Cardiology Services

Audited Entities

• National Health Service (NHS)

Audit Objective(s)

• The audit looked at how effectively the NHS in Scotland manages Cardiology services, how much is spent and whether patients across Scotland have the same access to services.
• The audit also assessed whether there is scope to improve the efficiency of Cardiology services by comparing activity across Scotland and identifying areas of good practice where efficiencies have been made.

Audit Scope

• The report focuses on Cardiology services provided in hospitals. In addition to Cardiology activity, the audit looked at all hospital activity for heart disease patients being looked after in other wards. The audit did not look in detail at the work of other services that provide a lot of care for patients with heart disease, such as Cardiac Surgery, General Medicine and the Scottish Ambulance Service, but examined some issues to do with how hospital Cardiology services work with these services.
• The audit also looked at some examples of activity and prevention work that take place in the community, mostly through general practitioners and their teams.

Audit Criteria

• Not available.

Main Audit Findings

• More people in Scotland are surviving heart disease with death rates falling by around 40 per cent over the last decade. Waiting times for the two main Cardiology procedures have also gone down.
• More could be done to ensure all patients get the services they need, including those who may benefit from cardiac rehabilitation, those at risk of stroke, heart failure patients and people who have had a severe heart attack.
• There is scope to make efficiency savings of at least £4.4 million in a number of areas such as using less expensive tests, reducing length of stay, increasing day case rates and making savings in prescribing and procurement. In outpatients, there is scope to improve referral processes, reduce demand and increase the number of available appointments. These efficiency savings are a conservative estimate as we have not been able to calculate savings in a number of areas due to limitations in the data.

Audit Recommendations

• The Scottish Government and NHS boards should:
  • continue to improve the evidence base on the impact and cost effectiveness of measures to help prevent heart disease and use this evidence to identify priorities for spending to help improve outcomes and address inequalities, particularly in deprived areas; and
  • ensure that consistent and accurate activity, workforce, cost and quality information is available and shared nationally to allow NHS boards to monitor their performance, compare services and identify potential improvements in value for money.
• NHS boards should:
  • work with regional planning groups to ensure their strategic plans to develop and monitor services meet patients’ needs and address gaps in services;
  • examine variation in Cardiology services, including tests provided for heart disease, length of stay, day case rates, prescribing, procurement and outpatients, to ensure services are being provided in the most efficient way and identify scope for improving efficiency; and
  • use the checklist available on the Audit Scotland website to help improve the efficiency and effectiveness of Cardiology services.

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