Cardiac rehabilitation services

This is an extract from the commissioning guide. The complete commissioning guide is available at www.nice.org.uk/guidance/cmg40

7 Further information

Table 11 summarises national drivers that are relevant to commissioning cardiac rehabilitation services.

Table 11 National policy relating to cardiac rehabilitation

Document	Author	Year	Significance
NHS Outcomes Framework 2011/12	Department of Health	2011	Domains 1, 2, 3 and 4.
Quality, innovation prevention and productivity (QIPP)	Department of Health	2011	The workstream on long-term conditions is of particular relevance when commissioning cardiac rehabilitation.
Liberating the NHS: legislative framework and next steps	Department of Health	2011	Describes in detail how reforms of the NHS will be put into practice, including the development of NICE quality standards.
NHS operating framework for 2011/12	Department of Health	2011	Sets out the role of PCT clusters in oversee management and implementation of medium term QIPP plans. Sets out some of the mechanisms to support reform of the NHS including the NHS Outcomes Framework and extension of quality accounts to cover community services for 2010/11.
Using the Commissioning for Quality and Innovation (CQUIN) payment framework – a summary guide	Department of Health	2010	Makes a proportion of providers' income conditional on quality and innovation.
Department of Health's commissioning pack on cardiac rehabilitation	Department of Health	2010	Includes a service specification, and procurement and contracting tools to support the commissioning of cardiac rehabilitation.
Coronary heart disease: national service framework for coronary heart disease - modern standards and service models	Department of Health	2000	Chapter 7 sets out standards and milestones for cardiac rehabilitation.

Additional resources

Commissioners may also find the resources in table 12 useful when commissioning cardiac rehabilitation services.

Table 12 Additional resources for commissioning cardiac rehabilitation

Document or web page	Source	Year	Significance
Chronic heart failure pathway	NICE	2011	Provides a visual representation of NICE guidance on chronic heart failure.
NHS Improvement: heart	NHS Improvement	Various	Part of NHS Improvement's Heart Team, the Cardiac Rehabilitation (CR) workstream aims to support clinicians, commissioners, providers and patients to deliver effective clinical practice through service improvement and redesign.
Cardiac rehabilitation	Supported by the British Heart Foundation	n/a	Provides names and addresses of cardiac rehabilitation services throughout the UK.
Commissioning of cardiac services – a resource pack from the British Cardiovascular Society	British Cardiovascular Society	2011	Provides a summary of existing standards and guidelines that can be used as a basis for commissioning decisions
Heart disease and South Asians: delivering the national service framework for coronary heart disease'.	British Heart Foundation and Department of Health	2004	Focuses on work which aims to improve services for South Asian people, who are 50% more likely to die prematurely from heart disease than the general population.
Standards for physical activity and exercise in the cardiac population	Association of Chartered Physiotherapists In Cardiac Rehabilitation	2009	Aims to standardise the quality and approach taken by exercise professionals when delivering the exercise component of CR.
National Infarct Angioplasty Project (NIAP) interim report	Department of Health	2008	NIAP is a feasibility study looking at how far primary angioplasty can be rolled out as the main treatment for heart attack in place of clot-busting drugs.
BACR education	BACR education	various	Information on training courses for health and exercise professionals in the management of cardiovascular disease across the UK, including BACR exercise instructor training.
Guidance on the referral of patients between physiotherapists and fitness instructors and referral to a physiotherapist or fitness instructor for supervised exercise - referral advice for GPs	Chartered Society of Physiotherapy and Fitness Industry Association	2011	Clarifies the roles of physiotherapists and fitness instructors in delivering supervised exercise-based programmes.
Physiotherapy works: cardiac rehabilitation	Chartered Society of Physiotherapy	2011	Demonstrates the cost effectiveness of physiotherapy in cardiac rehabilitation.
Shared learning database	NICE	2011	Examples of how organisations have implemented NICE guidance locally.
NHS Evidence	NHS evidence	Various	Provides free access to clinical and non-clinical information – local, regional, national and international. Includes a QIPP library with case studies.

General information on quality and corporate assurance can be obtained from the following sources:

Indicators for Quality Improvement Programme from the NHS Information Centre. A resource of robust indicators to help local clinical teams select indicators for local quality improvement and a source of indicators for benchmarking
NHS Alliance online resources. NHS Alliance is the representational organisation of primary care and primary care trusts, and provides them with an opportunity to network and exchange best practice. The alliance supports its members with an open-access helpline, in-house and joint publications and briefings, internal newsletters and a website.
NHS Institute for Innovation and Improvement support for commissioners, includes The Productive Leader programme to enable leadership teams to reduce waste and variation in personal work processes, and Better care, better value indicators to help inform planning, to inform views on the scale of potential efficiency savings in different aspects of care, and to generate ideas on how to achieve these savings.
The Quality and outcomes framework (QOF) is a voluntary quality incentive scheme that rewards general practices for implementing systematic improvements in the quality of patient care.
Skills for Health works with employers and other stakeholders to ensure that those working in the sector are equipped with the right skills to support the development and delivery of healthcare services.

Sources of further information to help you in assessing local health needs and reducing health inequalities include:

NHS Evidence provides free access to clinical and non-clinical information - local, regional, national and international. Information includes evidence, guidance and Government policy
The National Cardiovascular Disease (CVD) profiles provide a snapshot of key issues relating to heart disease and stroke - these profiles have been designed to help local health services to assess the impact of these elements of cardiovascular disease on their local populations and the services provided to meet those needs
Department of Health Delivering quality and value – focus on benchmarking.
NICE Health equity audit – learning from practice briefing.
NHS Comparators provides comparator data for NHS commissioning and provider organisations to enable users to investigate aspects of local activity, costs and outcomes.
The Disease management information toolkit (DMIT) is a good-practice tool for decision-makers, commissioners and deliverers of care for people with long-term conditions, which presents data on conditions that contribute to high numbers of emergency bed days. It models the effects of possible interventions that may be commissioned at a local level and helps users to consider the likely impact of commissioning options.
Disease prevalence models produced by the Association of Public Health Observatories provides primary care trust-level prevalence estimates for coronary heart disease.
PARR (Patients at risk of rehospitalisation) is a risk-prediction system for use by primary care trusts to identify patients at high risk of hospital re-admission.
PRIMIS+ provides support to general practices on information management, recording for, and analysis of, data quality, plus a comparative analysis service focused on key clinical topics.
SHAPE (Strategic health asset planning and evaluation) application provides support to strategic health authorities and primary care trusts on strategic planning across a whole health economy.