The 2023/24 Heart Failure Targeted Funding Programme (HFTFP) was developed by the NHS England (NHSE) Clinical Policy Unit (CPU). The HFTFP provided non-recurrent indicative targeted funding of over £4.4 million to improve access to a HF specialist/specialist HF multidisciplinary team (MDT) in community settings and during admission. 

The programme aims were to support local systems to work towards delivering the NHS Long Term Plan aims and the broader Cardiac Transformation Programme ambition to reduce HF 30-day readmission rates through:

• Early detection of HF in community settings
• Providing rapid access to a HF specialist/MDT during admission and implementing robust discharge planning
• Early specialist HF MDT follow-up in the community.

The NHSE CPU commissioned the NHS Strategy Unit to evaluate the use of this funding. The evaluation provided findings relating to how HF services had used the funding through eight case studies (from fifty-five funded projects) relating to particular themes of interest, and also made recommendations for NHSE on designing future non-recurrent funding programmes.

The full report and executive summary are available here, along with a summary of the findings.

How HF services used the funding

Introducing digital tools to HF services

Two case study projects used the funding to introduce digital tools for remote patient monitoring. The evaluation found that:

• There are significant Information Governance considerations with introducing remote monitoring and the time for this needs to be factored into planning
• Introducing a new digital tool to a service will take considerable time and resources to build practitioner and patient confidence to use it, and therefore may not be suitable for a short-term project delivered at scale.

Enhancing community detection of HF

Two projects were seeking to enhance community detection of HF. The evaluation found that:

• Upskilling primary care colleagues in the detection and management of HF can be an efficient method for creating sustainable transformation in HF services, reducing the burden on hospital services and enhancing preventative measures
• A targeted approach to HF screening in primary care based on specified risk factors is likely to reduce healthcare inequalities by improving the identification of HF in underserved groups and those with multi-morbidities.

Patient education

Two projects were focused on developing patient education around HF. The evaluation found that:

• Securing support from primary care was critical to deliver the projects, and this required a clear communications strategy and resource to deliver it.

Rapid up-titration of HF medications

Two projects were developing an approach to rapid up-titration based on the STRONG-HF trial. The evaluation found that:

• Rapid up-titration was supported by dedicated HF specialist nurses who did not have a prescribing qualification; obtaining a prescribing qualification may make rapid up-titration more efficient
• Deciding the inclusion and exclusion criteria that determine which patients are appropriate for rapid up-titration is a critical task to consider for similar projects.

How future national non-recurrent funding programmes might be adapted

Although the HFTFP successfully delivered funding to over fifty projects, ensuring projects could be delivered as planned was a challenge, as was monitoring their impact on HF performance. The evaluation made the following recommendations for similar national funding programmes.

Project funding

• Two years is a more feasible time period for these kinds of projects (rather than the one-year provided). It is important that funding is available at the start of the financial year and projects are not subject to delays linked to processes for receipt of funding through their ICB or other routes
• Releasing funding in stages may reduce the risk of money being distributed that cannot be spent. For example, allocating and releasing a proportion of the funding to set-up a project and, once it is confirmed as ready to deliver, releasing the remainder of the funding with agreement from local finance teams that this can be spent in full
• Services receiving non-recurrent funding should determine whether recruitment is necessary for introducing a short-term project, or whether capacity for delivering this work could be ringfenced or secured in other ways that take less time.

Programme design

• The HFTFP prioritised improving early detection of HF, enhancing provision of rapid access to a HF specialist during an admission and better post-discharge support for HF patients. Delivering transformation activities to support these ambitions is challenging and requires detailed plans with evidence provided as part of proposals of support from relevant clinical, operational and system leads. As part of the funding process for this (and similar schemes) there should be further scrutiny on bids to assess the potential delivery risks and mitigations in place
• NHSE should provide projects with structured opportunities for sharing learning with each other, particularly in the early stages of the programme when projects are being set-up, to support them to overcome challenges and mitigate delays.

Monitoring the impact of funding

• National funding programmes with short timescales should focus on supporting projects which deliver interventions with an existing evidence base. This makes it more likely they will have existing data to demonstrate impact and be able to be delivered within the funding cycle. Innovation projects with no or limited evidence to suggest their impact might better be supported through a separate innovation-focused programme.