1. 7 th York Cardiac Care Conference A National Campaign for Cardiac Rehabilitation C ARE AND E DUCATION R ESEARCH G ROUP www.cardiacrehabilitation.org.uk/campaign Bob Lewin

2. 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 don’t get a chance to take part and every years lives are shortened needlessly. The Facts

3. BHF / BACR survey 2003-2004 permission Dr Hugh BethellTarget Got CR 2003/4% 2002 target All who would benefit 58,097 38% 18% Targets have not been achieved. There has been little improvement. There are wide disparities between regions and postcodes

4. 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 Main Problems

5. YesNo Don’t 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% Getting better or worse?

6. 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

7. Key elements for improvement National Annual Audit of Cardiac Rehabilitation so that we can describe the extent of the problemso that we can describe the extent of the problem show where provision and quality are bad and where it is goodshow where provision and quality are bad and where it is good measure if things are getting bettermeasure if things are getting better Know when the campaign has succeeded and can stopKnow when the campaign has succeeded and can stop

8. Cardiac Rehab Patients Cardiac Rehab Patients fill in questionnaires 3 times, before, after CR and at 12 months after rehabilitation Cardiac Rehab Patients Cardiac Rehab Patients fill in questionnaires 3 times, before, after CR and at 12 months after rehabilitation CR Programmes enter data BHF York Annual National Audit Reports ONS HES nationalbenchmarking, print reports etc nationalbenchmarking, CCADCCAD

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

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

11. 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 National Audit of Cardiac Rehabilitation Download from www.cardiacrehabilitation.org.uk/campaign www.cardiacrehabilitation.org.uk/campaign

12. 5 demands of the campaign

13. 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 11.50 – 12.15 Roger Boyle, comments and chair a discussion

14. 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.

15. www.cardiacrehabilitation.org.uk THE END