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Commissioning a cardiac rehabilitation service

Reabling people with coronary heart disease

photograph of Professor Roger Boyle

Professor Roger Boyle CBE, National Director for Heart Disease and Stroke

There is a wealth of evidence to support the fact that cardiac rehabilitation improves outcomes for many people with heart disease, enabling them to remain active for longer and manage their condition more effectively.  Indeed, the Coronary Heart Disease National Service Framework (2000) included a separate chapter on cardiac rehabilitation to make it clear that it forms an intrinsic part of the cardiac pathway for eligible patients.

Despite this, we know from the National Audit of Cardiac Rehabilitation that significantly fewer people are accessing the benefits of a high quality cardiac rehabilitation service offers.  Even for those who are, it is often insufficiently flexible or responsive to ensure all those who could benefit to take up the offer.

This is due, in part, to the complexity of the service; the fact that it includes a range of services, in a variety of settings provided by different people and organisations does make it more challenging for non-specialists to understand and commission.  Yet, these barriers need to be considered against the facts; that cardiac rehabilitation is a cost effective way to help people with heart disease to live longer, healthier lives and that people value it, deriving significant benefit, particularly in terms of improving their quality of life.  The NHS has a responsibility to ensure that those who are eligible and can benefit from cardiac rehabilitation are able to do so.

This is not just a problem for England.  A recent study indicates that there is low provision of cardiac rehabilitation in many countries, with a lot of the same barriers to take up identified.  However, I believe that the approach this pack takes offers the NHS in England an opportunity to make a step change in the commissioning of cardiac rehabilitation services. At its heart is a clear and evidenced service specification, which is supported by procurement and contracting tools to enable both commissioners and provider organisations to understand what is required, from whom and critically to assess whether what is being provided is of high quality and meeting peoples’ needs and expectations.  I would urge colleagues in the NHS to use this pack to make a real difference to peoples’ lives.


The Cardiac Rehabilitation Reference Group was established to review and advise on the clinical content of the pack. The involvement of leading cardiac rehabilitation professionals and patients has provided us with the opportunity to include best practice approaches currently employed in the NHS.

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