Written - Inequalities In Health Fund – Cardiac Rehabilitation

The proposal for an Inequalities in Health Fund (IIHF) emerged as part of work to review the resource allocation formula. That work and Professor Peter Townsend’s report (Targeting Poor Health) promoted a ‘dual strategy’ approach advocating strategic action inside and outside the NHS to improve health and tackle inequalities in health.

The Fund was subsequently established in 2001, originally as a three-year pilot programme to ‘test bed’ initiatives and assess their future potential. The Fund’s first priority and the focus of project action is coronary heart disease with work being targeted at our most disadvantaged communities. The Fund is currently supporting 62 projects (5 others have previously reached completion) providing diverse action or services including screening and risk assessment, lifestyle change advice around nutrition and smoking cessation, workplace health, exercise on referral and cardiac rehabilitation programmes.

In recognition of their work, Ministers extended the projects in 2003 and again in 2006. The extensions have enabled projects to develop, further embed services and gather more information of results, though there was never an intention to provide long-term funding for services through this Fund.

Just under a third of the current IIHF projects have a cardiac rehabilitation element and in many cases what were originally intended as short-term non-recurrent ‘research’ monies are now funding front-line services in this area. Cardiac rehabilitation consists of four phases of intervention. Phase 1 covers the hospital based recovery period immediately following medical intervention. Phase 2 covers the sedentary home rest period lasting 6-8 weeks following discharge from hospital. Phase 3 provides an introductory exercise and education phase held mostly in leisure centres and lasting 6-8 weeks. Phase 4 is a community based programme delivered by leisure services staff in the community setting with the aim of encouraging long term maintenance of changed behaviour. The majority of IIHF projects are funding phase 3 and 4 services, but one or two projects are covering all four phases. In addition, the Fund supports two Angina Management projects and two Heart Failure service projects, all of which follow the recognised cardiac rehabilitation model of delivery. Projects are operating in areas such as Blaenau Gwent, Bridgend, Caerphilly, Carmarthen, Denbigh, Gwynedd, Merthyr, Neath / Port Talbot, Newport, Rhondda Cynon Taff and Ynys Mon.

Tackling cardiac disease remains one of the Assembly Government’s top health priorities. Preventing cardiac disease and managing people at risk of the disease is a key part of our strategy as set out in the Coronary Heart Disease National Service Framework. Local Health Boards and Health Commission Wales are responsible for assessing local health need and working with partners including Cardiac Network colleagues commissioning health services to meet that need.

IIHF project teams have reported progress and achievements to commissioners throughout the life span of the projects and are currently working with them with a view to mainstreaming successes where appropriate. Commissioners will be looking for robust evidence of sound methodologies, the quality of resources developed, good practice and improved patient outcomes to inform decisions around future investment. It is open to commissioners, if they so wish to consider the evidence and results emerging from the cardiac rehabilitation projects supported by the IIHF and decisions about the continued funding of these schemes are for them to make in light of their local priorities.

The introduction of new regional commissioning arrangements provides Local Health Boards with the opportunity of pooling resources and planning and commissioning services across wider geographical areas to meet patient need.  Local Health Board commissioning decisions will need to take account of the expert and specialist advice which the 3 regional cardiac networks can provide on the development needs of cardiac services in their area in order to meet the requirements of the CHD NSF.

The Assembly Government is aware of the valuable work which has been developed over time in the area of cardiac rehabilitation. In the third Assembly, discussions will continue in conjunction with local commissioners to explore ways to preserve the resources and services developed to date.