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Summary of the heart surgery choice scheme's monitoring and information requirements.

Purpose

This note summarises the monitoring arrangements and information systems to support the choice initiative for heart surgery.
These are built around the information needed to operate the scheme at local level. But the initiative is also a national pilot for the introduction of patient choice, so the arrangements need to enable the new elements of the scheme to be assessed, to inform the wider rollout of choice.
The monitoring arrangements - some already in place - cover
- activity and waiting
- clinical outcomes
- take-up of choice
- patient experience.
Paragraphs 14 and 15 below adds some information on the arrangements to support PCAs in providing information to patients on the choices available to them.

Activity and Waiting Times

Existing monthly data returns already cover numbers of CABG and PCTA waiters by trust, in 3 month bands CABGs and PCTAs undertaken, by trust CABGs and PCTAs sub-contracted to the independent sector, by trust.
This information will enable progress to be monitored against the planned use of the £100m allocation for this initiative in 2002-03, set out in the Investment Plans prepared by Strategic Health Authorities for end of June.

Clinical Outcomes

All tertiary centres have been required to collect, since 1 April 2002, outcome information by individual surgeon for CABGs, reporting through the Central Cardiac Audit Database.
In addition, the specification for the central tender exercise required all private and overseas providers to submit outcome measures on a monthly basis (mortality, returns to theatre, re-suturing of sternum, period of hospitalisation).. Sub-contracts with these providers should require this information to be sent, for the present, to the Heart Team at the Department of Health at the following address: cardiactender@doh.gsi.gov.uk

Take Up of Choice

An important new dimension of the initiative is the process of offering choices to patients, and the nature of their response. Early experience from the CHD scheme will be important in shaping later developments nationally, as well as supporting PCAs, trusts and commissioners in the local management of the scheme.
The Department of Health is currently consulting with the field on the monthly dataset for this. The draft dataset is attached at Annex A and is recommended for use meantime. Please note that this is a new requirement.

Patient Experience

It will also be important to gather information on patients' response to the CHD choice initiative in the round. To do this, the Department has developed a short patient experience questionnaire, to be offered to all patients eligible for the scheme.
Subject to securing National Ethics Committee approval, survey questionnaires and reply paid envelopes will be sent to PCAs in mid-August. PCAs will be asked to send the questionnaire to all patients who have been identified as eligible to be considered for the choice scheme, a month after their surgery has taken place. For any patients treated early in July, there may need to be retrospective surveying.
Patients will be asked to return the questionnaires to a national point for analysis. When sufficient numbers of responses have been received to safeguard patient confidentiality, trusts will receive benchmarked feedback on the responses from patients treated under their local choice initiatives.

Information on Capacity Available Nationally

In order to offer patients as wide a range of options as possible, PCAs will need information both on the available slots in their host trust and the mini-network with which that trust has sub-contracts, and on the capacity available and prevailing waiting times in other receiving units around the country.
PCAs will be responsible for ensuring that they have information on the local options. They have also been sent a list of hospitals participating in the scheme, to enable them to offer wider choices. The Department of Health is working on the development of a web-based system to offer more detail on available capacity and will make this available as soon as possible, with further guidance on its use.
For further information on this note, please contact Ken Cooper on 0207 972 1314 or ken.cooper@doh.gsi.gov.uk.

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