ABM12006

Annual Business Meeting 1: 

Annual Business Meeting 1 Chairman The President – Mr Patrick Magee

Apologies for Absence: 

Apologies for Absence Peter Goldstraw Sam Nashef

Announcement of members deaths: 

Announcement of members deaths W G Bigelow * “Bill” Cleland “Jack” Belcher A Logan Norman Shumway* Sir Brian Barratt-Boyes* *Honorary members

Minutes 2005 ABM 1 & 2: 

Minutes 2005 ABM 1 & 2 Previously circulated Confirmation Matters arising not considered elsewhere

Report from the Hon. Secretary: 

Report from the Hon. Secretary James Roxburgh

Attendance at the 4 Executive Committee meetings of 2005-2006: 

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 2 – Dalrymple-Hay 1 – Wood

Retiring Executive members: 

Retiring Executive members Patrick Magee Simon Kendall Richard Page

Candidates for President-Elect & 2 Elected members of the Executive: 

Candidates for President-Elect & 2 Elected members of the Executive President-Elect Leslie Hamilton Chris Munsch David Taggart 168 votes out of 344 members 49% Elected members Simon Allen Geoffrey Berg Ben Bridgewater Frank Collins Timothy Graham Leonidas Hadjinikolaou Jim McGuigan

Results of Ballot: 

Results of Ballot President-Elect Leslie Hamilton Elected members Ben Bridgewater Timothy Graham

SCTS representation on other organisations: 

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.

Ratification of new members: 

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

Prizes for 2005 Annual Meeting: 

Prizes for 2005 Annual Meeting Ionescu Scholarship - D Pagano Thoracic Surgery Scholarship – S Stamenkovic St Jude Scholarship – P Hayward Ronald Edwards Medal – E Soo John Parker Medal – E Lim Society Medal – K Redmond

The Bulletin: 

The Bulletin sunil@ohri.co.uk

CTSNet: 

CTSNet 70% increase in sessions and100% increase in page views. Google search engine. E-learning EACTS: Multimedia manual AATS/STS/EACTS e-learning protocols Journals Journal-based CME program Personal folders PowerPoint downloads Google full text indexing Personal portfolios Development of an e-commerce service for CTSNet organizations 99.9% uptime over last 5 years

Role as external reviewer: 

Role as external reviewer A new development 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

NHS & The IT project – progress??: 

NHS & The IT project – progress?? Connecting for Health Secondary Users Service HRGs and Payment by Results Choose and Book

Connecting for Health: 

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

Payment by results and HRGs: 

Payment by results and HRGs Ben Bridgewater

Payment by Results: 

Payment by Results Activity paid for on the basis on cases treated Number Complexity Casemix classification, prices and payment rules set nationally Local negotiation about range of services and referral or treatment protocols

Objectives of PBR: 

Objectives of PBR Improve efficiency and value for money Facilitate choice 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 Get the price ‘right’

Implementation of PBR: 

Implementation of PBR Will be implemented in all Trusts in 2006/2007 Number of services excluded Cardiothoracic transplantation ICDs and CRT Slight differences in rules for foundation and non-foundation Trusts

PBR - essentials: 

PBR - essentials Uses DoH minimum data set Via coding departments Diagnoses (ICD10) Procedures (OPCS 4) Healthcare Resource groups (HRGs version 3.5)

Developments: 

Developments Minimal revision to HRGs version 3 to version 3.5 Accepted that OPCS methodology is limited NIC project - suspended OPCS 4.3 enhancements

Current Tariffs: 

Current Tariffs

Complexities: 

Complexities Tariffs determined from Trusts reference costs Long-stay trim point Eg elective CABG 13 days, £286 per day thereafter Market Forces factor 1.0 to 1.44 Paid directly from DoH to Trusts

HRG development: 

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 Recognised importance of Clinical drivers, high cost disposables, critical care costs

Cardiac costing study: 

Cardiac costing study NHS Information authority funded Wythenshawe and Oxford Cardiology and cardiac surgery Patient level ‘micro-costings’ Combines clinical and financial database Determine procedural costs and clinical cost drivers

Results: 

Results 9839 procedures 4743 diagnostic catheterisations 2171 percutaneous coronary interventions 1566 cardiac surgical operations 878 pacemakers 303 electrophysiology procedures/ablations 178 implantable defibrillators

Comparison of tariffs and ‘actual costs’ – elective procedures: 

Comparison of tariffs and ‘actual costs’ – elective procedures

Effect of urgency and multiple procedures: 

Effect of urgency and multiple procedures

Effect of urgency and procedure type: 

Effect of urgency and procedure type

HRG developments: 

HRG developments Strict rules around HRGs National volume threshold National cost threshold Significant costs differences between separate HRGs Cannot include urgency Continue with differential tariff for elective and non-elective

Recommendations for HRG v 4.0: 

Recommendations for HRG v 4.0

OPCS 4.3 enhancements: 

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

Problems with PBR: 

Problems with PBR Accuracy of coding Limitations of OPCS 4.3 methodology Limitations of HRG methodology Failure of Tariff to reflect costs Concerns over transitional arrangements

Summary: 

Summary PBR is here Existing Tariffs are too low Will be supplemented by critical care HRGs at some stage Enhancements have been recommended to OPCS – version 4.3 April 2006 HRGs – version 4 April 2007

Choose & Book: 

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.”

Choose & Book: 

Choose & Book Cardiothoracic & Cardiac Surgery Adult Cardiac Surgery Paediatric Cardiac Surgery Adult Congenital Cardiac Surgery Paediatric Congenital Cardiac Surgery Thoracic Surgery Adult Thoracic Surgery Paediatric Thoracic Surgery

British Cardiac Society: 

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

Expert witnesses: 

Expert witnesses Concern over rules and regulations Written to GMC – no reply yet MDU MPS MDDUS Letters will be available on www.scts.org & notice board

Working groups: 

Working groups Thoracic Audit Richard Page NCEPOD Steve Livesey Bloodborne Infection Graham Venn Job plans James Roxburgh Constitution review Graham Cooper

Bloodborne Infection: 

Bloodborne Infection Chair – Graham Venn Based on an original idea by Ted Brackenbury Posted on web More complex than we all thought at the outset

Job plans: 

Job plans On hold Charity commission Indemnity New SCTS High priority in the new SCTS Important service to membership BUT we need your feedback and support

The new charitable status and SCTS (GB&) Ltd: 

The new charitable status and SCTS (GB&) Ltd An overview

Background: 

Background Old SCTS not fit for purpose Set up new SCTS 1st as 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

Current status: 

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

What does this mean: 

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

It is our Society, so what do we want from it?: 

It is our Society, so what do we want from it? David O’Regan Jim McGuigan Graham Cooper

Review of the Constitution and working of the Executive: 

Review of the Constitution and working of the Executive

Society for Cardiothoracic Surgery: 

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

Review of the Constitution and working of the Executive: 

Review of the Constitution and working of the Executive To join the reference group e-mail: graham.cooper@sth.nhs.uk

The Future of SCTS: 

The Future of SCTS …in the business of health care… David J. O’Regan MBA MD FRCS C-Th

Evolutionary mismatch...: 

Evolutionary mismatch... Health care Government Society time Value for money Business Theories Professional and Functional divides

PESTEL analysis: 

PESTEL analysis Politics - subjugation Economic - national tariff Social – increasing age and more women Technology and Training Environment – smoking, healthy schools Litigation and League Table

Payment by Results: 

Payment by Results …it must be quality driven not quantity

Systems and Processes: 

Systems and Processes Patient Care Pathways vs Business Process Reengineering

The Toyota Way: 

The Toyota Way …remove ‘muda’ and realise ‘kaizen’… Lancet 28 January 2006

Climbing the Quality Scale: 

Climbing the Quality Scale Adapted from the paper by McLaughlin and Kaluzny

Politics and Administration: 

Politics and Administration

Slide60: 

Adapted from Mintzberg Board Manager Doctor Nurse Control Clinical External Internal

Performance at the Limit business lessons from F1 Racing: 

Performance at the Limit business lessons from F1 Racing

…from the ‘art’ to the ‘science’: 

…from the ‘art’ to the ‘science’ Adapted from the paper by McLaughlin and Kaluzny

Carcharodon Cardiothoracus: 

Carcharodon Cardiothoracus

…I have every confidence that us humans can live with fish…: 

…I have every confidence that us humans can live with fish… President George Bush

…the axis of ‘E’ vil...: 

…the axis of ‘E’ vil... ego empires equity

Slide66: 

T E A M ogether veryone chieves ore

Beal feirste Baile Atha Cliath : 

Beal feirste Baile Atha Cliath 1 million 1.5 million 1969 2006

Slide68: 

"Ireland today is the richest country in the European Union after Luxembourg.“ June 30, 2005 New York Times Thomas L. Friedman

Slide69: 

It is my ambition to say in ten sentences; what others say in a whole book. Friedrich Nietzsche Born Saxony 1844

Slide70: 

We are within a few miles of the birthplace of many of the literary giants of 19th and 20th century These were often revolutionary men Their words eerily suit a presentation aimed at the need for change in our Society

An unreasonable man: 

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 George Bernard Shaw Born Dublin 1856 Nobel Prize 1925 Oscar 1938

Change in Ireland 1916: 

Change in Ireland 1916 All changed, changed utterly: A terrible beauty is born. William Butler Yeats Born Sandymount 1865 Nobel Prizewinner 1923

Don’t Laugh !: 

Don’t Laugh ! Every madman thinks everyone else is mad The Destinies of Darcy Dancer J. Patrick Donleavy Born Brooklyn 1926

We do need some gravitas in this discussion: 

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 DEAR DIRTY DUBLIN

Brevity is occasionally brief: 

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” Samuel Beckett Born Dublin 1906 Nobel Prizewinner 1969

Slide76: 

How much change does the SCTS need? The annual meeting

Thoracic Critics of SCTS beware: 

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. Brendan Behan

Change can be too delayed and then may occur too quickly: 

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 Laureate Nobel Lecture December 7, 1995

Gradual change: 

Gradual change It is the random accumulation of triumphs which is so nice J.P. Donleavy from The Beastly Beatitudes of Balthazar B

Slide80: 

A selfish and highly personalized view of the SCTS

Slide81: 

True friends stab you in the front Oscar Wilde Born Dublin 1854 Portora Royal School Fermanagh Northern Ireland To: Society of Cardiothoracic Surgery From: The Thoracic Forum

Slide82: 

Lead Specialty Interest of Executive SCTS Adult Cardiac = 12 Don’t know = 3 General Thoracic = 1 Adult Cardiac Surgery = 24 pts General Thoracic Surgery = 8 pts Paediatric Cardiac Surgery = 2 pts [Named specialty = 2pt, 2nd or 3rd = 1pt] Don’t know

Clive Staples Lewis 1898-1963‘Jack’ : 

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

Paul F Drucker: 

Paul F Drucker

Imagination and the SCTS program: 

Imagination and the SCTS 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

Cardiac Surgical Academic Abstract Domination: 

Cardiac Surgical Academic Abstract Domination Cardiac Surgical Research better funded better track record more academically funded posts more academic output a breadth of units more specific research sources more technical innovation

Low Esteem Specialty Sector : 

Low Esteem Specialty Sector Thoracic Surgical Research Small number of thoracic led units A small fragmented specialty Too few thoracic consultants for workload, MDTM’s, Palliative Interventions, Management. Researchers have large clinical loads SPR’s prefer cardiac research projects

What areas compete with thoracic surgical research ?: 

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

Slide89: 

Cardiac Surgery Oncology Respiratory Medicine AUGIS One lucky shot won’t do it this time ! Walliath David

Belfast Thoracic Unit: 

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 6 between 1990-1994 5 between 1995-2000 0 between 2001-2005

Reasons to publish and present elsewhere: 

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

Paying thoracic surgical audience at a cardiac dominated meeting: 

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.

Possible Changes ?: 

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

Rename the Society Meeting ?: 

Rename the Society Meeting ? Professional Academic Thoracic component significant Research based Inter-specialty within a specialty Congenial colleagues kerbside consults Knowledge disseminating

What do you mean;“It’s a bit muddy!”: 

What do you mean; “It’s a bit muddy!”

Discussion : 

Discussion Chair Patrick Magee Summing up Bruce Keogh

Problems facing the Society: 

Problems facing the Society Unemployment Percutaneous intervention Reduction in CABG Training EWTD, reduced simple procedures, public scrutiny Public disclosure Diversity of views May be difficult to achieve consensus Political influence has disappeared 250 surgeons out of > 50,000 doctors NHS in financial meltdown

Opportunities: 

Opportunities Thoracic surgery Re-certification Patients & public support Committed to a good service They don’t want: Poorly trained surgeons Unemployment with waiting times Risk averse practice Poor information on results of PCI / CABG Independent and represent votes Advice seen as impartial

How to engage patients’ support: 

How to engage patients’ support Patient seconded on to Executive How to select, How representative? Patients’ forum How to select, How representative? Patient membership category More representative Regain political initiative Financial benefit to Society