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22 Apr 2009 : Column 116WH—continued
However, in January 2008 the Prime Minister set out—I am not sure whether it could be called another example of a rushed announcement like yesterday’s on Members’ expenses—plans to extend dramatically the availability of predict-and-prevent checks. Those are meant to give people information about their health, to support lifestyle changes, and to offer early interventions,
when those are deemed necessary. The checks were to be systematic ones for people in the age group 40 to 74. It was not a bad announcement, but as so often happens something seems to have gone slightly awry, because vascular screening was supposed to have been up and running this April.
Over Easter I took the opportunity to discuss the issue with a doctor from my local medical committee, who said he had received no guidance yet. It would be useful if the Minister would explain or outline the guidance that primary care trusts and commissioners will receive. I am pleased to say that those concerned have not been idle on the matter; they have been talking to the local pharmaceutical committee, which is something that does not happen everywhere. A provisional system was arrived at by which the two professions—pharmacy and the GPs—would work together so as not to duplicate effort, and to avoid treading on people’s toes. It was a quite simple idea: the surgeries would produce lists of the patients most in need of a check, rather than a blanket list of everyone in the relevant age group, some of whom would already be in a doctor’s regular care, and the people in question would be directed to a pharmacy for a vascular screening check. That seemed to me a quite grown-up way for professions to come to a practical solution, each doing the work they are best placed to carry out, without antagonising each other in the process. In health, things sometimes get a little territorial between the professions.
I was pleased that the hon. Member for North-East Cambridgeshire mentioned pharmacy. I should declare an interest as a fellow of the Royal Pharmaceutical Society. It is worth mentioning that 96 per cent. of the population live within 20 minutes of at least one pharmacy and I echo the hon. Gentleman’s comment that pharmacy is currently an under-utilised resource. In addition to vascular checks, pharmacies can help with smoking cessation—which was mentioned just now by the hon. Member for North-West Leicestershire (David Taylor)—diabetes screening and management and weight management services. They can sometimes be of most use to the groups that are harder to reach, such as men who do not go regularly to the doctor but who might live near a pharmacy and be able to pop in on a Saturday. Sometimes members of ethnic minority groups, and particularly women, may shop in the local pharmacy, but be less likely to go to the surgery. Pharmacies such as the Green Light Pharmacy in London have done a huge amount of work with diabetes in ethnic minority communities, to the extent that local consultants noticed that something was going on and worked back to trace the source of the improvement to Green Light’s work. We need to examine those examples of best practice and build on them. Even with such a stunning example of success, however, Green Light Pharmacy does not always find it easy to persuade the PCT to commission services.
I welcome the Cardio and Vascular Coalition’s document, which acknowledges what has been done and serves as a useful focus on what should happen next. No one can really argue with its list of ambitions, which include reducing the incidence of cardiac and vascular disease to among the lowest in western Europe within a generation. I have the same slight reservation I mentioned before, about the difficulty in knowing how to target where one is going, without knowing where everyone else is going as well. Hopefully movement will be in the right direction,
but I should like something a little more specific. The ambitions also include the reduction of inequalities and better integration across health and social care. I cannot, either, argue with the general framework, which is about adopting the best evidence-based practice. It should be patient-centred, with a focus on prevention, and there should be effective joined-up commissioning of services. There is also the standard request for more research.
How is it all going to be achieved? If it were easy it would all have been done by now, and that is part of the problem. To start by thinking about inequalities, in its report the Select Committee on Health did a thorough job of examining the barriers that mean people do not get access to care. It is clear that there are still wide inequalities in this country, whether in the context of class, educational attainment, gender or ethnic minorities.
I was a little concerned about the idea in the document that awareness-raising campaigns are a useful tool. Those campaigns are very difficult to carry out. When politicians try to raise awareness of something that we are doing in a community it takes many different approaches and a lot of time and effort in different media to achieve the desired level. The new buzz phrase is social marketing, but I have yet to be convinced that it works. There is a lot of emphasis on TV and newspaper campaigns, but a lot of younger people today do not even watch much TV. They do not read newspapers. They get all their information from the internet, where it is much more difficult to target an awareness-raising campaign.
It would be more effective if, instead of wasting resources on advertising, they were put into the quality and outcomes framework, so that general practitioners could identify the patients most at risk. Most surgeries have extremely good database information on their patients, and some have put much time and effort into identifying at-risk patients and even more time and effort into making contact. Usually, they invite them in to see a doctor, but if they do not go, somebody will try and make contact with the patient themselves to provide help and advice. That seems to be a much better use of resource than marketing campaigns.
Another interesting aspect of the Select Committee report dealt with the better integration of patient pathways. It talked about health and social care, which was music to my ears because it is a Liberal Democrat policy. However, before moving to that, there is a problem with co-ordination between primary, secondary and tertiary care. Quite often, local commissioners are very focused on primary care but do not—many doctors have told me this—consult enough with the secondary care level to ensure that the whole approach is joined up. One of the biggest hurdles facing my local medical committee, who I met recently, is the lack of continuity between hospitals and communities. When somebody is discharged with a new medication regime, information does not always follow in a timely manner. Mistakes are quite often made upon discharge. No mechanism is in place for checking that.
There is the quite simple idea of patient-held record cards. I wondered whether that was the result of exasperation with the non-appearance of the NHS IT system, which stills seems some years away from being joined up. However, we should not knock old-fashioned card and pen. Using maternity services, pregnant women keep records of what is going on, because they come into contact with a number of different practitioners. It
would be useful if patients felt more empowered and had something to which they could refer and of which they were custodians.
Prevention is the key. Much has been said about healthy lifestyles. We all know what foods we are supposed to eat, that we are not supposed to drink too much, that we are supposed to exercise and that we are not supposed to smoke. Knowing is one thing, but putting it into practice is another. I do not think that anyone has cracked that one yet. Much emphasis is placed on food and diet, but we are not actually eating that much more than we did decades ago, although we might be eating slightly differently and consuming more fat. However, we are exercising less. We need a greater focus on exercise, because what is good at fighting cardiovascular diseases has also been shown to be beneficial in preventing cancer and other diseases.
That would be a useful focal point, particularly from a preventive point of view. However, if a condition develops we must ensure that the earliest and best treatment is provided. For example, diabetes can go undetected for up to 12 years, and people will often have developed complications by the time that it is diagnosed. Indeed, the complications are often diagnosed first and then the diabetes is discovered. Again, prevention is the key message, but equally, if we get better at early diagnosis, we can save the health service a huge amount of money. It is very cost-effective.
Twenty thousand strokes could be avoided through preventive work on high blood pressure, regular heartbeats, smoking cessation and improved statin use. The Stroke Association is calling for a more co-ordinated and strategic prevention programme that brings all the varied initiatives together and recognises the commonalities of cardiac and vascular conditions. It also wants early and full implementation of the 20 quality markers in the 2007 national stroke strategy. It would be useful to know how the Government plan to evaluate its implementation. When will the Department of Health commission an evaluation process, what form will it take and when can we expect the results? I again acknowledge that progress has been made in this area, but as budgets tighten, it would be useful to have an indication of where priorities lie and which areas will be resistant to any budget restrictions. We need national leadership, and the excuse that it is up to the local PCTs to set priorities will not, in this case, suffice.
3.35 pm
Mark Simmonds (Boston and Skegness) (Con): I am pleased to serve under your guidance, Mr. Pope. I, too, congratulate my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss) on securing this important debate, which he introduced in an extremely articulate, comprehensive and detailed way, setting out clearly the issues that the Government need to address. Congratulations must also be offered to the Cardio and Vascular Coalition for the excellent work of its disparate groups and for the production of the report, which will enable a continued focus to be placed, quite rightly, on this area of the provision of health care services in the forthcoming months and years.
I want to give the Minister plenty of time to respond to this afternoon’s excellent debate. However, while clearly progress has been made—my hon. Friend was right to emphasise that—issues remain to be addressed. I was slightly surprised by the hon. Member for Romsey (Sandra Gidley), who was completely dismissive of any sort of European comparators. For example, the UK is significantly behind France in respect of mortality rates. Indeed, only two countries on mainland and western Europe have worse rates than us—Finland and Ireland. Although progress has been made, significantly more needs to be done.
Additionally, the prevalence of illnesses is likely to increase as the population age, as other Members have said. We need to ensure, therefore, that the requisite resources are put into this area, especially given that cardiovascular illnesses will be exacerbated by rising obesity levels and reducing levels of physical activity. The Foresight report concluded that, on current trends, by 2050, 60 per cent. of males and 50 per cent. of females will be classified as obese. Irrespective of which political party we belong to, we all have a collective and significant role to play in trying to ensure that the country’s population get the message about the importance of lifestyle changes.
I do not necessarily agree with the hon. Lady’s analysis. People understand that smoking is bad for them—the hon. Member for North-West Leicestershire (David Taylor) made a powerful case for the need to do more on that. However, I do not think that people necessarily understand that the significant lifestyle choices they make about, for example, diet, drinking too much and lying in the sunshine for too long also have very significant negative health impacts. Central Government and other bodies have a role to play in disseminating that very important information.
The initial national strategy framework pulled together for the first time all the inherently linked problems associated with cardiovascular diseases such as kidney disease. That focus in 2000, along with the additional resources funded by British taxpayers’ money, has made a difference, and we recognise the improvements made. However, in order to ensure improved delivery and patient outcomes, the Government still need to focus on specific areas on which, arguably, they have not focused sufficiently over the past decade or so.
The first area is prevention. It is clear that the Government have not done enough to raise awareness of the risk factors, causes and symptoms of cardiovascular illness. Although we welcome, for example, the recent FAST campaign on stroke awareness, we believe that both primary and secondary prevention must be more prioritised, which is why we have pledged to have a much greater focus on public health, with ring-fenced public health budgets, locally appointed directors of public health and an enhanced role for the chief medical officer’s department, with a specific focus on this area.
The second area that we need to concentrate on is health inequalities. It is well documented that the prevalence of cardio and vascular illnesses is significantly higher in areas of socio-economic deprivation. For example, women in the most deprived areas have a heart disease rate 50 per cent. greater than those in the least deprived areas. Health messages about such illnesses should be targeted at the most at-risk groups to reduce health inequalities. Excellent work is being done by primary
care trusts to address some of those areas, but it is very patchy and it needs to have greater priority across the board. Moreover, things are being done in other countries that we could do in the UK to improve and reduce health inequalities.
Thirdly, significant regional variations were clearly highlighted in the Destination 2020 report. In particular, there were variations in access to cardiac care with relation to revascularisation and National Institute for Health and Clinical Excellence care. We cannot just wait for people to come to the health service; we must take health care out to people in the form of outreach. The hon. Member for Romsey was right about that. Money is often wasted on marketing when it could be used in significantly different ways. In some pockets around the country and in Scotland, such an approach is already under way.
Let me mention the NHS health checks. At the beginning of the debate, we had a party political exchange in which the hon. Member for North-West Leicestershire referred to me as part of the Taliban. That slightly surprised me because I have never been referred to in such a way before. I am sure that the hon. Gentleman will be the first to acknowledge that that exchange was started by one of his own colleagues, rather than by my hon. Friend the Member for North-East Cambridgeshire or myself. For the benefit of patients and patient outcomes, Opposition Members should pressurise the Government to deliver as fast as possible what the Prime Minister promised in January 2008.
David Taylor: Most people in this place would not see me as a boneheaded loyalist, but as far as the NHS is concerned, the Government’s record of the last 12 years stands in stark contrast to the 18 years that preceded it. I am referring here to investment, success and changes in outcome. That is the point that the hon. Member for North-East Cambridgeshire (Mr. Moss) brought out clearly in his positive and objective remarks.
Mark Simmonds: Obviously I was not in the House in the 18 years of the previous Conservative Administration, but I say that we need to look forward. We have clearly said that the health service will be our No. 1 priority in government. We will continue to increase in real terms the investment going into the health service, but we will ensure that taxpayers’ money is used to maximum effectiveness to deliver patient outcomes. In the past 12 years, that has not happened in the way in which it should have done. We would do things differently—for example, by focusing on patient outcomes rather than on process-driven targets.
I urge the Minister to ensure that the policies that were announced in January 2008 are delivered as fast as possible. Triple A screening, for example, should be delivered across the country because it would save a significant number of lives a year. My hon. Friend the Member for Westbury (Dr. Murrison), who is no longer in his place, was right to raise the issue. He has been an assiduous and continuous advocate of rolling out the triple A screening programme. Moreover, there are issues related to peripheral arterial disease, such as the rise in amputation rates. The UK has the lowest number of PAD patients referred to vascular specialists per head of population of any major country in western Europe. Therefore, the Government must focus on that particular issue as well.
One of my final points before the Minister winds up relates to NICE guidance. Although I do not urge the Minister to pressurise or get involved with NICE—that is certainly not her role—it is essential that once NICE guidance has been issued, it should be implemented as fast as possible for the benefit of patients.
The final area that the Government should consider—we are looking at it in great detail—is information. Information should be easily accessible and communicable to the patient. Patients need the information to make choices about not just where they receive their treatment but the type of treatment they receive, so that it best suits their particular circumstances.
In conclusion, I was very pleased to read this excellent report. Many of its principles fit very comfortably with the Conservative party health policy. We have long been calling for a patient-centred national health service with a greater focus on public health, on prevention and on stronger and more effective commissioning closer to the patients. I am very pleased that the report confirms and agrees with much of what we have been saying in the past few months.
3.44 pm
The Parliamentary Under-Secretary of State for Health (Ann Keen): May I say what a pleasure it is to be under your chairmanship today, Mr. Pope? I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) most sincerely on his success in the ballot, which has enabled us to have this very important debate in Westminster Hall today.
Cardiac and vascular health is very important to us all. I learned that as a young nurse in the health service. I spent much of my 30 years in the health service as a cardiac nurse. Sadly, my father died in his 50s of his third myocardial infarction. With today’s treatment and expertise, he would not have died so young. As we have heard in this debate, cardiovascular conditions account for a very significant burden of disease and premature mortality. We have demonstrated our commitment to tackling such conditions by developing the national service frameworks for coronary heart disease, diabetes and renal disease and the national stroke strategy. They have been developed with active input of the NHS, the third sector, patients and carers.
I understand why hon. Members have to be elsewhere on Budget day, but I am sorry that they are not here. I should like to thank them on behalf of the Government and the Department for the work that they do with carers and with the group nationally in an all-party way. Such strategies have helped to drive the excellent progress we have seen across the NHS in cardiac and vascular services. I would particularly like to pay tribute to the role of the third sector in supporting progress in those services.
During this debate we have heard many mentions of the British Heart Foundation, which has made enormous contributions across the whole range of cardiac services. The Department of Health has enjoyed a good relationship with the BHF over the years and we have worked on many projects together. For example, the Department of Health worked with the BHF on developing its genetic information service. I should like to congratulate the British Heart Foundation on the development of such a service.
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