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1.27 pm
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson): It is a pleasure to respond to a debate of such length and quality, to which
hon. Members have made many heartfelt contributions. I congratulate my hon. Friend the Member for Stockton, South (Ms Taylor) on bringing this important issue to the House's attention.As my hon. Friend explained movingly and passionately from her personal experience and the experience of many families that she described, it is devastating for families when an apparently healthy young person dies suddenly without warning. To see young people struck down unexpectedly before they have reached their full potential or had a chance to say their goodbyes is a tragedy beyond measure for their families and friends.
I add my warm tributes to those already paid to the dedicated work of Cardiac Risk in the Young and the other voluntary organisations that provide a counselling network to help families recover from their loss. Support from people who have real experience and genuine understanding of the impact of sudden cardiac death can be a remarkable comfort and help to those who have lost loved ones in those circumstances.
Before I move on to the specific issue of sudden cardiac death, I want to take a leaf out of the book of my hon. Friend the Member for Telford (David Wright) and set this matter in the wider context of progress that we have already made in cardiac care generally. Hon. Members will be delighted to know that we are well on the way to reaching our targets to reduce by 40 per cent. coronary heart disease and stroke in people under 75 by 2010. The number of deaths has already fallen by more than 23 per cent. in the period 2000 to 2002, over a 1995 to 1997 baseline. Current evidence strongly suggests that that target is likely to be met as early as 2008.
Prescription of statins by general practitioners is increasing by about 30 per cent., which indicates that important work is taking place in primary care. The national service framework for coronary heart disease—mentioned by a number of Members—and the NHS plan set the target of an extra 6,000 heart operations by April 2003. It was met a year early. The number of heart operations carried out each year has risen from 40,983 in 2000 to about 56,850. Waiting times for heart surgery are tumbling. In 1996, some patients waited two years for heart operations; today, no one waits longer than nine months, and in 2005 no one will have to wait more than three months.
The patient choice scheme came into operation on 1 July 2002. All patients who must wait longer than six months for operations are now offered the option of treatment at another NHS or private hospital, or at a hospital abroad, unless there are medical contra-indications.
About 275,000 people experience heart attacks every year along with the hon. Member for Cheltenham (Mr. Jones). Evidence has shown that administering clot-busting drugs—thrombolysis—within 60 minutes of a call for professional help can save 65 lives in every 1,000. There has been a consistent and sustained improvement in the faster delivery of clot-busting drugs to heart attack patients since the publication of the national service framework just over three years ago.
Much progress is being made in the prevention of coronary heart disease. Since 2000, 3,770 people have been helped to stop smoking. GP practices are working towards the establishment of disease management
registers, and are actively managing patients at risk of coronary heart disease. Money is being invested through the New Opportunities Fund to increase consumption of fruit and vegetables. We have a national school fruit scheme, which by the end of the year will give 2.2 million children in infant schools a free piece of fruit each day. We also have five-a-day programmes.I mentioned the importance of statins, spending on which has increased to more than £500 million a year. That benefits more than 1.8 million patients, and protects them from heart attacks. Patients with established heart disease, or at high risk, will benefit from the improvements in care. More effective prescribing will save lives—more than 1,000 lives a year just from the prescription of aspirin for heart attack survivors, and 3,000 from the prescription of statins to people at significant risk.
The national service framework has led to improvements in treatment for people with heart conditions. At 110 sites, 681 defibrillators have been installed, and evidence shows that 36 lives have already been saved. The target of 6,000 extra operations was met a year early. Currently, no one is waiting more than nine months for heart surgery, compared with nearly 2,700 in March 2000. Rapid access chest pain clinics are operating in all acute trusts, giving diagnosis or the all clear to patients within two weeks rather than the months for which they used to have to wait. The Government have set explicit targets for reductions in angiography waiting times. For the first time ever, no one will wait more than nine months for angiography by March 2004.
In June 2003, there were 618 consultant cardiologists in post, a 29 per cent. increase since 1999. The number of cardiothoracic surgeons has increased by 18 per cent., to 217, over the same period. Data from the Royal College of Physicians myocardial infarction national audit project—MINAP—show that more than 75 per cent. of heart attack victims now receive thrombolysis within 35 minutes of arriving in hospital, compared with only 30 per cent. in March 2000; 50 per cent. are being treated within 20 minutes, and 43 per cent. within 60 minutes.
Mr. Kevan Jones: What the Minister is saying is fascinating, and it is good news that a Labour Government have put extra money into the health service, but what on earth does all this have to do with the Bill?
Miss Johnson: One of our colleagues discussed developments in treatment for coronary heart disease, and such developments form the background to the Bill. My hon. Friend is not showing the enthusiasm for these matters that I would have expected. We have implemented a £582 million hospital building programme, and we are spending huge sums on cardiovascular disease, replacement catheterisation laboratories and improved standards and delivery across the piece.
In the light of all the excellent progress being made, it is easy to forget about the times when all the hard work in improving services has not made it possible to help. In most cases of sudden cardiac death, there is little or no warning, which is what makes each story so tragic. Two
main conditions cause sudden cardiac death in young people: hypertrophic cardiomyopathy and dilated cardiomyopathy. Experts estimate that some four to eight sudden deaths occur each week, which equates to about 200 to 400 deaths each year. The incidence of hypertrophic cardiomyopathy—the most common underlying condition—has been estimated at one in 500 in the UK. I am sorry that the hon. Member for Twickenham (Dr. Cable) is not in his place, but in response to his question, we cannot do better than that figure in defining the numbers at risk from these conditions.The other causes of sudden cardiac death are other cardiomyopathies and disorders of the heart's electrical conduction system that can cause arrhythmias, such as Long QT syndrome and Wolfe-Parkinson-White syndrome. The majority of people with these underlying conditions do not have any symptoms for all or most of their lives, but in a small minority of cases the condition leads to sudden and unexpected death, often in early adulthood.
Given what has been said today, I know that the whole House shares my concern at the terrible effect that such problems can have on the families affected. In recognition of that, and in order to provide further support, we are funding a three-year project run by CRY. It will offer specialist skilled support for those who have suffered the loss of a young family member through sudden cardiac death. It will also offer training as counsellors for people who have had similar experiences, and at the end of the course, fully trained counsellors will be available in all parts of the country.
CRY has called for the screening of young people to identify those with cardiomyopathy and those who are at increased risk of sudden death. It argues that screening would save lives and reduce parental anguish, and my hon. Friend the Member for Stockton, South has passionately taken up its cause. We have looked at its arguments carefully, and we entirely agree that increased awareness of the disease is important, and that the careful provision of information can do much to educate the public. CRY and the other organisations concerned are very active in this regard. We also agree wholeheartedly that if young people are experiencing symptoms that are of concern—unusual breathlessness, palpitations, dizziness or fainting—it is important that they seek advice from their GP. We must also consider whether the available evidence indicates that screening is always the right course of action.
The UK National Screening Committee advises the Government about all aspects of screening policy and to inform its proposals it draws on the latest research and the skills of a specially convened multi-disciplinary expert group.
The NSC assesses proposed new screening programmes against a set of internationally recognised criteria covering the condition, the test, the treatment options and the effectiveness and acceptability of the programme. Such assessment is intended to ensure that programmes do more good than harm at a reasonable cost. While screening has the potential to save lives and improve quality of life through early diagnosis of serious conditions, it can never be 100 per cent. accurate.
The NSC is increasingly presenting screening in a risk reduction context. Its child health sub-group has advised that there is currently insufficient evidence to introduce a national screening programme for hypertrophic cardiomyopathy, the most common cause of SAD, either for the whole population or for specific sub-groups. The child health sub-group advises on all aspects of childhood screening programmes, and its advice in this case is that there should not be a national screening programme until further evidence is available.
I emphasise that the child health sub-group examined carefully the concerns about the possible negative aspects of screening and its consequences for the future employment and insurance of the young people involved. It also considered the psychological consequences of telling young adults and their families that they have a condition that might kill them suddenly, without warning. The sub-group has considered the position again in the light of recent research, but has decided that it remains the same as at present.
We have concerns about the possible negative aspects of screening and whether it would truly be of benefit to young people. It is not an easy decision to take. While the meaning of a positive screening is so inconclusive, we must think carefully about whether it is fair to impose this burden on the young. The issue is not clear-cut by any means.
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