What England's cardiovascular disease 'framework' could mean for you
Safiya Tarmahomed and Meg Stapleton analyse the UK Government’s new Cardiovascular Disease (CVD) Modern Service Framework, and outlines what's needed to turn proposals into action that can help people living with heart and circulatory conditions.
For too many people living with, or at risk of, CVD, getting the right care can depend on where they live, how quickly their symptoms are recognised and how easily they can navigate the NHS.
We regularly hear from people about the challenges they face. "It can almost feel like a full-time job to manage a long-term health condition, let alone several. But trying to keep on top of all appointments and getting teams to communicate with each other is nigh on impossible."
The UK Government’s new Cardiovascular Disease Modern Service Framework (CVD MSF) is an important opportunity to improve this experience.
It sets out how the NHS in England should prevent CVD, identify people at risk earlier, improve treatment, and support people following a diagnosis or cardiac event. Its central ambition is to achieve the Government’s commitment to reduce early deaths from heart disease and stroke by 25 per cent over the next 10 years.
We see the framework as a significant step forward. It shows that the Government and the NHS are serious about tackling CVD and reflects many of the improvements that we want to see for heart patients.
But progress will depend on what happens next. Here we outline some of the key proposals and what is needed to turn them into action.
Finding problems earlier
Millions of people are living with risk factors such as high blood pressure and high cholesterol without knowing it. These conditions often have no obvious symptoms, but without treatment they can increase risk of a heart attack or stroke.
The CVD MSF asks local NHS services to do more to identify these risks and help people manage them. For patients, this could mean more chances to have blood pressure or cholesterol checked in convenient settings, clearer explanations of results, and earlier support to reduce their risk.
This reflects what heart patients have told us: “If there's a way to get that awareness out there and get people understanding the risks and why they definitely need to take action earlier, and ways of preventing high blood pressure, diabetes, etc, from early, as opposed to needing to solve the problem later. I think that would be good."
Support should be practical, compassionate and tailored to the individual. People’s health is shaped by their circumstances, so services must recognise the different challenges people may face when managing their risk.
Supporting recovery and reducing inequalities
We are particularly pleased that cardiac rehabilitation is one of the framework’s national priorities.
Rehabilitation can help people recover physically and emotionally, rebuild confidence and adjust to life with CVD. Yet access remains inconsistent, and some people are never offered it. Services must be flexible, personalised and easy to access.
Regular follow-up is also essential, so people can discuss new symptoms, review medicines and receive ongoing advice.
One patient said: "If we had people like me all doing rehab, and…[professionals] with monitors...they could say, 'Okay, that exercise, it's safe’.”
The CVD MSF also rightly recognises that CVD does not affect every community equally. Where someone lives, their income, ethnicity, sex, age and access to transport can influence their exposure to CVD risk factors and chances of receiving timely, high-quality care.
A key ambition of the framework is to ensure that improvements are seen everywhere, helping to narrow the gap between communities with the best and worst outcomes. However, many health inequalities are driven by factors beyond the NHS such as poverty, housing and the environment.
Tackling these will require sustained and joined up action across government, alongside healthcare.
Turning ambition into action
The CVD MSF provides a positive national direction, but it is not yet accompanied by a detailed delivery plan.
Questions remain about health system funding, staffing, and how progress will be reported publicly. There is also limited detail on some specialist cardiovascular services and inherited heart conditions.
We also want to see how the framework will connect with other health system priorities, such as neighbourhood health providing care closer to people’s homes.
Success will ultimately be judged by whether patients experience real change. That means people being diagnosed earlier, receiving the support they need closer to home, accessing rehabilitation when they need it and feeling confident that their care is coordinated.
It also means ensuring improvements reach people in every community and help reduce longstanding health inequalities.
We will continue working with heart patients and their loved ones, the Government and the NHS, as well as our sector partners as the framework is put into practice.
By keeping patients’ experiences at the heart of delivery, this framework has the potential to help more people live with a healthier heart for longer.