National Priorities 2003-04
NHS Lothian – Coronary Heart Disease / Stroke Final
(a)
Title of Service:
CORONARY HEART DISEASE/STROKE
Coronary heart disease (CHD) and stroke are major national and local priorities.
The recent Coronary Heart Disease and Stroke Strategy issued by the Scottish
Executive builds on our local work programme but in addition provides a helpful
guide to issues requiring further development.
(b)
The Local Position
Ongoing work in Lothian relevant to the National Strategy includes:
 Taking forward our Primary Care Coronary Heart Disease Strategy aimed
at implementing SIGN guidelines and developing the primary and
secondary care interface.
 Supporting Heartstart Plus, emergency life support training for members of
the community, and Want2Quit, smoking cessation sessions for adults and
young people, as part of our Health Improvement agenda. Both are
funded.
 Taking forward the audit of CHD management in primary and secondary
care (including audit of the referral pathway for revascularisation). Funded.
 Strengthening the Chest Pain Service across Lothian.
 Ensuring projects forwarded to the National Opportunities Fund reflect local
strategic priorities.
 Supporting the Cardiac Rehabilitation Redesign Project in formulating a
redesigned care pathway for Lothian cardiac patients, placing special
emphasis on the role of cardiology nurses in risk factor management.
Seeking funding through the National Opportunities Fund.
 Developing a Heart Failure Service for Lothian. Part of our work to reduce
inequalities by addressing a need which has received little attention in the
past. Currently seeking NOF funding.
Cardiac surgery rates, persons aged 45 years and over:
(PAF 2.05.01)
Progress against a national average - Lothian’s rates for revascularisation are
above the national average – currently projected at over 1500 p.a.
Percentage reduction in age standardised mortality rate for stroke in people aged
less than 75 years:
(PAF 1.02.03)
Progress towards a relative target – Lothian is progressing towards its target
more quickly than was planned.
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National Priorities 2003-04
NHS Lothian – Coronary Heart Disease / Stroke Final
A recent review of Lothian’s performance against local and national targets for
CHD/Stroke showed:
 a steady reduction in CHD mortality since 1995 for both Scotland and
Lothian
 survival rates following an emergency admission with myocardial infarction
have remained constant across Lothian in recent years, at around 83%, a
little higher than the Scottish level. Local trends mirror Scottish rates.
(c)
Changes to Improve Services
In the light of the CHD/Stroke Strategy, key priorities for the 2003 update to the
local Health Plan will be:
 To establish managed clinical networks for CHD and stroke in line with
national recommendations and building on local knowledge, expertise and
structures.
 To develop data collection systems for monitoring of CHD and stroke
services in conjunction with national initiatives.
 To ensure recommendations from the Cardiac Rehabilitation Redesign
Project are debated and where appropriate implemented.
 To capture the many exciting health projects underway in Lothian and bring
them together under a co-ordinating forum similar to “Have a Heart
Paisley”.
 Establishing a Stroke Liaison Nurse, improving co-ordination of patient care
during hospital admission and providing support after discharge.
 Improving services for stroke patients at St. John’s Hospital to provide a
more equitable service across Lothian.
 Improving access to radiological services for stroke patients.
These initiatives are subject to approval and support as part of the national
strategy on coronary heart disease and stroke.
(d)
Outcomes
 MCNs for CHD and Stroke established and working by April 2004.
 Performance measured against recommendations contained in the
National Strategy implementation plans for CHD/Stroke:
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Arrangements for local cardiac services MCN by
Dec.’03
MCN for CHD in operation with agreed QA programme by April ’04
Arrangements for local stroke services MCN by
Dec.’03
MCN for Stroke operational with agreed QA programme by April ’04
Achieve revascularisation rate of 1,230 pa for Lothian population.
Access to radiology within recommended times for acute stroke patients
admitted to hospital.
 Performance maintained against relevant PAF indicators.
 Continued improvements monitored against national and local targets.
 CHD waiting times will be achieved – see Waiting Times template.
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