1. Annual Business Meeting 1 Chairman The President Mr Patrick Magee

2. Apologies for Absence

Peter Goldstraw

Sam Nashef

3. Announcement of members deaths

W G Bigelow *

Bill Cleland

Jack Belcher

A Logan

Norman Shumway*

Sir Brian Barratt-Boyes*

• • *Honorary members

4. Minutes 2005 ABM 1 & 2

Previously circulated

Confirmation

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

2 Dalrymple-Hay

1Wood

7. Retiring Executive members

Patrick Magee

Simon Kendall

Richard Page

8. 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

9. Results of Ballot

President-Elect

Leslie Hamilton

Elected members

Ben Bridgewater

Timothy Graham

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

John Parker Medal E Lim

Society Medal K Redmond

13. The Bulletin

[email_address]

14. CTSNet

70% increase in sessions and100% increase in page views. Google search engine.

E-learning

• EACTS: Multimedia manual

• AATS/STS/EACTSe-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

15. 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

16. NHS & The IT project progress??

Connecting for Health

• Secondary Users Service

HRGs and Payment by Results

Choose and Book

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

• Number

• Complexity

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 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

21. 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

22. PBR - essentials

Uses DoH minimum data set

• Via coding departments

• Diagnoses (ICD10)

• Procedures (OPCS 4)

Healthcare Resource groups

• (HRGs version 3.5)

23. Developments

Minimal revision to HRGs version 3 to version 3.5

Accepted that OPCS methodology is limited

NIC project - suspended

OPCS 4.3 enhancements

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

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

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

Recognised importance of

• Clinical drivers, high cost disposables, critical care costs

27. 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

28. Results

9839 procedures

• 4743 diagnostic catheterisations

• 2171 percutaneous coronary interventions

• 1566 cardiac surgical operations

• 878 pacemakers

• 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

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

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

Accuracy of coding

Limitations of OPCS 4.3 methodology

Limitations of HRG methodology

Failure of Tariff to reflect costs

Concerns over transitional arrangements

36. 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

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

• • Adult Cardiac Surgery

• • Paediatric Cardiac Surgery

• • Adult Congenital Cardiac Surgery

• • Paediatric Congenital Cardiac Surgery

Thoracic Surgery

• • Adult Thoracic 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

Written to

• GMC no reply yet

• MDU

• MPS

• MDDUS

Letters will be available onwww.scts.org& notice board

41. Working groups

Thoracic Audit Richard Page

NCEPOD Steve Livesey

Bloodborne Infection Graham Venn

Job plans James Roxburgh

Constitution reviewGraham Cooper

42. 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

43. 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

44. The new charitable status and SCTS (GB&) Ltd An overview 45. Background

Old SCTS not fit for purpose

Set up new SCTS

• 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:

[email_address]

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

P olitics - subjugation

E conomic - national tariff

S ocial increasing age and more women

T echnology and Training

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.

Friedrich Nietzsche

Born Saxony 1844

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

George Bernard Shaw

Born Dublin 1856

Nobel Prize 1925

Oscar1938

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 !

Every madman thinks

everyone else is mad

The Destinies of

Darcy Dancer

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

DEAR DIRTY DUBLIN

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

Samuel Beckett

Born Dublin 1906

Nobel Prizewinner 1969

76.

How much change does the SCTS need?

The annual meeting

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.

Brendan Behan

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.

A selfish and highly

personalized view

of the SCTS

81.

True friends stab you in the front

Oscar Wilde

Born Dublin 1854

Portora Royal School Fermanagh Northern Ireland To: Society of Cardiothoracic SurgeryFrom: The Thoracic Forum 82.

Lead Specialty Interest of Executive SCTS

Adult Cardiac = 12

Dont know = 3

General Thoracic = 1

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

better funded

better track record

more academically funded posts

more academic output

a breadth of units

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

6 between 1990-1994

5 between 1995-2000

0 between 2001-2005

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 ?

P rofessional

A cademic

T horacic component significant

R esearch based

I nter-specialty within a specialty

C ongenial colleagues kerbside consults

K nowledge disseminating

95. What do you mean; Its a bit muddy! 96. Discussion

Chair

• Patrick Magee

Summing up

• Bruce Keogh

97. 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

98. Opportunities

Thoracic surgery

Re-certification

Patients & public support

• Committed to a good service

• They dont 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

99. 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