Transforming 2-6 Week Heart Failure Pathways to Improve Access to Care

In October 2025, the Transformation Unit (TU) was commissioned by St George’s University Hospitals (SGUH) NHS Foundation Trust, in partnership with NHS England (NHSE), to address delays in the 2- and 6-week Heart Failure Pathways in line with National Institute of Clinical Excellence (NICE) and British Society of Echocardiography (BSE guidance).

The TU team provided programme leadership, facilitation and Clinical Pathway Mapping (CPM) expertise to support the development and successful implementation of future state pathways across six pilot sites. This work enabled more timely access to urgent and routine pathways and treatment for heart failure.

The programme ran until March 2026 and followed the TU’s Clinical Redesign Methodology to define, design, collect data insights, implement and evaluate changes made to service pathways.

The Challenge

In 2025 NHSE conducted a detailed review of NICE and Alliance for Heart Failure reports to demonstrate the need for improvement to 2–6-week heart failure pathways. The findings showed that England sees approximately 200,000–300,000 new heart failure diagnoses each year. Around 20% of these patients have raised NT-proBNP levels, placing an estimated 40,000–60,000 people in the highest-risk category. Despite national guidance recommending specialist assessment within 2–6 weeks, these patients were typically waiting 7–8 weeks for echocardiography, with specialist review taking even longer.

The review identified the opportunity to reduce avoidable admissions by around 2,000-6,000 each year. This would require a reduction in the assessment pathway for high-risk patients to a maximum of 2-weeks.

To address this challenge and opportunity, cardiology clinical leads from two Trusts transformed their 2–6-week assessment pathways and became exemplar sites for this programme. The exemplar sites formed a national working group of clinical and operational leaders, created to support and provide guidance to the six selected pilot sites selected for this programme.

Our Approach

We partnered with clinical and operational leads at each of the six pilot sites to deliver end-to-end pathway transformation. Using our established clinical redesign methodology we:

1. Mapped existing pathways with each pilot site to identify bottlenecks to inform changes.
   
2. Co-designed improved future state pathway maps with frontline teams
   
3. Built clear plans for implementation and evaluation through go-live logs and data collection methods.

To maintain a robust approach to measuring the impact of pathway changes, we established baseline data supported by a standardised data collection template that was shared with all pilot sites.

We also developed a bespoke heart failure transformation toolkit showcasing real pilotsite case studies, with staged guidance and practical project management tools to support rapid, scalable delivery and replication in future sites.

The Outcome and Impact

This project saw the TU support the implementation of around 15 key changes to pathways across the six pilot sites as well as the development of core supporting materials for pathway transformation such as Standard Operating Procedures (SOPs), standardised referral forms, triage guidance, MDT Terms of Reference (ToR) and Equality Impact Assessments (EIAs), to enable sustainable pathway transformation.

The project was delivered within agreed timelines and as of March 2026, all the six pilot sites have implemented their new heart failure pathways and are now in the evaluation phase of this project. Each of the pilot sites are collating quantitative and qualitative data collection to measure the impact of the pathway transformation.

Early results from the pathway changes are positive, indicating that the new pathways are enabling the right people to receive the right support more quickly through the transformed 2‑ and 6‑week pathways, aligning with the intended aims of the programme and contributing to less urgent hospital admissions. More definitive evidence will be available following the formal evaluation (scheduled for Summer 2026), where the data collection tool that we developed through this programme will play a critical role in enabling pilot sites to capture key data items and measure outcomes that will directly inform the final evaluation.

Feedback

The TU received positive feedback from NHSE, the pilot sites and the SGUH Project Lead, all highlighting the TU’s strong project management support, communication and clinical pathway mapping (CPM) expertise.

Project Lead, Dr Lisa Anderson (Consultant Cardiologist):

“Excellent project support. The TU team rapidly became very knowledgeable about the pathway and the challenges. The project management support was rigorous but carried out in a friendly way – all pulling together to achieve the aim”.

Alex Czopowyj, NHSE’s Programme Manager and heart failure and heart valve disease Lead:

“The TU team were able to quickly grasp the aim of the work and support across all aspects to mobilise at pace. This was done through a proactive attitude to meet with key stakeholders and build strong relationships to understand the work required and the best route to implementation”.

Next Steps

If you are interested in this work or would like support with large scale programme and programme/project management or clinical pathway mapping expertise, please get in touch via our website contact page. Our highly skilled team would be very happy to have a conversation about your requirements.