Western Isles
Patients per year
312
from 240 in 2012.
Urban / rural split
40%
from 40% in 2012.
Total region population
26,900
from 26,190 in 2012.
Specialist HF nurse WTE posts
2.79 WTE (5 staff)
from 2 WTE, from 3 staff in 2012.
Service provision
| 2012 | 2018 |
|---|---|
| HFrEF | HFrEF |
| HFpEF | HFpEF |
| HF post MI | HF post MI |
| Valvular HF | All valvular HF |
| Congenital HF | Congenital HF |
| Palliative Care | General palliative care with links to specialist services |
| Cardiac Rehabilitation for HF | |
| Screening for psychological distress- no direct referrals to psychology |
Service model
| 2012 | 2018 |
|---|---|
| Home | Home |
| Clinic | Clinic |
| In-pt education | In-pt education |
| In-pt management | In-pt management |
| GP surgery | Stand alone clinic in GP surgery |
| Virtual | Virtual |
Additional notes
Service achievements
- Team have participated in several Hub work streams: Supportive and Palliative care and psychological assessment. We have developed links to palliative care services, telephone consultation with Roxburgh House or discussion with GP with hospice responsibility
- Day case IV diuretic therapy now available.
- Routine use of ‘Florence’ text based support for heart failure and cardiac specialist nurse
caseloads
Service challenges
- Maintaining professional development and networking/benchmarking in a challenging financial climate (ability to travel off island due to financial constraints).
- Increased service remit since last report in addition to the delivery of HF care.
- Provision of an equitable cardiology service across the Western Isles, due to population spread and remoteness of some parts of the island chain.
- Cardiac specialist nurse team also deliver Cardiac Rehabilitation, RACPC and Familial Hypercholesterolaemia services
Future improvements
- Utilise new IT such as Attend Anywhere to improve equity.
- ‘MORSE ‘system in development to move from current database leading to paperless
working. - Development IV Iron pathway
REMINDER
The following details are from our 2012 report and may not reflect the current state of the Western Isles Health Board.
Further details
| (Actual number of staff) | 2008 - 2 WTE (3 staff) |
| SIGN Ratio | 1:13,095 (2008 1:13,075) |
| Ave. caseload per post | 120 (community) |
| Individual patients managed by service (average year) | 240 patients |
| Service Provision | Home visits 30% / Hospital Clinic 40% / Community Clinic 30% |
| Provision for HF-PEF | No |
| Administration support per week | 22.5 hours (across service) |
| Providing education to non-specialist staff | No |
| Doctor with specialist interest in Heart Failure | 1 GPwSI |
| Cardiac Rehabilitation available/number seen | Yes - 20 patients per annum |
| Access to psychological support referral pathway | None |
Notes on current service provision
Patients are spread unevenly across the island chain with sparse population in remote and rural areas, particularly the southern isles (Uists & Barra). Many patients are in hard to reach remote areas requiring long journeys (including ferries) to home visit or clinic setting.
Funding in comparison to 2008
Substantive funding now in place for 2 WTE posts, following initial BHF funded period. BHF funded Healthcare Assistant pilot (over 2 years) post not continued.
Challenges
Elderly demographic plus remote/rural setting results in higher than ‘usual’ number of visits required. Cardiac rehabilitation access through Change Fund initiative for 2 years and substantive funding not confirmed from NHS.
Development opportunities
We are fortunate to have access to BNP testing (community only) but we may lose this facility as it is being reviewed due to costs. Support from the Scottish National Advanced Heart Failure Service via Tele-link, which is invaluable for the more complex cases.