Borders
Patients per year
160
from 140 in 2012.
Urban / rural split
47%
from 47% in 2012.
Total region population
115,020
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 |
|---|---|
| HFrEF | HFrEF |
| HFpEF | HFpEF |
| 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
REMINDER
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 Ratio | 1:86,823 2008 – 1:44,499) |
| Ave. caseload per post | 80 (community) |
| Individual patients managed by service (average year) | 140 patients |
| Service Provision | Home visits 75% / Clinic Appointments 25% |
| Provision for HF-PEF | No |
| Administration support per week | 15 hours (across service) |
| Providing education to non-specialist staff | Yes - but only on an ad hoc basis to ward staff, GPs |
| Doctor with specialist interest in Heart Failure | None |
| Cardiac Rehabilitation available/number seen | No |
| Access to psychological support referral pathway | Inadequate |
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.
Challenges
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.