Lanarkshire
Patients per year
800
from 400 in 2012.
Urban / rural split
89%
from 89% in 2012.
Total region population
656,490
from 562,477 in 2012.
Specialist HF nurse WTE posts
3.7 WTE (5 staff)
from 3.6 WTE, from 4 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 |
| Cardiac Rehabilitation for HF | |
| Screening for psychological distress- 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
- Developed a chronic cardiac disease anticipatory care plan.
- Improved links with Palliative care team both inpatient and community based.
- Improved access to Complimentary Therapy support and services via the palliative Care team in the Community for both patients and their carers.
- Development of a collaborative (service & industry) Heart Failure Titration Clinic at University Hospital Monklands (UHM). Support has been offered at University
Hospital Wishaw and University Hospital Hairmyres. - Access to IV Iron at UHM. Inpatient (day case), administration of IV Iron where
necessary. Improved psychological support for patients with access to outpatient reviews at UHM. Access to a Cardiology MDT which has been well supported by both
medical and other AHP’s at University hospital Wishaw. - Improved involvement in the recruitment of patients for Clinical Trials.
- Access to Nt-proBNP for all sites (mainly for initiation of Sacubitril Valsartan).
- Heart Failure staff have managed to maintain their involvement in the Heart Failure Forum and the Heart Failure Hub to try to improve services across Scotland for Heart failure patients.
- Lanarkshire have developed a Cardiac Nurse Forum (Cardiac Rehab, RACPC, HFNS,
Cath Lab staff, Community CNS), to improve equity and communication over all 3 sites. - Recently a regional adult congenital heart disease clinic was set up at UHW
Service challenges
- Increased patient referrals which were further affected by the introduction of Sacubitril/Valsartan.
- No real increase in resources other than at UHH. UHM and UHW both still at 1.4 WTE each.
- Due to increased activity, more clinics set up to manage the patient numbers having an impact on admin support and activity within the service. This in turn has changed activity from home visits to mainly clinic access.
- New staff requiring study time to complete training for role. This impacts on patient monitoring for their caseload.
- Unable to implement MDT’s at UHH and UHM due to time constraints and caseloads activity.
Future improvements
- The implementation of an improved inpatient service. The aim is to improve patient education and management. Support has again been offered by a pharmaceutical company for a feasibility study.
REMINDER
The following details are from our 2012 report and may not reflect the current state of the Lanarkshire Health Board.
Further details
| (Actual number of staff) | 2008 - 3 WTE (4 staff) |
| SIGN Ratio | 1:156,244 (2008 1:186,046) |
| Ave. caseload per post | 100 (community) |
| Individual patients managed by service (average year) | 400 patients |
| Service Provision | Home visits 80% / Clinic Appointments 20% |
| Provision for HF-PEF | No |
| Administration support per week | 13 hours (across service) |
| Providing education to non-specialist staff | No - no capacity |
| Doctor with specialist interest in Heart Failure | 2 Consultants with interest) |
| Cardiac Rehabilitation available/number seen | Limited (one site) - 3 patients |
| Access to psychological support referral pathway | None |
Notes on current service provision
Challenging area, both geographical and due to large areas of deprivation and multiple co- morbidities with a high incidence of alcohol and drug dependence in young people, all of which results in educational challenges due to lack of insight. Numbers are fairly static despite discharges and deaths and new referrals are regularly received; each site is at optimal capacity. Covering three District General Hospitals can at times result in a lack of cohesive decisions/discussion between consultants.
Funding in comparison to 2008
Core funded by NHS Lanarkshire.
Challenges
Running at capacity does not allow any additional time to develop sustainability of the service and leads to training issues such as prescribing courses, clinical assessment and proposed rotation of other cardiology nurses. Unable to access clinic at Wishaw General Hospital since service started (no availability in outpatient department), which would improve ability to meet demand.
Development opportunities
Three nurse prescribers in Lanarkshire (one pending results).