Chamber
Meeting of the Parliament 24 January 2013
24 Jan 2013 · S4 · Meeting of the Parliament
Item of business
Cardiac Rehabilitation (Clinical Standards)
I would obviously need to get the glasses, but I will take that as a compliment.
Heart disease has been a clinical priority for the Scottish Government and for NHS Scotland for more than 15 years now. Over that period, thanks to the dedication of the staff within the NHS, we have achieved a dramatic 60 per cent decrease in the number of premature deaths from heart disease. As I am sure everyone agrees, that has been achieved through the fantastic efforts of our NHS staff.
Jackson Carlaw is correct that such achievements bring additional challenges. As more people survive heart attacks and live with heart disease, there is a need for more access to high-quality rehabilitation and support. Those needs have been recognised both within the NHS and by campaigning organisations such as Chest, Heart and Stroke Scotland and the British Heart Foundation, which have a long-standing commitment to cardiac rehabilitation.
The key messages from those organisations’ campaigns were incorporated into our “Better Heart Disease and Stroke Care Action Plan”, which places a greater emphasis on the importance of proper support following an acute episode of treatment. The action plan recognises the wealth of evidence supporting the clinical effectiveness and cost-effectiveness of cardiac rehabilitation, which several members have referred to. The importance of cardiac rehabilitation is also echoed in Scotland’s SIGN guidelines and in the clinical standards for heart disease.
Put simply, cardiac rehabilitation is an inexpensive treatment that saves lives. We want everyone who could benefit from cardiac rehabilitation to get appropriate access, and we want to ensure they have the best possible chance of a full recovery.
In recent years, we have been making excellent progress towards achieving that goal. According to ISD Scotland, uptake of cardiac rehabilitation for people with either myocardial infarction or a cardiac intervention has increased from 45 per cent in 2006 to 65 per cent in 2011. Equally impressive is the evidence that shows the high quality of services now being delivered in Scotland. Most areas have a full range of psychosocial, health, lifestyle and medical risk management provisions in place—all areas that were recently highlighted in the BACPR standards.
The audit findings have triggered a range of improvement works in services, and I want to see evidence of further improvements by all boards when further audit results are published later this year. Like BACPR, we want to ensure that cardiovascular prevention and rehabilitation services are safe, effective and person centred. The revised BACPR standards emphasise the need for rehabilitation to be provided in a way that meets an individual’s needs. That fits the Scottish Government’s person-centred approach to the delivery of healthcare, and it is reassuring that the audit found that many NHS boards already offer a menu-based approach to cardiac rehabilitation.
The national advisory committee on heart disease has already identified cardiac rehabilitation as a priority. As part of our heart disease programme, we have supported the most comprehensive audit of cardiac rehabilitation ever undertaken in Scotland; provided some £20,000 funding to the Angus activity programme for people with a long-term condition; and funded the development of an online version of the Lothian heart manual.
There remains much more to do. Helen Eadie is correct to highlight that the clinical standards for heart disease are clear that all people with heart failure and acute angina should be assessed for their suitability for cardiac rehabilitation. We know that referral rates for those groups continue to be low. Rehabilitation services in NHS Scotland are working to address that through service redesign. They are implementing a menu-based approach, anticipating that that will enable an increase in service capacity. I expect the work, which is being developed by boards, to achieve improved outcomes for patients.
We also need to look at the rehabilitation services that can, and should, be made available for people with heart failure and unstable angina. Only a proportion of heart failure and angina patients will be suitable for cardiac rehabilitation programmes that are based in secondary care. It is essential that people with heart failure and angina get the support that they need in their homes and communities.
Clearly, there remains further scope for promoting exercise for people with cardiovascular disease and, indeed, other long-term conditions within the community, particularly within our leisure centres. There are several examples of excellent programmes, including one in Lanarkshire, and I want to see those approaches explored further and rolled out elsewhere.
In terms of our next steps, I have asked our national advisory committee to consider, at its next meeting in February, how we ensure that people with heart failure and acute angina get the support and rehabilitation that they need. The establishment of a new heart failure group will support that process. The development of a HEAT target proposal for cardiac rehabilitation is one of the options that I will ask the group to consider.
The revised BACPR standards make clear the importance of on-going audit. The enthusiasm for the previous audit was extremely heartening. We have therefore explicitly committed NHS Scotland to the on-going monitoring of the provision of cardiac rehabilitation. A further audit report will be issued later in spring.
We have provided substantial funding to Chest, Heart and Stroke Scotland, the British Lung Foundation and the British Heart Foundation Scotland on a programme aimed at supporting people with conditions, including those with heart failure and acute angina, to access appropriate exercise and support. I expect to provide further information to Parliament on that later in the year.
I thank NHS Scotland staff for all the work that they have done to improve the care of people with heart disease. I restate the Government’s commitment to supporting on-going improvements in cardiac services, including rehabilitation services.
13:04 Meeting suspended.
Heart disease has been a clinical priority for the Scottish Government and for NHS Scotland for more than 15 years now. Over that period, thanks to the dedication of the staff within the NHS, we have achieved a dramatic 60 per cent decrease in the number of premature deaths from heart disease. As I am sure everyone agrees, that has been achieved through the fantastic efforts of our NHS staff.
Jackson Carlaw is correct that such achievements bring additional challenges. As more people survive heart attacks and live with heart disease, there is a need for more access to high-quality rehabilitation and support. Those needs have been recognised both within the NHS and by campaigning organisations such as Chest, Heart and Stroke Scotland and the British Heart Foundation, which have a long-standing commitment to cardiac rehabilitation.
The key messages from those organisations’ campaigns were incorporated into our “Better Heart Disease and Stroke Care Action Plan”, which places a greater emphasis on the importance of proper support following an acute episode of treatment. The action plan recognises the wealth of evidence supporting the clinical effectiveness and cost-effectiveness of cardiac rehabilitation, which several members have referred to. The importance of cardiac rehabilitation is also echoed in Scotland’s SIGN guidelines and in the clinical standards for heart disease.
Put simply, cardiac rehabilitation is an inexpensive treatment that saves lives. We want everyone who could benefit from cardiac rehabilitation to get appropriate access, and we want to ensure they have the best possible chance of a full recovery.
In recent years, we have been making excellent progress towards achieving that goal. According to ISD Scotland, uptake of cardiac rehabilitation for people with either myocardial infarction or a cardiac intervention has increased from 45 per cent in 2006 to 65 per cent in 2011. Equally impressive is the evidence that shows the high quality of services now being delivered in Scotland. Most areas have a full range of psychosocial, health, lifestyle and medical risk management provisions in place—all areas that were recently highlighted in the BACPR standards.
The audit findings have triggered a range of improvement works in services, and I want to see evidence of further improvements by all boards when further audit results are published later this year. Like BACPR, we want to ensure that cardiovascular prevention and rehabilitation services are safe, effective and person centred. The revised BACPR standards emphasise the need for rehabilitation to be provided in a way that meets an individual’s needs. That fits the Scottish Government’s person-centred approach to the delivery of healthcare, and it is reassuring that the audit found that many NHS boards already offer a menu-based approach to cardiac rehabilitation.
The national advisory committee on heart disease has already identified cardiac rehabilitation as a priority. As part of our heart disease programme, we have supported the most comprehensive audit of cardiac rehabilitation ever undertaken in Scotland; provided some £20,000 funding to the Angus activity programme for people with a long-term condition; and funded the development of an online version of the Lothian heart manual.
There remains much more to do. Helen Eadie is correct to highlight that the clinical standards for heart disease are clear that all people with heart failure and acute angina should be assessed for their suitability for cardiac rehabilitation. We know that referral rates for those groups continue to be low. Rehabilitation services in NHS Scotland are working to address that through service redesign. They are implementing a menu-based approach, anticipating that that will enable an increase in service capacity. I expect the work, which is being developed by boards, to achieve improved outcomes for patients.
We also need to look at the rehabilitation services that can, and should, be made available for people with heart failure and unstable angina. Only a proportion of heart failure and angina patients will be suitable for cardiac rehabilitation programmes that are based in secondary care. It is essential that people with heart failure and angina get the support that they need in their homes and communities.
Clearly, there remains further scope for promoting exercise for people with cardiovascular disease and, indeed, other long-term conditions within the community, particularly within our leisure centres. There are several examples of excellent programmes, including one in Lanarkshire, and I want to see those approaches explored further and rolled out elsewhere.
In terms of our next steps, I have asked our national advisory committee to consider, at its next meeting in February, how we ensure that people with heart failure and acute angina get the support and rehabilitation that they need. The establishment of a new heart failure group will support that process. The development of a HEAT target proposal for cardiac rehabilitation is one of the options that I will ask the group to consider.
The revised BACPR standards make clear the importance of on-going audit. The enthusiasm for the previous audit was extremely heartening. We have therefore explicitly committed NHS Scotland to the on-going monitoring of the provision of cardiac rehabilitation. A further audit report will be issued later in spring.
We have provided substantial funding to Chest, Heart and Stroke Scotland, the British Lung Foundation and the British Heart Foundation Scotland on a programme aimed at supporting people with conditions, including those with heart failure and acute angina, to access appropriate exercise and support. I expect to provide further information to Parliament on that later in the year.
I thank NHS Scotland staff for all the work that they have done to improve the care of people with heart disease. I restate the Government’s commitment to supporting on-going improvements in cardiac services, including rehabilitation services.
13:04 Meeting suspended.
In the same item of business
The Deputy Presiding Officer (John Scott)
Con
The next item of business is a members’ business debate on motion S4M-04623, in the name of Helen Eadie, on clinical standards for cardiac rehabilitation. Th...
Helen Eadie (Cowdenbeath) (Lab)
Lab
I start by thanking all my colleagues in the Scottish Parliament and you, Presiding Officer, for enabling me to bring to Parliament this afternoon a debate o...
Dave Thompson (Skye, Lochaber and Badenoch) (SNP)
SNP
I thank Helen Eadie for securing this debate on an extremely important issue.As vice-convener of the cross-party group on heart disease and stroke, I too hav...
Jackie Baillie (Dumbarton) (Lab)
Lab
I congratulate Helen Eadie on securing the debate. She is very committed to the issue and has worked extremely hard over the years, as convener of the cross-...
Dennis Robertson (Aberdeenshire West) (SNP)
SNP
I congratulate Helen Eadie on bringing this debate to the Parliament. I, too, am a member of the Parliament’s cross-party group on heart disease and stroke.M...
Jackson Carlaw (West Scotland) (Con)
Con
The distance between Fife and Troon, where, respectively, Helen Eadie and I live, is probably as great as the distance between her and me politically on almo...
The Minister for Public Health (Michael Matheson)
SNP
Like others, I congratulate Helen Eadie on securing time for what has been, although short, a very interesting debate focusing on a couple of specific issues...
Jackie Baillie
Lab
If Michael Forsyth is Voldemort, is the minister Harry Potter?
Michael Matheson
SNP
I would obviously need to get the glasses, but I will take that as a compliment.Heart disease has been a clinical priority for the Scottish Government and fo...