BACR Standards: A Useful Tool?

1. BACR Standards: A Useful Tool? Jennifer George / Michelle Bull SWL Cardiac and Stroke Network

2. Overview • Background 2.Our work before the standards 3. How we have used the standards 4. Some Issues 5. Conclusion

3. Networks “Should come together to form local networks of cardiac care, agreeing detailed locally relevant referral criteria and care pathways” CHD NSF (2000)

4. Networks • The purpose of a network is to guide and support the services that comprise it and the people that use them. • Organisations join networks because they can do what they need to more effectively together than if they operate alone. National Stroke Strategy 2007

5. South West London Tertiary Centre • 7 programmes • 1 Tertiary Centre • 4 DGHs • 2 Community Hospitals • Task group

6. Work before the standardsBaseline Assessment Aim: • To create an accurate picture of CR provision • To identify any gaps in the current service across SWL • To use information to determine a work programme for the task group. Method: All 7 programmes completed the assessment which was designed against Chapter 7 of the NSF.

7. Baseline Assessment Outcomes: • Staffing levels, team make-up and funding were variable and did not appear to be based on need. • All programmes had a waiting list. • Current data systems did not allow for assessment against NSF goal of 85% of people with diagnosis of AMI or revasc being offered cardiac rehabilitation. Next steps: An audit to gain an understanding of patient numbers and patient movement through each programme.

8. Work before the standardsRetrospective Audit Aim: • Justification of service e.g., referral numbers. • Patient flow and movement through programme e.g., identify specifics of where they drop out & why. • Benchmarking Method: • One years worth of data • Patients with either a diagnosis of MI or after Coronary Artery Bypass Graft, PCI or other intervention (e.g., valve) were included in line with the NSF. • Hospital admission data was requested from IT departments • Data was collected manually by pulling individual patient files.

9. Assessment & Audit Outcomes • Each programme provided different services to patients, leading to inequity of provision and making comparison across the sector difficult • Agreed there was a need for core elements that a rehab service should include (in line with NSF standards and latest evidence) • Endorsement of the BACR standards

10. The Standards • A Co-ordinator who has overall responsibility for the CR service • A CR core team of professionally qualified staff with appropriate skills and competences to deliver the service • A standardised assessment of individual patient needs • Referral and access for targeted population • Registration and submission to the NACR • A CR budget appropriate to meet the full service costs

11. The Core Components • Lifestyle • Physical activity and exercise: • Diet and weight management: • Smoking cessation: • Education • Risk factor management • Psychological status and quality of life • Cardio protective drug therapy and implantable devices • Long-term management strategy

12. How we used the Standards? Assessment tool -

13. Findings  Not meeting the standard  Partially meeting the standard  Totally meeting the standard

14. What we did with results • Sector wide • Quality assurance role • NACR • Agreed ideal pathway • Increased profile for cardiac rehab • Individual Programmes • Development of new services • Supporting programmes through change

15. Standard 4

16. Programme 2 • Standard 4 - ICD pilot • Standard 2 - Business case development for heart failure

17. Programme 2 • Standard 2 – core team development • Regular physiotherapy input

18. How we used the standards  Not meeting the standard  Partially meeting the standard  Totally meeting the standard

19. Programme 5 • Standard 5 – web based NACR pilot • Standard 4 - PCT secured funding to develop local community based programme • Standard 2 - Appropriate staffing levels • Able to advise re appropriate model

20. How we used the standards  Not meeting the standard  Partially meeting the standard  Totally meeting the standard

21. Programmes 3 and 4 • Local programme resourced by staff from PCT and acute trust • Plans to move phase 3 to community as part of review of CNS roles • Conflict between providers and commissioners

22. Programmes 3 and 4 • Core Components • Process mapping • Peer review • Links with other services • Phase 4 mapping • Standard 2 • Skills assessment

23. Where the standards have caused debate • Definitions • ACS • Cardio protective drug therapy • Staffing levels • Budget • Commissioning • Annual review • Who will assess this • “Programme under development”

24. Are they a useful tool? • Yes • Useful driver to support development work • Support for programmes undergoing change • Informing commissioning

25. But ……. • Need to have strategic commitment at local level • Need higher national profile • Need agreement re “enforcement”

26. www.southwestlondoncardiacnetwork.nhs.uk Jennifer.george@stgeorges.nhs.uk Michelle.bull@stgeorges.nhs.uk (020) 8725 2924