National service framework

National service framework (NSF) for coronary heart disease

The national service framework for coronary heart disease (NSF CHD), published in March 2000, set out a strategy to modernise CHD services. It detailed standards for improved prevention, diagnosis, treatment and rehabilitation and includes goals for securing fair access to high quality services.  

At the time we said that “For the whole NHS and other bodies to implement the NSF in its entirety could take 10 years or more”.  

March 2010 does not mark the end of the CHD NSF’s implementation.  Much of what is in the NSF is as relevant now as it was nine years ago, and much of it will still be relevant in 10 years time.  But, ten years on from publication, it is time to take stock – to look at why we have been able to make such excellent progress in some areas but not in others.

Excellent progress has been made and the Government’s aim of reducing the death rate from CHD, stroke and related diseases in people under 75 by at least 40 percent was met five years early.  

But there are areas that have developed less slowly than others, for example cardiac rehabilitation and the treatment of heart failure and we need to understand why.

Also, the NHS has changed a lot since the CHD NSF was published.  Working practices in cardiology are changing.  Patient expectations have changed.  Technology has advanced.  Simultaneously it is clear that over the next few years, at the same time as continuing to deliver high quality services, the NHS will need to focus firmly on improving quality and productivity.

To enable us to learn the lessons of the past 10 years and develop the evidence for where we need to work with the NHS to focus our attention in the future, the Department has commissioned three strands of work to:

- review the impact of the CHD NSF to determine the success factors and the barriers to progress in implementing the NSF, including how the needs, requirements and expectations of patients have altered since 2000.  

- look at how the burden of disease has changed since 2000 and determine how it is expected to change over the next decade.  

- analyse what technological changes have taken place and consider the impact of future developments on the provision of cardiac services.  

We are working with key stakeholders on these three strands of work.  If you are interested in contributing to any of these pieces of work please contact the Heart Team by clicking on the link below.

Sheila Leatherman is a research professor at the School of Public Health, The University of North Carolina and a visiting fellow of the London School of Economics is providing independent advice to the Department on this work.

Based on what we learn through our work, we hope to make recommentations to the NHS Quality Board later in the year about how best to ensure that tackling heart disease - and other vascular diseases which share the same risk factors like stroke, diabetes and kidney disease – remains a top priority for the NHS.