The final item of business today is a members’ business debate on motion S3M-6031, in the name of Nanette Milne, on Grampian Cardiac Rehabilitation Association. The debate will be concluded without any question being put.
Motion debated,
That the Parliament congratulates Grampian Cardiac Rehabilitation Association (GCRA) for the support that it gives to patients recovering from a heart attack, cardiac surgery or any other cardiac condition in Grampian; notes that GCRA provides cardiac rehab exercise classes led by instructors in 16 communities across Grampian, and understands that GCRA is now the largest provider of cardiac rehab exercise in the voluntary sector in Scotland and has established successful partnership links with NHS Grampian, Aberdeenshire Council, Aberdeen City Council, Robert Gordon University, Aberdeen Petroleum Club, BP Exel Club in Dyce, Meadows Sports Centre in Ellon and Garioch Sports Centre in Inverurie to provide facilities for exercise care in the community.
17:11
Until I was contacted by one of the directors of Grampian Cardiac Rehabilitation Association Ltd—or GCRA for short—I had no idea how much valuable work was being done by that organisation throughout Aberdeenshire. I am delighted that I have been given the opportunity to put some of its achievements on the record, and that Mr Pacitti has come down from Aberdeenshire to listen to the debate.
There is no doubt that cardiac rehabilitation for patients who are discharged back into the community can save and transform the lives of many people with heart disease. It improves general fitness, reduces anxiety and depression, and is proven to reduce deaths from heart disease by more than 30 per cent over 10 years. At a cost of £600 per patient, compared with £1,400 per day in a coronary care unit and £8,000 for a heart bypass, it is clearly cost effective. It saves national health service resources by cutting readmissions to hospital, and it reduces the risk of further cardiac events by helping people to make and maintain changes in order to have a healthier lifestyle.
Prior to 2001, cardiac rehab in Grampian was NHS funded and run by the Swedish style association
, but those classes were stopped on the ground of safety. Thereafter, the NHS paid for the training of exercise instructors to British Association for Cardiac Rehabilitation
—BACR—standards to allow them to take classes. The local authorities did not take up the running of such classes as anticipated, so three of the people who had attended the Swedish style classes decided to set up an association to develop and run their own classes. That was eventually achieved after lengthy discussions with NHS Grampian as to their ability to cope with the task.
The inaugural meeting of GCRA was held in June 2002, following which it became a charity and began to run its classes. Thereafter, it became a company limited by guarantee and continues as such today.
The classes are run by instructors within BACR guidelines and use a mix of exercise styles. They are aimed at giving members the type of exercise that they want and enjoy, and have become popular and are much in demand. The association has grown to 600 exercising members in 32 classes, spread throughout Aberdeenshire. The total number of present and past members to date is estimated to be more than 1,100. I have heard excellent reports from participants, and it is my intention to see for myself, and to take part in, a class as soon as possible after 6 May has come and gone.
GCRA’s funding initially came from a variety of local groups, private donations and fundraising events. Then, for three years from June 2004, it received New Opportunities Fund money, and in 2007 got significant funding from NHS Grampian. BACR training courses were paid for by the Grampian heart campaign and the Lloyds TSB Foundation for Scotland
. However, most of GCRA’s funding now comes from annual subscriptions, class fees, donations and fundraising events—which is not easy to sustain in these straitened times.
Partnerships have been set up with local industry, a university and councils to enable classes to be held in their facilities at little or no cost to GCRA. The Robert Gordon University school of health science was approached and has run BACR training courses in Aberdeen, which makes it easier to recruit instructors locally. Negotiations to put in place elective modules for CR instructors within physiotherapy, occupational therapy and sports science degrees are continuing. That is a first in Scotland, and only Loughborough University is currently doing the same thing.
A survey is planned for the autumn to get clear information on GCRA’s members, their motivation, what they like or dislike about the classes and how their health has improved, or otherwise, as well as statistical information on referral and so on. All that should be very useful for future planning.
From a rocky start, when NHS Grampian regarded the pioneers of GCRA as a “band of old codgers”—to quote GCRA’s briefing paper—who did not know the implications of what they were trying to do, GCRA is now very much a working partner with NHS Grampian. Hundreds of patients and GCRA members are being helped to return to normal, active lives in the community. Two members of the GCRA management board, all of whom work on a voluntary basis, now sit on the coronary heart disease and stroke managed clinical network project board.
It is GCRA’s intention that there will be nowhere in Grampian where anyone who needs and wants a cardiac rehabilitation class cannot access one easily. That is an ambitious goal, but GCRA is working on it.
I am sure that members will agree that GCRA is an excellent example of the voluntary sector at its best: it provides a very real service to patients and saves a great deal of money and resource for the NHS in Grampian. The board would like to see what GCRA does being repeated throughout Scotland. To that end, it now works with the British Heart Foundation and with Chest, Heart and Stroke Scotland to promote cardiac rehab throughout the country. It is working actively in the current Scottish campaign for cardiac rehabilitation and it participates in the Parliament’s cross-group party on heart disease and stroke. I know that it has put questions to the Scottish Government about the future provision of cardiac rehab in Scotland, which I hope the minister will deal with in her response to the debate.
The availability of cardiac rehabilitation is patchy across Scotland at present. It ranges from being non-existent in many areas to being driven by the council, by the NHS or by the voluntary sector in other areas. It is clear that that is less than satisfactory.
In 2005, in a speech to the European Society of Cardiology in Amsterdam, Professor Bob Lewin said:
“If there were a pill that cost very little, reduced cardiac deaths by 27 (now over 30)%, improved quality of life, and reduced anxiety and depression, every cardiac patient in Europe would be expected to take it. There is no such pill, but taking part in a cardiac rehabilitation programme can provide all these benefits.”
Surely such programmes should be available to all who need them.
I will finish by warmly congratulating the founders and management board of GCRA on their magnificent achievements to date, and by wishing them well for the future. I hope that the minister will take on board the importance of their work to the whole of Scotland and let us know, in her reply to the debate, what the Government will do to secure the availability of cardiac rehab to all those in our country who need it and want it, whatever their postcode.
17:18
I congratulate Nanette Milne on securing the debate and I congratulate the self-styled “old codgers” who had enough gumption to get up and do something themselves. That is the epitome of what we want Scots to do about their health. At one time, we had virtually the worst record in Europe on cardiac health. That is changing for the better, at least in part because the people of Scotland realise that we need to do something about it ourselves as individuals and as groups.
We ought to encourage groups of patients to address such issues. GCRA has been extremely effective in engaging with the professionals and, in particular, in funding the training of instructors at the appropriate nationally recognised levels. It is to its great credit that it raised—I think—around £18,000 to train 24 instructors to deliver the classes.
Nanette Milne did not, I am sure, mean to exclude the city of Aberdeen when she said that the GCRA operates throughout Aberdeenshire—that was, surely, a slip of the tongue—given that the classes are delivered throughout the NHS Grampian area. Not only are the classes delivered on different days and at different times, but they allow people individual choice about the kind of exercises in which they want to participate. People are given lots of opportunities to take part at levels that they are capable of achieving.
Undoubtedly, the classes provide a benefit not just to cardiac health: all sorts of evidence suggests that people who take up the classes feel better about themselves. For some folk—most individuals who might need cardiac rehabilitation will be older people—the classes can also be a great social occasion. Certainly, the prime movers behind the association seem to have taken up a considerable interest not just in their personal health, but in contributing to the general wellbeing of their colleagues throughout the area.
One question is whether cardiac rehabilitation, instead of being restricted, as it is at present, primarily to those who have already suffered a heart attack, might be advanced or offered to those who are at greater risk of having a heart attack. Many people who have angina—especially those who have chronic angina, although there might be other groups of people as well—might get exactly the same benefits. Perhaps that could be considered.
Of course, it is always a challenge for any Government to find finance for training facilities and so on to deliver change. However, given the cost benefit analysis that is available for cardiac rehabilitation—and given the dedicated commitment that the GCRA has shown in its fundraising efforts—we should encourage the provision of such services throughout Scotland, and perhaps encourage its being broadened to include other groups of people who have cardiac difficulties.
17:22
I thank my colleague Nanette Milne for securing tonight’s debate. I commend Grampian Cardiac Rehabilitation Association’s partnership with the local councils—including Aberdeen City Council—and with the Robert Gordon University, the sports centre that is mentioned in the motion, British Petroleum and the Aberdeen Petroleum Club. The association is a great example of how health is everyone’s business and not just the domain of the national health service.
The benefits of cardiac rehabilitation are undoubtedly significant, both for the patient and for NHS resources. For patients who have experienced cardiac events, cardiac rehab allows them to return to normal life and reduces by 26 per cent their chances of dying prematurely from heart disease. That is indeed significant. In 2008, less than 3 per cent of patients with angina and less than 1 per cent of patients who have suffered heart failure received cardiac rehabilitation, so much more needs to be done, obviously. As Nanette Milne said, the cost of cardiac rehab for one person is £600, whereas the cost for a heart bypass operation is £8,000, and a single day in a coronary care unit costs £1,400. Given that heart disease is the second most common cause of death in Scotland, cardiac rehabilitation not only saves lives but has a significant impact on NHS resources by cutting readmissions to hospital by 30 per cent.
The success of the Grampian Cardiac Rehabilitation Association is an example of best practice that I hope will be examined and rolled out, where appropriate, to the rest of Scotland. On its website, the GCRA states
:
“In the Grampian Region area more than 16,000 people suffer from coronary heart disease. Fortunately with correct medical intervention and change of lifestyle many can and do live a normal life.”
Clearly, the voluntary sector plays an integral role in the association. With the support of the Government, more associations throughout Scotland could provide the level of support that is available in Grampian and more people who are affected even in a small way by cardiac events could benefit from such services.
That brings me to the Highlands and Islands. The geography and remoteness of many communities, together with poor transport links and a lack of suitably qualified staff, are undoubtedly challenging. Despite that, cardiac rehabilitation classes have been established, through funding from the Big Lottery Fund, the Highland News group, the British Heart Foundation and NHS Highland, and thanks to the dedication and commitment of many individuals.
Through the Highland heartbeat centre, which is based at Raigmore hospital in Inverness, it has been ensured that the majority of people can access classes within 30 minutes of their homes. Classes run from Wick in the north to Kingussie in Strathspey, and from Fort William in the west to Nairn in the east. It can be done. That will ensure that individuals can get access to experts, and advice on diet, medication, exercise and stress management wherever they are. Coupled with the classes, that provides a comprehensive and cost-effective way to rehabilitate people who have faced cardiac problems.
Community support in rural areas for people who have been newly diagnosed with cardiac conditions such as angina or heart failure remains underresourced. Brian Adam touched on that. I hope that the Scottish Government will allocate funds to support cardiac rehabilitation, particularly given the financial difficulties that face us over the next few years, which will undoubtedly impact on all public services.
Support groups such as those that exist in Grampian, which utilise the various skills of people in the voluntary sector and elsewhere, can have a positive and life-changing impact on those who have been affected by cardiac events. It is an example of putting the patient in the driving seat. Too often, patients are talked at and handed prescriptions. Initiatives such as those that we have been discussing give patients more control over their condition—it is a great example of putting money towards health benefits and the prevention of ill health.
17:27
I, too, congratulate Nanette Milne on securing the debate. I join her in congratulating Grampian Cardiac Rehabilitation Association on all its valuable work. I also pay tribute to all those in the NHS who provide care and treatment for people with coronary heart disease.
The Government has confirmed that tackling coronary heart disease continues to be a national clinical priority for the NHS in Scotland. That is right and welcome. Almost a fifth of deaths in Scotland are related to heart disease. That is preventable. Every year, about 10,000 people in Scotland survive a heart attack and 13,000 angina patients require admission to hospital. I absolutely agree with Mary Scanlon on the cost of that to the NHS, never mind to the individual. All of those people, plus a further 6,000 patients with chronic heart failure, would undoubtedly benefit from cardiac rehabilitation. The number of people who are affected by coronary heart disease is greater still. There is a clear need for provision in this area in local communities.
Comprehensive cardiac rehabilitation can be delivered by multidisciplinary professional teams and by trained volunteers, who are all engaged in maintaining people’s physical health. That involves not just exercise but behavioural change, education and psychological support, all of which are geared towards facilitating a return to normal living.
In most cases, as in Grampian, patients are the catalyst for setting up rehabilitation associations. I pay tribute to those in Grampian who took the time and trouble to get involved in establishing their group. That support is much valued, and not just by increasing numbers of people in Grampian; I also know that it is valued from my own constituency experience. It is fortunate that a number of local groups provide cardiac rehabilitation in Dumbarton, the Vale of Leven and Helensburgh. One such group is the healthy heart lifestyle club, which runs two classes a week at the Concord community centre in Dumbarton. I have been out and about with its members on a couple of occasions, and they put me to shame. The club was established 15 years ago, by staff working alongside patients at the Vale of Leven hospital. Those patients had been admitted following heart incidents. They underwent an initial rehabilitation programme at the hospital, and following discharge were referred to the club to continue their treatment by developing and maintaining a longer-term exercise plan.
Brian Adam was right when he said that classes become social occasions. The club has become quite a social group, with a number of things going on. It has grown in size and currently has approximately 40 attendees. Instructors are trained to certified standards of the British association for cardiac rehabilitation.
Since the first group was established 15 years ago, a further three heart and lifestyle classes have been formed in the constituency. Two are run by the local authority, at the Vale of Leven swimming pool and at the Meadow centre in Dumbarton; the other, which is in Helensburgh, is run by a private instructor—that is unusual. Like the Grampian group, they all do exceptional work.
Nanette Milne was right to say that there is a patchwork of provision, which does not cover the whole of Scotland. We know that cardiac rehabilitation can improve the prognosis and quality of life of people who live with heart disease. There is no doubt that it is an effective preventive measure. I agree with Brian Adam that we should consider broadening coverage to include people with other heart conditions, as a preventive measure.
I hope that the minister and all members will support and encourage the development of community-based cardiac rehabilitation services. It does not matter whether services are run by communities, local authorities or in partnership; what we need is a network of services that are accessible to every community. As Mary Scanlon said, cardiac rehabilitation works. It cuts readmissions and it can help to save lives. Anything that we can do to encourage the development of a network of services would be thoroughly positive.
17:31
We need no convincing about the value of cardiac rehabilitation. The intervention is clinically effective. It transforms and saves lives. As a bonus, particularly in the current economic climate, it does not cost much in comparison with other interventions.
Nanette Milne described cardiac rehab well. The approach epitomises the self-management that is at the heart of our work on long-term conditions in general, because it encourages people to take responsibility for their health while having access to professional support when they need it. It is about rebuilding people’s confidence and helping them to get back on their feet and regain control over their lives. The debate is therefore timely.
For the reasons that I have given, cardiac rehabilitation has featured strongly in our strategic work on heart disease for at least the past decade. It featured in the CHD and stroke strategy that was published in 2001 and in the first set of standards that were developed by the predecessor to NHS Quality Improvement Scotland. It is the subject of a guideline from the Scottish intercollegiate guidelines network and it features in the new heart disease standards that NHS QIS will publish at the end of the month. The audit of cardiac rehabilitation services is an integral part of the NHS QIS heart disease improvement programme.
It is no coincidence that the Cabinet Secretary for Health and Wellbeing launched our action plan on better heart disease and stroke care last June at a cardiac rehabilitation class in Glasgow. The action plan sets out three key actions for NHS boards in relation to cardiac rehab. The thinking in that part of the action plan was informed by the cardiac rehab campaign that the British Heart Foundation and Chest, Heart and Stroke Scotland launched in 2008. Given the effectiveness of cardiac rehab, the campaigners want it to be available to everyone who would benefit from it. The Scottish Government shares that aim.
NHS Grampian offers a good example of the cardiac rehab services that boards can provide. Nanette Milne talked in some detail about why that is the case. The board offers a comprehensive service across six sites, and I am sure that the quality of the service has a great deal to do with the fact that NHS Grampian’s CHD managed clinical network has a cardiac rehabilitation subgroup, which is chaired by the head of the Grampian Cardiac Rehabilitation Association. The approach is also a good example of how the NHS can work in partnership with the voluntary sector, which is another key element of our work on long-term conditions.
It is clear that more could be done. We know from the campaign that we need to get more people who have heart failure into cardiac rehabilitation. Data from ISD Scotland, which Mary Scanlon referred to, showed that in 2007 only 1 per cent of people who had heart failure were getting cardiac rehab. I am pleased that they are mentioned in the clinical standards, because the SIGN guideline is clear about the benefits that cardiac rehab can bring to that group of patients.
Until recently, only people who had had a heart attack or a cardiac intervention had access to cardiac rehabilitation. In keeping with our anticipatory care approach, we want to extend the scope of cardiac rehab to other groups, such as those with unstable or new-onset angina. In keeping with the importance that we attach to tackling health inequalities, we want to ensure that groups who have been underrepresented—women, people from ethnic minorities and older people—are also included.
There are also issues about people in remote and rural communities, which have a particular relevance for Grampian. We should be thinking about making more of telehealth care and exploring innovative methods to expand its use. To do that, we are funding a project in NHS Highland that is developing a menu-based telecardiac rehabilitation service for people in remote parts of the Highlands. That will allow them to take part in specialist sessions at all stages of their recovery and will enable the setting up of a more comprehensive community programme. That could help with the cardiac rehab campaign’s aim of offering alternative models, such as home-based rehabilitation.
Another example of good practice is the heart manual that has been developed in NHS Lothian. The action plan calls on boards to use it or an equivalent to ensure that people receive structured information and education to allow them to develop the skills to manage their own condition. The fourth edition, which I launched in 2008, relies more on images to get its message across and to make it more user friendly, and that change has been welcomed. I know that NHS Grampian has been successful in making the manual available, and I hope that it can build on that approach to take forward the Grampian Cardiac Rehabilitation Association’s suggestion that there is a role for practice nurses in delivering cardiac rehab in community settings.
I am also aware of the value that NHS Grampian’s cardiac rehabilitation subgroup attaches to the importance of education, and I share its view that people can self-manage much better once they have had access to information and education that is couched in language that they understand. That may help with the problem that the subgroup identified of people disappearing at the end of phase 3 of the rehabilitation programme and not going on to phase 4, which deals with long-term maintenance of physical activity and lifestyle change.
We are doing a lot of general work in those areas, but a very practical example of how we can encourage people to stick to the complete programme is the Braveheart
project in Falkirk. It has created a role for older people who have themselves gone through cardiac rehab in mentoring others who are just starting the process. It has been shown to support people through phases 3 and 4 and to reduce readmissions to hospital. We would like all boards to adopt that approach.
I know that Grampian Cardiac Rehabilitation Association has expressed concerns about resources to help boards take forward the improvements in cardiac rehabilitation services that we all want. The allocation of resources has to be a matter for boards, but I believe that the evidence base for the clinical and cost effectiveness of cardiac rehabilitation, the prominence that it is given in our action plan, the new standard that NHS QIS is publishing and the results that we expect from the next audit round—which will be interesting to members—will all help to strengthen the hand of those who seek extra resources to improve services.
I will be happy to keep members up to date on the progress that is made in improving access to cardiac rehabilitation as we take the work forward, and I will look at ways of doing that on a regular basis.
Meeting closed at 17:39.Previous
Decision Time