|Previous Section||Index||Home Page|
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
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. Friends 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. Friends 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 involvedthe mums, dads, daughters and sonscannot 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 someones 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
investment supports the building and equipping of 90 new or replacement catheterisation laboratoriesI have had the pleasure of visiting such units at Harefield, Kings College and St. Peters in Chertsey in the past few monthsand 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 statinsmy hon. Friend mentioned those cholesterol-lowering drugsand 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 frameworkQOFwas 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
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 areasI 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 QOFs 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.
That the draft Northern Ireland Assembly (Elections) (Amendment) Order 2009, which was laid before this House on 3 December, be approved.