B&H H&S Network

1. B&H H&S Network Network Conference 2010 Heart failure New developments and building new services David Hackett Cardiac Clinical Lead 15 Jul 2010 www.bhhsnetwork.nhs.uk

2. Heart failure National Heart Failure audit 2008-09 Average length of stay = 12.7 days www.bhhsnetwork.nhs.uk

3. Heart failure www.bhhsnetwork.nhs.uk

4. Commissioning Benefits of commissioning an effective heart failure service: • Reduce recurrent hospital stay • Improve clinical outcomes • Prolong life and improving the quality of life • Reduce inequalities • Increase patient choice • Better value for money www.bhhsnetwork.nhs.uk

5. Admissions - Herts www.bhhsnetwork.nhs.uk

6. Admissions - Herts www.bhhsnetwork.nhs.uk

7. Prevalence www.bhhsnetwork.nhs.uk

8. Prevalence www.bhhsnetwork.nhs.uk

9. Prevalence www.bhhsnetwork.nhs.uk

10. Concerns • No clear or formal commissioning aims or objectives • No systematic audit system or audit data or data on outcomes • Admissions have generally not decreased • Costs have generally increased • Cost-effectiveness unclear www.bhhsnetwork.nhs.uk

11. B&H H&S Network Objectives of commissioning heart failure services: • Equity in access • Equity of investigation & treatment • Service outcomes to include reduction in hospital readmissions and length of stay • Better cost-effectiveness • Improved diagnosis and care of patient with HF • Improve awareness of HF • Sustainable and cost-effective service www.bhhsnetwork.nhs.uk

12. B&H H&S Network Model of care: • Community and hospital services for heart failure patients should be integrated • Agreed integrated pathways of care based on NICE guidance • Teams providing integrated service • Unified clinical leadership of the service • Unified operational management of the service • Strategic management and commissioning should remain with the Primary Care Trust, with advice from the Network www.bhhsnetwork.nhs.uk

13. B&H H&S Network Strong clinical leadership is required • Can only be provided by a consultant cardiologist with a specific interest in heart failure; likely to be a consultant cardiologist in the local acute trust • A consultant cardiologist and lead cardiac nurse should be explicitly responsible for the clinical & operational function of community heart failure services in each defined area (eg each PCT area) • The dedicated times required for these roles, and reimbursements for them, must be explicitly defined and agreed by the commissioner and the employer www.bhhsnetwork.nhs.uk

14. B&H H&S Network Operational management of the service • The professional accountability for service can only be delivered by a consultant cardiologist • Professional accountability should be delivered primarily by audit returns & outcomes, as well as reports of activity • A common audit template should be agreed by the Network for use across all PCTs and Trusts www.bhhsnetwork.nhs.uk

15. B&H H&S Network Management of the staff • There should be a specific identified human resources department that manages the staff providing the community heart failure service responsible for arrangements for pay, leave, sickness absence, disciplinary issues, etc. • Operation of the service should not be reliant on charity funding www.bhhsnetwork.nhs.uk

16. B&H H&S Network Diagnosis of heart failure – 1 • BNP should be available in all acute hospitals and to all GPs; this is both clinically and cost-effective • Rapid access heart function assessment clinics should be provided, with access times of within 2 weeks in certain groups of patients. These clinics should be integrated with a cardiology department imaging service – for provision of staff, image reviewing, networking and archiving, and to ensure clinical governance and provide quality assurance www.bhhsnetwork.nhs.uk

17. B&H H&S Network Diagnosis of heart failure – 2 • Whether community or hospital based will depend on the catchment area, demand and caseload; it is neither clinically nor cost-effective to provide isolated or single-handed heart function assessment clinics • Clear agreed referral systems should be publicised • Equity of access and treatment must be ensured www.bhhsnetwork.nhs.uk

18. B&H H&S Network Heart failure registers • Major variations in the prevalence of heart failure between GP practices within PCTs are unexplained • The diagnosis of left ventricular systolic dysfunction in patients on the QOF Heart failure registers should be validated; the local PCT should initiate and ensure joint reviews by general practitioners and the community heart failure nurse teams of the diagnoses in patients on the heart failure registers www.bhhsnetwork.nhs.uk

19. B&H H&S Network Treatment of chronic heart failure – 1 • Community heart failure nurse model as part of an outreach hub and spoke, or integration of community with hospital services model • Individual patient management plans developed • Capacity for regular and initially frequent up-titration visits/reviews • All nurses should be prescribers; this should be a requirement for employment as a heart failure nurse, or the employer should ensure that individuals become prescribers before starting clinical work www.bhhsnetwork.nhs.uk

20. B&H H&S Network Treatment of chronic heart failure – 2 • The service should align individual or locality case-loads with the local burden of disease according to local GP QOF heart failure registers • Treatments of all people on the Heart Failure registers should be reviewed at least every year to ensure appropriate beneficial treatments • Rehabilitation should be made available for all heart failure patients • Plans for end of life care should be made jointly with local palliative care services www.bhhsnetwork.nhs.uk

21. B&H H&S Network Audit measures – 1 • Accountability and sustainability should be proven by audit returns and outcomes rather than reports. A common audit template is to be developed • Systematic audit measures of outcomes to be supplied by providers and collated by the Network www.bhhsnetwork.nhs.uk

22. B&H H&S Network Audit measures – 2 • Number of admissions/month • Number of readmissions/month • Median/average length of stay • Proportion of patients with echo result recorded during admission • Proportion of patients on core medications • Proportion of patients referred to the community heart failure service on discharge www.bhhsnetwork.nhs.uk

23. B&H H&S Network www.bhhsnetwork.nhs.uk

24. B&H H&S Network Heart Failure Breakout session David Hackett dhackett@globalnet.co.uk 15 Jul 2010 www.bhhsnetwork.nhs.uk