Legal right to 2 week review of patients with suspected heart failure (HF)
The 2010 NICE guidelines recommend that patients with suspected HF should be reviewed by a specialist – within 2 weeks for urgent cases. Patients are presently waiting up to 20 weeks for specialist assessment.
The Government should ensure that this recommended right to a review within 2 weeks is set out in law.
Many heart failure patients have poor outcomes, with 1-and 5-year mortality rates worse than some of the most common cancers.
In 2010 it became a legal right of NHS patients with suspected cancer to be seen by a hospital doctor within 2-weeks of a GP referral.
We request that NICE quality standards are implemented with the same vigour as they are in cancer, and for the government to legislate that high-risk patients with suspected heart failure are seen by a specialist within 2-weeks of referral.
Petition question asked by Dr Fozia Ahmed and Nick Hartshorne-Evans
“The Government’s ambition to improve outcomes of people with heart failure remains a priority, with new initiatives to detect heart failure early and providing support for those diagnosed with it.”
Read the response in full
The National Institute for Health and Care Excellence published guidance on the diagnosis and management of heart failure in 2018. It recommended that patients should receive a clinical examination and those with suspected heart failure should be reviewed urgently by a specialist and that transthoracic echocardiography be undertaken within 2 weeks of referral. NICE guidance
There are no plans to set out in law that patients should be reviewed by a specialist within 2 weeks of referral.
Heart Failure, along with other conditions associated with cardiovascular disease (CVD), are a key priority in the NHS Long Term Plan (LTP). One of the ambitions of the NHS LTP is to raise awareness of the symptoms of heart failure and to ensure early and rapid access to diagnostic tests and treatment.
To improve early detection of heart failure, NHS England and Improvement (NHSEI) is committed to increasing access to the brain natriuretic peptide (BNP) blood test and echocardiography, with early adopter sites testing clinical pathways in 2021. Greater access to echocardiography in primary care will improve the investigation of those with breathlessness, a key heart failure symptom.
In April 2020, the Quality and Outcomes Framework (QOF), which is an annual reward and incentive programme for GP surgeries in England, was updated to support moves towards earlier diagnosis and management. GP surgeries are asked to capture data to show they have fulfilled their QOF requirements, which encourages the earlier confirmation of heart failure diagnosis. This update also means that patients with heart failure can now expect to have an annual review.
NHSEI is also working with Health Education England (HEE) to develop a new e-learning tool to support primary care professionals, in learning to better recognise the symptoms of heart failure. This will raise awareness of heart failure as a long-term condition and improve the support that GPs and other primary care professionals offer those with heart conditions. We anticipate that this will be made available via digital platforms in late summer 2021.
To increase the support for people at greater risk, NHSEI plan to increase the numbers of people who have access to remote blood pressure monitoring. The NHS@Home programme remains committed to addressing health inequalities. We have introduced targeted blood pressure monitoring systems for patients that are clinically extremely vulnerable with high blood pressure, individuals from Black, Asian or Minority Ethnic backgrounds from areas of higher deprivation, and those that are 65 years of age or over.
From April 2021, a further 198,000 remote blood pressure monitors will be available for primary care. This intervention will allow people to monitor their blood pressure from their home, avoiding a trip to their GP practice, by communicating their results to their primary care clinician via a digital platform or phone call to the practice.
NHSEI has commissioned five areas of the country to provide targeted and specialist support to people with heart failure. Working with a specialist clinician, patients will be supported in their own home to better manage their condition. This includes managing medications, reducing salt intake, monitoring and recording their weight and blood pressure daily. Importantly, people will also be supported to recognise if their condition deteriorates and to take the appropriate action.
Similar approaches elsewhere have led to a reduction in hospital admissions, increased patient experience and quality of life and improved patient and carer knowledge of how best to manage heart failure.
The NHS Long Term Plan sets out that people with heart failure and heart valve disease will be better supported by multi-disciplinary teams as part of primary care networks (PCNs). From 1 July 2019, all patients in England have been be covered by a PCN. Development of a PCN Directed Enhanced Service for CVD prevention and diagnosis is ongoing and will be implemented in 2021/22. This emphasises the importance of early diagnosis and management of patients with heart failure and heart valve disease in primary care in line with published NICE guidance.
The LTP also commits to improving rapid access to heart failure nurses so that more patients with heart failure, who are not on a cardiology ward, will receive specialist care and advice. Better, personalised planning for patients will reduce nights spent in hospital.
We have made enormous progress in understanding more about heart failure, we must also acknowledge that, along with other forms of heart disease, heart failure remains high on the list of the biggest killer diseases in England. The Government’s ambition to improve the health outcomes of people in this country living with heart failure remains a priority and we are addressing the key issues by putting in place new initiatives to detect heart failure early and by providing support for individuals who have been diagnosed with it.
Department of Health and Social Care
See the petition on the government petition website