Review of Scottish heart failure specialist nurse services in 2025: workforce, service delivery and priorities for equitable care

Introduction

Heart failure (HF) prevalence continues to rise, driven by an ageing population, increasing multimorbidity and survival[1]. HF specialist nurses (HFSN) are central to delivering guideline-directed, patient-centred care across settings; however, increasing service pressures risk undermining sustainability and equity of access[2].

Purpose

To describe the current national provision of HFSN services across Scotland, highlight service innovation and expanded roles, identify variation and gaps against contemporary standards, and define priorities for workforce planning and service development.

Methods

A national service evaluation was undertaken by the Scottish Heart Failure Nurse Forum using a structured survey of HFSN services. Responses were received from all 14 Scottish health boards, with 22 service-level responses where service models varied.Quantitative workforce and service data were supplemented by qualitative insights on caseload pressure, education, MDT working and data infrastructure.

Results

In total, 94 HFSN representing 69.5 WTE posts were reported nationally. Services deliver complex, evidence-based care across community, outpatient and inpatient (IP) settings, with community and outpatient activity accounting for 83% of WTE provision and IP services accounting for 17%. Expanded roles include assessment at diagnosis, treatment optimisation, admission avoidance and post-discharge care, with qualitative feedback highlighting increasing clinical complexity.

Workforce capacity has not increased in line with demand, with growth in WTE posts since 2018 largely confined to IP services and little change in outpatient or community provision. Qualitative responses described escalating workload, competing service demands and concerns regarding sustainability. Most nurses practise at an advanced specialist level (77.9%), with limited senior leadership or consultant-level capacity (5.7%). Although uptake of non-medical prescribing is high (21/22 services), access to protected education time and structured career progression remains inconsistent.

Multidisciplinary working has improved since 2018, with structured MDT input reported by 11 boards; however, access to key services remains uneven. Less than half of services reported routine access to psychological support (32%), specialist palliative care (41%) or quality-of-life assessment (45%). Provision of care for HF with preserved ejection fraction has increased but remains uneven (8/14 boards). Fragmented data systems and limited administrative support constrain outcome measurement and service planning.

Conclusion

HFSN services deliver high-impact, evidence-based care with national coverage; however, significant sustainability challenges remain. Strategic priorities include workforce growth and coordinated planning, structured education and career pathways, consistent multidisciplinary provision and strengthened data infrastructure to support equitable HF care across Scotland.National characteristics of HFSN serviceFor image description, please refer to the figure legend and surrounding text.Figure 1.Scottish HFSN service snapshotFor image description, please refer to the figure legend and surrounding text.