EACTSe-learning protocols
-
- Journal-based CME program
-
- Google full text indexing
- Development of an e-commerce service for CTSNet
organizations
- 99.9% uptime over last 5 years
15. Role as external reviewer
- SCTS has been asked to provide professional representation to 2
reviews of regional cardiac services.
- These have been in conjunction with the NHS, Management
Consultants and the York Health Economics group
16. NHS & The IT project progress??
- HRGs and Payment by Results
17. Connecting for Health
- CT Surgery - major involvement in electronic data
collection
- Concern over dumbing down in drive by NHS to complete
project
- 12 months to get a meeting
-
- Scott Surgery, Eccles A&E
- Impressed with how far ahead of the NHS we are - internal
conflicts
- Meeting with head of SUS J Thorp
18. Payment by results and HRGs Ben Bridgewater 19. Payment by
Results
- Activity paid for on the basis on cases treated
- Casemix classification, prices and payment rules set
nationally
- Local negotiation about range of services and referral or
treatment protocols
20. Objectives of PBR
- Improve efficiency and value for money
- Facilitate plurality and increase contestability
- Enable innovation and improve quality
- Drive the introduction of new models of care (eg community
based)
- Fairer and more transparent system
21. Implementation of PBR
- Will be implemented in all Trusts in 2006/2007
- Number of services excluded
-
- Cardiothoracic transplantation
- Slight differences in rules for foundation and non-foundation
Trusts
22. PBR - essentials
- Uses DoH minimum data set
- Healthcare Resource groups
23. Developments
- Minimal revision to HRGs version 3 to version 3.5
- Accepted that OPCS methodology is limited
24. Current Tariffs 4993 3660 PCI 2828 1093 Other circul
tryprocedures>18 9194 7208 CABG 12792 9805 Valve procedures
Non-elective tariff Elective tariff HRG 25. Complexities
- Tariffs determined from Trusts reference costs
-
- Eg elective CABG 13 days, 286 per day thereafter
-
- Paid directly from DoH to Trusts
26. HRG development
- Recognised need to develop HRGs to underpin Payment by
results
- Existing HRGs produced from HES data using hospital length of
stay as indicator of resource
-
- Clinical drivers, high cost disposables, critical care
costs
27. Cardiac costing study
- NHS Information authority funded
- Cardiology and cardiac surgery
- Patient level micro-costings
- Combines clinical and financial database
- Determine procedural costs and clinical cost drivers
28. Results
-
- 4743 diagnostic catheterisations
-
- 2171 percutaneous coronary interventions
-
- 1566 cardiac surgical operations
-
- 303 electrophysiology procedures/ablations
-
- 178 implantable defibrillators
29. Comparison of tariffs and actual costs elective procedures
9275 7208 CABG10,385 9805 Cardiac valve proceduresActual costs
National tariff HRG 30. Effect of urgency and multiple procedures
13182 11695 Non - elective 10206 9730 Elective Surgery + CC Surgery
31. Effect of urgency and procedure type 18,251 15.442 9497 15,555
Non-elective 10,802 11,861 9292 10385 Elective Other no valve Other
plus valve CABG Valve Procedure 32. HRG developments
-
- National volume threshold
-
- Significant costs differences between separate HRGs
-
-
- Continue with differential tariff for elective and
non-elective
33. Recommendations for HRG v 4.0 Congenital surgery HRGs
(Standard) E_v4_26 Congenital Surgery HRGs (Intermediate) E_v4_25
Congenital Surgery HRGs (Complex) E_v4_24 Congenital Surgery HRGs
(Major Complex) E_v4_23 Other Complex Cardiac Surgery + other (inc
PCI, Pacing, EP, RFA +/- cath not ICD) E_v4_22 Other Complex
Cardiac Surgery + cath E_v4_21 Other Complex Cardiac Surgery(inc.
CABG + valve; multi-valve; aortic surgery; additional surgical
procedures and 're-do's) E_v4_20 Valve (Single) + other (inc PCI,
Pacing, EP, RFA +/- cath not ICD)E_v4_19 Valve (Single) + cath
E_v4_18 Valve (Single) E_v4_17 CABG (first time) and other(inc PCI,
pacing /EP/ RFA +/- cath) E_v4_16 CABG (first time) and Cardiac
Catheter E_v4_15 CABG (first time) E_v4_14 Heart Transplant E_v4_02
Heart & Lung Transplant E_v4_01 34. OPCS 4.3 enhancements
- Mapped all existing OPCS 4 codes into new HRGs
- Produced new OPCS 4.3 codes where needed to map into new
HRGs
35. Problems with PBR
- Limitations of OPCS 4.3 methodology
- Limitations of HRG methodology
- Failure of Tariff to reflect costs
- Concerns over transitional arrangements
36. Summary
- Existing Tariffs are too low
- Will be supplemented by critical care HRGs at some stage
- Enhancements have been recommended to
37. Choose & Book
- Choose and Book is a national service that, for the first time,
combines electronic booking and a choice of place, date and time
for first outpatient appointments.
- It revolutionises our current booking system, with patients
able to choose their initial hospital appointment, and book it on
the spot in the surgery or later on the phone or via the internet
at a time that is more convenient to them.
38. Choose & Book
- Cardiothoracic & Cardiac Surgery
-
-
- Paediatric Cardiac Surgery
-
-
- Adult Congenital Cardiac Surgery
-
-
- Paediatric Congenital Cardiac Surgery
-
-
- Paediatric Thoracic Surgery
39. British Cardiac Society
- The SCTS representation has been formalised
- The Hon. Sec now sits on BCS Council
- Early days useful contacts
- We have set up a joint session at the next BCS meeting
40. Expert witnesses
- Concern over rules and regulations
- Letters will be available onwww.scts.org& notice board
41. Working groups
- Thoracic Audit Richard Page
- Bloodborne Infection Graham Venn
- Constitution reviewGraham Cooper
42. Bloodborne Infection
- Based on an original idea by Ted Brackenbury
- More complex than we all thought at the outset
43. Job plans
- High priority in the new SCTS
- Important service to membership
- BUT we need your feedback and support
44. The new charitable status and SCTS (GB&) Ltd An overview
45. Background
- Old SCTS not fit for purpose
-
- 1 stas new company called
-
- Society for Cardiothoracic Surgery in Great Britain and
Ireland
-
- Constitution approved at extraordinary ABM June 05
-
- Approved by Companies House & Charity Commissioners
46. Current status
- This meeting is being held under the new constitution and with
the new name
- Old SCTS is being merged into new company which has now been
registered as a charity
- Set up 2nd limited company SCTS (GB&I) Ltd
- 3 directors ex-President, B Sethia & P Goldstraw
- SCTS (charity) is sole share holder
47. What does this mean
- We are legal, indemnified and capable of undertaking a wide
range of activities to meet the needs of our members and the
profession
- We now need to discuss how we take the new SCTS forward
- Copies of new constitution are available to view at
registration desk previously circulated
48. It is our Society, so what do we want from it? David
OReganJim McGuigan Graham Cooper 49. Review of the Constitution and
working of the Executive 50. Society for Cardiothoracic Surgery
- Professional organisation for its members and the wider
NHS
- To be credible the organisation has to operate with
transparency and accountability
51. Review of the Constitution and working of the Executive
- To join the reference group e-mail:
52. The Future of SCTS in the business of health care David J.
ORegan MBA MD FRCS C-Th 53. Evolutionary mismatch... Health care
Government Society time Value for money Business Theories
Professional and Functionaldivides 54. PESTEL analysis
- E conomic - national tariff
- S ocial increasing age and more women
- E nvironment smoking, healthy schools
- L itigation and League Table
55. Payment by Results it must be quality driven not quantity
56. Systems and Processes Patient Care Pathways vs Business Process
Reengineering 57. The Toyota Way remove muda and realise kaizen
Lancet 28 January 2006 58. Climbing the Quality Scale Adapted from
the paper by McLaughlin and Kaluzny 59. Politics and Administration
60. Adapted from MintzbergBoard Manager Doctor Nurse Control
Clinical External Internal 61. Performance at the Limitbusiness
lessons fromF1Racing 62. from the art to the science Adapted from
the paper by McLaughlin and Kaluzny 63. Carcharodon Cardiothoracus
64. I have every confidence that us humans can live with fish
President George Bush 65. the axis of E vil... ego empires equity
66. T E A M ogether veryone chieves ore 67. Beal feirste Baile Atha
Cliath 1 million 1.5 million 1969 2006 Change 68. "Ireland today is
the richest country in the European Union after Luxembourg. June
30, 2005 New York Times Thomas L. Friedman All Change 69.
- It is my ambition to say in ten sentences; what others say in a
whole book.
70.
- We are within a few miles of the birthplace of many of the
literary giants of 19 thand 20 th century
- These were often revolutionary men
- Their words eerily suit a presentation aimed at the need for
change in our Society
71. An unreasonable man
- The reasonable man adapts himself to the world; the
unreasonable one persists in trying to adapt the world to
himself
- Therefore all progress depends on the unreasonable man
72. Change in Ireland 1916
- All changed, changed utterly: A terrible beauty is born.
William Butler Yeats Born Sandymount 1865 Nobel Prizewinner 1923
73. Dont Laugh !
J. Patrick Donleavy Born Brooklyn 1926 74. We do need some
gravitas in this discussion
- The mocker is never taken seriously when he is most
serious
- James Joyce: Born Rathgar Dublin 2/2/1882
75. Brevity is occasionally brief
- James Joyce was a synthesizer, trying to bring in as much as he
could. I am an analyzer, trying to leave out as much as I can
76.
- How much change does the SCTS need?
77. Thoracic Critics of SCTS beware
- Critics are like eunuchs in a harem; they know how it's done,
they've seen it done every day, but they're unable to do it
themselves.
78. Change can be too delayed and then may occur too quickly
- Northern Ireland between 1968 and 1974 violent change
admittedly, but change nevertheless, and for the minority living
there, change had been long overdue. It should have come early
Seamus Heaney Poet LaureateNobel LectureDecember 7, 1995 79.
Gradual change
- It is the random accumulation of triumphs which is so nice
- J.P. Donleavy fromThe Beastly Beatitudes of Balthazar B
80.
81.
- True friends stab you in the front
Portora Royal School Fermanagh Northern Ireland To: Society of
Cardiothoracic SurgeryFrom: The Thoracic Forum 82.
- Lead Specialty Interest of Executive SCTS
- Adult Cardiac Surgery = 24 pts
- General Thoracic Surgery = 8 pts
- Paediatric Cardiac Surgery = 2 pts
- [Named specialty = 2pt, 2 ndor 3 rd= 1pt]
Dont know 83. Clive Staples Lewis 1898-1963 Jack
- Reason is the natural order of truth; but imagination is the
organ of meaning C. S. Lewis
Little Lea Belfast 84. Paul F Drucker 85. Imagination and
theSCTS program
- SCTS Program ; The Options
- A high quality research dominated program with papers chosen
strictly on merit
- A program reflecting submission by percentages
- An inclusive program guaranteed to produce a meeting worth
attending for the vast majority
86. Cardiac Surgical Academic Abstract Domination
- Cardiac Surgical Research
- more academically funded posts
- more specific research sources
- more technical innovation
87. L owE steemS pecialtyS ector
- Thoracic Surgical Research
- Small number of thoracic led units
- A small fragmented specialty
- Too few thoracic consultants for workload, MDTMs, Palliative
Interventions, Management.
- Researchers have large clinical loads
- SPRs prefer cardiac research projects
88. What areas compete with thoracic surgical research ?
- Pulmonary; Oncology, Genetics, Epidemiology and Respiratory
Medicine
- Oesophageal; Oncology, Genetics, Epidemiology, Gastroenterology
and Upper GI Surgery
- Trauma; A&E Interests, Intensivists, Epidemiologists,
Imaging Specialists and death and destruction experts in trauma the
human skin and contents
89. Cardiac Surgery Oncology Respiratory Medicine AUGIS One
lucky shot wont do it this time ! Walliath David 90. Belfast
Thoracic Unit
- Only 20 of the last 80 peer reviewed publications were in
Cardiothoracic Journals
- Only 11 of the last 100 published abstracts were presentations
at SCTSGBI
91. Reasons to publish and present elsewhere
- Most Belfast full-time supervised research fellows are non-CTS
trainees
- Cancer biology projects more appropriately discussed at cancer
meetings/journals
- Higher impact scores Thompson ISI
- Oesophageal presentations more appropriate at gastroenterology
meetings
92. Paying thoracic surgical audience at a cardiac dominated
meeting
- NHS consultant and SPR time is expensive and must be considered
on top of meeting costs
- Professional leave is limited; Where should we go to maximise
learning opportunities ?
- Some SCTS members think that four people listening to a state
of the art thoracic lecture from an informed presenter is
wasteful.
93. Possible Changes ?
- Special interest sessions and presentations from members and
others.
- Ring fenced sessions for paediatric, transplant, basic science
and most importantly of course thoracic !!
- Specialist interest session not only research abstracts but
educational and/or innovative presentations
94. Rename the Society Meeting ?
- T horacic component significant
- I nter-specialty within a specialty
- C ongenial colleagues kerbside consults
95. What do you mean; Its a bit muddy! 96. Discussion
97. Problems facing the Society
- Percutaneous intervention
-
- EWTD, reduced simple procedures, public scrutiny
-
- May be difficult to achieve consensus
- Political influence has disappeared
-
- 250 surgeons out of > 50,000 doctors
-
- NHS in financial meltdown
98. Opportunities
- Patients & public support
-
- Committed to a good service
-
-
- Unemployment with waiting times
-
-
- Poor information on results of PCI / CABG
-
- Independent and represent votes
99. How to engage patients support
- Patient seconded on to Executive
-
- How to select, How representative?
-
- How to select, How representative?
- Patient membership category
-
- Regain political initiative
-
- Financial benefit to Society