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1.11 pm
Dr. Andrew Murrison (Westbury) (Con): I congratulate the hon. Member for Stockton, South (Ms Taylor) on introducing the Bill. It has cross-party support, which is a good start for a private Member's Bill. I also congratulate her on its simplicity. Having recently spent some weeks navigating the convolutions of the Human Tissue Bill, it is a joy to find a measure that makes sense on first reading.
I think that my hon. Friends felt that as a medic I am well equipped to cope with the daunting list of conditions involved in sudden cardiac death. In truth, however, ion channelopathy, arrhythmogenic right ventricular dysplasia, hypertrophic obstructive cardiomyopathy and the rest tripped off the tongue of the hon. Member for Stockton, South as well as they can trip off mine. She demonstrated a command of a very difficult subject area and dealt with it comprehensively.
As well as the hon. Lady's speech, we heard excellent contributions from 10 Back Benchers: my hon. Friends the Member for Brentwood and Ongar (Mr. Pickles) and for New Forest, East (Dr. Lewis); and the hon. Members for Inverness, East, Nairn and Lochaber (Mr. Stewart), for Cheltenham (Mr. Jones), for Sheffield, Heeley (Ms Munn), for North Durham (Mr. Jones), for Gower (Mr. Caton), for Ogmore (Huw Irranca-Davies), for Telford (David Wright) and for Twickenham (Dr. Cable). I particularly enjoyed the speech by the hon. Member for Twickenham, who dealt sensibly with the economic benefits and disbenefits of screening, and the reasons for sometimes not screening.
In March, my hon. Friend the Member for South Suffolk (Mr. Yeo) and I, with other colleagues, tabled an early-day motion that drew attention to the fact that the range of conditions that we are debating is not given the attention that it deserves. Indeed, I could find little direct reference to it in the national service framework for coronary heart disease when I checked on its website last night. To be fair to the authors and to Ministers, for most people heart disease tends to means furred-up arteries, aschemic heart disease and heart attacks. It tends to mean the elderly and the middle-aged, not the young—schoolchildren and pre-school children or young people in the springtime of their adult life and in their physiological prime. Yet that is what we are discussing—sudden death when it is least expected, causing tragedy to families that can last for a lifetime.
We are discussing a range of conditions that are mercifully uncommon, but as has been said, they are by no means confined to the minutiae of medicine. The medical profession has some way to go in embracing best practice that it has established and in cutting the toll of sudden death in the young. We have heard many comments about that, and I endorse them. Several helpful suggestions have been made about the way in which doctors and professionals can act to improve notification of the conditions and ensure that those who might be affected are adequately screened. Screening is in place and accessible, and it should be accessed by those who are deemed to be at risk.
On Wednesday, those of us who attended the CRY reception met several people with first-hand experience of such covert conditions. I was reminded of my cousin, David Horn, who collapsed and died in his school playground when he was 10. As is invariably the case, the event had profound and enduring consequences for David's family. For his parents and grandparents, nothing was ever the same again. That experience was shared by several people at the CRY reception.
Screening is an intrinsic part of our health care system. It begins for many of us before we are born. Heart and congenital defects are often picked up by ultrasound in utero, and screening continues with routine health checks immediately after birth, throughout early childhood and into adult life. Cervical and breast screening are routine and we now have health checks for the elderly. Most of that is driven by evidence-based research and screening for other conditions, such as prostate and bowel cancer, may be added to existing provision.
It is important that all such screening be based on the best available evidence and that we are clear that it improves people's lives, longevity and general well-being. We therefore need to be fairly directed in our screening efforts. However, the UK National Screening Committee has said that population screening is not appropriate for hypertrophic cardiomyopathy. It finds no evidence that outcomes will be affected, and the case for population screening falls, according to the Bradford-Hill criteria that govern such matters. The Bradford-Hill criteria determine whether screening is a useful test. They have been used for many years and are as relevant today as ever.
We should put aside for a moment the fact that population screening is not the subject of the Bill. In a written answer in December, the Minister appeared to confuse hypertrophic cardiomyopathy with sudden cardiac death. The former is only one of many causes of the latter and it would be instructive for the UK National Screening Committee to consider the other causes against the criteria for screening that I described. Perhaps the Minister will comment on that, especially since we understand that the UK National Screening Committee is reviewing the evidence base this month.
It would be interesting to know what has been learned from Italy, where cardiac screening for athletes has been routine since 1971. Indeed, a certificate of fitness is needed there to compete as an athlete. Clearly, that involves school sport. I understand that our Government want to reverse the decline in British school sport in their fight against obesity and diabetes. The Minister might feel that that provides a good opportunity to dovetail nicely with adopting the Italian
approach to screening youngsters. That is currently on the agenda, with the improvement of our school sports facilities. As part of that, perhaps the Minister will consider whether aspects of Italian practice might be introduced in this country. I would be interested to hear her thoughts.In the meantime, the UK National Screening Committee and the British Heart Foundation recommend that relatives of people who have died from a sudden cardiac cause or who have been diagnosed with an underlying condition should be screened. This gives an official stamp to clinical good practice, and it seems likely that practitioners who fail to comply will lay themselves wide open to claims for professional negligence. Very few cases are brought against doctors for professional negligence in this area, and I suspect that that is because this range of conditions is not well known among the public at large. There appears, therefore, to be a very strong case for raising awareness both in the profession and among the general public.
The screening of first-degree relatives is quite straightforward, and the British Heart Foundation makes it quite clear that it should always happen. Assessing the significance of common complaints is far more difficult, however. Some of the symptoms cited in the Bill as triggers for screening are so common as to be almost universal. It is often said that common things occur commonly, and fainting, giddiness and palpitations almost always do not have a significant cardiac cause. In each case, a careful history must be taken, and I would suggest that, in the young, a physical examination will invariably be warranted as well.
I suspect that the threshold for referral for further testing is being lowered all the time. However, a GP might be quite clear that a person has simply fainted for a particular reason, for example, and in such circumstances would not consider that person to be at any greater risk than anyone else. The value of screening in such a situation is perhaps debateable. I hope that the publicity that we are generating today will help to lower the screening threshold and make doctors think very carefully about the possible cardiac origins of apparently trivial symptoms. The American and European colleges of cardiology have set out the symptoms and circumstances that should prompt screening, and doctors who ignore them are on a very sticky wicket.
The Alder Hey scandal, in which children's organs were retained as a matter of routine, rightly prompted the Human Tissue Bill, which I understand will return to the House shortly. In welcoming that Bill, however, we should be alive to drawbacks that might have been only dimly foreseen at the time of drafting, and which touch on this area. A histopathologist has written in CRY's recent booklet that, post-Alder Hey, pathologists have been somewhat reluctant to retain material that might previously have been kept for a second opinion or further tests. I think that that is understandable. The author points out that requests may come from grieving parents who are struggling to come to terms with their loss. Indeed, in my experience, such a request might come many months after the bereavement, but in future, that opportunity will be denied to them. The same pathologist hints at a feeling of professional inadequacy
when dealing with sudden cardiac death, as it is often not possible to identify any structural cause. Given the uncertainty, one wonders how many other deaths with a cardiac cause are wrongly put down to epilepsy, asthma, drowning or simply the coroner's catch-all: natural causes.In June 2001, the then Under-Secretary of State, the hon. Member for Pontefract and Castleford (Yvette Cooper), described coroners' practice in this regard as "antiquated". Will the Minister tell us what progress has been made to update it? Such updating would go some way towards addressing the concern expressed by hon. Members earlier about the true number of sudden cardiac death cases. It is important to ensure that we tighten up our diagnostic criteria, in order to get a true representative number of cardiac deaths, because at the moment the margin is simply too great.
In June 2001, the same Under-Secretary of State responded to an Adjournment debate on this subject led by my hon. Friend the Member for New Forest, East (Dr. Lewis). It was a very good debate, and I spent some time studying it last night. In it, my hon. Friend was told that the Minister would investigate the potential for using IT in raising awareness about sudden cardiac death, both among health professionals and the general public. That relates to a point raised earlier about how to increase knowledge of this set of conditions among the public and doctors, because at the moment, clearly, they are poorly understood. IT provides a good way, as the then Minister was right to say three years ago, of broadening the knowledge of that set of conditions among the profession and the public. I would be grateful if the Minister would comment in her winding-up remarks on what has been achieved in the three years since the June 2001 debate.
We know that a great deal has been achieved by CRY. We know that a simple electrocardiograph helps enormously to distinguish the worried well from patients with problems. Electrocardiography may not yet be routinely carried out in all GP premises but there is no particular reason why it should not be. Reporting can, of course, be done elsewhere, or even, these days, automatically. CRY has provided a large number of ECG machines for that purpose, which I hope will encourage doctors to investigate symptoms that previously might not have been investigated.
This Bill is unusual. Its intention is to set out primary legislation that will articulate best clinical practice. The Minister may point out that successive Governments have declined to mandate best clinical practice in this way. She may well contrast this Bill with the way in which we deal with screening for other issues. It could be said that the departure from the norm that we are discussing today could set a trend that might lead ultimately to the incorporation of large tracts of medical practice in the statute books. We would need to consider the implications of that. Nevertheless, the hon. Member for Stockton, South and CRY have constructed a good case, which is worthy of further examination. I look forward to the Minister's remarks, and I hope that she will have something substantial to say in response to the issues raised.
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