National Advisory Committee on Heart Disease minutes: November 2019

Items and actions

Welcome, introduction and apologies

The Chair welcomed attendees to the NACHD’s third meeting of 2019. Apologies were noted.

The minutes of the last meeting, on 29 April 2019, were agreed as an accurate record subject to amending the wording in section 5, para 4 to read ‘limited study leave’.

The Chair noted that the action points had been either achieved or were on the agenda for discussion today.

Action point 1:

• Secretariat - amend section 5, paragraph 4 of the 29 April minute to reflect discussion

Review of Heart Disease Improvement Plan (HDIP)

Refresh of the improvement plan 

Following discussion with the Clinical Priorities Team the Chair proposed that the Heart Disease Improvement Plan should be refreshed and presented a possible outline. The Chair proposed that a refreshed plan would focus on the patient pathway rather than being disease/condition specific. 

The group agreed to refreshing the plan and with the Chair’s proposal. Members made additional suggestions including:

• consideration being taken for patients re-entering the pathway at different stages
• creating a network service ensuring that patients receive the right treatment at the right time regardless of barriers such as location
• focus on survivorship, lived experience, technology, artificial intelligence and long term conditions 

The group were reminded that developing the improvement plan would be a collaborative piece of work and input from all members is encouraged and welcomed. 

It was noted that Clinical Priorities would lead on the refresh. A draft would be circulated ahead of the next meeting of the group. 

Action point 2:

• Chair/Secretariat - develop a draft refresh of the HDIP for the next meeting of the group

NACHD structure and membership 

Following discussions with the Clinical Priorities Team the Chair proposed that the NACHD could benefit from a possible change to how it operates and presented a possible new structure. A NACHD Executive Committee would be formed comprising of representatives from SG, NACHD Chair, other appointed NACHD members. Members from other organisations could be invited to site on the Executive Committee – for example, National Planning Boards, Health Improvement Scotland, Scottish Access Collaborative, NCAP, ISD and NES. The current NACHD would still be regarded as an advisory committee and membership would remain the same. 

It was also proposed that sub-committees could then be formed with a focus on specific priorities e.g. data collection. The sub-committees would provide regular progress updates to the Executive Committee and NACHD advisory commiittee and would be short life working groups rather than permanent sub-committees. Terms of Reference of the NACHD would be revised to reflect these proposals. 

The group were supportive of the proposals. 

It was suggested that an economist/financial advisor should be included in the new structure to support/advise on costs and savings. It was suggested that a contact at the Scottish Health Technologies Group could be a possible contact for advice.

Audits and data collection

The Chair reminded the group that the Scottish Government is contracted to be part of the UK National Cardiac Audit Programme until June 2020. The Chair highlighted the importance of collected data and acknowledged that more needs to be done to improve cardiac data collection across Scotland.   

The group was updated on work progressing a mechanism for atrial fibrillation (AF) audit where data would be obtained at GP practice level. They were informed of the background on how GP Clusters operated and the role of the Cluster Quality Lead in reporting to peers about processes and tools. Slow progress was reported regarding software development for the Scottish Primary Care Information Resource (SPIRE) however, all the necessary data protection is in place. SPIRE could be used at GP practice level effectively once the software has been developed. 

Regarding secondary care, the Chair presented on the National Audit Programme audits. He emphasised the need to be able to benchmark major services against hospitals across the UK but highlighted that this was being hindered due to Boards not inputting data. The Chair talked about the eRegistry work currently being conducted in the west of Scotland and the possibility of employing this approach. The group agreed that there was a lot of data available that is not being utilised. The group also discussed work on heart failure data collection.

The group agreed that more needs to be done to improve data collection and this should be a key priority for the NACHD. The group agreed that a NACHD sub-group on data collection should be established as soon as possible with the first meetings taking place in the new year. 

Action Point 3:

• Secretariat - establish a NACHD sub-group on data collection

Women and heart disease

The British Heart Foundation (BHF) updated the group following the publication of the ‘Bias and Biology’ report on 30 September. 

The Chair reminded the committee that the Scottish Government have committed to putting in place a Women’s Health Plan as part of the current Programme for Government. One of the actions is to reduce inequalities in health outcomes for women’s general health, including work on cardiac disease.

The committee agreed that more work needed to be done to understand women’s heart health. The Chair highlighted the BeatSCAD charity’s concerns regarding cardiac rehabilitation for women. The group welcomed the CMO’s health plan and agreed that a NACHD sub-group on women’s heart health should be established to feed into this work. 

Action point 4:

• Secretariat - establish a NACHD sub-group on women’s heart health

National specification for inherited cardiac conditions

The Chair invited an update on the circulated paper. It was reported that the BHF Miles Frost Funding obtained by FANS to support screening work was due to end in early 2020. Boards had agreed in general terms to continue supporting the Miles Frost commitments. The group was asked for their support to ensure Boards remained committed to providing this funding.

The FANS commissioning document paper tabled at the February meeting of the group based on services and costings for the management of inherited cardiac conditions. The current paper built on this to provide formal support for the FANS work programme. It was reported that FANS was progressing well and their remained an ongoing focus to continue improvements and would be rebranding itself to cover hyper- cardiomyopathies.

The group agreed to endorse the specifications paper. It was agreed that a letter from the Chair to Board Medical Directors asking for their support would be drafted and circulated.

Action point 5:

• Chair/Secretariat - circulate letters to Board Medical Directors requesting their formal support for the work enabled by Miles Frost funding

Scottish Obstetric Cardiac Network

The presentation highlighted heart disease as a leading cause of maternal death as well as leaving survivors with significant morbidities. The role and structure of the network, current guidelines and priorities focussed on care pathways, data and audit, communication & education, pre-pregnancy counselling and patient issues were presented on.

The group for their support in achieving the network aims. It was noted that the same Network Manager across services would be employed to ensure continuity of care and to avoid duplication of effort. The group welcomed the aims, noted NACHD’s support for this work, the links to the women’s health agenda and the coordinated approach outlined to improve management for this group of patients. The group was reminded that the HeartE modules are currently being refreshed and it could be a good opportunity to have a module created on obstetric cardiac services and care. 

Updates

The Chair of the Heart Failure Hub updated the group on the work of Hub. This included progress on data collection and Atlas of Variation work. A very successful National Patient and Carers Conference had taken place at Dunblane Hydro. The Ensuring Success in Heart Failure 2020 conference was scheduled for 29 January at the Royal College of Physicians and Surgeons of Glasgow. The recommendations from the Scottish Heart Failure Nurse report were being examined. A UK Heart Failure report due to be published in November was to set out the challenge for heart failure nurses. BNP testing was now formally available across Scotland.

The group was updated on ongoing work on cardiac physiology and reported on significant work with various groups. Regarding reforming educational pathways into the profession, a consultation was going out for five weeks from Monday 11 November. A service need for associate practioners was being worked on. Engagement with other groups and bodies was being progressed. A meeting had been scheduled for the following week with officials at the Scottish Government. Links were being made with the Safe Staffing Bill. Steps were being taken to look at removing barriers to international recruitment such as educational qualifications of equivalence. Work was also moving forward on recruitment and retention premiums.

Details of next meeting

The Chair noted that Secretariat would circulate details of the next meeting.

Action point 6:

• Secretariat - confirm details for the next meeting of the group

Action points

Number	Action point	Responsibility
1	Amend Section 5, para 4 of the 29 April minute to reflect discussion	Secretariat
2	Develop a draft refresh of the HDIP for the next meeting of the group	Chair / Secretariat
3	Establish a NACHD sub-group on data collection	Secretariat
4	Establish a NACHD sub-group on women’s heart health	Secretariat
5	Circulate letters to Board Medical Directors requesting their formal support for the work enabled by Miles Frost funding	Chair/Secretariat
6	Confirm details for the next meeting of the group	Secretariat