Better Heart Disease and Stroke Care Action Plan

3.7

Promoting Healthy Lifestyles

All GPs and practice nurses should undertake training in brief intervention/health behaviours and inequalities change, to help them support their patients to make positive lifestyle changes. Greater use could be made of community pharmacists, who should also be included in brief intervention training programmes, and trained in the use of CVD risk assessment tools. There is also a role for health coaches, as the Stroke Association work in England indicates.

NHS Boards

Ongoing

3.9

Promoting Healthy Lifestyles

NHS Boards, through their cardiac and stroke MCNs, should ensure appropriate referral to community advice and support on alcohol use.

NHS Boards

Ongoing

3.29

Promoting Healthy Lifestyles

ASSIGN should be promoted more actively within primary care, and integrated with current GP systems. ASSIGN must be available easily, in a variety of formats, to all clinicians dealing with CVD.

SGHD/ NHS Boards

Ongoing

3.32

Promoting Healthy Lifestyles

The Scottish Government Health Directorates ( SGHD) should use the outputs from the 2009 national conference to further develop the Health Promoting Health Service concept, and issue a follow-up CEL.

SGHD

By spring 2010

3.35

Improving mental health

Once evaluated, the lessons from the 'Living Better' pilots should be rolled out by NHS Boards and their cardiac and stroke MCNs.

NHS Boards

3.39

Reducing health inequalities

The Scottish Government should consider extending the community pharmacy contract to include blood pressure measurement, phlebotomy and ECGs where appropriate.

SGHD

3.44

NHS Boards, through their cardiac and stroke MCNs, should develop plans for adopting the flexible and culturally-sensitive approach to services developed by the NHS Tayside 'Community Heart' project.

NHS Boards

March 2010

4.6

New definition of AMI/ ACS

Patient groups and charities are informed of the national consensus on the new definition of Acute Myocardial Infarction/Acute Coronary Syndromes ( AMI/ ACS), particularly in areas where this represents a significant change in the diagnosis rates of AMI/ ACS.

SGHD/ NHS Boards

4.6

New definition of AMI/ ACS

All clinical staff involved in caring for CHD patients must understand the rationale for the change in the definition of AMI/ ACS and promote it within their own hospital, participating in the education of colleagues outwith the specialist cardiology environment.

NHS Boards

4.6

New definition of AMI/ ACS

Cardiac rehabilitation departments are aware of the change of AMI/ ACS definition, and make sure service provision matches the likely increase in those diagnosed with non- ST elevation MI ( NSTEMI).

NHS Boards

4.6

New definition of AMI/ ACS

Hospital coding departments are informed of the change of AMI/ ACS definition.

NHS Boards

4.6

New definition of AMI/ ACS

GPs are made aware that the change in AMI/ ACS definition may result in an apparent rise in the number of patients coded as having MI, and that this could have an impact on their CHD registers.

NHS Boards

4.6

New definition of AMI/ ACS

Hospital biochemistry departments should review their troponin assay in relation to the new AMI/ ACS definition to ensure a standardised approach across Scotland.

NHS Boards

4.6

New definition of AMI/ ACS

The National Advisory Committee on Heart Disease should monitor progress of all actions relating to raising awareness of the new definition of AMI/ ACS, to ensure consistency of approach to ACS diagnosis and treatment across Scotland.

National Advisory Committee on Heart Disease

4.17

Improving delivery of pre-hospital thrombolysis

The Scottish Ambulance Service should review current arrangements for delivery of pre-hospital thrombolysis across Scotland, particularly in rural areas, including assessment of staff training needs, and submit a report to the National Advisory Committee on Heart Disease.

SAS

March 2010

4.19

Improving delivery of ORT

The inter-regional cardiac group will re-convene to ensure consistency of approach across Scotland, for example in relation to Optimal Reperfusion Therapy ( ORT).

NHS Boards

4.24

Developing approaches to public access defibrillation

NHS Boards should seek advice from their cardiac MCNs in considering the introduction of both static and non-static approaches to public access defibrillation ( PAD) in particular whether there are suitable locations in their area in which the static approach might be beneficial. If recommended, NHS Boards should introduce these.

NHS Boards

March 2010

4.31

Improving access to cardiac rehabilitation

NHS Boards should, through their cardiac MCNs, undertake a needs assessment of their cardiac rehabilitation process for all eligible patients, identify priorities and allocate appropriate resources.

NHS Boards

end March 2010

4.33

Improving patient experience of cardiac rehabilitation

NHS Boards, through their cardiac MCNs, should implement the 'Heart Manual' or equivalent to ensure that people receive structured information, education and develop the skills needed to help them manage their own condition.

NHS Boards

4.33

Improving patient experience of cardiac rehabilitation

NHS Boards, through their cardiac MCNs, drawing on the Network's patient representatives, should adopt the 'Braveheart' approach to cardiac rehabilitation.

NHS Boards

end December 2009

4.37

Improving Heart Failure Services

NHS Boards, through their cardiac MCNs and CHPs, should adopt the BHF Scotland Heart Failure Nurse Educator project.

NHS Boards

March 2011

4.40

Improving Heart Failure Services

NHS Boards, through their cardiac MCNs, should consider the recommendations of the short life working group involving NHS 24 and the chronic heart failure nurses as soon as they are available.

NHS Boards

4.44

Improving Heart Failure Services

In preparation for the publication of the new CHD clinical standards, NHS Boards, through their cardiac MCNs, should undertake a needs assessment of cardiovascular nurse specialists delivering care to heart failure patients, including the potential for delivering out-of-hours cover through the education of primary care nurses.

NHS Boards

end December 2009

4.45

Improving Heart Failure Services

NHS Boards, through their cardiac MCNs, should work with Chest, Heart & Stroke Scotland to replicate its heart failure support service initiatives across Scotland.

NHS Boards

Ongoing

4.52

Improving Palliative Care

NHS Boards' cardiac and palliative care MCNs should jointly undertake an audit of practices' implementation of the palliative care Directed Enhanced Service, and collaborate to ensure implementation of Boards' Living and Dying Well Delivery Plans.

NHS Boards

end December 2009

4.63

Coordinating the introduction of new technologies for heart disease

When considering the introduction of highly specialised new technologies, NHS Boards should continue to ensure that their MCNs are fully integrated with local and regional planning and prioritisation processes.

NHS Boards

4.69

Improving psychological support for Advanced Heart Failure

National Services Division of NHS National Services Scotland, as commissioners of the National Centre for the Treatment of Advanced Heart Failure, should as a matter of urgency address the issue of provision of psychological support at the Centre.

NSD

4.78

Improving Adult Congenital Cardiac Services

NSD and the Golden Jubilee National Hospital should work towards achievement of the Department of Health in London's commissioning standards for adult congenital heart disease and address issues of awareness raising, development of referral pathways and data collection.

NSD, GJNH

4.82

Supporting people with inherited cardiac conditions

ISD should work with the Familial Arrhythmia Network Scotland ( FANS) towards developing a national register of familial arrhythmias.

ISD, NSD

4.94

Supporting people with inherited cardiac conditions

Over time, there should be a single national Managed Clinical Network covering all forms of inherited cardiac disorders covering arrhythmias, cardiomyopathies and multi-system genetic diseases with a substantial cardiac involvement.

NSD

4.97

Supporting people with Familial Hyper-cholesterolaemia ( FH)

A national forum for Familial Hyper-cholesterolaemia ( FH) should be established by SGHD to raise awareness of FH among primary care professionals, to prioritise the need for diagnosis, to define and agree referral protocols, and to develop good practice for clinical investigations, genetic testing and cascade screening within families.

SGHD

end December 2009

4.100

Supporting people with Familial Hyper- cholesterolaemia ( FH)

The Aberdeen molecular genetics laboratory should develop a funding proposal for a pilot project of cascade testing for FH, for submission to CSO.

Aberdeen molecular genetics laboratory

5.1

Improving stroke services

NHS Boards, through their stroke MCNs, should ensure their stroke services are comprehensive and include each of the essential elements identified in Chapter 5.

NHS Boards

Ongoing

5.4

Raise public awareness of stroke

The Scottish Government Health Directorates and NHS Boards, through their stroke Managed Clinical Networks, should continue to support the ongoing ( FAST) public awareness campaigns run by Chest, Heart & Stroke Scotland, taking account of the evaluation of the Stroke Association campaign in England.

SGHD/ NHS Boards

Ongoing

5.4

Raise public awareness of stroke

The National Advisory Committee on Stroke should consider how best to develop a national strategy for the evaluation and delivery of FAST.

SGHD

end March 2010

5.4

Raise public awareness of stroke

NHS Boards, through their stroke MCNs, in conjunction with CHPs and the voluntary sector, should develop a local communications strategy to raise public awareness of stroke.

NHS Boards

end March 2010

5.5

Raising awareness of stroke

NHS 24 staff, primary care staff, ambulance crews and A&E department staff should all receive appropriate stroke awareness training, including FAST.

NHS Boards, NHS24, SAS

5.8

Supporting stroke services

ISD will integrate audits of pre-hospital and hospital-based stroke care, building on the Scottish Stroke Care Audit work, and provide a minimum dataset to reflect performance against NHSQIS stroke standards.

ISD

end December2009

5.12

Improving TIA services

NHS Boards, through their stroke MCNs, should engage with the Scottish Centre for Telehealth, to ascertain whether the Unscheduled Care TIA & Stroke Telemedicine Service to Orkney model is a viable option for TIA outpatient redesign in their area.

NHS Boards

5.17

Improving thrombolysis services

NHS Boards, with advice from their stroke MCNs, should consider appropriate models to facilitate access to thrombolysis for stroke patients, particularly in areas with limited medical cover.

NHS Boards

5.20

Improving stroke care

The Regional Planning Groups, in conjunction with the local stroke MCNs, the Scottish Ambulance Service and the Scottish Centre for Telehealth, should consider how to deliver optimal hyper-acute stroke care, including thrombolysis.

NHS Boards, SAS, SCT

end December 2010

5.23

Improving stroke services

A short life working group of the National Advisory Committee on Stroke should be established, to include representation from the Directors of Planning Group, to draw on NHS Boards' existing experience to explore the service and other implications of developing a HEAT target relating to stroke unit admissions.

SGHD

5.25

Improving stroke services

SGHD should continue to highlight NHS Boards' performance in the SSCA on an annual basis and NHS Boards should provide action plans that will address any shortcomings.

NHS Boards

5.27

Improving stroke services

NHS Education for Scotland should establish a method for nurses working in a stroke unit to demonstrate that they have achieved the defined level of specialist knowledge and skills.

NES

end December 2011

5.29

Improving access to imaging

The newly-established Scottish Imaging Managed Diagnostic Network, in conjunction with the SAS and NHS 24, should as a matter of urgency be asked to address whether duplex ultrasound, CT and MRI services can be delivered on a 24-hour basis in all hospitals admitting those who have had a stroke, and the additional neuroradiology capacity required.

Scottish Imaging Managed Diagnostic Network, SAS, NHS24

5.31

Supporting younger people who have had a stroke

NHS Boards should adopt the model developed by Chest, Heart & Stroke Scotland and NHS Lanarkshire which helps younger people deal with the wider social consequences of stroke such as access to education and training, employment, family relationships and the economic impact of stroke. Access to vocational rehabilitation support should also be provided.

NHS Boards

5.34

Improving early supported discharge

NHS Boards with their local planning partners must ensure that early supported discharge and community rehabilitation teams are integrated and easily accessible to assist people who have had a stroke to become as fully independent as possible.

NHS Boards

5.37

Improving early supported discharge and long term support

NHS Quality Improvement Scotland should consider the wider standards that could be developed to reflect the most up to date evidence once the revised SIGN guideline 64 on Stroke Rehabilitation is published and discuss options for taking forward this work with the National Advisory Committee and stroke MCNs.

NHSQIS

5.39

Improving rehabilitation and recovery

NHS Boards, through their stroke MCNs, should investigate the implications of allowing self referral to AHP services by those recovering from a stroke.

NHS Boards

5.40

Improving rehabilitation and recovery

NHS Boards, through their stroke MCNs, should continue to work with leisure industry representatives to make best use of the new training course 'Exercise After Stroke: Physical Activity and Health' to improve access to exercise and fitness training for people with stroke in their area.

NHS Boards

5.41

Improving rehabilitation and recovery

NHS Boards, through their stroke MCNs, should prioritise the provision of Occupational Therapy services for stroke rehabilitation, given the strong evidence base in this area.

NHS Boards

5.42

Improving rehabilitation and recovery

NHS Boards, through their stroke MCNs, should ensure implementation of the Best Practice Statement on Ankle-Foot Orthoses, once available.

NHS Boards

5.45

Improving rehabilitation and recovery

NHS Boards, through their stroke MCNs, should ensure that provision of speech and language therapy services is included in the mapping exercise being undertaken by the Rehabilitation Co-ordinator in each NHS Board, and supported appropriately, including voluntary sector communication support services.

NHS Boards

5.46

Improving rehabilitation and recovery

NHS Boards, through their stroke MCNs, should encourage the use of the Stroke Workbook which provides information and support to patients who have had a stroke and their carers.

NHS Boards

5.52

Improving palliative care

NHS Boards' stroke and palliative care MCNs should collaborate to implement the objectives in NHS Boards' Living and Dying Well Delivery Plans, and ensure that the best practice statement on palliative care is implemented once it is available.

NHS Boards

5.54

Reducing delays to carotid surgery

NHS Boards and Regional Planning Groups should urgently implement the kind of service re-design undertaken in NHS Lothian and elsewhere to reduce the current unacceptable delays in time to carotid endarterectomy for eligible patients.

NHS Boards

5.61

Improving stroke services

NHS Boards should ensure that their stroke MCN is providing in-service training opportunities such as STARS (Stroke Training and Awareness Resources) to staff involved in stroke care. Boards should also ensure that staff have access to on-line training through their hospital IT systems.

NHS Boards

March 2010

5.62

Improving stroke research

The Chief Scientist Office should be able to demonstrate increasing year-on-year recruitment to clinical stroke studies through the Scottish Stroke Research Network.

Scottish Stroke Research Network

6.5

Improving patient information

NHS Boards, through their cardiac and stroke MCNs, need to make concerns about communication issues for heart disease and stroke patients one of their priorities, and develop plans to tackle these concerns locally.

NHS Boards

7.7

Improving HD data collection

NHS Boards, through their cardiac MCNs, should ensure that information systems are in place to meet the requirements of NHSQIS and ISD for the reporting of information relevant to cardiac care from a range of core indicators.

NHS Boards

May 2010

7.7

Improving HD data collection

NHSQIS, ISD and other relevant bodies, including the SAS, are required to establish mechanisms for reporting and publishing data relating to patient care for cardiac conditions.

NHS Boards, ISD, SAS

7.8

Improving HD data collection

The cardiac MCNs, and staff collecting information, should ensure that data definitions meet NCDDP criteria.

ISD, NHS Boards

7.8

Improving HD data collection

The NCDDP should be extended to include familial hypercholesterolaemia.

ISD

7.10

Improving HD data collection

The Scottish Government will establish an eCardiology Strategic Group to develop an action plan for consideration by the eHealth Programme Board.

eCardiology Strategic Group

end 2009

7.13

Improving HD data collection

The eCardiology Strategic Group should look at extending information gathering on cardiology patients to primary care.

SAS

7.14

Improving HD data collection

NHS Boards, in conjunction with their cardiac MCNs, need to establish mechanisms to collect the NCDDPACS data set through SCI- CHDACS (or a compliant alternative system).

SGHD

by March 2010

7.14

Improving HD data collection

The eCardiology Strategic Group, working closely with representatives from the Scottish Government, will ensure development priorities for cardiac data are delivered within the agreed funding arrangements and timetable.

eCardiology Strategic Group

7.16

Improving HD data collection

The Scottish Ambulance Service, working with other national bodies, should continue to explore mechanisms to link their databases with SCI- CHD, to improve national data collection on the delivery of optimal reperfusion services.

SAS