Call for faster action to improve NHS cardiac rehab services

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.

One third of the cardiac rehabilitation services visited for the survey had unfilled vacancies, and one in five reported difficulty recruiting and keeping staff. Other staff shortages included a need for more psychologists, physiotherapists, counsellors and occupational therapists to help run rehabilitation programmes. But the survey found that patients who had undergone angioplasty procedures or were recovering from a heart attack were offered the chance to join in rehabilitation within four to six weeks, although in one centre delays were from three to nine months.

Accommodation was a common problem with only one in four centres having purpose-built facilities and 43% of centres citing lack of facilities and space as a major drawback. Two out of three said their accommodation was inadequate to deal with patients on a one-to-one basis.

Prof David Brodie, Head of the Health Studies Research Centre at Buckinghamshire Chilterns University College, which produced the report, said: “It is extremely disappointing to find that while many people in the NHS are doing their best to provide adequate cardiac rehabilitation services, insufficient resources appear to be reaching services at the point of delivery preventing them achieving the goals and government standards laid out in the National Service Framework.”

Coronary Prevention Group member Dr Hugh Bethell said: “The report aimed not just to highlight problems but to offer solutions The study found some lamentable weaknesses. We need to achieve much more effective action to raise access and standards throughout the country. Along with the British Association of Cardiac Rehabilitation, we have drafted a new set of recommendations for improvements and will incorporate further feedback from our symposium in the final report which will be delivered to the Secretary of State for Health who we hope will see this as an opportunity to help local services improve patient care.”