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22 Apr 2009 : Column 110WH—continued
Mr. Andrew Pelling (Croydon, Central) (Ind):
It is a great pleasure to serve under your chairmanship, Mr. Pope. I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing the debate. I was very pleased that he mentioned the importance of
the care of, and a proper strategy for, those who suffer from congenital heart disease. It is perhaps a testament to the Government’s success that so many babies survive with that condition. It is notable, though, that not all the recommendations in the Monro report were implemented, due partly to the fact that clinical expertise is spread rather thinly across the service. A group chaired by Dr. Patricia Hamilton is re-examining these issues and I hope that early recommendations will be made such that sufficient specialist staff can be trained. A larger number of children with congenital heart disease are surviving to adulthood, and clearly resources are needed to ensure that doctors and nurses with specialist knowledge of adults with such a condition are appropriately trained. When the Minister replies, I would be interested to hear about the approach being taken to congenital heart disease and how that policy is distinguished from the rest of the policies regarding the treatment of coronary heart disease.
This debate is about the treatment of those with cardiac and vascular disease, which many of us will have experience of in the coming years. I am particularly concerned to spend some time considering the expectations of the 380,000 residents of Croydon and what they will face in the context of proposed changes in provision for stroke victims. As the hon. Member for North-East Cambridgeshire said, early treatment is very important when a stroke strikes. It is also a great testament to improvements in the service that 70 per cent. of stroke victims are now treated within 60 minutes—and very important that is too, given that for every hour that treatment is delayed, brain cells are haemorrhaging away at a rate normally experienced over 3.6 years.
In Croydon, the Mayday hospital treats 500 cases of suspected acute stroke each year; at present, we have a nine-to-five, Monday-to-Friday capability for dealing with such cases. However, Healthcare for London proposes that such provision should be provided solely at St. George’s hospital. Healthcare for London is, in some ways, setting up an artificial choice between Mayday and St. George’s. As we heard, it is important that treatment is given within 60 minutes; even with their blue lights, and despite what the London ambulance service might say, it is extremely difficult to get to St. George’s from many parts of Croydon. It is appropriate to say that the population of south-west London would be better served by having two acute stroke units.
It is suggested that St. George’s would be the best location, but Mayday’s proposals to Healthcare for London were made in partnership with St. George’s, the latter saying that the ideal scenario would be to have a joint acute unit with two front doors—at Mayday and at St. George’s. Only under the artificial construct by which Healthcare for London pitches hospital against hospital for the right to receive one of eight acute stroke units in London does it make no sense to retain Mayday’s hyper-acute provision. After all, the unit in Croydon is performing well; indeed, it has been commended on its strong performance. Its thrombosis treatment is reaching levels provided by the very best in Europe, including in Helsinki. It seems odd to propose removing the excellent provision provided at Mayday yet at the same time to propose endowing Princess Royal university hospital in Bromley with such provision, given that the latter does not have a distinct record in stroke treatment.
I am concerned that as many as 20 per cent. of those presenting with symptoms of stroke are suffering mimic stroke. Taking such patients on the long journey to and from St. George’s could put great stress on the London ambulance service. Mayday has experienced significant difficulties in the quality of liaison—it is now becoming a main general hospital—with tertiary centres. I was grateful for the interest shown by the Secretary of State in two cases that seemed to show real difficulties in communication between the hospitals.
More than 1,000 signatures have been added to a petition on the matter. I cite two residents who expressed concern. Given the expected traffic difficulties of travelling across south-west London, Peter Mason quite rightly says:
“Less miles means more lives are saved.”
“My mother had a stroke and the only reason she is still mobile is that Mayday was so near to our home.”
It is important to consider Croydon’s demographics. It is notable that the Healthcare for London bid consultation document cited a 60 per cent. greater incidence of strokes in the black African and black Caribbean populations, which is exacerbated by social deprivation. That is an important concern for Croydon, which has a higher than average population in that respect compared with London and England. It may not be obvious at the moment, but we have a dynamic community. It is changing greatly, and that change will be further driven by migration flows, as Croydon becomes host to the Border and Immigration Agency. That sector of the population—the BME community, and particularly the black Caribbean groups—is now ageing and is much more likely to be exposed.
St George’s hospital has explicitly stated it does not have the capacity to take all acute stroke patients. Its bid identified a maximum capacity at the prospective unit of 20 beds, with a preferred bed complement of 14. The Healthcare for London tender made under the consultation suggests that 26 beds are needed for south-west London. It would be appropriate for St. George’s and Mayday hospitals to share that provision.
Given the configurations considered in the consultation, it would be somewhat safer to have a stroke in Westminster or other parts of central London. It is partly to do with history and the quality of hospitals in the central area, but coverage in London’s periphery seems rather sparse. Although it is never the Government’s intention to discriminate against the suburbs, disjointed decisions made in different parts of the public sector have resulted in discrimination against Croydon.
3.5 pm
David Taylor (North-West Leicestershire) (Lab/Co-op): I warmly congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing this important debate. He is known to be a fair-minded man, and he delivered merited praise to the Government when justified. He also presented a thoughtful analysis and an objective critique when appropriate. All in all, his contribution was delivered in a non-partisan manner, despite provocation from the Taliban tendency of the Conservative Front Bench.
The Cardio and Vascular Coalition’s excellent “Destination 2020” strategy, to which the hon. Member for North-East Cambridgeshire referred, is both timely and significant. The aim is to reduce rates of cardio and vascular disease in the United Kingdom to one of the lowest in western Europe. That is a commendable aim, and we should have no trouble in welcoming and supporting it, and taking the appropriate decisions to ensure that it is delivered. As the coalition readily acknowledges, the Government have made important progress, tackling these generally fatal diseases through the national service frameworks to which the hon. Gentleman referred. That is particularly so for coronary heart disease, kidney disease, stroke and diabetes.
Vast improvements have been made to the way in which the NHS diagnoses and treats cardiac and vascular diseases, but although everyone in Parliament should be proud of that, it is vital to recognise that it is only a stepping stone to better health outcomes throughout society. In my view, the key areas for improvement are preventing cardiac and vascular disease and the rehabilitation of patients.
The hon. Member for Croydon, Central (Mr. Pelling) gave a helpful and encouraging speech. I declare an interest as chair of the Ibstock stroke club. The hon. Gentleman was talking about specialist stroke units. We have one in Leicester general hospital, which serves getting on for 1 million people in the city and the county. A feature of its care is the rehabilitation offered as an intermediate step at community hospitals in the county, including at my community hospital at Coalville. I hope that the Minister, who is an able, approachable and articulate member of the ministerial team, will accept an invitation to visit the Coalville hospital to see the work done in the stroke rehabilitation unit. Such an offer is probably difficult to refuse.
I return to the thrust of the debate. Lord Darzi’s review of the NHS will undoubtedly lead to fundamental changes to the organisation and commissioning strategies of the national health service. I am a confessed sceptic of the personalised health budget, polyclinics and the choice mantra—I hope that the Minister has not already cancelled her ticket to Coalville. Lord Darzi’s emphasis on local commissioning has the potential to continue the Government’s record of improving standards and patient outcomes in the NHS. However, in an era in which local health authorities are commissioning rather than providing primary health care, it is vital that the Government retain a strategic view of prevention, diagnosis, treatment and rehabilitation for cardiac and vascular patients, and for all other long-term chronic conditions.
As the report “Destination 2020” spells out, and as the hon. Member for North-East Cambridgeshire said, project-based approaches on their own will not necessarily realise our ambition of reducing the number of cardiac and vascular disease patients or improving their care pathway. The Government need to spell out their strategic policy—I guess that we will hear something about that in the Minister’s reply—and the changes to the NHS proposed in the Darzi review must fit around that policy, not the other way around.
I want to focus my main comments on the third principle outlined in “Destination 2020”, which talked about the CVC’s ambitions being delivered through standards of excellence, a patient-centred approach, effective commissioning, research, addressing specific
areas of need and particularly by a new focus on prevention. At this point, I should declare an interest as the chair of the all-party group on smoking and health, and that is the issue to which I now wish to turn.
The Government’s Health Bill, which is proceeding through the House, is key to a new approach to preventing the diseases that we are discussing. There are overt links between smoking and many fatal diseases, such as cancer, and deaths from coronary heart disease are about 60 per cent. higher in smokers. That means that tobacco smoking accounts for more than 30,000 deaths from cardiovascular disease in the UK every year. As a result of smoking, 100 people will die from CVD today, 14 or 15 of them in the city of London.
Smoking is a major cause of death from CVD and of the morbidity associated with it, although its prevalence is decreasing, which has made a significant contribution to decreasing CVD rates. It has been estimated that about 48 per cent. of the decline in coronary heart disease mortality in England and Wales between 1981 and 2000—a period of 20 years—was attributable to the reduction in the prevalence of smoking. Smoking rates have declined since my teens and 20s—that was 40 years ago—when about half the adult population probably smoked, although prevalence varied widely by social class and age. None the less, as the Minister well knows, more than 20 per cent. of the population still smoke, and the figure is significantly higher in deprived communities. We therefore need to maintain momentum and to continue to recognise smoking as a risk factor that can and, indeed, must be minimised. It is important to recognise that even by the most optimistic estimates of smoking cessation rates, there will still be at least 5 million smokers in the UK in 10 to 12 years’ time, when a fifth Labour Government will be coming to a very satisfactory conclusion.
Even a temporary cessation in smoking improves health outcomes. Crucially, the ability of cardiovascular patients to survive surgery and avoid post-operative complications improves significantly. I do not know whether my hon. Friend the Minister, who is a London MP, was aware of this, but the London Health Observatory reached the following conclusion in its 2006 report on the short-term benefits of pre-operative smoking cessation in London:
“If patients admitted for planned surgery were to stop smoking prior to operation 2,500-5,300... post operative complications would be avoided each year, and the NHS would make the following savings: 2,600-4,000 bed days could be saved; £0.5-£1.1 million each year across London’s PCTs could be saved”.
In addition, a sum of between £1 million and £3 million could be saved across London’s hospital trusts. Those are significant figures in financial and health terms. If they were extrapolated to the rest of the country, that would result in hundreds of thousands of bed days being freed up and hundreds of millions of pounds being saved.
The risk of CVD increases in young smokers. It has been shown that people under the age of 40 have a five times greater risk of heart attack if they smoke. The immensely successful and well-organised pressure group, Action on Smoking and Health, to which I pay tribute, recently conducted work on the issue. Its report, “Beyond Smoking Kills” found that smoking accounts for 16 per cent. of circulatory disease treatment costs for patients aged 35 and over and for more than twice that figure—
34 per cent.—in the 35 to 64 age group. Coronary heart disease caused by smoking accounts for £180 million— 20 per cent.—of all CHD treatment costs for patients aged 35 and over, and the figure rises to 41 per cent. for those under 65.
We know that prevention must start early—we often say that and we know that it is common sense—but it must start even earlier where tobacco is concerned. The best way to minimise smoking as a risk factor in CVD is to prevent children from taking it up at all. Most smokers start before the age of 18, and most will never manage to quit. Smoking is a childhood addiction, not generally an adult choice. The Health Bill, which is currently in the House of Lords, is an important part of our prevention strategy. Encouragingly, it proposes a ban on point-of-sale display and on the sale of tobacco from vending machines, as well as plain packaging for tobacco products. I hope that all three of those initiatives survive through to Third Reading in the Commons.
During the Bill’s earlier stages in the Lords, the tobacco industry used front groups—a common tactic for the industry—to promote scare stories about costs, which are not justified by the facts, and to undermine this important public health measure. Ending the display of tobacco in shops will, like the ban on tobacco advertising, help to ensure that tobacco is not seen as normal for our children and that it is not seen and bought alongside sweets and newspapers. Smoking accounts for half the difference in life expectancy between the richest and the poorest in our nation. Breaking the cycle of addiction in the poorest parts of society is the only way seriously to reduce and eventually end such health inequalities. Population-level prevention measures have been shown to work, and the proposed legislation will work across all our communities to help put tobacco out of sight and out of the reach of our children.
When the Bill comes to the Commons, I hope that there will be cross-party consensus in voting to support bans on point-of-sale display and tobacco vending machines, as well as the introduction of plain packaging. I am sure that the hon. Member for North-East Cambridgeshire will raise such issues with the leader of his party, who refreshingly confessed to his personal experience of the difficulties of giving up smoking. I hope that the Leader of the Opposition will be persuaded of the significance of the measures in the Bill and support the CVC’s vital ambition of ensuring that the Government adopt a new approach to preventing the diseases that we are discussing. Worthy as they are, however, and highly likely though they are to be effective, the proposed measures will not work in isolation and must be part of a comprehensive approach. Such an approach should be supported and linked to a CVD strategy of the type outlined in the excellent and concise report “Destination 2020”, which the Minister will have read.
I have two final points to make. First, the provision of appropriate smoking cessation services in secondary care—the hon. Member for North-East Cambridgeshire mentioned this briefly—must be a standard part of care for all those with CVD or CVD risk factors. That must be an element of our strategy. Secondly, second-hand smoke makes its own deadly contribution to CVD. We banned smoking in enclosed workplaces only in July
2007. Evidence from Scotland, which implemented the measure rather earlier, shows that smoke-free legislation does lead, has led and will lead to fewer heart attacks across the population and that second-hand smoking is often a serious risk factor for those with a pre-existing CVD condition.
The Minister has readily assented to a meeting with the all-party groups that have an interest in this issue, and I hope that we can talk to her. As I said, she is a very approachable Minister, and we have confidence that she will be able to carry forward some of the things that we say to her. Everyone on both sides of the Chamber—there is no serious political divide on this issue—wants to build on the Government’s progress to date. The Department of Health would do well to root its future cardiovascular disease strategies deeply in the work that the coalition has recorded in its very clear and concise document. We all—politicians and the general population alike—owe it a debt of gratitude for that work. I hope that the Minister will give her personal, professional and political response to the contents of what is a very useful document for framing the health policy of the next 10 to 15 years and more.
3.20 pm
Sandra Gidley (Romsey) (LD): I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing the debate. It is a timely one and I welcome his commitment to the issue. We had a bit of political knockabout early in the proceedings, which I found interesting, because to try to get an idea of what all the parties are doing we had tried to find out Conservative policy on the matter, and could find only one reference:
“The Conservatives have committed to lowering the number of premature mortality from stroke and heart disease to below the EU averages by 2015.”
That is from a document called “Delivering Some of the Best Health in Europe: Outcomes Not Targets.” I suppose it is a start, but I have a slight problem with it because one is not quite sure where to aim without knowing where the rest of Europe is going. Anything that makes a comparison with a basket of other countries is almost destined to fail. It is much better to have a clear target that says, “This is where we want to be.”
It is important to be fair and acknowledge that things are much better now than in 2000, when I was elected. There has been a lot of progress in the area we are discussing. In 2000 the Government produced the national service framework for coronary heart disease, which was a 10-year plan. We do not have anything against which to monitor its progress. It was really a framework to build on; but at the time it gave a clear direction. I am sure that the Minister will give us full details—probably quoting from the progress report for 2008, which we all received fairly recently. Credit where it is due: the target for decreased numbers of deaths was met five years early and waiting times for surgery have decreased—that is partly due to increased use of statins and emergency thrombolysis.
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