Please click here to view the National Rollout of Minimally Invasive Cardiac Surgery (MICS) & ERACS – Support Pack
Expression of Interest (EOI) Pack for Participating Centres
Invitation:
Cardiac surgical services in the UK sit at transformational crossroads. Patients demand for high quality surgery with low morbidity and accelerated recovery; there are increased healthcare capacity constraints and increased competition with catheter-laboratory based alternatives. A stepwise change in the delivery of cardiac surgery in the UK is urgently needed.
Minimally Invasive Cardiac Surgery (MICS) and Enhanced Recovery After Cardiac Surgery (ERACS) represent evidence-based, patient-centred innovations with the potential to transform outcomes and operational performance across the NHS.
We cordially invite NHS cardiac surgery centres to participate in the national Minimally Invasive Cardiac Surgery and Enhanced Recovery Programme. This is a nationally supported initiative (led by SCTS in partnership with NHS England, BISMICS and ACTACC) to transform cardiac surgery pathways.
Participation offers your centre a unique opportunity to become an accredited MICS and ERACS centre, accessing specialist training, implementation support, and peer networking to rapidly adopt minimally invasive techniques and ERACS protocols. The program is aligned with the professional group and NHS’ goals of improving patient outcomes and operational efficiency -and is expected to yield substantial benefits for patients (lower morbidity, expedited recovery, less pain, increased satisfaction) and for hospitals (shorter LOS, reduced ICU utilisation, reduction in costly complications).
Purpose and Scope of the Programme
Purpose:
The purpose of this program is to embed minimally invasive surgical techniques and enhanced recovery pathways into routine cardiac surgical care nationally. Selected participant centres will receive comprehensive support to implement a MICS & ERACS pathway for cardiac surgery with the aim of improving patient outcomes and experience while increasing service efficiency.
Scope of Support:
Participating centres will benefit from a structured support package over the course of the program, including:
Training and Education
Inclusion in specialised training courses delivered by SCTS/BISMICS/ACTACC, covering:
- Surgical techniques in MICS (e.g., MI valve repair, thoracoscopic skills)
- Peri-operative TOE in MICS (e.g., cannulation, venous drainage, cardioplegia, clamp leak, LV distension, de-aring, exclusion of aortic dissection etc)
- Team training and SOP generation in MICS (development of shared understanding of procedural workflow through generation of SOPs by MICS procedure type), including drills rehearsal (e.g., defibrillation, de-airing, major bleeding, sternotomy conversion) and dry runs.
- Team training in ERACS processes: visits to reference centres
- Formal Accreditation as “National Minimally Invasive Cardiac Surgery and Enhanced Recovery Centres” and will be recognised for excellence, fostering reputation and patient trust.
- Pathway Redesign Support: We will provide help in mapping and redesigning patient pathways. This includes templates for patient selection criteria, preoperative optimisation (pre-habilitation) plans, intraoperative checklists for MIS, postoperative care bundles (early extubation, mobilisation schedules, analgesia regimens, etc.), and discharge planning tools. Sites will be guided by proven models from high-performing centres.
- Data and Monitoring Tools: In time, we will provide tools to collect and monitor key metrics (e.g. conversion rates to open surgery, ICU hours, postoperative length of stay, patient-reported outcomes). The NACSA audit platform will be utilised for tracking and benchmarking progress. Participant sites will receive regular feedback reports comparing their outcomes with peers, enabling continuous improvement.
- Peer Network and Knowledge Sharing: Centres will join a community of practice with other participating sites. Regular collaborative forums (both virtual and in-person) will allow sharing of lessons learned, troubleshooting challenges, and celebrating successes. The program will foster a culture of collaboration rather than competition, so that even non-participating units can learn and join in future waves.
- National Visibility and Future Opportunities: Early adopter centres will be highlighted in national forums and publications. This recognition can assist in attracting referrals, research opportunities, and additional funding (for example, many pilot sites find that demonstrating innovation helps in securing future grants or expansion funding). Successful sites will be well-positioned to become training hubs for the wider NHS in minimally invasive cardiac surgery.
The scope of this EOI, therefore, is not just to select sites, but to kick-start a transformative journey for those hospitals ready to lead change. The program’s initial phase will run [for 12 months] during which selected centres are expected to implement the new approaches and achieve defined targets (such as performing a threshold percentage of eligible cases via MIS and meeting ERACS discharge goals). Beyond this, the long-term vision is for all cardiac units to adopt these practices, with early centres acting as exemplars and mentors.
Eligibility Criteria
The program is open to NHS trusts (or health boards) that provide adult cardiac surgery services. Eligibility criteria for applicant centres include:
- Established Cardiac Surgery Service: Both surgical centres with no prior MIS experience and those already doing some MIS are welcome to apply.
- Leadership Commitment: Demonstrable support from hospital and clinical leadership. Applications must have the endorsement of the Clinical Director for Cardiac Surgery and the executive leadership (e.g. Medical Director and Chief Executive). This ensures the program has backing at the highest level for necessary changes.
- Multi-disciplinary Team Readiness: The presence of a core team willing to champion MICS/ERACS will be critical. – at minimum, at least one cardiac surgeon interested in or already trained in minimally invasive techniques, an anaesthetist supportive of ERACS protocols, and engaged representatives from perfusion, cardiac nursing/ICU and physiotherapy. You should identify these key individuals (“local champions”) in the application.
- Volume and Case Mix: An adequate surgical volume and case mix to implement the program. While we do not strictly require a minimum caseload, sites should have sufficient throughput of suitable cases to feasibly incorporate MIS on a regular basis.
- Infrastructure and Equipment: Basic infrastructural capabilities to support MIS and ERACS. This includes availability of necessary equipment such as video thoracoscopic towers, long-shafted instruments, and compatible imaging (e.g. transoesophageal echo) and perfusion technology. If certain equipment is lacking, the application should note this and willingness to acquire it. A hybrid theatre or advanced imaging is not required, but standard cardiac theatre with minimally invasive adaptability is expected.
- Commitment to ERACS Principles: Agreement to adopt enhanced recovery practices. The entire perioperative team (surgeons, anesthetises, ICU, physio) must be willing to implement protocolised ERACS elements – e.g. early extubation, multimodal analgesia, early mobilisation. If any current practice deviates (for instance, routine overnight ventilation), the site should demonstrate a plan to change this as part of the program.
- Data and Audit Commitment: Willingness to collect and share data. Participating centres must agree to submit required data to the national audit and programme team, and to participate in evaluation activities (surveys, interviews, etc. if requested). Data transparency is crucial; results (anonymised where appropriate) will be shared to gauge program impact.
- Patient Experience: Demonstrate a focus on improving the patient experience including detailing any steps you will introduce to enhance this.
- Exclusion: There are no strict exclusion criteria aside from not meeting the above. However, if a centre is already significantly advanced in MICS (e.g. doing >50% MIS cases routinely), they may not be prioritised as they are effectively already at goal (though they could be considered as a mentor site). Conversely, centres that are unable to demonstrate executive support or a willing clinical team would not be suitable at this time.
All applications will be judged primarily on the strength of commitment and readiness to benefit from the program, rather than current performance. Both early innovators and those just beginning their minimally invasive journey are encouraged to apply.
Submission Guidance and Timeline
How to Apply:
Interested centres should complete the Expression of Interest Form here. The form includes sections for a narrative response – please ensure all sections are filled out.
Key Dates:
- EOI Launch Date: 26th September 2025.
- Submission Deadline: 5:00 pm on 1st December 2025. EOIs must be received by this deadline. Late submissions will not be accepted, to ensure a fair process.
- Evaluation Period: December 2025. During this time, the selection panel (Steering Group) will review applications. We may contact you for any clarifications or additional information needed. Shortlisting and Interviews: If the volume of high-quality applications exceeds available slots, a shortlisting may occur. Shortlisted sites might be invited to a brief virtual interview or discussion. We advise applicants to ensure that key team members (e.g. Lead surgeon, Clinical director, and a senior manager) are available during that window in case of interviews. Details will be provided to those selected.
- Announcement of Results: By 10 January 2026. All applicant sites will be notified of the outcome. Selected participant centres will receive an official confirmation letter and next steps for onboarding.
- Onboarding & Launch: The program “go-live” with first cases and interventions is expected in early 2026
Support for Applicants:
If you have questions during the application please contact Enoch Akowuah (enoch.akowuah@nhs.net), Aman Coonar (aman.coonar@nhs.net), Ranjit Deshpande (ranjit.deshpande@nhs.net), Bonnie Kyle (bonnie.kyle@nhs.net)
Applicants should use the following template to structure their Expression of Interest submission.
We look forward to receiving your application. This initiative is a major step towards modernising cardiac surgery in the NHS, and your enthusiasm and plans are vital to its success. Together, we can deliver safer surgeries, faster recoveries, and better experiences for our cardiac patients.