Hansard

We need no convincing about the value of cardiac rehabilitation. The intervention is clinically effective. It transforms and saves lives. As a bonus, particularly in the current economic climate, it does not cost much in comparison with other interventions.

Nanette Milne described cardiac rehab well. The approach epitomises the self-management that is at the heart of our work on long-term conditions in general, because it encourages people to take responsibility for their health while having access to professional support when they need it. It is about rebuilding people’s confidence and helping them to get back on their feet and regain control over their lives. The debate is therefore timely.

For the reasons that I have given, cardiac rehabilitation has featured strongly in our strategic work on heart disease for at least the past decade. It featured in the CHD and stroke strategy that was published in 2001 and in the first set of standards that were developed by the predecessor to NHS Quality Improvement Scotland. It is the subject of a guideline from the Scottish intercollegiate guidelines network and it features in the new heart disease standards that NHS QIS will publish at the end of the month. The audit of cardiac rehabilitation services is an integral part of the NHS QIS heart disease improvement programme.

It is no coincidence that the Cabinet Secretary for Health and Wellbeing launched our action plan on better heart disease and stroke care last June at a cardiac rehabilitation class in Glasgow. The action plan sets out three key actions for NHS boards in relation to cardiac rehab. The thinking in that part of the action plan was informed by the cardiac rehab campaign that the British Heart Foundation and Chest, Heart and Stroke Scotland launched in 2008. Given the effectiveness of cardiac rehab, the campaigners want it to be available to everyone who would benefit from it. The Scottish Government shares that aim.

NHS Grampian offers a good example of the cardiac rehab services that boards can provide. Nanette Milne talked in some detail about why that is the case. The board offers a comprehensive service across six sites, and I am sure that the quality of the service has a great deal to do with the fact that NHS Grampian’s CHD managed clinical network has a cardiac rehabilitation subgroup, which is chaired by the head of the Grampian Cardiac Rehabilitation Association. The approach is also a good example of how the NHS can work in partnership with the voluntary sector, which is another key element of our work on long-term conditions.

It is clear that more could be done. We know from the campaign that we need to get more people who have heart failure into cardiac rehabilitation. Data from ISD Scotland, which Mary Scanlon referred to, showed that in 2007 only 1 per cent of people who had heart failure were getting cardiac rehab. I am pleased that they are mentioned in the clinical standards, because the SIGN guideline is clear about the benefits that cardiac rehab can bring to that group of patients.

Until recently, only people who had had a heart attack or a cardiac intervention had access to cardiac rehabilitation. In keeping with our anticipatory care approach, we want to extend the scope of cardiac rehab to other groups, such as those with unstable or new-onset angina. In keeping with the importance that we attach to tackling health inequalities, we want to ensure that groups who have been underrepresented—women, people from ethnic minorities and older people—are also included.

There are also issues about people in remote and rural communities, which have a particular relevance for Grampian. We should be thinking about making more of telehealth care and exploring innovative methods to expand its use. To do that, we are funding a project in NHS Highland that is developing a menu-based telecardiac rehabilitation service for people in remote parts of the Highlands. That will allow them to take part in specialist sessions at all stages of their recovery and will enable the setting up of a more comprehensive community programme. That could help with the cardiac rehab campaign’s aim of offering alternative models, such as home-based rehabilitation.

Another example of good practice is the heart manual that has been developed in NHS Lothian. The action plan calls on boards to use it or an equivalent to ensure that people receive structured information and education to allow them to develop the skills to manage their own condition. The fourth edition, which I launched in 2008, relies more on images to get its message across and to make it more user friendly, and that change has been welcomed. I know that NHS Grampian has been successful in making the manual available, and I hope that it can build on that approach to take forward the Grampian Cardiac Rehabilitation Association’s suggestion that there is a role for practice nurses in delivering cardiac rehab in community settings.

I am also aware of the value that NHS Grampian’s cardiac rehabilitation subgroup attaches to the importance of education, and I share its view that people can self-manage much better once they have had access to information and education that is couched in language that they understand. That may help with the problem that the subgroup identified of people disappearing at the end of phase 3 of the rehabilitation programme and not going on to phase 4, which deals with long-term maintenance of physical activity and lifestyle change.

We are doing a lot of general work in those areas, but a very practical example of how we can encourage people to stick to the complete programme is the Braveheart

project in Falkirk. It has created a role for older people who have themselves gone through cardiac rehab in mentoring others who are just starting the process. It has been shown to support people through phases 3 and 4 and to reduce readmissions to hospital. We would like all boards to adopt that approach.

I know that Grampian Cardiac Rehabilitation Association has expressed concerns about resources to help boards take forward the improvements in cardiac rehabilitation services that we all want. The allocation of resources has to be a matter for boards, but I believe that the evidence base for the clinical and cost effectiveness of cardiac rehabilitation, the prominence that it is given in our action plan, the new standard that NHS QIS is publishing and the results that we expect from the next audit round—which will be interesting to members—will all help to strengthen the hand of those who seek extra resources to improve services.

I will be happy to keep members up to date on the progress that is made in improving access to cardiac rehabilitation as we take the work forward, and I will look at ways of doing that on a regular basis.