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Such improvements in care fit perfectly with the drive in the NHS for better quality of patient care and improved productivity but, of course, it is also important to prevent the ever-increasing occurrence of diabetes. We need much more research to find out what is really causing the increasing prevalence of that difficult disease.
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Prevention is always better than cure, for the patient as well as the NHS. Now could be the right time for a national target to reduce Britain's rising amputation rates. A national campaign to raise awareness, among not just health professionals-especially GPs-but the general public, seems justified at this time.

1.44 pm

The Minister of State, Department of Health (Gillian Merron): I congratulate my hon. Friend the Member for Bolton, South-East (Dr. Iddon)on securing this important debate and commend him for his excellent work in the all-party group on diabetes, which is a sign of his commitment to reducing vascular disease. He said that he was seeking to persuade me, and as always the points he made were persuasive and well-informed. They shone a light on something that perhaps few have drawn attention to.

My hon. Friend has raised an issue that perfectly illustrates the challenge the NHS must meet in the coming years. His speech reminded me of a quotation. At the turn of the last century, George Bernard Shaw despaired of a society that

In this century, the NHS has changed and continues to change: it is not just a service for treating illness, but a national health service for the promotion of good health. Specifically, it is true that we must do more to save more people from the terrible tragedy of limb amputation. As my hon. Friend says, although peripheral arterial disease can have devastating consequences and affects a significant number of people, it is not often in the public eye. That is why I particularly welcome the debate and am grateful to him for drawing attention to the matter.

To give a wider context, under our five-year plan "From good to great", the NHS must do three things: take a more preventive approach, stopping more people developing serious illness, as we have discussed; be more people-centred, organising services around the individual, and in particular managing long-term conditions in more effective ways; and put quality at the heart of everything it does-improving diagnosis, treatment and management of disease, and building stronger multidisciplinary teams to improve the care that a patient receives.

I absolutely agree with my hon. Friend that peripheral arterial disease is a clear case in point. We must get better at preventing and diagnosing it and managing it at primary care level, and get better at joining up primary and secondary care, so that fewer patients end up facing limb amputation.

As to awareness, it is an unfortunate fact that by the time many of us get to 50, we will have some fatty build-up in our arteries, which can lead to peripheral arterial disease, or indeed to heart disease or stroke. A typical candidate for peripheral arterial disease might be over the age of 50 and would probably be a smoker-often male-and perhaps would have diabetes. Many GPs therefore come across cases fairly regularly, and in the early stages of the disease can treat it themselves with advice about blood pressure and the means to lower cholesterol levels. However, I accept the points that my hon. Friend raised about awareness. It is always good to ensure that GPs are brought into contact with the latest thinking about diagnosis and treatment.

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Bob Spink: I would like to add to the Minister's list obesity, poor diet and lack of exercise, which are also causal factors.

Gillian Merron: I thank the hon. Gentleman for that intervention. I will come on to the contribution that obesity can make, which my hon. Friend the Member for Bolton, South-East has already referred to.

The responsibility for the content of GPs' continuous professional development lies with the royal colleges, as my hon. Friend knows. I confirm that, as a result of the debate taking place, I plan to write to them, raising his concerns and seeking their assurance that peripheral arterial disease features on the curriculum. I am sure he will welcome that.

As to improving the way that people live and their health, the sensible points that my hon. Friend made reminded me of the importance of reducing smoking and encouraging healthier lifestyles. We know that that is vital for reducing cardiovascular disease and diabetes. I was therefore very encouraged recently to hear that, as a result of our Change4Life campaign, more parents-indeed, we estimate that it is a million more mums-are shopping more healthily, putting better food on the table and encouraging their children, like themselves, to move forward. In other words, they are thinking more about their children's diet and exercise, putting them on the road to better vascular health later in life.

My hon. Friend rightly mentioned that the biggest risk factor in peripheral arterial disease is smoking. More than 90 per cent. of people with the disease are smokers-a shocking figure. It is clear that quitting smoking can not only prevent peripheral arterial disease, but can improve and stabilise the condition once it is established. Our ambition to halve smoking rates through the tobacco control strategy that we recently presented will therefore help to reduce peripheral arterial disease, as more people seek to quit and more people do not take up smoking in the first place.

My hon. Friend is right to make those links as, after all, many people would be shocked to hear that by smoking they could ultimately find themselves facing limb amputation, if peripheral arterial disease sets in.

Stopping smoking is perhaps the single biggest prevention measure for vascular disease, but there are other prevention strategies, particularly those linked with the coronary heart disease national service framework and the national service framework for diabetes, which will help to reduce the risk of peripheral arterial disease. The national service framework for diabetes helps to increase the rate of diagnosis, and with diagnosis comes better management of the condition.

I am glad to say that we can point to real progress in reducing vascular disease overall. The Government met their 2010 target on reducing mortality rates for cardiovascular disease five years early, and we have nearly halved death rates compared to the 1995-97 baseline, saving more than 34,000 lives in 2008 alone. The other important development is the NHS health check programme, which was launched last year. It is thought to be one of the most ambitious public health programmes in the world, with around 15 million 40 to 75-year-olds eligible for universal screening and assessment of their risk of developing vascular disease.

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The programme will not only spot potential candidates for peripheral arterial disease earlier on-which, as we have heard, is crucial-but will help GPs and other health professionals to talk to patients about risk factors, helping them to adapt their lifestyles early on and prevent the disease.

Clearly, if people develop peripheral arterial disease, it is vital that they get fast access to the treatment that they need, as my hon. Friend said. I was glad to hear the compliments rightly given about the dramatic improvements we have seen in places such as Ipswich, Middlesbrough and Southampton, and I congratulate all the staff who have made that possible. We would like to see the same results across the national health service.

Last June, the Department of Health commissioned a primary care service framework for peripheral arterial disease, which is about giving primary care trusts support and guidance to improve the commissioning of services to diagnose and manage the disease. The National Institute for Health and Clinical Excellence is developing a new specific guideline on peripheral arterial disease, which I hope my hon. Friend will welcome.

My hon. Friend emphasised the connection with diabetes, and he will therefore know that there is best practice guidance on improving the range and quality of hospital foot care services. That is vital for reducing the number of amputations linked to diabetes, including those brought about by peripheral arterial disease. There is also a considerable amount of work under way to improve support for people living with long-term conditions, which includes delivering more personalised care to help them to manage their own conditions more effectively, and wider use of personal health budgets.

We want to give patients flexibility and control over their treatment. By empowering patients, we will drive up the quality of care, encourage better integration across clinical teams and ensure that patients get the multidisciplinary treatment that my hon. Friend referred to as the best practice. Those are all good points that he rightly made on peripheral arterial disease.

Quality draws all this together. We have embarked on an ambitious quality and productivity programme, and over the next year the national health service will put huge energy into identifying the most effective and efficient, and the safest, treatment across the system. The leadership will be provided by the National Quality Board, whose role it will be to take decisions on prioritisation in relation to specific conditions, if that should prove necessary.

My hon. Friend made a call for a specific target to reduce lower limb amputations, and I absolutely understand why he has done so. In recent years, we have tried to move to a position in which we are improving quality throughout the NHS and making quality the organising principle. Linked to that, we have to set service-wide ambitions, such as our commitment to an 18-week maximum wait between GP and operating theatre, the new commitment to one-week cancer diagnosis and the commitment to a maximum four-hour wait in accident and emergency.

All those commitments are crucial to continuing the excellence of health care for patients and what they should rightly have, which should, of course, achieve improvements for everybody. We believe that the approach of setting more service-wide ambitions will ultimately
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be rather more effective than setting ever more, and ever more condition-specific, targets.

The conditions are right for the NHS to build on the work that has been done over the past decade to reduce and contain all forms of vascular disease and diabetes. It is clear, I agree, that we have to improve the treatment of symptomatic peripheral arterial disease, as my hon. Friend so clearly and rightly described. Above all, we have to do everything we can to prevent more people from developing the condition in the first place. That is where our primary focus will be, and it is why we
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continue to devote so much effort to programmes such as Change4Life and the NHS stop smoking services. We will, however, continue to take heed of the points that my hon. Friend has made, and I look forward to continuing improvements and a lessening of the number of limb amputations.

Question put and agreed to.

1.57 pm

Sitting adjourned.

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