7th York Cardiac Care Conference A National Campaign for Cardiac Rehabilitation

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7th York Cardiac Care ConferenceA National
Campaign for Cardiac Rehabilitation
Bob Lewin
www.cardiacrehabilitation.org.uk/campaign
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The Facts
Cardiac rehabilitation is one of the most
effective medical treatments available for heart
patients. It saves lives. It It is cheap. Every
survey of cardiac patients has said we want
more. In England in 2000 the Department of
Health said that 85 people who have had a Heart
Attack, Angioplasty or By-pass Surgery should be
offered cardiac rehabilitation. Once that target
was achieved services should be expanded so that
all cardiac patients, except those with unstable
angina, should be offered CR. National Institute
for Clinical Excellence has said all heart attack
patients should take part. The scandal - the
great majority of patients dont get a chance to
take part and every years lives are shortened
needlessly.
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Targets have not been achieved. There has been
little improvement. There are wide disparities
between regions and postcodes
Target Got CR 2003/4
2002 target All who would benefit 58,097 38 18
BHF / BACR survey 2003-2004 permission Dr Hugh
Bethell
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Main Problems
1) Too few people getting a chance not enough
rehabilitation programmes up to 70 not invited
(missed on discharge, no protocol, etc) 20-50
choose not to attend (inflexible delivery
options) 2) Inequalities ethnic minorities,
women, elderly place of residence, postcode
lottery 3) Huge variation in resources and
staffing cost per patient varies from aprox.
150 to 990 per patient! 4) Developing crisis
because not in payment tariff price for an
admission with MI or surgery not included in GP
quality mechanism
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Getting better or worse?
Yes No Dont know
Is your programme under threat in any way? 37 40 23
Is your service currently threatened with closure? 10 63 27
Do you have an accepted business case and secure funding? 39 30 31
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Today - bring together key players Dept of
Health. Professor Roger Boyle, (Heart Tsar)
Elizabeth Lyneham (Head of Vascular
Programme) Academics. Jane Cooper, Royal College
of Physicians British Cardiac Society. Dr Jane
Flint, Dr Nick Boon, Dr Paul McIntyre BACR.
Bernie Downie, Patrick Doherty British Heart
Foundation Dr Mike Knapton, Betty
McBride Patient organisations Mel Clarke, (BHF
Heart Voices) David Geldard Heart Care
Partnerships People who know how to campaign and
improve CR services, Dr Hayes Dalal, Denise Lewis
and Pat Marley, Trudie Loban but most
important of all, representatives of patient
support groups
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• Key elements for improvement
• National Annual Audit of Cardiac Rehabilitation
• so that we can describe the extent of the problem
• show where provision and quality are bad and
  where it is good
• measure if things are getting better
• Know when the campaign has succeeded and can stop

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• Key elements for improvement
• National Standards for CR (defined by BACR)
• To tell providers what the minimum they must
  provide
• To decide if a patient has had rehabilitation
• To decide who enters the audit

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• Aims of the National Audit
• to improve access, equity, quality and outcomes
  for patients
• reporting of Government targets
• inform local and national planners and patients
  about under provision and/or lack of fairness
• inform programmes how they are performing
• process benchmarking - examine the relationship
  between methods and outcomes to determine
  optimal staffing, timing, length of
  programme methods of behaviour change
• etc.

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Key elements of the Campaign 3. Campaign
literature
1. Lay Version for patients and the public
2. Evidence for GPs, providers, medical
journalists, etc.
3. Annual Audit results mid-year
Download from www.cardiacrehabilitation.org.uk/cam
paign
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5 demands of the campaign
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This morning How do we know it is important
Angela Cooper the evidence Why are we in this
mess? Jane Flint A potential solution by
reorganising services Hayes Dalal How to
campaign Trudie Lobban 11.50 12.15 Roger
Boyle, comments and chair a discussion
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This afternoon The patient perspective Mel Clark
and David Geldard An example of 2 programmes
that campaigned to save their services Advice on
using the media in campaigns Betty McBride The
Strategy Discussion Should we do anything at
all? How can we change things? Who should lead
it? Etc.
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THE END
www.cardiacrehabilitation.org.uk