Coronary Heart Disease and Stroke in Scotland
3 Managed Clinical Networks
Strategy Recommendations
Local health plans should, by December 2002, include provision for the development of local Managed Clinical Networks for cardiac services and stroke. NHS Boards should give consideration to making innovative appointments to MCNs, rather than to institutions.
By April 2004 each NHS Board should have a local cardiac services MCN in operation.
By April 2004 each NHS Board should have a Stroke MCN in operation.
3.1 Managed Clinical Networks (MCNs) represent a way of working which relies on clinicians being part of a virtual organization that actively involves patients in service design and focus. It brings together clinicians from all backgrounds and sectors in the NHS, working together with patients across boundaries between primary, secondary and tertiary care. MCNs were envisaged in the 2002 Strategy as being the key vehicles to deliver real and sustainable service improvement.
3.2 This year saw the last pieces of the MCN jigsaw come into place. Every NHS Board now has an operational MCN for both CHD and stroke. Each MCN has appointed a lead clinician and network managers are in place. And these MCNs sit alongside other Networks, for example in cancer and diabetes. Both stroke and CHD MCNs have received two years' worth of specific pump priming to help them establish themselves. This funding, worth 3m over two years was made available from April 2003 - although some MCNs were later in getting established, they will not lose out on this funding.
3.3 As an assessment of MCN maturity, network managers were asked this autumn to identify a number of key generic and disease specific components that their MCN had in place. This exercise showed that although these components varied between the NHS Boards, the general picture was that MCNs were demonstrating significant levels of maturity and integration within local health planning structures.
The work of the MCNs
3.4 MCNs for stroke and CHD have a broad remit. They are involved in all aspects of planning stroke and cardiac care in each NHS Board. Each MCN is responsible for establishing its own work plans in identifying local priorities and taking into account those set out in the CHD and Stroke Strategy. These include:
ensuring access to acute stroke units and neuro-imaging facilities
development of rapid access out-patient, chest pain and heart failure services
addressing the issue of pre-hospital thrombolysis for AMI in rural communities
setting targets for secondary prevention and ensuring inclusive stroke and cardiac rehabilitation and follow-up services
developing primary care standards and primary prevention strategies for stroke and CHD
monitoring and reporting on MCN performance indicators
3.5 Where public involvement had previously been restricted to consulting on specific changes, NHS Boards and their MCNs are beginning to see this as a much wider process of informing, engaging and consulting them on health and community care policy and service developments. With patient representation on many MCNs - and a goal to have patient representation on all MCNs - patients are not just consulted on changes, they are actively engaged in shaping and initiating change directly.
3.6 MCNs have also been working with the Commission for Racial Equality, along with the Scottish Executive, to ensure that services are fully accessible to people from minority ethnic groups. This is particularly important for CHD and stroke services, where there is evidence to suggest that people in certain ethnic groups - particularly South Asians - are at greater risk of developing these conditions. There is good practice to build upon - for example, Ayrshire and Arran NHS Board published its Cardiac Disease Equity Audit in 2002. This was a detailed analysis of CHD services across Ayrshire and Arran, which aimed to identify inequalities in service provision and make recommendations for future redesign.
Project Funding
3.7 The Strategy came with significant additional funding - a total of 40m over three years. The lion's share of this is being allocated to MCNs over the three years of the Strategy to engage in projects, including service redesign, that will bring tangible benefits to patients. NHS Boards were invited to submit bids to the Executive for their relative share of the additional funding. Each Board was encouraged to submit joint stroke and CHD bids in such a manner that would reflect their local priorities but that would balance the development of local stroke and CHD services. So far, some 17m has been made available in this way, and it is already starting to make a difference across some 146 diverse projects. These include:
establishing an acute stroke unit in Tayside
establishing a rapid access chest pain service in Highland
development of CT imaging service for stroke in Argyll and Clyde
establishing a cardiology out reach clinic in Fife
publishing "My Stroke" and "My Heart" books for patients in Greater Glasgow
setting up chronic disease management programme for CHD in Greater Glasgow
3.8 Some NHS Boards were not as quick as others in establishing MCNs, and not all the money that has been made available to the MCNs has yet been spent. But this unspent funding remains available to the MCNs and the Scottish Executive has re-emphasized to NHS Boards the importance of putting the project funding to effective use.
Links with National Advisory Committees
3.9 To support the development and maintenance of local MCNs, and to provide a forum to share best practice, the National Advisory Committees for both stroke and CHD have set up MCN Subgroups. These two Subgroups are each chaired by a member of the National Advisory Committee and bring together the 15 lead clinicians from the MCNs.
Next Steps
3.10 As MCNs grow in experience and confidence, the Scottish Executive expects NHS Boards to explore the potential to integrate their various condition specific MCNs under a single administrative office within their existing planning structures. Enhancing the links between the clinical networks and financial planners within the NHS Boards could only be beneficial to both groups. Whilst lead clinicians have benefited from networking at the national Subgroup on MCNs, network managers and other members have not had this opportunity. The Scottish Executive is therefore planning a series of Network Development Days throughout 2005 to enable all members of MCNs to share ideas and map out the way ahead.