77thth York Cardiac Care Conference York Cardiac Care Conference

A National Campaign for Cardiac A National Campaign for Cardiac RehabilitationRehabilitation

CCAREARE ANDAND E EDUCATIONDUCATION R RESEARCHESEARCH G GROUPROUP

www.cardiacrehabilitation.org.uk/campaignwww.cardiacrehabilitation.org.uk/campaign

Bob Lewin

Cardiac rehabilitation is one of the most effective medical treatments available for heart patients.

It saves lives.

It It is cheap.

Every survey of cardiac patients has said “we want more”.

In England in 2000 the Department of Health said that 85% people who have had a Heart Attack, Angioplasty or By-pass Surgery should ‘be offered’ cardiac rehabilitation. Once that target was achieved services should be expanded so that all cardiac patients, except those with unstable angina, should be offered CR.

National Institute for Clinical Excellence has said all heart attack patients should take part.

The scandal - the great majority of patients don’t get a chance to take part and every years lives are shortened needlessly.

The Facts The Facts

BHF / BACR survey 2003-2004

permission Dr Hugh Bethell

TargetTarget Got CRGot CR2003/42003/4 %%

2002 target 2002 target

All who would All who would benefitbenefit

58,09738%

18%

TargetsTargets

have not been achieved. have not been achieved. There has been little There has been little improvement.improvement.

There are wide disparities There are wide disparities between regions and between regions and postcodespostcodes

1) Too few people getting a chancenot enough rehabilitation programmesup to 70% not invited (missed on discharge, no protocol, etc)20%-50% choose not to attend (inflexible delivery options)

2) Inequalities ethnic minorities, women, elderly place of residence, postcode lottery

3) Huge variation in resources and staffing cost per patient varies from aprox. £150 to £990 per patient!

4) Developing crisis becausenot in payment tariff – price for an admission with MI or surgerynot included in GP quality mechanism

Main ProblemsMain Problems

YesYes NoNo Don’t Don’t knowknow

Is your programme under threat in Is your programme under threat in any way?any way?

37%37% 40%40% 23%23%

Is your service currently threatened Is your service currently threatened with closure?with closure?

10%10% 63%63% 27%27%

Do you have an accepted business Do you have an accepted business case and secure funding?case and secure funding?

39%39% 30%30% 31%31%

Getting better or worse?Getting better or worse?

Today - bring together key players Today - bring together key players

Dept of Health.Dept of Health. Professor Roger Boyle, (Heart Tsar) Elizabeth Professor Roger Boyle, (Heart Tsar) Elizabeth Lyneham (Head of Vascular Programme)Lyneham (Head of Vascular Programme)Academics.Academics. Jane Cooper, Royal College of Physicians Jane Cooper, Royal College of PhysiciansBritish Cardiac Society.British Cardiac Society. Dr Jane Flint, Dr Nick Boon, Dr Paul Dr Jane Flint, Dr Nick Boon, Dr Paul McIntyre McIntyre BACR.BACR. Bernie Downie, Patrick Doherty Bernie Downie, Patrick DohertyBritish Heart FoundationBritish Heart Foundation – Dr Mike Knapton, Betty McBride – Dr Mike Knapton, Betty McBridePatient organisationsPatient organisations – Mel Clarke, (BHF Heart Voices): – Mel Clarke, (BHF Heart Voices): David Geldard Heart Care PartnershipsDavid Geldard Heart Care Partnerships

People who know how to campaign and improve CR servicesPeople who know how to campaign and improve CR services, Dr , Dr Hayes Dalal, Denise Lewis and Pat Marley, Trudie Loban Hayes Dalal, Denise Lewis and Pat Marley, Trudie Loban

but most important of all, representatives of patient support groupsbut most important of all, representatives of patient support groups

Key elements for improvementKey elements for improvementNational Annual Audit of Cardiac RehabilitationNational Annual Audit of Cardiac Rehabilitation

• so that we can describe the extent of the problemso that we can describe the extent of the problem

• show where provision and quality are bad and where it is goodshow where provision and quality are bad and where it is good

• measure if things are getting bettermeasure if things are getting better

• Know when the campaign has succeeded and can stopKnow when the campaign has succeeded and can stop

Cardiac Rehab PatientsCardiac Rehab Patients fill in questionnaires 3 times, before, after CRand at 12 months after rehabilitation

Cardiac Rehab PatientsCardiac Rehab Patients fill in questionnaires 3 times, before, after CRand at 12 months after rehabilitation

CR Programmes enter dataCR Programmes enter dataCR Programmes enter dataCR Programmes enter data

BHF YorkBHF YorkBHF YorkBHF York

Annual National Audit ReportsAnnual National Audit ReportsAnnual National Audit ReportsAnnual National Audit Reports

ONSONS

HESHES

national national benchmarking,benchmarking,

print reports etcprint reports etc

national national benchmarking,benchmarking,

print reports etcprint reports etc

CCADCCADCCADCCAD

Key elements for improvementKey elements for improvementNational StandardsNational Standards for CR (defined by BACR) for CR (defined by BACR)

• To tell providers what the minimum they must provideTo tell providers what the minimum they must provide

• To decide if a patient has had rehabilitationTo decide if a patient has had rehabilitation

• To decide who enters the auditTo decide who enters the audit

Key elements of the CampaignKey elements of the Campaign3. Campaign literature 3. Campaign literature

1. Lay 1. Lay Version for Version for patients and patients and the publicthe public

2. Evidence for 2. Evidence for GPs, providers, GPs, providers, medical medical journalists, etc. journalists, etc.

3. Annual Audit results3. Annual Audit results

mid-year mid-year

National Audit of Cardiac National Audit of Cardiac RehabilitationRehabilitation

Download from Download from www.cardiacrehabilitation.org.uk/campaign

5 demands of the campaign5 demands of the campaign

This morningThis morningHow do we know it is important – Angela Cooper the How do we know it is important – Angela Cooper the evidence evidence

Why are we in this mess? Jane FlintWhy are we in this mess? Jane Flint

A potential solution by reorganising services – Hayes DalalA potential solution by reorganising services – Hayes Dalal

How to campaign Trudie Lobban How to campaign Trudie Lobban

11.50 – 12.15 Roger Boyle, comments and chair a discussion11.50 – 12.15 Roger Boyle, comments and chair a discussion

This afternoonThis afternoonThe patient perspective Mel Clark and David GeldardThe patient perspective Mel Clark and David Geldard

An example of 2 programmes that campaigned to save their An example of 2 programmes that campaigned to save their servicesservices

Advice on using the media in campaigns Betty McBride Advice on using the media in campaigns Betty McBride

The Strategy Discussion The Strategy Discussion

Should we do anything at all? How can we change things? Should we do anything at all? How can we change things? Who should lead it? Etc.Who should lead it? Etc.

www.cardiacrehabilitation.org.uk

THE ENDTHE END