Major failings in National Health Service provision for patients recovering from heart attacks and surgery are revealed in a new report on rehabilitation services in England launched today. (Feb 3rd)
The report from the Coronary Prevention Group (CPG) highlights that many cardiac rehabilitation services are understaffed, under-resourced and unable to achieve government targets, leaving thousands of patients missing out on recommended support for their recovery.
Heart disease is Britain’s biggest killer, but around 160,000 people who survive a heart attack each year can be helped by cardiac rehabilitation, which can reduce the risk of death within three years by 20%.
The CPG, a London-based medical charity, commissioned research to examine services across the 28 strategic health authorities in the NHS. The report "A Detailed Examination of Cardiac Rehabilitation in England", which looked at a sample of 11% of the 260 centres operating in England, concluded they were “clearly failing to meet the requirements” set in the National Service Framework for coronary heart disease in 2000 and also in guidelines adopted by the British Association for Cardiac Rehabilitation in 2003.
While most centres claimed they met the government target of 85% of patients being offered rehabilitation after a heart attack or bypass surgery, none had figures available to support the claim. The report also noted that the “typical standard of record-keeping” made it impossible to evaluate clinical standards.
Only one service achieved the NHS requirement to carry out a 12-month audit to follow up heart attack and bypass patients who had undergone rehabilitation to check that they were exercising 30 minutes each day, not smoking and were not obese.
The survey uncovered confusion over who was responsible for gathering information. Some services failed to gather required data, but half the rehabilitation co-ordinators interviewed in the survey did not know who was responsible for implementing some standards. More than half the designated coronary heart disease lead officers in some trusts could not provide the number of heart attack cases and bypass operations within their cardiac rehabilitation catchment population, suggesting “either an inability to collect or access available data.” Directors of Public Health were repeatedly unable to supply figures for the number of eligible patients receiving cardiac rehabilitation in their area. “The overwhelming opinion of coronary care unit nurse managers was that cardiac rehabilitation services were failing to address the needs of all patients with coronary heart disease,” the report said.
It found that only six centres in the survey met requirements of six full time equivalent staff for every 500 patients, with most running with two staff below the recommended level. Only two services had doctors as core members of the team although doctors were considered to be essential. Just over half the services held their own budgets, and the services surveyed were run at an average cost of just £288 per patient each year.