Supporting the National Roll Out of the Rapid Access to Valve Assessment (RAVA) Pathway

Funded by NHS England, the Rapid Access to Valve Assessment (RAVA) programme builds on a highly successful pilot delivered at Manchester University NHS Foundation Trust (MFT), with the Transformation Unit playing a key role in its design and implementation. The Transformation Unit provided programme leadership, supported pathway redesign, and facilitated stakeholder engagement to codevelop an effective and scalable model. The pilot streamlined patient journeys which had previously been fragmented, reduced unnecessary appointments, and enabled earlier multidisciplinary review for high‑risk patients. Quantitative outcomes showed substantial reductions in time from diagnostic assessment to specialist review and treatment decision, alongside positive feedback from patients and clinicians. This pilot provided a strong clinical and operational evidence base for national adoption.

Following the pilot’s success, NHS England commissioned the Transformation Unit to lead the national rollout, a recognition of our expertise in clinical redesign, stakeholder engagement and programme management.

The ambition was clear: to develop a consistent, scalable model for managing left-sided valve heart disease that enables:

• Reduced referral‑to‑assessment times for patients with suspected severe valve disease
• Direct referral from echocardiography providers into specialist services
• Reduced duplication, unnecessary appointments and pathway fragmentation
• Improved patient experience through faster, clearer and more coordinated care

The programme was implemented across five surgical centres:

• Blackpool Teaching Hospitals NHS Foundation Trust
• Hull University Teaching Hospitals NHS Trust
• Imperial College Healthcare NHS Trust
• Leeds Teaching Hospitals NHS Trust
• The Royal Wolverhampton NHS Trust

The Challenge

Early pathway mapping and a retrospective analysis across the five sites identified a consistent set of challenges, including prolonged waits, indirect and often unclear referral routes and fragmented patient journeys across multiple services. While the specific points of delay varied between organisations, all sites demonstrated significant inefficiencies and a lack of standardisation. This resulted in avoidable delays to treatment, increased administrative burden and a suboptimal experience for patients navigating the pathway.

The Transformation Unit was asked to bring its clinical redesign, stakeholder engagement and programme delivery expertise to streamline pathways and implement a model that supports timely, effective decision-making for patients with left-sided valve heart disease.

The Approach

Working in close partnership with clinical teams across all five sites, we led the end-to-end programme, adapting the proven Manchester pilot model to reflect local contexts while maintaining core principles.

Our approach focused on co-design, data-driven insight, and structured implementation. We:

• Mapped existing pathways and worked collaboratively with clinicians, stakeholders and patients to identify opportunities for improvement
• Translated the pilot model into locally deliverable pathways, accounting for differences in referral routes, cardiology team structures, and service configurations
• Developed implementation plans, supporting documentation, and governance frameworks
• Established baseline data, agreed key metrics, and implemented consistent data collection processes

This ensured each site could embed the RAVA model in a way that was both locally relevant and nationally consistent.

The Impact

Variations in service configuration and local nuances across sites resulted in each proposed pathway being shaped differently. This bespoke approach was necessary to optimise efficiency and deliver the greatest improvement for patients with severe valve disease in their localities. Data collection points and outcome measures were tailored to reflect local pathway design and priorities. As a result, each site established slightly different metrics and data capture processes to ensure improvements were measured meaningfully and aligned to their specific pathway configuration, while still supporting overall programme evaluation.

Across the five sites clinicians saw 126 patients on the RAVA pathway, with the clearest improvements seen at the front end of the pathway. Teams referred, triaged and reviewed patients more quickly, and in some cases, made earlier decisions about their care:

• Blackpool: 59-day reduction from echo to decision
• Hull: 100-day reduction from echo to first clinic
• Imperial: 34-day reduction from echo to first clinic
• Leeds: 31.5-day reduction from echo to first clinic
• Wolverhampton: 146.5-day reduction from referral to decision

Across the five sites, 25 of 129 referrals (19.4%) required intervention, indicating that only a small proportion were suitable for treatment. Despite this, the pathway delivered significant benefit by reducing the time patients spent waiting in uncertainty, helping to alleviate anxiety associated with lengthy wait times. It also supported a more responsive, manageable pathway for clinicians without significantly increasing pressure on surgical services, demonstrating that the RAVA pathway could be successfully implemented at scale while improving patient experience and outcomes.

Reflections

“Establishing a RAVA clinic at the Wolverhampton Heart Centre has been a big positive for the team. It has encouraged advanced-level practice amongst cardiac physiologists and been greeted with enthusiasm by consultant colleagues. The initial feedback from patients has been one of gratitude and relief at being seen so quickly and having a clear management plan established. This is true for both patients in need of heart valve surgery but also patients where palliative care was the agreed treatment plan.” Dr Thomas Ingram, Consultant Cardiologist, The Royal Wolverhampton NHS Trust

“An excellent way to fast-track urgent valve patients who need intervention and gave our trust some guidance for the timelines in how these patients should be managed” Dr Ramyah Rajakulasingam, Consultant Cardiologist, Imperial College Healthcare Trust

“My highlight has been the recognition that RAVA as a concept has now been proven, not just in Manchester, but across five other regions, showing that patient benefits can be replicated elsewhere.” Professor Keith Pearce, Lead Consultant Cardiac Scientist, Manchester University Teaching Hospitals NHS Foundation Trust

Why it Matters

The national rollout of RAVA shows what’s possible when a good idea is tested, refined, and then scaled in the right way. What started as a local innovation is now delivering real benefits across the NHS.

For organisations looking to develop or scale similar initiatives, the Transformation Unit offers a trusted, experienced partner, able to work through complexity, bring people together, and deliver improvements that make a real difference for patients and services.