British heart foundation MPs Briefing for the health and social
care bill
The British Heart Foundation (BHF) welcomes the Government’s intention to create an NHS
which focuses on improving health outcomes, tackling health inequalities, and is responsive to
patients’ needs and wishes. We also support the emphasis on public health and the allocation of
a ring-fenced budget. However, we must ensure that the significant changes to the NHS being
considered by Parliament do not impede the delivery of high quality care for patients.
Key questions to ask:
1. High quality care: In December 2010 a national audit of heart failure showed that
patients were dying unnecessarily due to lack of access to high-quality specialist cardiac
care. What systems will the Government put in place to ensure that all heart patients
receive high quality specialist care, where ever they go for treatment?
2. Patient voice: How will the Government ensure that the NHS Commissioning Board and
GP consortia demonstrate significant and genuine patient and carer involvement in
service commissioning, design and development?
3. Patient choice: Genuine choice is dependent on patients having accurate and
understandable information, and having the confidence, skills and support to make
informed choices. Some people will still prefer to trust in healthcare professionals to make
decisions on their behalf. How will the Government ensure that appropriate information
and support is available to enable genuine choice, and ensure that every patient’s
preferences for decision-making are fully respected?
4. Partnership working with the voluntary sector: How will the Government ensure that
the NHS Commissioning Board involves and has genuine engagement with voluntary
sector organisations like the BHF?
5. Workforce planning: The Bill states that the Secretary of State must secure continuous
improvement in the quality of services for patients. Given the threat to specialist nurse
posts like the BHF heart specialist nurses, how does the Government intend to ensure
patients receive the highest quality care in the future?
6. Integrated care: Cardiac and stroke networks are key to promoting integrated and
innovative, cost-effective care. How will the Government ensure that increased
competition between providers does not impede networking and integrated care?
7. Multi-disciplinary and multi-agency commissioning: Specialist nurses, like BHF
specialist heart nurses, are well-placed to advise on the commissioning of high-quality
care. How will the Government ensure that there is multi-disciplinary and multi-agency
involvement in commissioning to improve the quality and continuity of care?
8. Clinical research: How will the Government ensure that research is prioritised by
commissioners and providers in the new market-orientated system?
9. Clinical audit: Clinical audits, such as the National Audit of Cardiac Rehabilitation,
provide valuable information on variations in service provision and performance, and have
a track record in monitoring and driving service improvement. How will the Government
ensure that support is made available so the work of national, independent, clinically-led
audits can continue?
Key messages from the BHF
The significant changes to the NHS must not impede the delivery of high quality evidencebased care
 In developing and implementing the ambitious plans for the NHS, the Government’s
primary priority must be the provision of high quality care, in accordance with national
guidelines.
 In December 2010 a national audit of heart failure showed that guidelines on the treatment
of heart failure patients were not being followed and that patients were falling through the

cracks and dying unnecessarily (this audit is covered in more detail at the end of this
briefing).
Systems must be in place, including through commissioning and national regulation, to
ensure that all heart patients have access to high-quality, specialist cardiac care.
Ensuring a strong patient voice
 The NHS Commissioning Board and GP consortia should be required to involve and
genuinely engage with patients and carers in commissioning decision-making.
 Local HealthWatch should build on the work of LINks, should work closely with local
services and clinical networks, and must have sufficient authority, independence, and
resources to carry out their functions.
 Advocacy work by local HealthWatch must not detract from patient and public involvement
in shaping services.
Supporting patient choice
 Genuine patient choice is dependent on access to accurate, understandable and
meaningful information at a time and place that suits patients, as well as patients having
the confidence, skills and personalised support to make choices. Some vulnerable groups
and some people from black and minority ethnic groups will need particular support in
being empowered to make and communicate choices.
 Voluntary sector organisations like the BHF, and specialist health professionals, including
BHF cardiac nurses, will provide valuable support to patients in exercising choice and
control.
 Some people may prefer to trust in healthcare professionals to make decisions on their
behalf - these preferences must be fully respected.
 Some people will find it difficult to act on choices or may have a more limited range of
options available due to lower incomes, lack of personal transport, or limited mobility. All
patients must receive high-quality evidence-based care, where ever they go for treatment.
 Shifts in demand must not destabilise essential local services or result in popular services
becoming overburdened.
Partnership working with the voluntary sector
 The NHS Commissioning Board should involve and have genuine engagement with
voluntary organisations like the BHF.
 Charities like the BHF can share experience of integrated care and commissioning, and
innovative service models, and can disseminate evidence and best practice to
professionals.
 Charities can also share intelligence on patients’ needs and experiences, and facilitate
discussions with the patients, carers, and health professionals with whom we already
engage.
Multi-disciplinary commissioning
 Specialist healthcare professionals, including BHF specialist cardiac nurses are wellplaced to advise on optimal patient pathways and the commissioning of high-quality,
patient-centred, and cost-effective care.
 To improve the quality and continuity of care and promote integration, the NHS
Commissioning Board and GP consortia should be required to involve health and social
care expert professionals in commissioning decision-making.
The new freedoms for providers must not impede the delivery of high quality
comprehensive care
 Providers must not be deterred from delivering specialised services for small and
dispersed patient groups or from taking on complex cases that may be more costly.
 Providers’ increased autonomy and accountability for planning and developing their own
workforce must not impede national workforce planning or access to consistently high
quality and comprehensive training and development.
 Increased competition between providers must not impede networking and integrated care
- cardiac and stroke networks and coordinator roles like BHF specialist cardiac nurses are
key to promoting coordinated, innovative, and cost effective care, and their vital work must
continue and develop.
Promoting clinical research
 Research must be regarded as a priority by commissioners and providers, and given
appropriate status in the new market-orientated system; the tariff system, the NHS
Outcomes Framework, and the quality regulation by the Care Quality Commission should
provide strong incentives for conducting research.
 As the principal budget-holders and commissioners, GPs will need considerable support
to recognise the importance of commissioning research activity and to ensure patients are
aware of clinical trials and similar opportunities.
 We welcome the commitment to make available for research aggregate datasets from
data held securely in people’s records - we look forward to further information about the
research data service that is to be developed.
Data collection to promote continuous improvement
 While we welcome the shift from targets to health outcomes, process measurement must
continue where clinically relevant - continuous improvement is dependent on the collection
of data not only on the overall outcomes of the NHS, but also on the effectiveness of
individual interventions that lead to these outcomes.
 The Government should ensure that support is made available so the valuable work of
national, independent, clinically-led audits can continue.
The National Heart Failure Audit
On 9 December 2010 the NHS Information Centre published a report on the third National Heart
Failure Audit, covering England and Wales. The Audit is run jointly by NHS Information Centre
and British Society for Heart Failure, and is funded by Healthcare Quality Improvement
Partnership (HQIP).
Key findings
 Many heart failure patients admitted to acute hospitals are not managed fully in
accordance with evidence-based guidelines.
 There is variation across the country and between different groups of patients in
relation to confirmation of diagnosis and access to treatment and specialist staff.
 Mortality for patients hospitalised with heart failure is high, with 32 per cent dying
within a year of admission.
 Outcomes are substantially improved if patients access specialist care
 Heart failure places a significant demand on hospital facilities and resources through
emergency admissions and readmissions - almost 90 per cent of heart failure
admissions are emergency admissions and heart failure accounts for 5 per cent of all
emergency admissions.
The report recommendations include calling on secondary care service providers to streamline
the heart failure care pathway to ensure all patients, regardless of admission ward, have
access to recommended medication in line with NICE guidelines and that treatment is
managed by specialist staff.
For more information, please contact Gemma Reay, Public Affairs Officer on 020 7554 0154
or at reayg@bhf.org.uk