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22 Apr 2009 : Column 104WH—continued
Mr. Moss:
I think that I agree with the hon. Gentleman. In his statement today, I think the Chancellor indicated that health spending would continue along the lines that had been built in some years previously. However,
the achievement in relation to cardiac and vascular disease over the past nine years is more to do with the focus that the Government brought to bear on that wide-ranging issue. That is just as important, of course, as the money that brought it to fruition.
Dr. Andrew Murrison (Westbury) (Con): Although I want to be non-partisan, I fear that we need to point out some failings. Does my hon. Friend agree that it is a scandal that we do not have a national programme for screening for abdominal aortic aneurism, for example, given that the national screening committee said years ago that that should happen? We continue to lose hundreds of men over 65 for want of a simple screening procedure that would probably save more lives than breast cancer or cervical cancer screening, yet Ministers continue to drag their heels.
Mr. Moss: My hon. Friend raises an important point. The Prime Minister himself announced not long ago that a special check system was to be put in place for that problem, which causes deaths in the over-60s and over-65s in the male population in particular. I thought that pilot schemes were due to start in the south-west as early as last year, but I am not aware—the Minister will probably say—that those pilot schemes for checks are in place yet. No doubt, the Minister can throw more light on that.
The Parliamentary Under-Secretary of State for Health (Ann Keen): In fact, we do have a strategy for aortic aneurism screening and we started that in April this year. That was the date that we announced and it has happened. We need to keep to the facts.
Mr. Moss: I think there is a draw on that one.
Dr. Murrison: That is a bit generous.
Mr. Moss: April 2009 is actually here and now, is it not?
Mark Simmonds (Boston and Skegness) (Con): Perhaps my hon. Friend would like to reflect on the fact that the announcement was made by the Prime Minister back in January 2008 and it has taken 15 months even to get the triple-A screening pilots started.
Mr. Moss: Another fact has been added to the record.
Some risk factors for cardiovascular diseases, particularly obesity and a lack of physical activity, are increasing. On current trends, 60 per cent. of males and 50 per cent. of females will be obese by 2050. If unchecked, it is predicted that that will lead to a massive increase in type 2 diabetes, with the current trend indicating that more than 4 million people in the UK will have that condition by 2025. That will result in a large increase in the number of patients who require medication to prevent cardiac and vascular events.
The number of people requiring kidney dialysis is set to double by 2014 to more than 45,000, but growth in the prevalence of cardiovascular disease and diabetes could increase the number still further. With a population that is ageing and increasingly overweight and obese, prevalence of cardiac and vascular conditions, and their associated treatment costs, will only increase. We must
therefore ensure that the health service is ready and prepared for the extra demands it will face. Investment now to prevent premature chronic illness will lead to savings in the future.
The success of the national service frameworks means that more people survive acute cardiac and vascular events. Of course, that is good news, but it means that more people are living with cardiac and vascular disease, and it is vital to plan for that. However, although the Department of Health has recognised, in its recent progress report on the national service framework for CHD, the case to build services around all cardiac and vascular disease, it remains unclear how exactly it plans to deliver that integrated approach. For that reason, the Cardio and Vascular Coalition, or CVC as I shall refer to it from now on, has published key recommendations for a new integrated approach to cardiac and vascular conditions for policy makers to consider.
The 41-strong membership of the CVC is a who’s who of organisations with an interest in cardiac and vascular disease, ranging from large representative organisations, such as the British Heart Foundation, the Stroke Association, the British Cardiovascular Society and the Royal College of General Practitioners, to smaller organisations representing rehabilitation and congenital heart disease—areas poorly served by the original NSF for coronary heart disease. Those organisations have come together to make a combined case for a renewed approach to cardiac and vascular conditions. Having one cardiac and vascular disease commonly predisposes people to another.
Dr. Hywel Francis (Aberavon) (Lab): I congratulate the hon. Gentleman on his initiative in seeking the debate, and convey to him the thanks of many of my constituents. Many of my constituents signed the British Heart Foundation’s petition, which, as he knows, attracted 130,000 signatories. Will he share his thoughts on how a national strategy should develop, and does he welcome the way in which the Government have sought to ensure that, in an era of devolution, the four Administrations work together for an effective UK-wide strategy?
Mr. Moss: I am grateful for the hon. Gentleman’s intervention, and I agree that there should be a co-ordinated approach, which the Government have shown to date. I hope that as a result of this debate and pressure from both sides of the House—this is an all-party subject of great interest—they will look ahead and continue their good work. I shall discuss the petition later.
As I said, having one cardiac or vascular disease commonly predisposes people to another—for example, people with diabetes or kidney disease are at much greater risk of developing heart disease. The shared risk factors, related pathology and possible co-morbidities of those conditions support the development of a consistent approach to the management of cardiac and vascular conditions.
It is report, “Destination 2020: A plan for cardiac and vascular health”, the CVC urges the Government to commit to a proactive and co-ordinated approach that builds on the success of the work done so far and meets the challenges of the future. That should incorporate coronary heart disease and the other cardiac and vascular diseases—stroke, diabetes and kidney disease—when appropriate. It should address key areas requiring further
progress and those that were not considered in the existing national service frameworks, including cardiac and vascular disease prevention, congenital conditions, rehabilitation, emerging needs for acute and chronic conditions and, finally, end-of-life care.
A key area where gaps remain is prevalence of disease and equality of access to services. The prevalence of coronary heart disease in men in England increases markedly with deprivation. The rate is one third higher among men in the most deprived group compared with the least deprived group. The difference is even greater in women, and those in the most deprived group have a rate of heart disease at least 50 per cent. greater than the least deprived group. It is clear that there is still inequality of access to cardiac interventions, and “Destination 2020” addresses how those inequalities in the prevalence and treatment of cardiac and vascular disease can be reduced.
Another important area of unfinished business is cardiac rehabilitation—measures to ensure sustained recovery and improvements in health and well-being following a cardiac event. Effective rehabilitation can bring about significant improvements in the lives of people who have had a heart attack or stroke, and reduce disability. Despite a target of 85 per cent. of eligible patients being offered cardiac rehab in the national service framework, a recent national audit of cardiac rehabilitation warned that only 47 per cent. of eligible patients receive that life-saving treatment. Cardiac rehab has been highlighted as a key area where further progress is needed.
Other areas that “Destination 2020” says should be addressed include planning for an increase in acute events, such as a heart attack or stroke, as a result of the risk factors that I outlined—many of the patients affected will be older and likely to have complex vascular disease requiring greater supportive care, as well as a longer hospital stay than is currently the case. The report recommends further development of child-specific services to prevent future cardiac and vascular disease, and the inclusion of children and adults with congenital heart disease in future planning—an area that is absent from the original national service framework for coronary heart disease. The CVC also calls for more long-term treatment and care services for those living with cardiac and vascular disease, to take account of anticipated increases in numbers; and, finally, better end-of-life care services for patients with cardiac and vascular disease. Those patients currently receive less specialist care than those with other conditions, most notably cancer, despite mortality and disability associated with some cardiac and vascular diseases, such as severe heart failure, exceeding that of most common cancers.
Chris Ruane: The hon. Gentleman has given a comprehensive list of areas for improvement, and I congratulate him on that. Will he join me, as chair of the all-party group on heart disease, in asking the Minister to meet the group to discuss his suggestions in detail?
Mr. Moss: That is an excellent idea. Perhaps the hon. Gentleman would like to invite the Minister to address our next meeting.
Ann Keen: I am exceptionally willing to do that, and I thank my hon. Friend for the invitation.
“Destination 2020” outlines the aims and principles that should underpin a renewed strategic approach to tackle cardiac and vascular disease in the next decade—for example, aims such as those relating to carers, third-sector organisations, and prevention. A person with cardiac or vascular disease should be placed at the centre of service and treatments with their carers and family. The aim should be to develop true partnerships between people with long-term conditions and the professionals and volunteers who care for them, underpinned by care plans and better patient information.
Carers play a crucial role in the ongoing care, rehabilitation and recovery of patients. They should be supported to provide that assistance, but a recent survey commissioned by the CVC showed that only 5 per cent. of carers had had a formal assessment of their support needs. Third-sector organisations representing patients with cardiac and vascular conditions and those around them should be encouraged to play a greater role in ensuring that their needs are addressed in policies and services.
Dr. Francis: I welcome the way in which the hon. Gentleman has emphasised the importance of carers. As chair of the all-party group on carers, I extend to his group the opportunity of having a joint meeting on this crucial issue. Will he respond positively to that?
Mr. Moss: Zero one, I think. The answer, of course, is yes, but the chairman of my group is sitting next to the hon. Gentleman, and all he needs to do is ask him.
Prevention measures should be at the heart of future planning for cardiac and vascular conditions, as they are ultimately the most effective way of reducing illness and preventing premature deaths. Comprehensive cardiac and vascular risk assessment and prevention measures should be encouraged, with particular emphasis on further progress in smoking prevention and cessation and reducing obesity.
“Destination 2020” also recommends measures to ensure that commissioning supports the provision of the resources, services and staffing required to implement a renewed strategy aimed at tackling cardiac and vascular disease. It supports the promotion of evidence-based practice and measures to maintain and strengthen the UK as a world leader in clinical trials in cardiac and vascular diseases to be conducted by both NHS and non-NHS research bodies. The Government's welcome NHS health checks programme aims to identify many of the major risk factors for cardiac and vascular diseases, and should form part of a wider focus on prevention.
It is essential that adequate plans and resources are put in place to meet the needs of the large number of people identified by the NHS health checks programme who will require follow-up. The shift towards prevention and the checks themselves are very welcome, but some questions require clarification. I did not give the Minister sight of those questions before the debate, and she may or may not have time to answer most of them, but no doubt any unanswered questions will be dealt with in correspondence in the usual way.
Mr. Moss: I thank the Minister in advance. The questions are as follows. The pace, scale and model of implementation appears to be decided by each primary care trust. Surely there is a risk that that will increase inequalities, as a result of variable implementation at local level. Will that be centrally monitored and action taken if necessary?
Accessibility to heath checks for patients is, of course, crucial. How is that best to be achieved? Will PCTs be ultimately responsible? Will the services be confined solely to GP practices, or will we set up specialist clinical centres? What will be the role of community pharmacies? There is no doubt in my mind that in community pharmacies we have a fairly universal and readily accessible professional resource that could play a key role in the health check programme. That new role seems to have been actively encouraged by parts of the NHS, but not universally. Some PCTs seem reluctant to embrace that great potential, through ignorance, professional opposition, lack of focus or simple tardiness. More centralised focus and targeting by the Department of Health may be required.
It is vital that those identified as being at risk of vascular disease or as already having a condition receive the best treatment. Does the NHS have a prediction of the numbers from both those groups that health checks will pick up? There is little point in identifying those at risk but being unable able to intervene effectively. What additional resources have been allocated for prevention interventions and the treatment of those identified as having a vascular disease? Are funds being ring-fenced for that purpose? Beyond smoking cessation, what evidence-based prevention interventions are available for PCTs to use?
How will PCTs’ success in providing the health checks be assessed and poor performance tackled? How will central Government ensure accountability for local delivery? The programme will yield huge amounts of data that will be invaluable for research and providing the evidence base better to inform commissioning in the future, but what plans are there to collect and use those data effectively?
It appears that two risk engines will be used to calculate people’s risk. Ideally, a national programme would be delivered locally using the same tools. Has the Department any plans to use one system only? It is good news that the Department is beginning to look across all cardiac and vascular conditions for the checks. If someone is identified as having multiple risk factors, are there plans in place to manage those risk factors holistically?
There is a clear groundswell of public opinion behind the calls for a renewed strategic approach to cardiac and vascular disease. The British Heart Foundation reports that the CVC’s case for a new plan has been backed by more than 135,000 people—a figure mentioned by the hon. Member for Aberavon (Dr. Francis)—who have signed the petition. That is a formidable voice, comprising 41 respected and authoritative organisations and tens of thousands of members of the public. They are asking not for a new national service framework or a replica of the current one, but for a clear vision of where we are going in the next 10 years.
This debate was inspired in part by the fact that the national service framework for coronary heart disease—a 10-year programme of action—is almost a decade old.
Given changes in the health service, growing demands and changing priorities, we surely require a renewed strategic approach for the next 10 years, dealing with areas of unfinished business and ensuring a consistent approach across all cardiac and vascular conditions. That call for a renewed strategy is not unique. Such a strategy would be entirely consistent with the Department’s announcement that it intends to publish a new strategy for mental health. The national service framework for mental health, which is also a 10-year strategy, is due to end this year, and the Department accepts that it needs renewal.
I am aware that the Department recently issued an update report on the national service framework for coronary heart disease. There was much to welcome in that document, including commitments, first, to address inequalities further; secondly to work across cardiac and vascular conditions; and, thirdly, to address unfinished business, including cardiac rehabilitation. The update rightly records progress made in the fight against coronary heart disease, and there is recognition that now is the time to build on the progress achieved, yet the report leaves some questions unanswered.
When will the promised reviews of the implementation of the current national service framework and the future of cardiology be delivered and how will they be applied to improve services? What is the Department’s vision to build on progress in combating inequalities across cardiac and vascular conditions? What exactly does the Department mean by “working across conditions” when it gives the impression that it will treat heart disease, stroke, diabetes and renal disease under separate programmes?
The fundamental concern about the update document was that, of its 20-plus pages, only one was devoted to future planning—for 2010 and beyond. The report is heavy on what has been achieved, but does not acknowledge that the growing burden of people living with heart and circulatory conditions requires a renewed vision for the next generation.
The health service looks very different now from how it looked 10 years ago, when the national service framework for coronary heart disease was first developed. Without a new national strategic approach to cardiac and vascular health in England, we run the risk of progress slipping away. We need a coherent integrated plan covering cardiac and vascular disease, with the experience of the patient, through prevention to palliative care, at the centre. That plan should embrace current initiatives and address remaining gaps in services, so that we can better meet the new challenges that we face, further improve the health of the nation and reduce the incidence of cardiac and vascular disease in England to one of the lowest levels in western Europe.
The CVC has produced a vision for a new comprehensive approach to all cardiac and vascular disease. Will the Minister commit seriously to considering the CVC’s “Destination 2020” document and working with the voluntary sector to plan the next phase of the fight against cardiac and vascular disease?
2.57 pm
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