Lothian

View our 2013 report for the Lothian region.

Region overview:

Service commenced

March 2002

Total board population

536,711

Urban / rural

89% / 11%

Specialist HF nurse WTE posts

4 WTE (4 staff)

Further details:

(Actual number of staff)2008 - 5 WTE (5 staff)
SIGN Ratio1:209,178 (2008 1:200,328)
Ave. caseload per post90 (community)
Individual patients managed by service (average year)310 patients
Service ProvisionHome visits 40% / Clinic Appointments 60%
Provision for HF-PEFNo
Administration support per week16-20 hours (across service)
Providing education to non-specialist staffLimited – on request only via lectures / informal meetings / One long term cardiac conditions module delivered.
Doctor with specialist interest in Heart FailureNone
Cardiac Rehabilitation available/number seenYes - all patients reviewed on referral
Access to psychological support referral pathwayAdequate

Notes on current service provision

The team review patients admitted to hospital in addition to clinic and day hospital referrals. There are a small proportion of GP referrals if they are known to have heart failure due to LVSD and are at risk of admission. The service takes a case management approach due to multiple co- morbidities. The service provides locality clinics in community hospitals and GP surgeries as well as in secondary care outpatient departments. Telephone follow up is also part of the review process.

Funding in comparison to 2008

Core funding via NHS Lothian remains unchanged. BHF funding for heart failure education post finished and no further funding was provided for this post by NHS Lothian.

Challenges

To continue to deliver an education programme in the absence of a dedicated nurse. To participate in service changes, for example Telehealth/education/ increased acute care focus with no additional staff. To support the Scottish Patient Safety Programme (SPSP) within the hospital whilst primarily delivering a community based service. Caseloads are always at maximum capacity despite regular discharges and referral to community teams.

Development opportunities

Currently developing a Telehealth programme in NHS Lothian and NHS 24 for patients with heart failure. Continue to build on success of the heart failure palliative care anticipatory care plan.