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Denise Lewis Denise Lewis Cardiac Cardiac Rehabilitation Rehabilitation Service Co- Service Co- ordinator ordinator
Denise LewisDenise LewisCardiac Cardiac
Rehabilitation Rehabilitation Service Co-Service Co-ordinatorordinator
WALESWALES
Ceredigion and Ceredigion and Mid Wales NHS Mid Wales NHS
TrustTrust
PopulationPopulation
• Ceredigion – Ceredigion – 75,00075,000
• Catchment Catchment population –population –121,000121,000
• Plus holiday-Plus holiday-makers and makers and studentsstudents
Background SummaryBackground Summary
• 1996 1996 - £25,000 pump priming BHF 2 year £25,000 pump priming BHF 2 year
grantgrant- Employed IWTE C.R. NurseEmployed IWTE C.R. Nurse- In Kind services by dietician, In Kind services by dietician,
pharmacist, physiotherapist, cardiac pharmacist, physiotherapist, cardiac nurse.nurse.
- Full funding for C.R. Nurse when grant Full funding for C.R. Nurse when grant money ended money ended
Back ground to the Present Back ground to the Present ServiceService
• In Nov 2003 a Big Lottery Fund award In Nov 2003 a Big Lottery Fund award of £289,572 allowed the development, of £289,572 allowed the development, implementation and evaluation of the implementation and evaluation of the Ceredigion Communities Cardiac Ceredigion Communities Cardiac Rehabilitation Scheme. Rehabilitation Scheme.
• Previously the supervised exercise Previously the supervised exercise element was only available at element was only available at Bronglais hospital, once weekly, and Bronglais hospital, once weekly, and only for patients recovering for a only for patients recovering for a Myocardial Infarction (M.I) living Myocardial Infarction (M.I) living within the Aberystwyth area.within the Aberystwyth area.
How Did We Do It?How Did We Do It?Partnership BiddingPartnership Bidding
Ceredigion/Mid Wales NHS Trust
University Wales Aberystwyth Local Council Authority
Ceredigion health alliance
Geophysical ProblemsGeophysical Problems
Geographically remote – sparse, rural, isolated Geographically remote – sparse, rural, isolated populationpopulation
• Deprived areasDeprived areas
• Poor public transport linksPoor public transport links
• Growing Elderly populationGrowing Elderly population
‘ ‘ rural deprivation can be difficult to recognise as it rural deprivation can be difficult to recognise as it often exists in isolated pockets and, because most often exists in isolated pockets and, because most statistical measures fail to take account of spatial statistical measures fail to take account of spatial factors which are a feature of rural deprivation, it is factors which are a feature of rural deprivation, it is difficult to illustrate statistically’. difficult to illustrate statistically’. Dyfed Powys Public Dyfed Powys Public Health Annual Report 2002 Health Annual Report 2002
Previous service Previous service INADEQUATE INADEQUATE
• Poor access to servicesPoor access to services
• 1 whole time equivalent CR Nurse post 1 whole time equivalent CR Nurse post
hospital basedhospital based
• 1 exercise session per week, in 1 exercise session per week, in
physiotherapy dept at BGH hospital ,for 8 physiotherapy dept at BGH hospital ,for 8
weeks.weeks.
The Cardiac Rehabilitation The Cardiac Rehabilitation Annual Report of 2000 Annual Report of 2000
stated thatstated that• Of those patients admitted to hospital with a Of those patients admitted to hospital with a
primary diagnosis of M.I only 40% of those primary diagnosis of M.I only 40% of those eligible attended hospital based Cardiac eligible attended hospital based Cardiac Rehabilitation..Rehabilitation..
• Patient reasons for non attendancePatient reasons for non attendance• distance to hospital (for most this would mean a distance to hospital (for most this would mean a
round trip round trip • 60 miles)60 miles)• local transport is inconvenient and inaccessible local transport is inconvenient and inaccessible • inability to drive due to cardiac conditioninability to drive due to cardiac condition• 4 hrs away from employment4 hrs away from employment
Patient service Patient service questionnaire for Cardiac questionnaire for Cardiac
Rehabilitation 2000Rehabilitation 2000Reported that:Reported that:• Readmission rates following M.I. had fallen from Readmission rates following M.I. had fallen from
23%23% 8.3% 8.3%• Smoking cessation had risen from Smoking cessation had risen from 68.1% to 91%68.1% to 91%• 92.3% attributed there recovery to the Cardiac 92.3% attributed there recovery to the Cardiac
Rehabilitation Specialist Nurse Rehabilitation Specialist Nurse
• ComplianceCompliance by patients has significantly risen inby patients has significantly risen in• cholesterol management, cholesterol management, • medication compliancemedication compliance• healthy eatinghealthy eating• exerciseexercise• and weight lossand weight loss
Aims - in Real LanguageAims - in Real Language
• To show people how much fun exercise can beTo show people how much fun exercise can be• To have a good laughTo have a good laugh• To keep them out of hospital To keep them out of hospital • To find out if what we do makes a differenceTo find out if what we do makes a difference• To find out if we are doing a good jobTo find out if we are doing a good job• To find out what we need to improve onTo find out what we need to improve on
Aims - in Real LanguageAims - in Real Language
• To help people through the rough times when To help people through the rough times when they have had bad news about their condition they have had bad news about their condition and get them back on trackand get them back on track
• To explain all the double Dutch jargon provided To explain all the double Dutch jargon provided by medics/cardiologists , ETCby medics/cardiologists , ETC
Aims - in Real LanguageAims - in Real Language
• To be that shoulder to cry onTo be that shoulder to cry on
• To teach them all about different ways to keep To teach them all about different ways to keep healthyhealthy
• To try and stop them from having another To try and stop them from having another cardiac eventcardiac event
Aims in Real LanguageAims in Real Language
Help them to cope with having a heart Help them to cope with having a heart problemproblem
To help them make new friendsTo help them make new friends
To always have any open door should they To always have any open door should they need itneed it
To teach them how to get the most from life To teach them how to get the most from life and live longerand live longer
In “Sales Talk” What Was In “Sales Talk” What Was Actually SaidActually Said
• To promote the benefits of a healthy life style To promote the benefits of a healthy life style of participants and their familiesof participants and their families
• To Promote social integration and reduce To Promote social integration and reduce social isolation through the provision of social isolation through the provision of community based cardiac rehabilitationcommunity based cardiac rehabilitation
• To promote a non threatening, non To promote a non threatening, non institutional approach to health promotioninstitutional approach to health promotion
Cont..Cont..
• To provide a research based cardiac To provide a research based cardiac rehabilitation service that is accessible for those rehabilitation service that is accessible for those residents of Ceredigion with established CHDresidents of Ceredigion with established CHD
• To provide and promote a safe and effective, To provide and promote a safe and effective, approved programme……….approved programme……….
• To establish a multi disciplinary approach to To establish a multi disciplinary approach to health carehealth care
What Did We Need?What Did We Need?
• Evidence of Need - audit, annual reporting ,the Evidence of Need - audit, annual reporting ,the bigger picture, link in with other organisationsbigger picture, link in with other organisations
• Enthusiasm - be positiveEnthusiasm - be positive
• Guts - don’t be afraid to ask for helpGuts - don’t be afraid to ask for help
• Determination- ask yourself how much you really Determination- ask yourself how much you really want it. If you don’t truly believe in what you are want it. If you don’t truly believe in what you are saying no one else willsaying no one else will
What Don’t You Need?What Don’t You Need?
• A negative attitude - nobody likes a whinerA negative attitude - nobody likes a whiner
• A false perception that lots of people will want to A false perception that lots of people will want to help youhelp you
• A false perception of how time consuming it is – a A false perception of how time consuming it is – a good quality report requires time investmentgood quality report requires time investment
Monitoring/EvaluationMonitoring/Evaluation• In partnership with the Sports and Exercise In partnership with the Sports and Exercise
Science Department, University of Wales, Science Department, University of Wales, Aberystwyth. PHD StudentAberystwyth. PHD Student
• Data collection mechanisms include:Data collection mechanisms include:– Participant throughput numbersParticipant throughput numbers– Physiological/psychological pre- and post-testingPhysiological/psychological pre- and post-testing– Follow up evaluation questionnaires/focus group Follow up evaluation questionnaires/focus group
meetingsmeetings– Reduction of further cardiac events – Reduction of further cardiac events –
retrospective study of readmissionsretrospective study of readmissions– Audit data collected from risk factor Audit data collected from risk factor
management tool management tool – Feedback sessions for staff,participants involved Feedback sessions for staff,participants involved
Measure Direction of change pre classes
to post classes
Direction of change post classes to 6
month follow-up
Overall direction of
change
Desired direction of change for improved
health
Health related quality of life
Self-rated health
Anxiety
Depression
Life Satisfaction
Physical self-worth
Global self-worth
Habitual physical activity
Motivation
The results below indicate the trend of the direction of change pre classes to post classes, post classes to 6 month follow up and the overall trend of the
score
Hip circumference
Waist Circumference
Weight
Skinfold measurements
Autonomy
Competence
Relatedness
Measure Direction of change pre classes
to post classes
Direction of change post classes to 6
month follow-up
Overall direction of change
Desired direction of change
for improved
health
6 month Maintenance 6 month Maintenance UsageUsage
12 Months12 Months• Aberystwyth 840Aberystwyth 840• Aberaeron 88Aberaeron 88• Cardigan 376Cardigan 376• Lampeter 639Lampeter 639
Total Usage 1374 Total Usage 1374
*Only gym use.*Only gym use.
*Does not include swimming or circuits *Does not include swimming or circuits
Evaluation of Outcomes Evaluation of Outcomes • 503 patients were referred in 24 503 patients were referred in 24
months indicating the level of months indicating the level of demand. demand.
Evaluation of Outcomes Evaluation of Outcomes
• 74% of referrals started classes 74% of referrals started classes indicating attractiveness. 69% of indicating attractiveness. 69% of patients completed treatment (national patients completed treatment (national average completion rates are 50%). average completion rates are 50%). Early exit was mainly due to ill-health. Early exit was mainly due to ill-health. This ill-health was associated with the This ill-health was associated with the patients’ condition, not as a result of the patients’ condition, not as a result of the scheme where there were no scheme where there were no hospitalisations, resuscitations or hospitalisations, resuscitations or deaths.deaths.
Evaluation of Outcomes Evaluation of Outcomes • The main source of referral was the The main source of referral was the
hospitals. A variable rate of referral hospitals. A variable rate of referral from different GP and health centres from different GP and health centres reflected different extent of reflected different extent of engagement.engagement.
Evaluation of Outcomes Evaluation of Outcomes • The scheme utilised local authority The scheme utilised local authority
leisure centres throughout the county leisure centres throughout the county demonstrating successful partnership demonstrating successful partnership work and the local community-base to work and the local community-base to the programme. the programme.
• Participant evaluation was very strong Participant evaluation was very strong with around 90%+ reporting high with around 90%+ reporting high satisfaction with the organisation, the satisfaction with the organisation, the staff, the exercise programme, and their staff, the exercise programme, and their own personal improvement in fitness, own personal improvement in fitness, health and confidence health and confidence
Evaluation of OutcomesEvaluation of Outcomes
• The structure of the Scheme and the The structure of the Scheme and the approach of the exercise leaders approach of the exercise leaders helped participants improve their helped participants improve their feelings of confidence and feelings of confidence and independence. Social aspects of the independence. Social aspects of the approach were also important. approach were also important. These factors were considered These factors were considered important in achieving a high important in achieving a high adherence and continuation rate.adherence and continuation rate.
Evaluation of OutcomesEvaluation of Outcomes
• The comprehensive programme The comprehensive programme resulted in statistically significant resulted in statistically significant improvement in health-related improvement in health-related quality of life, self-worth, habitual quality of life, self-worth, habitual physical activity, and exercise physical activity, and exercise tolerance along with a significant tolerance along with a significant reduction in anxiety, skin-folds and reduction in anxiety, skin-folds and resting heart rate. resting heart rate.
Evaluation of OutcomesEvaluation of Outcomes
• Six-month follow-up after patients Six-month follow-up after patients left the scheme showed a sustained left the scheme showed a sustained impact. Of the follow-up sample of impact. Of the follow-up sample of 121, 46% (80% of responders) were 121, 46% (80% of responders) were still exercising and demonstrated a still exercising and demonstrated a sustained improvement in habitual sustained improvement in habitual physical activity, exercise tolerance physical activity, exercise tolerance and physical health-related quality of and physical health-related quality of life. life.
How Do We Fit ?How Do We Fit ?
National and Local National and Local Plans / Policy ?Plans / Policy ?
• Improving Health in Wales: A Plan for the Improving Health in Wales: A Plan for the NHS and its Partners. (NHS and its Partners. (National Assembly National Assembly for Wales; February 2001).for Wales; February 2001).
• Improving Health in Wales: the Future of Improving Health in Wales: the Future of Primary Care: A Consultation Document Primary Care: A Consultation Document
((National Assembly for Wales; 2001)National Assembly for Wales; 2001)
• National Service Frameworks for CHD National Service Frameworks for CHD
((2001)2001)
• Designed for Life: Creating World Class Designed for Life: Creating World Class
Health and Social Care for Wales in the Health and Social Care for Wales in the
2121stst Century Century
((National Assembly for Wales; May 2005)National Assembly for Wales; May 2005)
Ceredigion Health Social Ceredigion Health Social Care and Well Being Care and Well Being
Strategy 2005-8Strategy 2005-8Major Risks to health and social well being Major Risks to health and social well being
include;include;• Ischaemic heart DiseaseIschaemic heart Disease• Unhealthy dietUnhealthy diet• Lack of exercise Lack of exercise • SmokingSmoking• ObesityObesity• Substance and alcohol abuseSubstance and alcohol abuse• Poor geographical access to servicesPoor geographical access to services• depression depression
Provide cardiac rehab specialist Provide cardiac rehab specialist services accessible for all residents of services accessible for all residents of Ceredigion with established CHDCeredigion with established CHD
Providing cardiac rehabilitation Providing cardiac rehabilitation scheme and access to long term scheme and access to long term facilities which are close to the patients facilities which are close to the patients homehome
Working in partnership with other Working in partnership with other organisations Ceredigion county organisations Ceredigion county Council, Aberystwyth University Sports Council, Aberystwyth University Sports Science Dept, Primary CareScience Dept, Primary Care
Clear pathways of Cardiac Clear pathways of Cardiac Rehabilitation CareRehabilitation Care• Including; Including;
• early assessmentearly assessment• self management plansself management plans• multi disciplinary approach to multi disciplinary approach to Cardiac Health and Well beingCardiac Health and Well being
Pro active participants - taking Pro active participants - taking responsibilityresponsibility
Chronic disease management of Chronic disease management of cardiac patientscardiac patients
Reduction in crisis management of Reduction in crisis management of cardiac patientscardiac patients
An Evolving An Evolving Community Community
service?service?
Participant DrivenParticipant Driven
Supervised WOODLAND walksSupervised WOODLAND walks
16 Supervised exercise sessions per week16 Supervised exercise sessions per week
Flexible to the needs of those with Flexible to the needs of those with
Chronic Disease Chronic Disease
What have WE GainedWhat have WE Gained• Knowledge and experience ofKnowledge and experience of project managementproject management Working in partnership with other organisations Working in partnership with other organisations Removing barriers to successRemoving barriers to success Greater health gainsGreater health gains Greater understanding of the research processGreater understanding of the research process
A service which has been properly researched using A service which has been properly researched using validated physical /psychological toolsvalidated physical /psychological tools
• The opportunity to:The opportunity to: show our vision was achievable and is successfulshow our vision was achievable and is successful improve our standards, develop protocols, improve our standards, develop protocols, Professionally develop Professionally develop Show capability to lead a projectShow capability to lead a project
IMPLICATIONSIMPLICATIONSFROM APRIL 07 ? FROM APRIL 07 ?
• Complete withdrawal of service from ALL Complete withdrawal of service from ALL four leisure centres across the county, four leisure centres across the county, Lampeter, Aberystwyth, Cardigan, Lampeter, Aberystwyth, Cardigan, Aberaeron. No community based service.Aberaeron. No community based service.
• 1 WTE job share cardiac rehabilitation 1 WTE job share cardiac rehabilitation nurse- hospital basednurse- hospital based
• 1 exercise session per week- hospital based 1 exercise session per week- hospital based in physiotherapy dept BGH hospital. in physiotherapy dept BGH hospital.
• Inequality of service provisionInequality of service provision
• Ceredigion producing less confident, Ceredigion producing less confident, more dependant cardiac patients, more dependant cardiac patients, withwith
• increased anxiety, increased anxiety, • decreased fitness decreased fitness • who are more likely to generate who are more likely to generate
avoidable admissions to secondary avoidable admissions to secondary care and avoidable G.P visits. care and avoidable G.P visits.
• Potentially, cardiac rehabilitation Potentially, cardiac rehabilitation has prevented this for 377 patients. has prevented this for 377 patients.
• The cost saving to secondary care, The cost saving to secondary care, based on average days in hospital, based on average days in hospital, would have been £would have been £484,633.50 for 2 484,633.50 for 2 yearsyears. .
CostingsCostings
Specialist CR Nurse 3,068
Specialist CR Exercise Instructor 1,768
Admin Assistant 660
Travel 503
Admin Costs 485
Total 6,485
6mth cost 38,907
12 months 77,814
What Did the What Did the Commissioners Commissioners
SAY? SAY?
VideoconferencingVideoconferencing
• Overcome some of the problems of Overcome some of the problems of ruralityrurality
• Improve time-managementImprove time-management• Currently for Machynlleth patientsCurrently for Machynlleth patients• Planned roll out to Tywyn patientsPlanned roll out to Tywyn patients
Health of the CommunityHealth of the Community
• All primary schools in Ceredigion All primary schools in Ceredigion using our bi-lingual workbook - Keep using our bi-lingual workbook - Keep Your Heart Healthy (ages 7-11)Your Heart Healthy (ages 7-11)
School Sports TopsSchool Sports Tops
• Logo + “Keep Your Heart Healthy – Logo + “Keep Your Heart Healthy – Be Active/Cadwch Eich Calon Yn Be Active/Cadwch Eich Calon Yn Iach – Byddwch Fywiog”Iach – Byddwch Fywiog”
• Visual message to raise awareness Visual message to raise awareness of the importance of activity in the of the importance of activity in the prevention of CHDprevention of CHD
• Money raised by patients local Money raised by patients local business and organisationsbusiness and organisations
Who Are WeWho Are We
• Multi disciplinary groupMulti disciplinary group• Term of referenceTerm of reference• Welsh C. R. StandardsWelsh C. R. Standards• C.R chapter in the updated NSF C.R chapter in the updated NSF
CHDCHD• HAVE OUR OWN VOICEHAVE OUR OWN VOICE
All Wales Cardiac Rehabilitation Relay Walk
8th - 14th September 2006. Why don’t you and your team join us in walking the length of Wales from Chirk to Cardiff Bay, along the way we will be inviting people to sign their support for funding for Cardiac Rehabilitation Services. This paper will be presented to the Welsh Assembly Government at the end of the walk. Please complete the application form below: Name: Address:
Job Title: Each section of the route is approximately 20 miles, we are asking that people attempt a minimum distance of 10 miles along the route of the walk. Please tick if you are willing to walk this minimum distance or more, and the section of the route you wish to walk. Minimum distance
More Other
Route Tick to walk along this section: Chirk to Welshpool Welshpool to Knighton Knighton to Hay on Wye Hay on Wye to Brecon Brecon to Merthyr Tydfil Merthyr Tydfil to Cardiff Bay Please tick here if you would be willing to walk outside of your local area. Event T-Shirts are available at a cost of £7.50. The sizes available are: XSMALL (35/36) SMALL (37/38) MEDIUM (39/40) LARGE (41/42) XLARGE (43/44) XXLARGE (45/46) XXXLARGE (47/48) XXXXLARGE (49/50) Payment by cheques to Cardiac Rehabilitation Charitable Fund and enclosed with this application form. Please return application forms to Denise Lewis, Cardiac Rehabilitation Coordinator, Bronglais Hospital, Caradoc Road, Aberystwyth, Ceredigion, SY23 1ER by 30th June 2006.
Welsh Cardiac Rehabilitation Working Group Denise Lewis, Chair Llinell Union/Direct Line 01970 635327 Ffacs Cyfrinachol/Confidential Fax 01970 635741 E-bost/ E-mail [email protected] Ein Cyf/Our Ref DL / LWH/001 26 April 2006 Mr Brian Gibbons Health Minister Welsh Assembly Government Cardiff Bay CARDIFF CF99 1NA Dear Mr Gibbons The All Wales Cardiac Rehabilitation Relay Walk, 8th - 14th September 2006. Cardiac Rehabilitation is an integral component of Cardiac Care as identified within the National Service Framework for Coronary Heart Disease. The Cardiac Rehabilitation teams across Wales have had a proven beneficial effect on long term health prospects for cardiac patients providing comprehensive Cardiac Rehabilitation programmes that are of high quality, accessible and part of local communities, meeting the requirements set within Design for Life. Unfortunately, due to resources available there is inequity in the delivery of services across Wales and many of the programmes have only been able to develop through the support of short term funding from Inequalities in Health and the Big Lottery Funds. As this support draws to an end these services are under threat of closure. In order to raise awareness of the concerns this presents to teams, patients and communities, the need for funding and the proven need for Cardiac Rehabilitation Schemes across Wales, Cardiac Rehabilitation teams from across Wales are drawing together to walk from North to South Wales, a distance of approximately 135 miles, starting at Chirk and ending at the Assembly buildings in Cardiff Bay. A paper will be carried and passed between teams outlining the main concerns and signatures of support. We would like to invite you to meet the teams at the end of this walk at the Assembly buildings and to accept this paper. Yours sincerely Denise Lewis Chair Welsh Cardiac Rehabilitation Working Group
AREA NAME OF SERVICE FUNDING STREAM START AND END OF
FUNDING
CURRENT STAFFING LEVELS CURRENT PROVISION IMPLICATIONS FOR SERVICE AT FUNDING
TERMINATION
STAFFING LEVELS POST FUNDING TERMINATION
UPTAKE AT JAN O6
SERVICE COSTS PER YEAR
Amman Valley Llandovery
Carmarthenshire Cardiac Rehabilitation Service
WAG Inequalities in Health Fund Big Lottery Fund
March 2002 Dec 07
3.5 WTE G/H Specialist Nurses 1.4 WTE F Grade Nurses 1.2 WTE E Grade Nurses 1.0 WTE Occupational Therapist 1.4 WTE Physiotherapists 2.0 WTE Secretarial Support
Phase 1 Community Service Home visits Phase 3 Hospital Rehabilitation 2 classes Phase 3 Community Rehabilitation 4 classes
Reduction of Service, decrease to 1 session per week (probably in hospital )
2.0 WTE Specialist Nurses G/H 0.2 WTE Physiotherapist 0.53 WTE Admin support
3200 £88,551
Bridgend Bro Morgannwg Cardiac Rehabilitation Service.
WAG Inequalities in Health Fund
April 2002 December 2007
1.6 WTE C.R. Nurses 0.1 WTE Clinical Psychologist 0.4 WTE Specialist Health Visitor 0.3 WTE Community Dietitian 0.8 WTE Senior Physiotherapist 0.4 WTE Secretary 0.06 WTE Occupational Therapist
Phase 1: Inpatient counselling Phase 2: Post discharge surgical patient visitsPhase 3: Exercise provision and C.R nurse input
Phase 1: No inpatient counselling Phase 2: No post discharge surgical patient visits Phase 3: No exercise provision and C.R Nurse input
0.6 WTE Specialist Health Visitor 0.4 WTE Clinical Psychologist
1798 £131,300
Cardiff Cardiff Community Cardiac Rehabilitation Project Vale Community Cardiac Rehabilitation Project
Big Lottery Fund May 2003- June 2007
2.0 WTE CR Nurse Band 6 1.0 WTE Occupational Therapist Band 61.0 WTE Physiotherapist Band 61.0 WTE Dietitian Band 61.0 WTE Physio Tech Band 0.2 WTE C. R. Support Worker Band 31.0 WTE Clerical Support Band 3Pharmacist (4hrs/8wks) Band 8a
Home visits Community based Phase 3 and 4 classes - 2phase 3 and 14 Phase 4 Community Dietetic clinic Community O.T. clinic Community nurse lead follow up clinic Long term exercise classes
Termination of Service zero 1398 £199,945
Ceredigion South Gwynedd West Powys
Ceredigion Communities Cardiac Rehabilitation Scheme
Big Lottery Fund April 04 - 31st March 2007
1.0 WTE Community C. R.Specialist Nurse 1.0 WTE Community C. R.Exercise Instructor 0.5 WTE hrs Admin Assitant
16 Community Based phase 3 and 4 classes 16 Classes per week across the county Home visits Individual assessments Supervised Woodland Walks
Termination of Service zero over 600 participants and 87 partners or friends
£78,000
Denbighshire Denbighshire Cardiac Rehabilitation Team
WAG Inequalities in Health Fund
31st December 2007
0.8 WTE Physiotherapist Post (Vacant) 1.0 WTE Specialist Cardiac Liaison Nurse G grade 0.2 WTE Cardiac Nurse F Grade 2.0 WTE Technical Instructors 0.48 WTE OT for psychology (Vacant)
Due to lack of staff will be cutting back on classes from Mid-January. Have been unable to recruit to vacant posts due to funding issues or due to posts being temporary.
Termination of Service zero 1669 Cost for both services £116,315
Denbighshire Acute Cardiac Rehabilitaion Team for Denbighshire
WAG Inequalities in Health Fund
31st December 2007
1.0 WTE C. R Co-ordinator (Vacant) 0.32 WTE OT for psychology (Vacant) 1.0 WTE C. R Specialist Nurse 0.59 WTE Physiotherapist
Cover acute team at Ysbytu Glan Clwyd on wards and in classes
Reduction of In Hospital classes for high risk patients
1.0 WTE Cardiac Rehabilitation Co-ordinator (Vacant) 0.3 WTE OT for psychology (Vacant) 1.0 WTE Cardiac Rehabilitation Specialist Nurse 0.6 WTE Physiotherapist
FIGURES NOT AVAILABLE
As above
Flintshire Flintshire Community Cardiac Rehabilitation Service
LHB Funding was BLF prior to this
Have now received Permanent Funding
1.2 WTE Specialist Nurse Band 6 ( 2 part time posts) 1.0 WTE Leisure centre based exercise instructor
Home visits for post MI / Surgical patients 3 Leisure centre based exercise classes Assessment sessions in health centre
N/A N/A 998 £66,664 Approximately
Gwent Heart Failure Rehabilitation Project
WAG Inequalities in Health Fund
Feb 2002 to Feb 2008
Nurse Band 7 - 0.91 Nurse Band 6 - 0.8 Physio Sen 1 - 0.32 Physio Basic - 0.2 Physio Tech - 0.16 Dietician Sen1 - 0.1 Psychotherapist - 0.05MTO lll - 0.05AC lll - 0.2 AC ll - 0.59 Fitness Instructor - 0.12
Comprehensive rehabilitation programme covering 4 phases of rehab model. Nurse led outpatient clinics
Termination of Service Zero 945 £102 651
Neath/Port Talbot Morgannwg Cardiac Rehabilitation Service.
WAG Iiequalities in Health
Sept 02 Dec 07 1.5 WTE C. R. Nurses 0.5 WTE Clinical Psychologist 0.3 WTE Senior Dietitian 0.8 WTE Senior Physiotherapist 0.5 WTE Secretary 0.06 WTE Occupational Therapist
Phase 1: Inpatient counselling Phase 2: Post discharge surgical patient telephoning Phase 3: Multidisciplinary outpatient cardiac rehabilitation programme
Termination of Service Zero 1170 £138,646
Newport Caerphilly Torfaen South Monmouthshire
WAG Inequalities in Health Fund
April 2002-March 2008
1.0 WTE Specialist Nurse 0.4 WTE Physiotherapist 0.21 WTE Physiotherapy helper 0.13 WTE Admin Support Dietician 1hr every 6 weeks Pharmacy Ihr every 6 weeks
Phases 1 to 4 Nurse lead clinics
Termination of service 0.4WTE Physiotherapist 0.2 WTE Physio helper
At Sept 06 1882 £88,220
Pembrokeshire Pembrokeshire Community based healthy hearts
Big Lottery Fund Feb 05 July 07 0.6 WTE CR Nurse Band 6 0.6 WTE BACR instructor 0.2 WTE admin admin
Phase 4 classes 5 phase 3 classes
Termination of Service Zero Approx 542 75,583
Swansea Swansea Cardiac Team
Big Lottery Fund July 05 - 31st December 2007
0.7 WTE Specilast Nurse H grade 0.8 WTE Specilaist Nurse F grade (vacant)0.6 WTE Sen II physio (rotational post)0.6 WTE Sen 11 OT 0.6 WTE Secretarial hours .
2 community classes per week. Hospital Service Health Promotion and Health Screening for BME population
Termination of Service Zero 556 £93,000
Food for thoughtFood for thought
• And God populated the earth with broccoli and And God populated the earth with broccoli and cauliflower and green spinach and yellow cauliflower and green spinach and yellow vegetables of all kinds, so man would live a long vegetables of all kinds, so man would live a long and happy life.and happy life.
• But Satan created McDonalds and brought forth But Satan created McDonalds and brought forth the double cheeseburger and Satan said to man the double cheeseburger and Satan said to man “You want fries with that?” And man said “Super “You want fries with that?” And man said “Super size them!”. size them!”.
• And man gained pounds….And man gained pounds….
And God said “try fresh fruit salad". But Satan And God said “try fresh fruit salad". But Satan created ice cream and man gained pounds.created ice cream and man gained pounds.
And God said “I have sent thee heart healthy And God said “I have sent thee heart healthy vegetables". But Satan created a steak so big that vegetables". But Satan created a steak so big that it needed its own platter and man gained pounds it needed its own platter and man gained pounds and his cholesterol went through the roof…..and his cholesterol went through the roof…..
And God brought forth running shoes and a And God brought forth running shoes and a resolve to lose those extra pounds. But Satan resolve to lose those extra pounds. But Satan created cable TV with remote control so man created cable TV with remote control so man would not have to toil to change those would not have to toil to change those channels. So man watched others exercise and channels. So man watched others exercise and gained pounds.gained pounds.
And God brought forth the potato a vegetable And God brought forth the potato a vegetable low in fat in brimming with nutrition. But Satin low in fat in brimming with nutrition. But Satin created the deep fat fryer in which to plunge created the deep fat fryer in which to plunge them….. them…..
And Man clutched his remote control, and ate And Man clutched his remote control, and ate his potato chips swaddled in fat and cholesterol. his potato chips swaddled in fat and cholesterol. It tasted so good, but man went into cardiac It tasted so good, but man went into cardiac arrestarrest
And God sighed and created quadruple bypass And God sighed and created quadruple bypass surgerysurgery
But….But….
Satan controlled the health care systemSatan controlled the health care system
Thank youThank you
