Michael McHale , 2025-05-09 07:30:00
Review of services finds significant variation in waiting times and referral processes around the country
Staffing levels in public cardiac rehabilitation services have fallen by 37.5 per cent in the last 15 years, with 81 fewer full-time posts in the area last year compared to 2009.
The figures were revealed in a new report which analysed current services provided and areas where additional resources are needed to improve access to cardiac rehabilitation.
The document found that, in May-June 2024, there were 134.6 whole-time positions filled in publicly-funded cardiac rehabilitation services, of which 84.8 were based in hospitals and 49.8 in specialist ambulatory care hubs.
This compares to 215.6 whole-time staffing positions filled throughout the service in 2009. This is despite demand for the service remaining relatively static – there was an estimated requirement for 19,220 rehabilitation places in 2014, compared to 18,551 places required in 2023.
“Hospital-based cardiac rehabilitation has experienced a depletion of cardiac rehabilitation staff since 2009 and the hubs, which in recent years have received funding to support a cardiac rehabilitation team, are experiencing challenges with regard to recruitment of complete cardiac rehabilitation teams,” the report noted.
Cardiac rehabilitation staffing reached its lowest level in 2015, when just 80.4 full-time roles were in operation.
The report highlighted that, since then, staffing levels have increased through the funding of cardiac rehabilitation in the chronic disease hubs which were established in 2020 as part of the v (ECC) programme.
However, staffing in hospitals has only increased by 4.4 whole-time equivalents nationally during the same period.
The majority of staff currently working in cardiac rehabilitation are nurses, who represent 84.9 full-time positions in the service. Physiotherapists account for 27.6 roles, while there are just 4.7 psychologists, two dietitians, 1.4 occupational therapists and one pharmacist employed in this area.
The review included a survey of cardiac rehabilitation staff with responses indicating a need for additional resources across all disciplines to deliver cardiac rehabilitation to priority patient groups.
“Lack of dietetic input was cited as a barrier by many, as there were no dedicated dietetic services resourced for cardiac rehabilitation in the hubs as part of the ECC programme, nor is there capacity for in-depth dietetics input in most hospital-based cardiac rehabilitation services,” the report said.
The review also found significant differences across the country in how patients were referred for rehabilitation services. The Model of Care for Integrated Cardiac Rehabilitation recommends that electronic referral services are used, but just six sites were found to have one of two common IT solutions to facilitate the referral process.
Major variation was also found in waiting times for services across Ireland, that is attributed to staffing levels, the ability of hubs to deliver the various components of cardiac rehabilitation and modes of delivery.
While the Model of Care recommends that phase III cardiac rehabilitation – usually consisting of an intensive outpatient exercise and education programme – begins within four weeks of a patient being discharged from hospital, the review found that waiting times varied from two to 29 weeks, with a median waiting period of 12 weeks.
“We know that cardiac rehabilitation reduces mortality, hospital readmissions and improves quality of life,” said Dr Angie Brown, medical director of the Irish Heart Foundation.
“The Overview of Cardiac Rehabilitation Services in Ireland is an important piece of work highlighting the gaps in service around the country.
She added: “The Irish Heart Foundation welcomes this report and the recommendations to address the issues identified, in particular the recommendation to prioritise allocation of posts to cardiac rehabilitation, with a particular focus on ensuring access to dietetic and psychology services. Implementation of these actions will lead to a high-quality cardiac rehabilitation service available to patients wherever they live in Ireland.”
The HSE said that it is already taking steps to address key service needs identified in the report. This includes an evaluation of the impacts of implementing all aspects of the Model of Care, which is currently taking place in Mayo and the Galway-Roscommon area.
The HSE is also collaborating with the National Institute for Prevention and Cardiovascular Health on the development of a clinical action guide. This will provide practical guidance on implementation of the Model of Care nationally.
