Under the microscope: Essex Cardiothoracic Centre

The Essex Cardiothoracic Centre celebrates its 16-year anniversary this summer, and with a recent funding injection leading to the development of a new cardiac catheter lab, the centre is gearing up to support more patients requiring thoracic procedures in the county.

The Essex Cardiothoracic Centre (CTC), located at Basildon Hospital and part of Mid and South Essex NHS Foundation Trust, serves a population of 1.8 million people across the county.

Each year, approximately 900 cardiac surgeries, 500 thoracic operations and close to 2,400 cardiology procedures are performed.

The CTC recently received £2.3m in national funding, which has been spent on a new 60 square metre cardiac catheter lab, expected to open in May 2023. The development will free up theatre space for thoracic surgery and increase lung cancer surgery numbers by a third.

Hospital Healthcare Europe caught up with Michael Catling, deputy director of operations for the Essex Cardiothoracic Centre and Mid and South Essex Cardiology, to find out more.

Why was the Essex CTC originally established?

Pre-2007, patients who needed heart or lung treatment had to travel to London as there was poor provision for these services in the county. The CTC was set up following a national requirement to increase capacity for cardiac surgery and specialist interventional cardiology procedures. The Department of Health selected Basildon as the site for a new Essex centre.

How will the latest investment improve thoracic services?

Our core capacity for thoracic surgery will increase by around 150 cases annually as heart procedures that were previously carried out in the hybrid theatre will be moved to the new cath lab, freeing up space.

We perform around 500 thoracic surgeries per annum of which around 180 are lung cancer cases. Demand has risen over the past five years, and until now, we have been reliant upon ad hoc additional lists, often taking capacity from cardiac surgery, which is not sustainable.

The ability to have an extra thoracic list every week in core capacity on the schedule without having to take any other service away releases the pressure and gives us the capacity to meet increasing demand in the coming years.

We provide a wide range of thoracic services for conditions of the lung, airway, pleura, mediastinum, chest wall and diaphragm. These incorporate cancer and benign disease with both open and minimally invasive approaches.

Why has there been an increase in referrals for lung cancer surgery?

The main driver is improvements in diagnostic services for lung cancer, including targeted screening, which increases the detection of early-stage cancers. Local community and hospital services are shortening diagnostic pathways and increasing access to diagnostics.

One of our communities within Essex was in the first wave of the national Targeted Lung Health Check (TLHC) programme that launched in November 2020. In April 2022, this rolled out to a second location and current plans are to extend this to all populations.

As of March, at least nine people in Southend had previously undiscovered lung cancer found and treated thanks to the TLHC. The same programme is also benefiting residents living in Thurrock. The latest data shows that 4,834 checks have been completed in Southend.

In addition, there has been a total of 1,827 CT scans and 127 referrals into hospitals after those scans to follow up care linked to cardiovascular disease, gallbladder, respiratory, breast, gastro, urology, liver and renal findings.

What facilities does the Essex CTC have?

A 16-bed cardiothoracic ITU, 32-bed cardiothoracic surgery ward, 28-bed cardiology ward, cardiothoracic theatre suite with four theatres including a hybrid IR theatre, cath lab suite including EP (electrophysiology) and structural labs, cardiac imaging including CT, MRI, special echo, outpatient suite, cardiac rehab department, pulmonary physiology department and overnight facilities for on-call teams and for relatives.

We offer a wide range of specialist tertiary services. Our higher volume procedures within cardiology are PCI (percutaneous coronary intervention), cardiac pacing, TAVI (transcatheter aortic valve implantation) and EP. Within the surgical service these are CABG (coronary artery bypass graft), AVR (aortic valve replacement), MVR (mitral valve repair), and complex aortic.

Additionally, over the past three years there has been a move from open lung surgery to minimally invasive lung surgery and our programme includes VATS (video-assisted thoracoscopic surgery).

How many employees does the CTC employ?

Around 600. This includes consultant cardiologists, surgeons, anaesthetists, thoracic histopathologists, specialist nursing teams, cardiac physiologists, clinical perfusion scientists, surgical care and operating department practitioners.

We also have UK training posts and international clinical fellows and have developed a strong national and international reputation for research within the centre. This is supported by our excellent relationship with the Anglia Ruskin University Medical School faculty with which we have a research fellow programme.

We have several colleagues with roles in external organisations and learned societies such as the British Cardiovascular Intervention Society. They contribute regularly to national and international events including presentations at Society for Cardiothoracic Surgery 2023, and by providing live-streamed cath lab cases for the 2023 physiology course at the Cardiovascular Centre in Aalst, Belgium.

How do you develop and retain your staff?

We’re very focused on doing what we do well, developing genuine tertiary services and particularly looking after our talented and passionate staff through training opportunities.

As a centre we are committed to offering excellent specialist training both to our own specialists and to related teams across Essex. The surgical team has delivered a programme of eight clinical simulation training events and wet labs over the past 12 months.

This has included two specifically related to the thoracic surgery service. In November 2022, we ran a lung resection day covering the teaching of both anaesthetic and surgical perspective with attendees from several other major tertiary centres in the UK.

In January 2023, we conducted a chest drain insertion day run jointly with the respiratory team, including hands-on simulation. Other courses in the past year have covered CABG, aortic and mitral valve surgery. This helps with staff development and retention.

What plans does the CTC have for the future?

As a specialist centre serving a large population and a number of local hospitals, our clinical plans incorporate continued development of specialist interventions and increased collaboration with local hospitals and primary care teams. This will include introduction of mitral TEER (transcatheter edge-to-edge repair), minimally invasive cardiac surgery, complex aortic surgery and thoracic port surgery techniques. We will be extending multi-disciplinary team working in chronic long-term conditions such as heart failure and atrial fibrillation through virtual ward models supported by latest technologies.

Our most important asset is our workforce, and we will continue to invest in training and education for our teams as well as developing new extended scope roles for advanced care practitioners.