Borders region

Service commenced in April 2007.

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Patients per year


from 140 in 2012.

Urban / rural split


from 47% in 2012.

Total region population


from 112,870 in 2012.

Specialist HF nurse WTE posts

1.1 WTE (3 staff)

from 1.3 WTE, from 3 staff in 2012.

Service provision

2012 2018
HF post MI HF post MI
Valvular HF Valvular HF (only with LVSD)
Congenital HF Congenital HF
Palliative Care General palliative care with links to specialist services for advice
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 GP surgery
Virtual Virtual

Additional notes

Service achievements since the last review in 2013

  • Increased clinic capacity resulting in a reduction of home visit model, increasing service efficiency

Service challenges since the last review in 2013

  • Increased caseloads and referrals with no concurrent increase in resource.
  • Elderly population, increasing complexity.
  • No cardiology lead – difficult getting support for service development or progressing change due to increased workload of staff.
  • No database or audit facility to demonstrate need to change.

Future improvements

  • Develop IV iron service,
  • Psychology pathway – although limited psychology access when escalation required.
  • BNP introduction


The following details are from our 2012 report and may not reflect the current state of the Borders Health Board.

Further details

(Actual number of staff)2008 - 2.5 WTE (3 staff)
SIGN Ratio1:86,823 2008 – 1:44,499)
Ave. caseload per post80 (community)
Individual patients managed by service (average year)140 patients
Service ProvisionHome visits 75% / Clinic Appointments 25%
Provision for HF-PEFNo
Administration support per week15 hours (across service)
Providing education to non-specialist staffYes - but only on an ad hoc basis to ward staff, GPs
Doctor with specialist interest in Heart FailureNone
Cardiac Rehabilitation available/number seenNo
Access to psychological support referral pathwayInadequate

Notes on current service provision

Large rural area with significant travel times between patient visits. One Heart Failure Nurse Specialist post and two Cardiac Specialist Nurses, who also provide support to the service with a small heart failure patient caseloads.

Funding in comparison to 2008

In 2008, NHS Borders had 2.5 WTE posts funded by the BHF (no longer funded by BHF). Health Board due to take on BHF funded post. Only 0.8 WTE now funded by NHS Borders but funding not secured and only at present until end March 2013. The Cardiac Specialist Nurses who support service are core funded by NHS Borders, but due to uncertainty of funding with the Heart Failure Specialist post, the service has been unable to develop.


Uncertainty in ongoing funding and staff changeover in the cardiac services has been unsettling and has added to overall workload. Unable to provide cover to review patients when staff are on annual leave.

Development opportunities

Unfortunately the heart failure service has been unable to develop as we would have liked it to due to financial constraints and staffing, but we hope to initially develop more formal educational sessions within the community.