Hansard

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 on a topic about which I am very enthusiastic. The subject is very important, so I offer the motion to colleagues for their support.

Modern cardiac rehabilitation is menu based and patient centred, and it provides a pathway from diagnosis to long-term management while meeting patients’ physical, psychological and social needs. It reduces all-cause mortality by up to 26 per cent and cardiac mortality by up to 36 per cent, while reducing unplanned hospital admissions by up to 56 per cent.

As members may be aware, I convene the cross-party group on heart disease and stroke. I have heard at first hand from patients and health professionals how popular cardiac rehabilitation is and how important rehab can be in aiding recovery from heart conditions.

The British Association for Cardiovascular Prevention and Rehabilitation—BACPR—presented on its standards at our last meeting in December, and made a compelling case for the extension of cardiac rehabilitation to every heart patient who needs it.

BACPR, the British Heart Foundation Scotland and Chest, Heart and Stroke Scotland want assessment for cardiac rehab to be mandatory for every heart patient. That would cut hospital readmissions, as well as unnecessary primary care appointments. Cardiac rehab is highly cost effective, especially when compared to surgical interventions.

I have been fortunate enough to visit in my constituency a cardiac rehab class that is part of BHF’s hearty lives programme. That project allowed the Fife cardiac rehab service to increase capacity by offering new programmes in different settings, including a community evening class. As a result, referrals doubled. That programme has been mainstreamed, and I hope that other national health service area boards may consider what lessons can be learned from that approach.

The NHS Quality Improvement Scotland clinical standards for heart disease from 2010 mandated an assessment for cardiac rehabilitation for all patients with the most common heart conditions. The Government’s “Better Heart Disease and Stroke Care Action Plan” of 2009 also indicated that NHS boards should regard cardiac rehab as a priority.

Referrals for rehab have improved since those documents were published, but not quickly enough—especially not for long-term heart conditions such as heart failure and angina. That is possibly because much of the published evidence for cardiac rehab—at least in terms of reductions in premature mortality—focuses on the benefits for acute patients, such as heart attack and bypass patients.

However, there is a growing body of evidence that shows that cardiac rehab for heart failure patients has significant benefits in terms of reducing unnecessary hospital readmissions and is, therefore, a highly cost-effective treatment for such patients.

A small study from Australia that has been discussed at the cross-party group compared hospitalisation rates for two groups of heart failure patients: one that had access to rehab once a week and one that had no such access. The group that received cardiac rehabilitation spent, on average, 9.36 days a year fewer in hospital than those who did not receive it. The authors calculated that for every 1 Australian dollar spent on rehab, 11.50 Australian dollars were saved through reduced rehospitalisation costs. I understand that the cardiac rehab team in NHS Ayrshire and Arran is looking to replicate that study using data from that area.

It is estimated that 70,000 people in Scotland are living with heart failure and figures from ISD Scotland suggest that only 3 per cent of those patients are being referred for rehab. How much money could be saved if, as a result of referrals to rehab for heart failure patients, the NHS were to save £11 for every £1 that it spent?

I urge the minister to consider what more the Government can do to improve provision of those crucial services, especially for long-term cardiac conditions such as heart failure. In particular, I urge him to consider what steps are needed to develop a sustainable audit, by NHS board area and by specific heart condition, of the provision of rehab services, and to consider what additional policies should be employed to drive assessments for cardiac rehab across the country.

The briefing that has been provided by the Scottish campaign for cardiac rehab suggests that the Government should consider a health improvement, efficiency and governance, access and treatment—HEAT—target for referrals to rehab for all patients. I urge the minister to take that on board.

I hope that politicians of all parties, the main charities that have campaigned for improvements in cardiac rehabilitation services for years—the British Heart Foundation Scotland and Chest, Heart and Stroke Scotland, and so on—NHS boards and health professionals on the ground can work together in the year ahead to ensure that every heart patient is referred for cardiac rehabilitation as a matter of course.

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