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15 Oct 2008 : Column 326WH—continued

The new facilities have provided the setting for substantially more cardiologists, increasing the capacity available by more than 50 per cent. However, as we know and have discussed, particular expertise is needed to detect and manage some conditions relating to coronary heart disease. Patients with refractory angina do not respond to the same types of treatment as patients with stable angina, as my right hon. Friend said when introducing this debate. The symptoms of many people with angina who do not react well to medication can be improved by
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revascularisation, but unfortunately there are others with angina for whom revascularisation is not suitable.

Patients with refractory angina understandably need a complex mix of specialist and innovative treatment coupled with care and support to ensure that their quality of life is protected as much as possible and their length of life compromised as little as possible. Providing patients with that sort of service is not easy. The role of specialist nurses in particular in dealing with cardiac conditions has been acknowledged at all times by patients and families. As a former nurse, I am fully aware of the fear cardiac patients experience when having chest pain and when they are discharged, still having chest pain, to their family, who may not have the expertise to help. It is very different from being inside a unit.

I am pleased that today’s debate has focused on the work of the National Refractory Angina Centre in Liverpool. That award-winning service’s mission is

It is easy to forget that the management of chronic disease relies not only on excellent clinical treatment but on protection of quality of life. Several services for patients with refractory angina are developing around the country, particularly in the context of chronic pain management, but the NRAC in Liverpool has led the way. It is important to place on record that, although I believe and am guided to say that Liverpool is the best, other centres provide or are developing facilities after the Liverpool model, including Royal Brompton and Harefield hospitals, Bradford Royal infirmary, Barnsley hospital, Castle Hill hospital in Hull, Pilgrim hospital in Boston, Queen Mary’s hospital, Roehampton and Southend university hospital. There are probably more, but I have given a flavour of the developments taking place, which it would be wrong not to mention.

The NRAC provides an extensive and comprehensive service for those with this chronic disease. The centre is to be congratulated on what it has achieved and, although the provision of such services locally is ultimately something for local service commissioners and providers to decide, I hope that the NRAC and how it has been developed and run will act as an exemplar for developing or planned services elsewhere in England.

The NRAC’s service is patient-centred. As well as raising awareness of the condition, its treatment and its management, the NRAC produces information for clinicians and patients. I hope that that information will be accessed by more clinicians and patients around the country as a result of this debate. I praise the guidelines produced by the centre under the guidance of the Cheshire and Merseyside cardiac network.

It would be remiss of me not to recognise, the personal contributions made to the development of the services
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by cardiologist Professor Mike Chester and pain management specialist Dr. Austin Leach. More than 10 years ago, they had the foresight to see that with that type of chronic condition, it was important not to focus solely on clinical results. Turning that foresight into action took commitment, as well as ability and innovation. They suggested, quite rightly, that success should be measured by what services mean to the patient and their quality of life. Mike and his collaborators have proved that NHS services of that sort can be changed to employ a more patient-focused way of working, and that that approach delivers results in both health care outcomes and patient satisfaction.

The Cheshire and Merseyside cardiac network has produced guidelines on the diagnosis and management of stable angina for use throughout Cheshire and Merseyside. I am pleased to have ministerial responsibility for that issue, and would also be pleased to visit the centre. The guidelines contain details of which patients would benefit from the services offered at NRAC, what is offered and how to refer patients. They also contain details on the development and provision of refractory angina services. Again, I hope that developing services will refer to those guidelines.

The ongoing development of the NRAC as a national and international centre of excellence for the treatment and management of refractory angina, coupled with support from the cardiac network and local service commissioners, means that we have not only the best possible service to which people in this country can be referred for that condition, but a blueprint for the development of other such services elsewhere. My right hon. Friend suggested that I should have a meeting with the professors and the experts. I will do so gladly. To sit around the table with them would be a good initiative. Our national standard framework includes a chapter on angina, but it is not sufficient now because we have progressed, thanks in particular to the NRAC.

We must all do what we can to ensure that the lessons learned from that collaborative approach are used to develop not just other refractory angina services, but patient-centred chronic disease management generally. We are moving our national health service into the 21st century following Lord Darzi’s report on patient-centred quality. The evidence is there; we must now use the science and research to do what we can to remove patients’ fear that their angina is different and not manageable. We must do everything we can within the health service and our medical and nursing professions to provide first-class, quality care. That is obviously taking place at the NRAC. I thank my right hon. Friend for securing this debate and bringing the matter to my attention.

Question put and agreed to.

Adjourned accordingly at three minutes to Five o’clock.

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