Lothian
Patients per year
800
from 310 in 2012.
Urban / rural split
89%
from 89% in 2012.
Total region population
889,450
from 836,711 in 2012.
Specialist HF nurse WTE posts
6.2 WTE (8 staff)
from 4 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 (only with LVSD) |
| Palliative Care | General palliative care with pathway 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 (stand alone clinic) |
| Virtual | Virtual/phone |
Additional notes
Service achievements
- Development of locality clinics across the Health Board.
- Rapid access diagnostic heart failure pathway with Natriuretic peptide testing
- Rapid access heart failure nurse clinic with heart failure consultant support for post admission review and de-compensating patients.
- Increased administrative support.
- Staff completing ANP pathway.
- Ongoing quarterly patient forum.
- Development of MDT and pilot of inpatient service with positive results
- Paperless service.
- Psychological screening at each review.
- Development of links with Palliative care services
Service challenges
- Difficulties in securing funding for pilot inpatient service and unclear whether it will be sustained.
- No database for audit purposes and future service planning/patient outcomes
Future improvements
- Continue to improve on palliative care work stream
- We would like to develop Heart failure database for improved audit in partnership with Heart Failure hub
REMINDER
The following details are from our 2012 report and may not reflect the current state of the Lothian Health Board.
Further details
| (Actual number of staff) | 2008 - 5 WTE (5 staff) |
| SIGN Ratio | 1:209,178 (2008 1:200,328) |
| Ave. caseload per post | 90 (community) |
| Individual patients managed by service (average year) | 310 patients |
| Service Provision | Home visits 40% / Clinic Appointments 60% |
| Provision for HF-PEF | No |
| Administration support per week | 16-20 hours (across service) |
| Providing education to non-specialist staff | Limited – on request only via lectures / informal meetings / One long term cardiac conditions module delivered. |
| Doctor with specialist interest in Heart Failure | None |
| Cardiac Rehabilitation available/number seen | Yes - all patients reviewed on referral |
| Access to psychological support referral pathway | Adequate |
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.