Executive Response / Action Plan , item 73. PDF 68 KB

Staffordshire Health Scrutiny Committee 

Cardiac Rehabilitation Scrutiny Review 

Summary of Responses to Recommendations and Actions 

Date: October 2011 

The following response has been received from the Cabinet Member for Public Health and Community Safety: 

The report is comprehensive, insightful and forward looking and clearly a lot of work has been done by everyone who 

contributed to it. The report has been discussed by colleagues in North Staffordshire and South Staffordshire Public 

Health Teams who are coming together as Staffordshire Public Health. My response is therefore on behalf of 

Staffordshire Public Health as a whole and covers the helpful recommendations made to the Staffordshire Director of 

Public Health (1a-1c and 8). 

Recommendation 

1 a) Undertake a health equity 

audit on cardio vascular 

disease to identify services 

and other resources that exist 

to support Phase III and IV 

care* (including voluntary and 

third sector organisations) 

b) Identify what workplace 

initiatives exist in the NHS and 

local authorities in 

Staffordshire to target those 

most of risk of coronary heart 

disease 

Organisation/Lead 

Officer 

Staffordshire County 

Council - Director of 

Public Health 



Public Health 

Response/Action 

● Appraisal of health equity audit 

methodologies 

● Link with health intelligence and 

district public health leads 

●Audit initiation document to be agreed 

●Audit completed and report presented 

●Work with Staffordshire Primary Care 

Trusts (PCTs), NHS providers and 

other partners to review and identify 

gaps in workplace initiatives 

●Develop action plan to address gaps 

and assess any costing implications 

Completion 

date 

Nov 2011 

Nov 2011 

Dec 2011 

April 2012 

Nov 2011 

Dec 2011





c) Review the way in which 

information regarding 

Cardiovascular Disease (CVD) 

prevention is publicised by 

Staffordshire local authorities, 

NHS and partner agencies 

(including workplace settings) 

to ensure that key public 

health messages regarding 

prevention of CVD are 

maximised. 

2 Review the investment in 

Phase III Cardiac 

Rehabilitation (CR) services 


Officer 



Public Health/partners 

Clinical Commissioning 

Groups (CCGs) in 

Staffordshire* 


●Work with Staffordshire PCTs and 

partners’ Communication leads to map 

activity and identify key gaps and 

opportunities for disseminating 

information 

●Health and social care staff, local 

authority (LA) staff who visit people at 

home 

●Communications from NHS, LAs and 

the third sector including media and 

free newspapers/newsletters 

●Third sector volunteers 

●Work with workplace health lead at 

Staffordshire County Council to review 

and ensure that dissemination of CVD 

health information 

●Explore opportunities for targeted 

community based programmes in line 

with local priories for CVD prevention, 

health need and provision of health 

lifestyle services 

●Review and co-ordinate resource 

materials for CVD prevention as 

appropriate 

Completion 

date 

April 2012 

April 2012 

April 2012 

April 2012 

April 2012 

April 2012 

April 2012






Officer 

North Staffordshire 

CCG 


●To discuss with Planned Care GP 

leads 

●Discuss at Local Health Economy 

cardiology commissioning group with a 

view to informing North Staffordshire 

prioritisation process 

●Directorate Manager at University 

Hospital of North Staffs (UHNS) 

informed of CCG position 

●Prioritisation process to consider the 

proposal 

●Commissioning intentions produced 

Completion 

date 

19.8.11 

19.8.11 

18.8.11 

30.9.11 

30.9.11 

Stafford and Surrounds 

CCG 

Long term Conditions Group reviewing 

care for patients with cardiac problems 

in Oct/Nov 2011 and will make 

recommendations to commissioners in 

early 2012. Review report will inform 

this process. 

Oct/Nov 2011 

Early 2012 

Seisdon CCG 

The CCG do not have the capacity to 

respond to this report. 

South East Staffs CCG 

Phase 3 has been available since 

August 2012 in both Tamworth and 

Lichfield through a contract between 

the PCT and the local authorities. 

Part of the contract included a





3 To ask Borough and District 

Councils to review Phase IV 

services in their local authority 

areas 


Officer 

Stafford Borough 

Council (SBC) 


requirement for the local authority to 

provide and increase the numbers of 

people accessing Phase 4. 

There are some risks regarding the 

number of trainers in Lichfield to 

ensure sustainability. Discussion is 

ongoing between the local authority 

and the CCG. 

●Review of Phase IV services leading 

to development of a strategic plan for 

delivery of Phase IV services in SBC 

●Work with partners to identify funding 

opportunities to extend the provision of 

Phase IV services in SBC including the 

provision of preventative advice and 

guidance 

●Phase IV care provision at 

Westbridge Park and Stafford Leisure 

Centres – exercise on referral 

schemes 

●Explore opportunities to provide 

training to increase the number of 

British Association for CR (BACR) 

accredited trainers 

●Wide range of educational and 

promotion work around healthy eating, 

physical activity, stopping smoking and 

alcohol awareness including practical 

Completion 

date 

June 2012 

June 2011 

To be agreed 

subject to 

funding






Officer 


cooking sessions and physical activity 

sessions 

●Workplace health initiatives to include 

reference to both issues relating to 

CVD prevention and appropriate life 

style choices 

●Walking for Health Programme 

extended into areas affected by health 

inequalities and offered to those at risk 

of CVD 

Completion 

date 

Ongoing 

Ongoing 

Ongoing 

Cannock Chase District 

Council (CCDC) 

(The Council provided 

further details that will 

be fed into the health 

equity audit) 

●The Council’s Culture and Leisure 

Services are continuing to explore with 

South Staffordshire PCT opportunities 

to develop a more structured exercise 

programme that will incorporate Phase 

IV CR alongside other programmes. 

●A new partner is being selected to 

deliver culture and leisure services and 

this will include provision of a fully 

equipped new fitness suite at Chase 

Leisure Centre. This will include over 

100 new fitness stations that will cater 

for a range of exercises and provide an 

ideal space for patients and customers 

to take part in physical activity 

sessions that will support CR provision. 

●The refurbishment of Chase Leisure 

January 2012 

February 2012






Officer 


Centre will also provide modern 

facilities including a 25 metre 

swimming pool, teaching pool and a 

third separate small water space with 

moveable floor for less confident and 

less active swimmers. A new dance 

studio and a dedicated health and 

physical activity suite will be created in 

the facility. The equipment in the 

Health and Physical Activity suite is 

provided by funding from South 

Staffordshire PCT and will be used to 

support and compliment activities for 

the less active and physically fit, 

including CR patients and those 

customers who are less likely to visit 

leisure centres on a regular basis. 

Completion 

date 

South Staffordshire 

District Council (SSC) 

Interim response. The only provision 

that the Council is aware of is the 

PACE scheme in Penkridge. There 

are no current plans for further 

provision. 

Tamworth Borough 

Council (TBC) 

●South Staffordshire PCT & TBC 

identified the gap in service provision 

for Phase III and Phase IV cardiac 

rehabilitation programme in Tamworth.






Officer 


Residents requiring the service prior to 

2010 had to travel to Lichfield to 

access the programme, unfortunately 

the Lichfield service was discontinued. 

●In 2010 SSPCT negotiated with TBC 

Community Leisure Services to provide 

a PH3 (only) CR service at the Castle 

Activity Centre Gym. This is was an 

interim established service, which was 

well accessed. 

Completion 

date 

Completed 

●In August 2011 a combined Phase 3 

& Phase 4 CR service has been 

commissioned from the TBC 

Community Leisure services. Service 

commenced in September 2011. 

●Tamworth Borough Council’s Health 

& Wellbeing Scrutiny Committee will 

review Phase 3 and Phase 4 Service 

provisions in 6 months time. 

February 2012 

Newcastle Borough 

Council (NBC) 

There are two existing members of 

staff trained in CR and there will be 

one new one at the new Health and 

Wellbeing Centre in Brunswick Street. 

The Centre will have excellent facilities 

including a wellness key that monitors






Officer 


exercise and activity and is then 

loaded onto a computer at the centre. 

Our leisure team are going to liaise 

with the PCT to see how we can move 

forward on Phase IV and possibly 

Phase III. 

Completion 

date 

Staffordshire Moorlands 

District Council (SMDC) 

Up to the early part of this year the 

Council were undertaking CR in 

partnership with NHS North 

Staffordshire. The Council revised the 

agreement for GP referrals and tried to 

include CR but they are not rolling this 

out in the north of the county at this 

time. The Council has a short term 

agreement as the preferred provider in 

the partnership up to the end of March 

and it is hoped with the new funding 

arrangement they receive this will 

continue on an extended three year 

agreement to include CR. The 

partnership is between Parkwood, 

NHS North Staffordshire and SMDC. 

The lead officer for the Health Authority 

is Dave Sugden, Principal Health 

Improvement Manager 

(Adults and Older People), North Staffs 

NHS.






Officer 


Completion 

date 

Lichfield District Council 

(LDC) 

The exercise component of a 

community-based cardiac rehab 

programme has been commissioned 

from LDC by South Staffs PCT. The 

programme includes delivering Phase 

III exercise provision and developing 

an ongoing Phase IV programme. The 

Phase III component is a 12 week 

gym-based programme run twice a 

week supervised by a cardiac nurse 

and a trained exercise instructor. It 

includes advice on how to exercise at 

home. This commenced in August 

2011 at Friary Grange Leisure Centre 

and is currently funded through a grant 

from the PCT. Phase IV is the ongoing 

maintenance of behaviour change and 

can be provided in many different 

ways, a 6month pilot Phase IV 

exercise class has been commissioned 

which includes funding to set up and 

run a dedicated weekly Phase IV 

exercise class. This will commence at 

Friary Grange Leisure Centre when the 

first cohort of patients has completed 

Phase III. Phase IV is intended to be 

self sustaining in the long term and will






Officer 


expand to meet need. As part of the 

Phase IV programme clients will 

receive ongoing support from the 

exercise instructor to access other 

activity opportunities. The outcomes 

from all of this will be monitored. 

Completion 

date 

4 To ask the Chief Executive of 

UHNS for an explanation of 

what mechanisms are in place 

at the Trust for taking on 

board the concerns of 

Consultant Cardiologists in 

relation to the availability of 

CR provision in north 

Staffordshire 

East Staffordshire 

Borough Council 

(ESBC) 

Chief Executive (CE), 

UHNS 

The Council is undertaking a review of 

Phase III and Phase IV services in 

East Staffordshire in conjunction with 

Burton Hospitals NHS Foundation 

Trust and local GPs. 

●The Consultant Cardiologists report 

to the Clinical Director (CD) for 

Cardiology. The CD attends the 

fortnightly Executive Directors (ED) 

meeting and has the opportunity to 

report any issues or concerns brought 

to his attention. The EDs meeting is 

chaired by the CE. However the CEO 

has an open door policy and whilst 

does not wish to take action outside of 

the appropriate management 

arrangements is accessible to any 

member of staff. 

●Issues of concern can also be raised 

through the Clinical Governance 

Framework, where risks are identified 

To begin end 

of Oct 2011 

Sept 2011





5 To ask the Commissioner for 

Care and Independence to 

clarify if Personal Health 

Budgets could be used to 

support patients wishing to 

access Phase IV CR. 

Members would also be 

interested to hear if there is 

any potential to assist those 

patients receiving CR using 

telehealth. 

6 To ask the Chief Executive of 

UHNS to review the 

arrangements for those 

patients on the waiting list at 

UHNS for Phase III care to 

ensure that they are being 

offered appropriate support 

but with a view to reducing the 


Officer 

Commissioner for Care 

and Independence, 


Council 

Chief Executive, UHNS 


and reported from the Directorates, 

through to the risk group, clinical 

governance executive group and up to 

the Trust Board. Specific risks 

associated with CR have not been 

formally raised through the clinical 

governance framework. However this 

is currently being reviewed by the 

Directorate. 

●The Joint Commissioning Unit will 

investigate the possibilities of using a 

Personal Health Budget for patients 

wishing to access Phase IV CR. 

●The Joint Commissioning Unit will 

work with Clinical Commissioning 

Groups to see if any of the telehealth 

solutions currently being investigated 

would support patients requiring 

cardiac rehabilitation. 

●The CR service is currently not 

commissioned by the PCTs. However 

there is ongoing dialogue with the 

cardiology commissioning group to 

identify option for the continuation and 

growth of the service. Discussions to 

date have focused on the model of the 

service based on the national 

Completion 

date 

January 2012 

January 2012 

April 2012





waiting lists and times. 

7 To ask the PCT Cluster Chief 

Executive to review CR 

investment in Staffordshire 

with particular reference to the 

capacity of UHNS to support 

high risk CR patients 

To review the current and 

planned provision of CR in the 

community based settings 

including primary care 


Officer 


commissioning guidance. Two models 

of care have been identified for 

consideration i.e. a service delivered 

by UHNS or a service delivered by 

primary care. There are currently 34 

patients waiting for exercise. However, 

there are no delays in education which 

can be started ahead of the exercise 

programme. The Trust is hopeful that 

the discussions with the 

commissioners will be successful and 

a funded service will be stabilised in 

the next financial year. 

●A paper will be presented to Cluster 

Directors setting out the 

recommendations in the report and 

asking for approval on the proposed 

next steps 

●A review of the business case 

commissioned by Dr Steve Fawcett will 

be carried out looking at CR provision 

at UHNS and the potential for 

community based provision 

●The Cluster will follow up responses 

to each of the Clinical Commissioning 

Groups actions, reviewing their 

investment in Phase III CR to ensure 

Completion 

date 

7.10.11 

31.3.12 

14.10.11





8 To ask the Director of Public 

Health in conjunction with the 

Staffordshire and Shropshire 

Heart and Stroke Network to 

explore examples of good 

practice in relation to 

promoting the recruitment and 

retention of BACR registered 

CR trainers; and 

If more funding could be made 

available to sponsor BACR 

registered trainers 


Officer 

Director of Public 

Health with 

Staffordshire and 

Shropshire Heart and 

Stroke Network 


that there is a co-ordinated approach 

to the review 

●Map current cohort of trained BACR 

instructors in Staffordshire including 

training public and private sector staff 

in relation to health need 

●Identify current cohort eligible for 

BACR training within Leisure Services 

●Explore workforce planning with all 

Staffordshire Councils (x7) to increase 

number of staff qualified to be BACR 

trained 

●Use NICE and BACR commissioning 

and benchmarking tool to identify: local 

indicative service (staff) requirements 

and change in capacity required. 

●Review current activity (including 

referral rates source of referral. 

Model future commissioning intentions 

and assess any potential costs. 

●Explore opportunities for 

development of appropriately trained 

workforce with other partners e.g. 

voluntary and private sector). 

Completion 

date 

December 

2011 

December 

2011 

December 

2011




• The Director of Public Health has also provided the following information: 

Objective Action Timescale 

To ensure Cardiac 

Rehabilitation Phase IV 

service provision meets health 

need. 

●Map current health need and patterns of service delivery 

●Identify and set up delivery in appropriate community venues (other 

than leisure services) to match health need (e.g. in areas of high 

health need poor service delivery). 

To improve retention of BACR 

trained staff and assure 

service quality 

To work collaboratively with 

Phase III in order to achieve 

national outcome targets of at 

least 85% of people who have 

had MI or undergone 

vascularisation surgery 

accessing CR 

Consult with staff and patients to inform Phase IV service 

development and improve service quality/the patient experience. 

●Work with LA partners to ensure staff are appropriately: 

- qualified 

- incentivised/remunerated for undertaking BACR training 

- supported as a staff group with ongoing continual professional 

development, membership of Register of Exercise 

Professionals. 

●Work closely with Phase III commissioners to ensure that the patient 

pathway is coherent and appropriate to the patients’ needs. 

●Phase IV providers to work closely with Phase III providers to 

ensure that patients where appropriate are referred and supported to 

Phase IV and that transition rates (number of patients/%of patients) 

from Phase III to Phase IV are sustained. 

*No response has been received from the CCGs for Cannock and East Staffordshire. 

January 2012 

In line with 4 year 

plan for 

realignment of CR 

as whole (NICE 

recommendation). 

By end of March 

2012

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