Guideline 57 - Supporting Material: Staff requirements for a cardiac rehabilitation service

[Scottish Intercollegiate Guidelines Network]

Guideline 57 - Supporting Material

Cardiac rehabilitation

Staff requirements for a cardiac rehabilitation service

The guideline development group have developed an estimate of the staff costs required to deliver multidisciplinary cardiac rehabilitation to patients with a wide range of needs. These represent the costs likely to be required to rehabilitate 500 patients. The following assumptions have been made:

The 500 patients will be a mixture of post MI, revascularisation, angina, and heart failure patients, with post MI and revascularisation patients predominating.
All patients with be suitable for some form of rehabilitation, with 250 (50%) opting for group exercise training, 150 (30%) preferring a home-based programme, and 100 (20%) not interested in any rehabilitation.
Patients attending Phase 3 group classes and those who undertake home-based programmes will each have a formal assessment of functional capacity at the beginning and end of their programmes.
Group exercise classes will run once a week for eight weeks and will accommodate 12-15 patients at any one time. It follows that three separate classes will be required each week. If a decision is taken to run group exercise classes twice a week, six classes will be needed.
The population served will be predominantly urban, arbitrarily defined as 80% of patients living within 10 miles of a district general or teaching hospital. For Health Boards with a significant rural population, costs are likely to be higher because of smaller class sizes and longer travelling times.
The first point of contact for patients with psychological distress will be a nurse therapist with training in cognitive behavioural therapy, rather than a clinical psychologist. A smaller number of clinical psychologist hours will then be required to help those patients whose anxiety or depression does not resolve with the advice and treatment provided by their nurse therapists.

These assumptions allow the following estimates of staff requirements to be made for Health Boards with and without a significant rural population:

Staff	WTE	Salary costs* (£)	Employers costs (£)	Total (£)
G Grade nurse	3.0	69,855	10,478
Senior 1 Physio	1.4	28,288	4,242
Senior 1 Dietitian	0.3	6,929	1,039
D grade Pharmacist	0.2	5,750	863
Clinical Psychologist (Grade A)	0.2	6175	926
Audit and Clerical (Grade 3)	0.5	5,924	889
		122,921	18,437	141,358
Rural supplement
G Grade nurse	0.5	11,642	1,746	13,388

Twice weekly class supplement
Senior 1 Physio	0.6	12,123	1,818	13,941

* 2000-01 salary scales

Cardiac rehabilitation costs which have not been included in these estimates are:

Health visitor seeing patient at home once a week for 3-4 weeks during Phase 2 rehab.
Heart Manual and training facilitators to administer the manual.
Providing training for rehabilitation nurses in cognitive behavioural therapy.
Travel for an outreach nurse in a mixed urban and rural population.
Supervision of self help group classes.
Long term cost of follow up in primary care.Educational material and other consumables.
Capital costs.

These estimates of cost reflect the likely requirement for cardiac rehabilitation if the targets set by the Clinical Standards Board for Scotland are to be met. Health Boards may wish to vary the amount spent on cardiac rehabilitation according to local needs and priorities. The cost of providing cardiac rehabilitation services in Scotland has also been considered by the Scottish Needs Assessment Programme (SNAP).