Hansard

The motion was stimulated by a discussion at the cross-party group on heart disease and stroke, of which I am a vice-convener, in March. At that meeting, we heard first hand from specialist nurses—as well as from the patients and families that they work with—about how invaluable the services are. I will come back later to examples that we heard about at that meeting, but it is important first to define heart failure in order to set our discussion in context.

Heart failure is a complex condition for which there is no cure for the majority of people. Heart failure occurs when the heart, which is a muscle, is damaged by a cardiac event—most commonly following a heart attack, or from long-term high blood pressure, or valvular disease, which I suffer from myself.

It is really important to make the distinction between heart failure and heart attack, because there is a common misconception that they are the same conditions—they are not. Heart failure can be the result of a heart attack, but heart failure is a long-term condition, whereas a heart attack is an emergency or acute event and happens when a blockage occurs in one of the arteries to the heart, which restricts the flow of blood.

Due in part to the very welcome improvements in the rate of premature mortality through heart disease, the prevalence of heart failure is rising. It is the only cardiovascular condition that is on the rise, in part because acute events such as heart attacks, which would have been fatal a few years ago, are now survivable. As a consequence, however, many people with damaged hearts end up living with heart failure. Additionally, because heart failure is more prevalent in older people, our ageing population also further increases its prevalence. Improved heart attack survival is, of course, tremendous progress, but it presents the national health service with different challenges, including how to help people to cope when living with heart failure.

Specialist heart failure nursing services are one of the most important ways that the NHS can treat heart failure patients. At the meeting in March of the heart disease and stroke cross-party group, we heard from Mr Thomas Stark, who is a heart failure patient. Thomas described his family’s and his experience of a heart failure diagnosis and his treatment and rehabilitation at Astley Ainslie hospital. Thomas, who felt that he had been well supported throughout his time at Astley Ainslie, described the value of group discussions and of listening to the experiences of others. He also shared a moving letter that his wife had written to the NHS to express their thanks. Thomas summed up the input of the specialist nurse in this way:

“I’ll no beat about the bush, but the nurse was our lifeline.”

We also heard from Mrs Lorraine Jones—a carer for a heart failure patient. Lorraine and her sister were both full-time carers for their mum since her diagnosis of end-stage heart failure. Lorraine described the journey that she and her family had been on as they had, after losing their father, then to deal with the impact of their mother’s illness, which was particularly challenging because she would not accept the diagnosis. Lorraine talked about all aspects of the support that was provided by the nurse. The support was practical, with arrangements for the end of life, and emotional, in that it supported everyone involved in coming to terms with what was happening. Lorraine summed up the support by saying,

“You can’t repay what she’s done for me and my family.”

Since 2002, the British Heart Foundation has supported heart failure specialist nurses around the United Kingdom to ease the burden and improve the quality of life for people with the disease. The British Heart Foundation has funded or pump primed many of those roles in numerous NHS board areas in the expectation that boards would mainstream the funding when the British Heart Foundation funding ended. An evaluation of the impact of the services, which was published in 2008, found dramatic reductions in hospital readmissions for patients who were cared for at home by specialist heart failure nursing services. The report concluded that every patient who is cared for by a specialist heart failure nurse equates to a saving of £1,826 per patient, including the costs of the specialist post. It seems to me essential, therefore, that NHS boards make specialist heart failure nursing services a top priority.

The Scottish heart failure nurse forum, which is the independent representative body for such nurses in Scotland and which is supported by BHF Scotland and Chest Heart & Stroke Scotland, produced the report that stimulated this evening’s debate. That report compares the provision of specialist heart failure nursing services in Scotland in 2012 to provision when it published its previous report in 2008. Unfortunately, the national situation is not a good one. Despite the fact that the prevalence of heart failure is increasing, nationally the overall provision of specialist heart failure nursing posts has fallen, from 51 whole-time equivalent posts in 2008 to 47 in 2012. Only four NHS boards meet the minimum ratio that is set down in the 2007 Scottish intercollegiate guidelines network recommendation of one nurse per 100,000 of population. One NHS board—NHS Orkney—has no specialist heart failure nursing service at all. That is simply not good enough.

We all know that NHS boards are operating in an increasingly challenging environment, but it is crucial that they up their game by improving provision of such nurses. Otherwise, as well as costing themselves more money in the medium to long term through increased hospitalisation costs, they will badly let down heart failure patients, who desperately need the kind of care that only specialist nurses can provide.

When the Parliament’s Public Audit Committee considered the issues last year during its inquiry into cardiology services, it concluded that clarification was needed from the Scottish Government on future plans for specialist heart failure nursing services. In response, Derek Feeley wrote to the committee and stated:

“On 1 November 2012 the National Advisory Committee on Heart Disease agreed to support the establishment of a heart failure short life working group. This group will be well placed to advise NHSScotland on how heart failure nurses role can be further strengthened. The group, which will include heart failure nurse representation, is expected to have its first meeting in spring 2013.”

That will be a welcome development if—it is a big “if”—the group’s recommendations are taken forward by ministers and NHS chief executives and are regarded as a priority. Perhaps in concluding the debate, the minister can inform us whether the group has met yet, when it will meet if it has not met, and what more he thinks the Government can do to get NHS boards to provide the services at a sufficient and sustainable level.

17:50