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The Parliamentary Under-Secretary of State for Health (Ann Keen): I congratulate my hon. Friend the Member for Rossendale and Darwen (Janet Anderson) on securing this important debate. Heart disease is exceptionally important for all of us who work in health, because the advances in addressing it have been overwhelming, as
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my hon. Friend described at the beginning of her contribution. My father died of coronary heart disease at the age of 57 some 30-odd years ago, and possibly he would be alive today if there had been the advances then that we now see so regularly in our NHS.

Appropriate and targeted services for the treatment of coronary heart disease are, of course, vital. I am advised that in the Blackburn with Darwen primary care trust area, which covers part of my hon. Friend’s constituency, mortality under the age of 75 from all circulatory diseases was significantly higher than the England and Wales average during 2005-07. Despite falls in circulatory disease mortality under the age of 75, it remains a leading cause of premature death both nationally and locally. In Blackburn with Darwen it accounted for more than one in three premature deaths in men and almost one in four in women in 2007. In the Lancashire area, which also covers my hon. Friend’s constituency, there has been a decrease in the early death rate from heart disease and stroke, but it still remains above the England average.

Nationally, coronary heart disease is the biggest cause of death in England, responsible for more than 110,000 deaths every year, and it costs the economy more than £7 billion annually. But the cost to the families involved—the mums, dads, daughters and sons—cannot be counted. In most instances we are talking about sudden death, and no one can say that people can recover from such a thing happening in their family. As a former nurse, I have often had to break bad news to relatives in this situation, and I have sometimes tried and failed to save someone’s life.

It is vital that frameworks are put in place both nationally and locally to address the financial and personal burden of cardiovascular disease. We have made tremendous progress in tackling the challenges of heart disease over the past 10 years. The national service framework for coronary heart disease set a 10-year framework for action to prevent disease, tackle inequalities, save more lives and improve the quality of life for people with heart disease. It set a framework to deliver quality services that are responsive to the needs and choices of patients.

I am pleased to report that the target set out in Our Healthier Nation to reduce the number of deaths from cardiovascular disease in people under 75 by 40 per cent. by 2010 was met five years early. Furthermore, the mortality rate fell by 44 per cent. between 2005 and 2007, compared with the 1995 to 1997 baseline. I pay tribute to all in the national health service who have achieved that target so many years in advance; it was met in 2008, rather than in 2010. That is something to be proud of when celebrating 60 years of the NHS.

One example of an initiative that has saved lives is the installation of 681 defibrillators in busy public places across the country, saving the lives of at least 93 heart attack patients. Indeed, my colleague in the Department of Health, Lord Ara Darzi, practised saving lives very successfully some time ago by using a defibrillator in the other place when a Member of the House of Lords was taken ill. These improvements have required significant investment in the prevention and treatment of coronary heart disease. Some £613 million has been spent nationally on providing new or expanded heart surgery hospitals across the country, and £122 million has been invested in improved diagnostic and treatment facilities. The
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investment supports the building and equipping of 90 new or replacement catheterisation laboratories—I have had the pleasure of visiting such units at Harefield, King’s College and St. Peter’s in Chertsey in the past few months—and that has met a real need to act fast not only when chest pain arrives, but when coronary arteries are diseased and that is shown through the angiogram process.

Furthermore, we now have 61 per cent. more cardiologists and 46 per cent. more cardiothoracic surgeons than in 1999. In the north-west region, the Lancashire cardiac centre was a £52 million capital development project, commissioned to serve the residents of Lancashire and south Cumbria. The centre includes three cardiac theatres, three catheter laboratories, eight ward beds and 14 intensive care unit beds. About 3 million people are receiving statins—my hon. Friend mentioned those cholesterol-lowering drugs—and that has saved an estimated 10,000 lives every year. Statins are now also available over the counter, rather than solely by prescription, thus enabling more people to benefit.

I am so proud that the NHS and Department of Health have narrowed by 32 per cent. the gap in coronary heart disease between the most deprived areas and the national average. We remain on track to meet the 2010 target of at least a 40 per cent. reduction. When the quality and outcomes framework—QOF—was introduced as part of the new GP contract in 2004, it was a pioneering approach to improving quality of care by rewarding GP practices for how well they care for patients, not just how many patients they have on their list. The Commonwealth Fund Survey published in November 2006 found that GPs in the UK are leading the world in the efficient management of chronic disease and the uptake of financial incentives to improve the quality of services.

The latest figures for the QOF show that practices have continued to deliver improvements in services for patients. We are also making real progress in addressing health inequalities between affluent and more deprived areas. We want the QOF to continue to support GP practices in delivering outcomes for patients that are among the best in the world. This is key to the vision developed in the primary and community care strategy, working closely with leading GPs and other health care professionals, as part of the NHS next stage review. That will be possible only if the QOF is continuously reviewed to reflect up-to-date evidence of best practice.

The Department is therefore asking the National Institute for Health and Clinical Excellence to lead a new independent and transparent process for developing
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and reviewing the evidence base for QOF indicators from April 2009, as part of its role in providing guidance to the NHS based on evidence of clinical and cost effectiveness. A consultation document was published on 30 October 2008 with the aim of consulting widely with patients, carers, NHS professionals and commissioners on how the new process should work. The consultation process is due to close soon, on 2 February.

My hon. Friend mentioned concerns about exception reporting. The overall exception rate for England reduced from 5.83 per cent. in 2006-07 to 5.26 per cent. in 2007-08. Independent research shows that practices in deprived areas are slightly more likely to exception-report patients than practices in affluent areas—I believe that the difference is less than 1 per cent. The research concludes that GPs in deprived areas achieved high QOF scores without high rates of exception reporting, and the differences in scores between affluent and deprived areas are small and of relatively little clinical significance.

Our proposals for a new independent and transparent process for reviewing QOF indicators are intended to build on the QOF’s ability to help reduce health inequalities and respond to the needs of our diverse society. There is evidence from research that some practices, whether in deprived or more affluent areas, may be using exception reporting inappropriately. Manipulating QOF data in order to increase rewards without delivering the required level of quality for patients is clearly unacceptable, and also unfair on the majority of practices, which comply with QOF requirements.

PCTs are responsible in England for verifying evidence for QOF achievement. They should analyse exception rates as part of this, investigating any outliers, correcting QOF payments where necessary and taking action if they uncover any actual fraud. I stress that fraud is the exception. We have provided guidance and training for PCTs on examining exception reporting as part of QOF assessment and verification.

The past 10 years have seen significant and tangible progress in cardiac services nationally, and I am keen for them to continue to improve. Our smoke-free policies have made a huge difference, but it is critical that we start early, with our young children and teenagers, in emphasising the need for a healthy lifestyle. I thank my hon. Friend for bringing this important issue to the attention of the House today, and I am glad to have been able to give her such a positive response.

Question put and agreed to.

7.54 pm

House adjourned.

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Deferred Division

Northern Ireland

The House divided: Ayes 276, Noes 184.
Division No. 17]


Abbott, Ms Diane
Ainger, Nick
Ainsworth, rh Mr. Bob
Alexander, rh Mr. Douglas
Anderson, Mr. David
Anderson, Janet
Armstrong, rh Hilary
Austin, John
Bailey, Mr. Adrian
Baird, Vera
Balls, rh Ed
Banks, Gordon
Barron, rh Mr. Kevin
Battle, rh John
Bayley, Hugh
Beckett, rh Margaret
Begg, Miss Anne
Bell, Sir Stuart
Benn, rh Hilary
Berry, Roger
Betts, Mr. Clive
Blackman, Liz
Blackman-Woods, Dr. Roberta
Blears, rh Hazel
Blizzard, Mr. Bob
Blunkett, rh Mr. David
Brennan, Kevin
Brown, Lyn
Brown, rh Mr. Nicholas
Brown, Mr. Russell
Browne, rh Des
Buck, Ms Karen
Burden, Richard
Burgon, Colin
Butler, Ms Dawn
Byers, rh Mr. Stephen
Byrne, rh Mr. Liam
Campbell, Mr. Alan
Campbell, Mr. Gregory
Campbell, Mr. Ronnie
Caton, Mr. Martin
Cawsey, Mr. Ian
Chapman, Ben
Clapham, Mr. Michael
Clark, Ms Katy
Clark, Paul
Clarke, rh Mr. Charles
Clwyd, rh Ann
Coffey, Ann
Cook, Frank
Cooper, rh Yvette
Crausby, Mr. David
Creagh, Mary
Cryer, Mrs. Ann
Cummings, John
Cunningham, Mr. Jim
Cunningham, Tony
Curtis-Thomas, Mrs. Claire
Darling, rh Mr. Alistair
David, Mr. Wayne
Davidson, Mr. Ian
Davies, Mr. Dai
Davies, Mr. Quentin
Dean, Mrs. Janet
Denham, rh Mr. John
Devine, Mr. Jim
Dhanda, Mr. Parmjit
Dismore, Mr. Andrew
Dobbin, Jim
Dodds, Mr. Nigel
Donaldson, rh Mr. Jeffrey M.
Donohoe, Mr. Brian H.
Doran, Mr. Frank
Dowd, Jim
Drew, Mr. David
Durkan, Mark
Eagle, Angela
Eagle, Maria
Efford, Clive
Ellman, Mrs. Louise
Engel, Natascha
Ennis, Jeff
Fitzpatrick, Jim
Flello, Mr. Robert
Flint, rh Caroline
Flynn, Paul
Follett, Barbara
Foster, Mr. Michael (Worcester)
Gapes, Mike
Gerrard, Mr. Neil
Gilroy, Linda
Goggins, Paul
Goodman, Helen
Griffith, Nia
Grogan, Mr. John
Gwynne, Andrew
Hain, rh Mr. Peter
Hall, Mr. Mike
Hamilton, Mr. David
Hanson, rh Mr. David
Harris, Mr. Tom
Healey, rh John
Henderson, Mr. Doug
Hepburn, Mr. Stephen
Heppell, Mr. John
Hewitt, rh Ms Patricia
Heyes, David
Hill, rh Keith
Hillier, Meg
Hodgson, Mrs. Sharon
Hood, Mr. Jim
Hoon, rh Mr. Geoffrey
Hope, Phil
Hopkins, Kelvin
Hosie, Stewart
Howarth, rh Mr. George
Howells, Dr. Kim
Hoyle, Mr. Lindsay
Hughes, rh Beverley

Humble, Mrs. Joan
Hutton, rh Mr. John
Iddon, Dr. Brian
Illsley, Mr. Eric
Irranca-Davies, Huw
James, Mrs. Siân C.
Johnson, Ms Diana R.
Jones, Helen
Jones, Mr. Kevan
Jones, Lynne
Jones, Mr. Martyn
Joyce, Mr. Eric
Kaufman, rh Sir Gerald
Keeble, Ms Sally
Keeley, Barbara
Keen, Ann
Kemp, Mr. Fraser
Khan, Mr. Sadiq
Kidney, Mr. David
Knight, rh Jim
Kumar, Dr. Ashok
Ladyman, Dr. Stephen
Laxton, Mr. Bob
Lepper, David
Levitt, Tom
Lewis, Mr. Ivan
Linton, Martin
Lloyd, Tony
Love, Mr. Andrew
Lucas, Ian
Mackinlay, Andrew
MacNeil, Mr. Angus
MacShane, rh Mr. Denis
Mactaggart, Fiona
Malik, Mr. Shahid
Mallaber, Judy
Mann, John
Marsden, Mr. Gordon
Mason, John
McAvoy, rh Mr. Thomas
McCarthy, Kerry
McCarthy-Fry, Sarah
McCartney, rh Mr. Ian
McCrea, Dr. William
McDonnell, Dr. Alasdair
McFadden, rh Mr. Pat
McFall, rh John
McGovern, Mr. Jim
McGrady, Mr. Eddie
McGuire, rh Mrs. Anne
McIsaac, Shona
McKechin, Ann
McKenna, Rosemary
McNulty, rh Mr. Tony
Meale, Mr. Alan
Merron, Gillian
Michael, rh Alun
Miliband, rh David
Miliband, rh Edward
Miller, Andrew
Moffat, Anne
Moffatt, Laura
Mole, Chris
Moon, Mrs. Madeleine
Moran, Margaret
Morgan, Julie
Morley, rh Mr. Elliot
Mudie, Mr. George
Mullin, Mr. Chris
Munn, Meg
Murphy, Mr. Denis
Murphy, rh Mr. Jim
Murphy, rh Mr. Paul
Naysmith, Dr. Doug
O'Brien, Mr. Mike
Osborne, Sandra
Owen, Albert
Pearson, Ian
Pelling, Mr. Andrew
Plaskitt, Mr. James
Pope, Mr. Greg
Pound, Stephen
Prentice, Bridget
Prentice, Mr. Gordon
Primarolo, rh Dawn
Prosser, Gwyn
Purchase, Mr. Ken
Purnell, rh James
Reed, Mr. Jamie
Riordan, Mrs. Linda
Robertson, Angus
Robertson, John
Robinson, Mr. Geoffrey
Roy, Mr. Frank
Roy, Lindsay
Ruane, Chris
Ruddock, Joan
Russell, Christine
Ryan, rh Joan
Salter, Martin
Sarwar, Mr. Mohammad
Seabeck, Alison
Sharma, Mr. Virendra
Shaw, Jonathan
Sheerman, Mr. Barry
Sheridan, Jim
Simpson, Alan
Simpson, David
Skinner, Mr. Dennis
Slaughter, Mr. Andy
Smith, rh Mr. Andrew
Smith, Ms Angela C. (Sheffield, Hillsborough)
Smith, Angela E. (Basildon)
Smith, Geraldine
Smith, rh Jacqui
Southworth, Helen
Spellar, rh Mr. John
Spink, Bob
Starkey, Dr. Phyllis
Stewart, Ian
Straw, rh Mr. Jack
Stringer, Graham
Stuart, Ms Gisela
Sutcliffe, Mr. Gerry
Tami, Mark
Taylor, Ms Dari
Taylor, David
Thomas, Mr. Gareth
Thornberry, Emily
Timms, rh Mr. Stephen
Tipping, Paddy
Touhig, rh Mr. Don
Trickett, Jon
Truswell, Mr. Paul
Turner, Mr. Neil
Twigg, Derek
Ussher, Kitty
Vaz, rh Keith
Waltho, Lynda
Ward, Claire
Watson, Mr. Tom
Watts, Mr. Dave
Weir, Mr. Mike

Whitehead, Dr. Alan
Wicks, rh Malcolm
Williams, rh Mr. Alan
Williams, Mrs. Betty
Wilson, Phil
Wilson, Sammy
Winnick, Mr. David
Winterton, rh Ms Rosie
Woodward, rh Mr. Shaun
Wright, Mr. Anthony
Wright, David
Wright, Mr. Iain
Wright, Dr. Tony
Wyatt, Derek

Afriyie, Adam
Alexander, Danny
Ancram, rh Mr. Michael
Atkinson, Mr. Peter
Bacon, Mr. Richard
Baldry, Tony
Barker, Gregory
Baron, Mr. John
Barrett, John
Beith, rh Sir Alan
Bellingham, Mr. Henry
Benyon, Mr. Richard
Bercow, John
Binley, Mr. Brian
Blunt, Mr. Crispin
Bone, Mr. Peter
Boswell, Mr. Tim
Bottomley, Peter
Brady, Mr. Graham
Brake, Tom
Brazier, Mr. Julian
Brokenshire, James
Brooke, Annette
Browne, Mr. Jeremy
Browning, Angela
Burns, Mr. Simon
Burrowes, Mr. David
Burt, Alistair
Burt, Lorely
Butterfill, Sir John
Cable, Dr. Vincent
Cameron, rh Mr. David
Carmichael, Mr. Alistair
Carswell, Mr. Douglas
Cash, Mr. William
Chope, Mr. Christopher
Clappison, Mr. James
Clarke, rh Mr. Kenneth
Clegg, rh Mr. Nick
Cox, Mr. Geoffrey
Crabb, Mr. Stephen
Curry, rh Mr. David
Davey, Mr. Edward
Davies, Philip
Djanogly, Mr. Jonathan
Dorries, Mrs. Nadine
Duncan, Alan
Duncan Smith, rh Mr. Iain
Dunne, Mr. Philip
Evans, Mr. Nigel
Evennett, Mr. David
Fabricant, Michael
Fallon, Mr. Michael
Featherstone, Lynne
Field, Mr. Mark
Foster, Mr. Don
Fraser, Christopher
Garnier, Mr. Edward
Gauke, Mr. David
George, Andrew
Gibb, Mr. Nick
Gillan, Mrs. Cheryl
Goldsworthy, Julia
Gray, Mr. James
Grayling, Chris
Green, Damian
Greening, Justine
Greenway, Mr. John
Grieve, Mr. Dominic
Hague, rh Mr. William
Hammond, Mr. Philip
Hammond, Stephen
Hancock, Mr. Mike
Hands, Mr. Greg
Harper, Mr. Mark
Harris, Dr. Evan
Hayes, Mr. John
Heath, Mr. David
Heathcoat-Amory, rh Mr. David
Hemming, John
Hendry, Charles
Herbert, Nick
Hoban, Mr. Mark
Hollobone, Mr. Philip
Holmes, Paul

Horam, Mr. John
Howard, rh Mr. Michael
Howarth, David
Howarth, Mr. Gerald
Huhne, Chris
Hunt, Mr. Jeremy
Hunter, Mark
Hurd, Mr. Nick
Jackson, Mr. Stewart
Jones, Mr. David
Kawczynski, Daniel
Kennedy, rh Mr. Charles
Kirkbride, Miss Julie
Kramer, Susan
Laing, Mrs. Eleanor
Lait, Mrs. Jacqui
Lancaster, Mr. Mark
Lansley, Mr. Andrew
Laws, Mr. David
Leech, Mr. John
Letwin, rh Mr. Oliver
Lewis, Dr. Julian
Liddell-Grainger, Mr. Ian
Lidington, Mr. David
Lilley, rh Mr. Peter
Luff, Peter
Mackay, rh Mr. Andrew
Maclean, rh David
Main, Anne
May, rh Mrs. Theresa
McIntosh, Miss Anne
Miller, Mrs. Maria
Mitchell, Mr. Andrew
Moore, Mr. Michael
Moss, Mr. Malcolm
Mulholland, Greg
Mundell, David
Murrison, Dr. Andrew
Newmark, Mr. Brooks
O'Brien, Mr. Stephen
Oaten, Mr. Mark
Öpik, Lembit
Osborne, Mr. George
Ottaway, Richard
Paice, Mr. James
Paterson, Mr. Owen
Penning, Mike
Pritchard, Mark
Pugh, Dr. John
Randall, Mr. John
Reid, Mr. Alan
Rennie, Willie
Robathan, Mr. Andrew
Robertson, Hugh
Robertson, Mr. Laurence
Rogerson, Dan
Rosindell, Andrew
Rowen, Paul
Ruffley, Mr. David
Russell, Bob
Sanders, Mr. Adrian
Scott, Mr. Lee
Selous, Andrew
Shapps, Grant
Shepherd, Mr. Richard
Simmonds, Mark
Simpson, Mr. Keith
Smith, Sir Robert
Spelman, Mrs. Caroline
Spicer, Sir Michael
Stanley, rh Sir John
Stuart, Mr. Graham
Swire, Mr. Hugo
Syms, Mr. Robert
Tapsell, Sir Peter
Taylor, Matthew
Thurso, John
Timpson, Mr. Edward
Tredinnick, David
Turner, Mr. Andrew
Tyrie, Mr. Andrew
Vara, Mr. Shailesh
Villiers, Mrs. Theresa
Walker, Mr. Charles
Wallace, Mr. Ben
Walter, Mr. Robert
Waterson, Mr. Nigel
Watkinson, Angela
Whittingdale, Mr. John
Wiggin, Bill
Willetts, Mr. David
Williams, Mark
Williams, Mr. Roger
Williams, Stephen
Wilson, Mr. Rob
Winterton, Ann
Wright, Jeremy
Young, rh Sir George
Younger-Ross, Richard
Question accordingly agreed to.
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21 Jan 2009 : Column 876

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