Service review of heart failure
Heart failure affects 900,000 people in the UK and is particularly prevalent among older people. The condition accounts for about 5% of all medical admissions to hospital, and rates of re-admission are also among the highest for any common condition in the UK. Providing services to patients with heart failure costs the NHS an estimated £625 million each year. Research indicates that care provided by effective multidisciplinary teams can have a positive impact on outcomes for patients and their quality of life.
The Healthcare Commission carried out a service review in 2005/2006 to assess the quality of healthcare for people with heart failure. We looked at whether primary care trusts (PCTs) and their associated secondary care trust(s) were ensuring good outcomes for people with heart failure by:
- effectively and swiftly diagnosing patients with heart failure, providing evidence-based treatment, and monitoring patients effectively in order to optimise treatment, detect deterioration and minimise admissions to hospital
- having effective and adequate multidisciplinary services and processes of care
- providing patients and their carers with education and support so that they can play an active role in the management of their care
This review was formally known as an improvement review and forms part of our wider piece of work to improve the quality of life for people with long-term conditions.
National findings
The review found that considerable progress had been made since 2003/2004, when the Commission for Health Improvement first reviewed progress on the implementation of the standard relating to heart failure services from the National Service Framework for Coronary Heart Disease. There is now better access to diagnostic services and key treatments, wider availability of specialist heart failure services and guidelines on services, more consideration of end-of-life needs and more comprehensive education and support arrangements.
However, commissioners and providers of services still need to work together in local communities to ensure that all patients with heart failure are identified, offered the full range of optimal medication and have access to specialists that is based on need rather than the care setting, type of ward or specialty of care. In addition, organisations need to improve the way they evaluate how they deliver care, based on the patient’s perspective, and they must establish robust clinical audit programmes.
Read the full report: Pushing the boundaries - Improving services for patients with heart failure (pdf 1214kb) (opens new window)
Press release: July 6th 2007: Progress on services for heart failure (pdf 61kb) (opens new window)
Media brief: July 6th 2007: Progress on services for heart failure (pdf 49kb) (opens new window)
Follow up
We are currently working with the 26 weakest-performing local communities that were reviewed, in order to develop action plans to address areas of poor performance (a 'community' comprises a PCT and the secondary care trust(s) which provides at least 10% of the PCT’s inpatient activity for patients with a diagnosis of heart failure). We are monitoring the progress of these communities against these action plans with strategic health authorities.
Our local assessment managers will also carry out ongoing follow up work as part of the annual health check. Trusts will also be expected to take account of the results in their future declarations of compliance with the Government's core standards.
Read our frequently asked questions for the plan improvement stage (pdf 301kb) (opens new window)
Results of the review
Members of all communities received a detailed report, highlighting where their community had performed well and where they could improve. Explore the detailed results for the review below.
Results of the review for each community, in alphabetical order by community name – All England (pdf 276kb) (opens new window)
Results of the review for each community in the London and the South East region (pdf 85kb) (opens new window)
Results of the review for each community in the Central region (pdf 114kb) (opens new window)
Results of the review for each community in the North region (pdf 108kb) (opens new window)
Results of the review for each community in the South West region (pdf 90kb) (opens new window)
Explore the full detailed results, including the underlying data, below:
Access the full detailed results of the review, including underlying data
Benchmarking toolkit
In addition to the formal published scores above, the Healthcare Commission has developed a benchmarking toolkit to provide organisations with feedback on the broader set of information collected as part of the review and to help inform local improvement activities. The benchmarking toolkit also includes the community-level scores from the review for completeness and ease of local reporting. This toolkit has been sent to our contacts in all organisations participating in the review, local cardiac networks and the British Society for Heart Failure.
The toolkit has been produced in the comparative software ‘Compare’. Staff in acute trusts may already be familiar with this software, which has been used for a number of years to report results from the Acute Hospitals Portfolio topics. A Guide to the service review of heart failure benchmarking toolkit in Compare has been produced to assist users install and use the toolkit. It also provides further information on the sources of data and rationale for each of the indicators. The guide can be accessed via the Compare CD or can be downloaded by clicking on the link below:
Access the Guide to the service review of heart failure benchmarking toolkit in Compare here (pdf 759kb) (opens new window)
Please note that this guide does not attempt to explain the scoring methods. Please follow the link above to the detailed results of the review for our Detailed guidance on analysis and scoring.
Instructions on how to install the toolkit can be downloaded by clicking on the link below:
Access the Instructions to install Compare here (pdf 28kb) (opens new window)
The production of the benchmarking toolkit is a one-off exercise and the Healthcare Commission regrets that it is unable to provide any ongoing support to users. However, we hope that it will prove useful to all those involved in improvement activities.
Background to the review
The data for this review was collected as part of our programme of improvement reviews in 2005/2006 (from organisations that existed on March 31st 2006), but the results did not contribute to the annual health check rating for 2005/2006 as originally planned. They will now be reported as part of the annual health check for 2006/2007, although they will not contribute to the annual rating of performance.
Read the revised framework of assessment (February 2007) (pdf 167kb) (opens new window)
Read our revised management summary for the service review of heart failure (February 2007) (pdf 158kb) (opens new window)
Further information
If you would like more information about the review of heart failure services, please contact our helpline on 0845 601 3012.
The following links also provide further information about the review and other work being carried out to improve the care and treatment of people with heart failure.
Summary of feedback from consultation (published October 2005) (pdf 32kb) (opens new window)
Key issues arising from consultation (published October 2005) (pdf 122kb) (opens new window)
More information on the Healthcare Commission's work in heart failure
NHS Heart Improvement (Opens new window)
Coronary heart disease (Department of Health) (Opens new window)
The British Heart Foundation (Opens new window)
Most reports on this site are PDF files, to view any PDF file you will need Adobe Acrobat Reader.