Western Isles

Western Isles region

Service commenced in April 2007.

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Patients per year


from 240 in 2012.

Urban / rural split


from 40% in 2012.

Total region population


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
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

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
  • Development IV Iron pathway


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 Ratio1:13,095 (2008 1:13,075)
Ave. caseload per post120 (community)
Individual patients managed by service (average year)240 patients
Service Provision Home visits 30% / Hospital Clinic 40% / Community Clinic 30%
Provision for HF-PEFNo
Administration support per week22.5 hours (across service)
Providing education to non-specialist staffNo
Doctor with specialist interest in Heart Failure1 GPwSI
Cardiac Rehabilitation available/number seenYes - 20 patients per annum
Access to psychological support referral pathwayNone

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.


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.