(1 year, 10 months ago)
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Jim Shannon (Strangford) (DUP)
I beg to move,
That this House has considered the impact of the covid-19 pandemic on people with heart and circulatory diseases.
May I say how pleased I am to have this debate in the main Chamber? It was originally earmarked for Westminster Hall, where most of my debates are—indeed, probably all of them—but on this occasion I have kindly been elevated to the main Chamber, and I am greatly humbled to have this opportunity. I spoke to Mr Speaker’s Office this morning to thank the staff for that. I understand the reasons for it, but the reasons do not matter: we are here, and that is the important thing. I am very pleased to be able to participate in this debate.
Bob Blackman (Harrow East) (Con)
I thank the hon. Gentleman for taking on the opportunity to have a debate in this Chamber; as he well knows, had he not been so flexible the House would be rising now. He has enabled the House to continue, and on behalf of the Backbench Business Committee I thank him. Of course, his season ticket is honourably renewed.
Jim Shannon
I thank the hon. Gentleman for his kindness. The Backbench Business Committee is kind to everyone who applies for a debate, so I am always very pleased to do so, and on a regular basis. It will not be too long before I am back looking for more debates.
On this debate, I put on the record my thanks to the Committee. I am pleased to see that Members from across the House are involved, although I am mindful that today right hon. and hon. Members have many other engagements that mean they are unable to be here, even though the debate is in the main Chamber.
It is just over two years since the start of the lockdowns, and a little more since the pandemic first arrived. Life changed for everyone—I do not think there is anyone in the United Kingdom of Great Britain and Northern Ireland who did not have a life-changing moment—and for some of us it may never be the same as it was. It will never be the same for those who have lost loved ones; that is very real for every one of us. Some of the changes that took place due to the pandemic and covid-19 were cosmetic, but others have been life changing, and it is those changes that we need to address.
I want to say a massive thank you to all the doctors, nurses, auxiliary staff and cleaning staff—there are so many to name—who have been outstanding. There is nobody in this House who does not know some of them, has not spoken to them and does not also want to put that on the record as well. I thank them at the beginning of this debate.
During lockdown, barriers and obstacles to providing care for heart patients and all patients rocketed. I know that happened across all health departments, but in particular I thank the British Heart Foundation and the Stroke Association for all the information, detail and evidence they sent to me and others for the debate. We are very pleased to have that.
Some of those efforts by doctors were heroic; I do not use that word often, but on this occasion it is a word that aptly describes their efforts. Despite those heroic efforts of doctors, nurses and other key workers in our health systems, however, we have seen cardiovascular services disrupted so greatly that people are still feeling the effects today.
I am beyond thankful for every NHS staff member who went ahead with emergency surgeries. The reality of life for elected representatives is that we do not get many people coming and saying, “Thank you very much for that.” We get the complaints, but that is what we do. We are a conduit for their complaints and concerns. Some of the people were waiting for emergency surgery were not sure whether they would pay a price for that, so again for that I sincerely say a big thank you.
We are all aware of the waiting lists, reduced access to primary care and the pressures on urgent and emergency care. They all have real consequences for people’s health. That is why hon. Members pushed for this debate and why we are so pleased to have the opportunity to hold it today in the main Chamber. I feel incredibly privileged, honoured and humbled to be able to present this case—not for me, because I am not important, but on behalf of our constituents who have experienced hardship because of those things.
Those problems have also had real consequences for families’ lives, their relationships and the happiness of their families. Very often, the issues for those who were ill reflected back on the families, who were under incredible pressure to deal with circumstances that would be difficult to deal with normally but that, with covid-19 and the pandemic, escalated even more. There are 11,000 people living with heart or circulatory diseases in my constituency. I know the Minister does not have responsibility for Northern Ireland, but I will provide examples from Northern Ireland that are relevant across the whole of the United Kingdom of Great Britain and Northern Ireland. There are 2,000 stroke survivors and 13,000 people who have been diagnosed with high blood pressure.
Long waits, difficulty accessing routine medical services and long ambulance response times make life more difficult for the 7.6 million people living with heart and circulatory diseases in the UK. I mention those issues not as a criticism, but to highlight them and raise awareness. Ambulance response times in many parts of the United Kingdom, including in my own constituency, have been difficult, as have been the waiting times outside accident and emergency departments, with ambulances in place. That is happening not just in Northern Ireland but elsewhere, as I am sure other hon. Members will confirm.
Someone in the UK dies from a heart or circulatory disease every three minutes. This debate has been going for six minutes, so that means two people will have died from heart disease since it began. By the time the debate is over—it is a stark headline, unfortunately—as many as 20 people will have passed away. That statistic reminds us of the fickleness of life. It also reminds us of what this debate is about and why we are here. Someone is admitted to hospital due to a stroke every five minutes. Indeed, someone will have been admitted to hospital since this debate began. Two thirds of patients leave hospital with a disability. Stroke as a standalone condition costs the UK economy £26 billion annually, yet it is largely preventable and recoverable.
I look forward very much to hearing the response to the debate from the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup). I know she is very committed to her job and has a deep interest in it, so I look forward to what she has to say in response to the questions we will ask her today. I also look forward to hearing from the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who is a good friend and with whom I seem to be in debates all the time. If we were not in the Chamber today, we would be in Westminster Hall.
Northern Ireland Chest, Heart and Stroke highlights that there were 15,758 recorded deaths in 2019. That is some figure and it is worrying. The top three causes were cancer, circulatory diseases and respiratory diseases; together, those accounted for 64.3% of all deaths in Northern Ireland. That figure reminds us of just how fickle life is and that we are just a breath away from passing from this world to the next. They have been the three leading causes of deaths since 2012. Deaths due to chest, heart and stroke conditions, when combined, are the No. 1 cause of death, at 36%. As I said earlier, that reminds us why this debate is so vital and why we look to the Minister for a response that can help us, encourage us and give us some hope for the future.
These are some of the most prevalent, serious and life-altering conditions that anyone could have the misfortune to suffer from. They touch everyone’s lives, be they in Northern Ireland, where my Strangford constituency is, Scotland or Wales—or England, with whose health matters this House is primarily concerned. I also very much look forward to hearing from—I apologise; I should have said it earlier—the hon. Member for Motherwell and Wishaw (Marion Fellows) on behalf of the SNP. She has a deep interest in health, too, and I look forward very much to her contribution.
Every one of us has a neighbour, a friend or a loved one who has problems with their heart. Those problems do not halt at any border. They do not even, dare I say it—rather mischievously, perhaps—stop at the Irish sea border, which is able to prevent most things from crossing over. What prevents them from getting the care they need? The most obvious issue is undoubtedly waiting lists, which are at record levels. One of the questions I would like to ask the Minister—I always ask such questions constructively; that is my way of doing things—is: what is being done to reduce waiting lists and to provide some hope? According to NHS England, only this month the queue for NHS care stood at 6.5 million, the highest number on record ever. The number of patients waiting more than a year to be seen has increased to 323,000, which is a massive number. These are record levels as the health sector recovers from the impact of the pandemic.
Although the pandemic has hugely affected waiting lists, the issue predates the pandemic. At the start of 2020, around 30,000 people were waiting more than 18 weeks for cardiac care. This problem was not caused by covid, but it was exacerbated and worsened by covid. If it was bad before, it is much worse now.
The pandemic has had a seismic effect. In April 2022, two months ago, 170 times more people in England were waiting more than a year for heart procedures than in February 2020. I look for an indication of how we can reduce that number, and I know there is a strategy. I am putting this constructively, because I believe there are ways to do it, and the hon. Members for Denton and Reddish and for Motherwell and Wishaw, other Members and I are keen to hear what they are. Waiting lists for cardiac care have also hit record levels, rising to 319,000 people. In Northern Ireland there are 31 times as many people waiting more than six months for cardiac surgery compared with the end of 2019.
And it is not only life-saving surgery, as some of this surgery is about people’s quality of life. Waiting times for echocardiograms, a kind of heart ultrasound used to diagnose a range of conditions, have risen, too. More than 170,000 patients were waiting for an echocardiogram at the end of April 2022, with 44.6% of them—almost half—waiting more than six weeks. That is a 32% increase on the year before. The covid-19 pandemic has increased those numbers, and I am not blaming anyone for that, but we need to address these issues, both as a Government and collectively, in a way that gives succour and support to our constituents.
In Northern Ireland, the number of people waiting more than six months for a cardiac investigation or treatment reached a new record in March 2022. That is the responsibility of Robin Swann, the Health Minister in the Northern Ireland Assembly, and I know he has taken steps to try to address it, but this is a general debate about how we address heart and circulatory diseases across the whole United Kingdom of Great Britain and Northern Ireland following covid-19.
Nearly three quarters of people in Northern Ireland waiting for an echocardiogram have waited longer than the recommended clinical maximum. A number of worried, heartbroken family members have come to my office to say that covid is killing their loved ones, even though they did not have covid themselves. The delays were and continue to be a threat to life. Covid-19 does not seem to result in the number of hospital cases that it once did, which is good news.
Although an echocardiogram is not open-heart surgery, delays still cause increased anxiety for patients and delay the treatment they need. Taken as a whole, cancelled operations risk a rise in avoidable deaths and disability, and they cause anxiety and put physical pressure on people with heart problems.
What can we do about this? The British Heart Foundation is watching this debate, and I thank it for giving me most of my information. I also have a staff member who is qualified in this, and she has given me some information, too. I am proud to work with the British Heart Foundation, which has welcomed the additional funding for the NHS and the announcement that 95% of patients who need diagnostic tests will receive them within six weeks by 2025. It is good news that we have a target but, with respect, that target is a few years away. We need to consider how we address the situation over the intervening three years. The foundation has also pushed for an accompanying Government strategy for cardiovascular disease to take us beyond recovery and address the problems that existed before the pandemic.
With all that in mind, we need to think about how we can do better and support those who need help today. The NHS long-term plan identifies cardiovascular disease as
“the single biggest area where the NHS can save lives over the next 10 years.”
If there is one issue I would love us to tackle, it is how we can save lives. I am ever mindful of the statistic I cited earlier that every three minutes someone dies as a result of heart problems. If we can save lives, that is what we want to be doing. We know that the NHS is doing all it can to deliver cardiovascular services, but without a properly funded cardiovascular disease strategy, it cannot meet its targets and deliver adequate care. When will a strategy be put in place to address the issues in the short term?
What else would such a strategy address? Cardiovascular diseases have many and varied impacts on patients, who need different forms of care as a result. Access to primary care is integral to the identification and management of heart conditions. When people cannot access primary care, opportunities to prevent heart attacks and strokes are lost, and more problems are caused for those who are already under pressure. How do we address that issue?
A 2021 survey of 3,000 heart patients found that 12% had a routine medication or condition review cancelled or rescheduled in the first year of the pandemic. I understand that the pandemic was not the Government’s fault; the Government are to be complimented and thanked for how they responded to it, because we are all beneficiaries of the vaccination programme and it is probably why some of us are alive today. However, the cancellation or rescheduling of routine medication or condition reviews explains the longer waiting lists. Four patients in 10 have had appointments cancelled or rescheduled more than once. I know people back home who have actually fasted for an operation and then been told that it would not go ahead, which has caused anxiety and worry.
Health Foundation analysis shows that 31 million fewer primary care appointments were booked between April 2020 and March 2021 than in the previous 12 months. The pandemic has also had an impact on how patients with heart and circulatory disease interact with primary care. Some people say that there are lies, damned lies and statistics, but statistics prove a point: there were 5 million fewer face-to-face GP appointments in 2020 and in 2021 than in 2019. We understand the reasons why, but we have had a lot of debates in this Chamber and in Westminster Hall about GP appointments, and there is not one of us who would not wish for the number of appointments that we once had. My constituents tell me that, and I am anxious and keen for appointments to return.
Many people welcome the flexibility and safety that remote appointments bring, but they can mean that healthcare professionals lose the opportunity to collect information that they usually gain through physical examination. Constituents have told me that their ailments and problems would be better assessed physically. The quicker we move back to physical assessments, the better. Someone cannot really be diagnosed at the other end of a Zoom call; they can say what their issues are, and by and large the doctor may get a fair idea, but in many cases it takes a physical examination. The situation is no one’s fault, but it may lead to a delayed or even missed diagnosis of a condition such as high blood pressure. I take a Losartan tablet for my blood pressure every day; I was told by my doctor not to worry about it, but after he told me I would have to take it every day, he said, “By the way, you can’t stop it.” At that stage, I realised that it is necessary to keep me on the straight and narrow and keep me breathing, so perhaps in a small way I understand the need to control blood pressure.
We do not know for sure how many missed diagnoses there have been but we do know that the NHS issued 470,000 fewer prescriptions for preventive cardiovascular drugs between March and October 2020 than in the same period of the previous year. The Institute for Public Policy Research forecasts that if those missing people with high-risk cardiovascular conditions do not commence treatment there will be an additional 12,000 heart attacks and strokes in the next five years. I ask the Minister what is being done to find those who have not been prescribed these preventive drugs over the last period of time, mindful that the unfortunate end result of that is more heart attacks.
This is a ticking time bomb, and we need to defuse it if we are to meet NHS long-term plan aspirations to prevent 150,000 heart attacks, strokes and dementia cases by 2028-29 and, more importantly, if we are to be able to look those families in the face. Behind every person who dies of a heart attack there is a grieving family; we know that probably personally and certainly from constituent cases. As the Good Book says, we have threescore years and 10; we might get less than that or we might get more, but one thing we do know is that our time will pass. We must address the issue of preventing heart attacks, strokes and dementia.
At least half of the 15 million adults in the UK who have high blood pressure are undiagnosed. We all need a bit of stress; it is part of life, and I thrive on a bit of stress, but we can only take so much and it is important to find the right balance. Many of those with high blood pressure are not receiving effective treatment. It is vital to find people early and support them to manage cardiovascular risk factors such as atrial fibrillation. The Automated External Defibrillators (Public Access) Bill was introduced in the House not long ago, with support from all parties; I hope the Government will support its progress so its measures can be introduced in health and education settings. Finding the people with conditions early is vital; we must try to help people manage conditions such as raised cholesterol and hypertension so they can longer and healthier lives.
However, we cannot do that if we do not know who they are, which shows that data is important; it comes up in almost every health debate I participate in. To be fair, the Government and the Minister understand this, as data helps to focus on the right strategy and develop it in a constructive way based on evidence. I ask the Minister to put on the record where we currently are in relation to the collection of data, as it will point the way forward.
Some patients do not need to be found, however, as they or a loved one call 999 because of a medical emergency. For cardiovascular conditions, that normally means they have had a heart attack or stroke. A fast response that gets the right person to the right hospital department at the right time in an ambulance can be the difference between life and death. The newspapers often present examples of ambulances not arriving in time for whatever reason and people passing away. Unfortunately, in England the average response time in May for a category 2 emergency such as a heart attack or stroke was almost 40 minutes; we must do better. The target is 18 minutes; it is not being met.
I did not manage to source the corresponding data for Northern Ireland, but I know personally of one 70-year-old lady who had called believing her husband was having a stroke. She was told to give him an aspirin to chew and that the ambulance was delayed. She was then told in another phone call, which was fairly frantic, that if possible she should bring him herself to hospital, so she dragged him to the car—he is a fairly big man—and arrived at the hospital crying and begging passers-by to help. This man was diagnosed with some form of hernia which presented like a heart attack, and I thank God for that because he could have died waiting on the ambulance and then waiting on his elderly wife to trail him to a car and on to a hospital; that is simply not good enough.
Owing to the scale of current ambulance and A&E delays, we will see more disability and deaths from heart and circulatory disease that could otherwise have been avoided, but if we can avoid them—if we can do things better—the debate will have achieved its goal. This is happening despite NHS workers and paramedics going above and beyond the call of duty to help those in need. I used the word “heroic” earlier, and I use it again now. It is not a word that is taken out of context when I apply it to those workers. Ambulance delays are the symptom of a system that is under immense pressure at every level. Problems in one part of the NHS affect other parts. Problems with accessing primary care lead to more emergencies, which means that, again, there is a greater demand for ambulances.
Margaret Greenwood (Wirral West) (Lab)
The hon. Gentleman is making an excellent speech, and I commend him for securing the debate. He mentioned the waiting times for category 2 emergencies. A constituent of mine lost her mother because the ambulance took more than an hour to arrive. This is a heartbreaking situation, and no family should have to go through it. Does the hon. Gentleman agree that we need urgent action to improve ambulance attendance times?
Jim Shannon
I certainly do, and I am sorry to hear of the passing of the mother of the hon. Lady’s constituent. If the ambulance had arrived earlier, perhaps she would be alive today. That example is probably replicated throughout the United Kingdom of Great Britain and Northern Ireland; I know that it is in my constituency, and indeed elsewhere. Perhaps when the Minister responds to the debate, we will hear some indication of how this could change.
A holistic response is needed. The NHS cannot begin to address this crisis, the very crisis to which the hon. Lady has just referred, without significant help from the Government—again, I look to the Minister—in the form of a cardiovascular strategy covering the whole patient pathway, as has been called for by the British Heart Foundation, which is also calling for a similar strategy in Northern Ireland. While the BHF wants the strategy in England, of which the Minister will be aware, to be replicated in Northern Ireland, I suspect that the same applies to Scotland and Wales.
The UK strategy, at its core, needs to address the issue of the workforce. Just as workforce shortages are key to issues involving waiting lists, access to primary care and ambulance delays; solving those shortages must be key to the response. I know from statements that Ministers have made, both in the Chamber and in Westminster Hall, that they are committed to increasing the number of nurses, doctors and other staff in the NHS, and the figures are certainly very encouraging. We have not yet reached the targets of 50,000 nurses and 20,000 GPs, but the Minister may be able to give us some timescales and some idea of when the Government hope to achieve those targets.
People who are at risk of cardiovascular diseases, and those already living with them, are supported by a diverse range of health professionals—paramedics, cardiographers, and specialist cardiac nurses—but the 2021 “Getting It Right First Time” cardiology report estimates that the NHS is short of nearly 100 consultant cardiologists; there are currently about 1,700. Perhaps the Minister will be able to tell us when those 100 vacancies will be filled. I ask these questions with the aim of being constructive and ensuring that our constituents throughout this great nation have a better idea of what is going to happen. It is said that we also need 760 new cardiac physiologists to meet the demand over the next decade. Is there a strategy and a recruitment plan? If there is, we will be greatly encouraged. I look forward to the Minister’s response.
Margaret Greenwood
I thank the hon. Gentleman for being so generous with his time. He has talked about shortages, and how we should plan for the future. A number of my constituents have written to me about the financial difficulties experienced by medical students, particularly during the final two years of their training. Does the hon. Gentleman agree that the Government really need to come up with a plan to protect and support student doctors, so that we can have the workforce that we need for the future, and ensure that people from all backgrounds can have a career in medicine?
Jim Shannon
I thank the hon. Lady for that helpful intervention. I am glad that she mentioned that: it should have been in my notes and she has reminded me. We do need to have a plan to help those students who wish to pursue a future vocation as consultant cardiologists. If we can recruit them now, it will take three, four or even five years before they are ready. I am not sure whether it is the Minister’s responsibility, but perhaps she could give us some idea of whether there is a plan to give students some financial assistance. I have asked the question before, and the answer would be very interesting. If people make a commitment to staying in the NHS for that period of time, perhaps the Government can make a financial commitment to them.
Mrs Flick Drummond (Meon Valley) (Con)
The hon. Gentleman is making an excellent speech and I am listening to it carefully. Doctors take between 10 and 15 years to become consultants once they have graduated, and they stay in the NHS for two years for the foundation levels. Many GPs are doing face-to-face appointments, and some departments are doing amazing work, such as St George’s Hospital in Tooting which is looking after a huge number of my family who have Brugada syndrome, a sudden death syndrome that affects the heart. I thank the hon. Gentleman for raising awareness of the issue: there are some very good things going on in the NHS at the moment.
Jim Shannon
The hon. Lady is right. There are some remarkable consultants, and we should be greatly encouraged by that, but I want to highlight some of the shortfalls and look to the Minister and the Government for how we can take that forward. I mentioned a timescale of three, four or five years, but I accept that 10 or 15 years is more realistic.
We greatly underestimate the number of heart failure specialist nurses required to deliver the NHS long-term plan. The recommendations do not consider the full extent of covid-19 backlogs and national recovery targets, meaning the shortages are likely to be even more pronounced now than they would have been before.
More generally, the number of full-time, fully qualified GPs in England decreased by about 6% in the five years between 2016 and 2021. Full-time equivalent district nurses have reduced by 45% between 2010 and 2021. Seven out of 10 practice nurses work less than full time, and around a third are aged over 55.
I accept that the Government have committed to recruitment, but the issue is how the shortfall can be made up. Without a workforce capable of meeting demand, heart patients are at risk across the entire patient pathway, from the moment they dial 999 to when they find themselves in limbo waiting for specialist treatment. The NHS is publishing its long-term workforce plan in the autumn, and that must address shortages at specialty level. We need to know where the gaps in the cardiac workforce are so that we can address them. Perhaps the Minister can give us some idea of where we are in relation to that.
I am also interested, as a Northern Ireland MP who is principally based in this House, in the discussions that take place with the regional Administrations. The shadow Minister from the SNP will speak shortly and I am sure she will give us—as she always does—good information and the evidential base for what is happening in Scotland. I am always keen that all the Administrations come together with their knowledge and information, whether from Scotland, Wales, Northern Ireland or England, so that we can swap ideas on how to do things better. I am keen to hear what is happening in that regard.
We also need to know where the gaps are regionally. While one postcode area may be exceptional, others may not be. While there might be a shortfall in England, we need to know what is happening in Northern Ireland, Scotland and Wales. The number and type of cardiac health workers is not spread evenly across the UK. The greatest number and range of workers is concentrated in large urban areas in England, meaning that many rural areas find themselves at a disadvantage. I hope the Minister can give us some idea of what can be done to improve the situation. The areas with the most workers are not necessarily the areas with the highest rate of cardiovascular diseases, or the poorest outcomes. We need to reappraise how that is done.
The British Heart Foundation is conducting a research project designed to further pinpoint gaps in the cardiac workforce and predict where they may come in future. I wish the BHF all the best as it carries out this vital informative work. That research project might be helpful to the Department; I hope the Minister will be able to tell us what discussions she has had with the BHF on that.
If we address the issue of workforce, we can start addressing waiting lists, primary care and ambulances, and start saving more lives. Let us not forget that the NHS long-term plan identified cardiovascular disease as the single biggest area in which the NHS can save lives over the next decade. We all want to save lives and if there is a way of doing so, the Government need to grasp that. This House and our constituents need to see a clear plan.
So there we have it—I have encapsulated the debate over a bit longer time than I thought I might, but it is an important issue. We need a UK Government strategy specific to cardiovascular disease that addresses the cardiac workforce crisis, the disparity across the United Kingdom and provides sufficient resources for the delivery of cardiac services.
Cardiac care cannot wait, because those suffering from cardiovascular diseases deserve better. In this place, every one of us can be a part of life-changing post-covid changes for the better. I hope that today’s debate is another step in that programme to change things. I look forward to the contributions from other Members. I thank those who have already intervened. I look forward to the responses from the shadow Ministers and especially to that from the Minister.
Madam Deputy Speaker (Dame Rosie Winterton)
We come to the SNP spokesperson, Marion Fellows.
Marion Fellows (Motherwell and Wishaw) (SNP)
I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate and for his passion in delivering his speech today. We all know and value the work he does to raise issues for his constituents here and in Westminster Hall. I also thank Chest Heart & Stroke Scotland and the British Heart Foundation for the valuable work that they do.
I start by pointing out that NHS Scotland is and always has been independent; NHS England or the NHS in Northern Ireland do not cover Scotland. We have always done things slightly differently, but work well in conjunction with the other health services.
Heart disease remains a major cause of death and disability in Scotland, accounting for more than 9,000 deaths each year. Ischaemic heart disease, which can lead to heart attack, is still Scotland’s single biggest killer, responsible for 11.2% of all deaths in 2019 and 25,000 hospital admissions every year. In March 2021, my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) spoke in a Westminster Hall debate on patients with heart failure, emphasising that the most important factor in such diseases and premature deaths is poverty. Within their limited powers, the Scottish Government are doing everything they can to help those in poverty in Scotland by such measures as mitigating the bedroom tax, introducing a baby box to give a good start to every baby born in Scotland, and introducing other benefits to those qualifying, including a best start grant, pregnancy and baby payment, and the Scottish child payment. These are all designed to improve life chances for people, and especially children, living in Scotland. If we keep the weans well, they will continue with good outcomes further on in their lives.
The covid-19 pandemic has been a worrying time for many folk, especially if they already had a pre-existing condition such as heart or circulatory disease. There is no doubt that covid-19 has impacted some groups more than others. It is an unwelcome reality that communities experience health, quality of life and life expectancy differently. Having a heart or circulatory condition probably does not make someone more likely to catch coronavirus, but if they have a heart condition, it can mean that they could get more ill if they catch it, so anyone with a heart condition is considered at an increased risk of more severe complications, and someone who is over 60 years old has a particularly high risk. The covid vaccine—we have to emphasise this—is safe for people with heart and circulatory conditions. Getting the vaccine is one of the main things that people can do to reduce the risk of becoming seriously ill from covid-19, as well as getting a booster shot when offered. During the first lockdown period of the pandemic, there was a deferral and reduction of services, including diagnostics, access to specialist support in the community, and cardiac rehabilitation. This needs addressing across the United Kingdom.
I am pleased that the Scottish Government are taking action on tackling heart disease in Scotland and have published an updated heart disease action plan. The covid-19 pandemic has brought the need to address heart disease in Scotland into even sharper focus, having had a significant impact on people with heart disease and on the services that support them. The heart disease action plan sets out the Scottish Government’s vision of minimising preventable heart disease and of ensuring timely and equitable access to diagnosis, treatment and care. The vision of the plan is to minimise preventable heart disease and ensure that everyone with suspected heart disease in Scotland gets what they need. We need to identify ways to support people with the emotional and psychological impacts of heart disease, giving as many people as possible access to specialist support, including vital rehabilitation services, and, where necessary, supporting access to palliative care. Addressing inequality will be monitored and considered carefully throughout the implementation of the plan. In Scotland, one of the things we are really good at is listening to a wide range of voices in efforts to create pathways and reshape models of care. The use of technology and care closer to home has also been vital to maintain care throughout the pandemic and has important lessons for delivering person-centred care in future.
Cardiovascular disease is one of the main causes of death and disability in the UK, but it can often be largely prevented by leading a healthy lifestyle, and the Scottish Government are supporting people to make healthier choices. It is not always good to talk about what has happened but good rather to think about how we can prevent it happening in future. Many people in Scotland live with cardiovascular risk factors such as high blood pressure or high cholesterol that place them at increased risk of heart disease or stroke. Health-harming products—alcohol, tobacco and unhealthy food and drinks—contribute to widening of health inequalities. Improving diet and levels of healthy weight is a public health priority. The Scottish Government are taking wide-ranging action to support healthier choices, as they have set out in “A healthier future: Scotland’s diet and healthy weight delivery plan”. The Scottish Government are shifting the emphasis from dealing with the consequences of obesity to tackling the underlying causes, which includes: ending poverty; supporting fair wages and families; and improving physical and social environments. The Scottish Government are committed to introducing during this Parliament a Bill that includes powers to restrict the promotion of food and drink that are high in fat, sugar and salt. They have long advocated that TV and online advertising of foods high in fat, sugar or salt should be restricted to give children the best start in life. The SNP welcomes the fact that the UK Government have now moved in line with the Scottish Government’s position, although it is disappointed at the delayed implementation.
The Scottish Government’s tobacco control action plan sets out the priorities for reducing smoking rates to 5% or less by 2034. Their alcohol framework sets out priorities for preventing alcohol-related harm, and it contains 20 actions, building on existing action to change Scotland’s relationship with alcohol, including Scotland’s world-leading minimum unit pricing policy.
The Scottish Government are investing in health and are committed to significantly reducing health inequalities. There is no doubt that covid-19 has had a disproportionate impact on people living in areas of socio-economic deprivation. The Scottish Government’s programme for Government includes commitments to improve life expectancy and to tackle health inequalities.
The Scottish Government are committed to ensuring appropriate staff resources and training to deliver timely and equitable services across Scotland for people with heart disease. Under the SNP, Scotland has record health funding: a total health portfolio funding of £18 billion, with resource funding up over 90% in cash terms under the SNP since 2006-07. Frontline health spending is £111 higher per head in Scotland than in England. That is important because the Scottish Government recognise that we start from a lower base of good health, and they are committed to improving health. As I have said, disease prevention is a big factor.
We now have higher staffing per head than NHS England. We have a record number of GPs working in Scotland, with more per head in Scotland than the rest of the UK. The Scottish Government’s NHS recovery plan, which is backed by more than £1 billion, sets out plans for health and care over the next five years. They are creating a network of national treatment centres, increasing capacity for more than 40,000 additional planned elective procedures and diagnostic care across 12 different specialities. They are also targeting improvements designed to maintain the 31-day standard and achieve the 62-day standard on a sustainable basis. They are also scaling up the use of NHS Near Me, which is a really good initiative and supported by £3.4 million a year. They are providing general practices and their patients with support from a wide range of healthcare professionals in the community. My own GP practice uses such healthcare professionals and it is really effective.
The Scottish Government also recognise the negative impact that long covid can have on the health and wellbeing of those affected, so they are spending more money to improve the care and support available for people with long covid across Scotland. The Scottish Government’s chief scientific officer is funding nine Scottish-led research projects on the longer-term effects of covid-19, which will also impact on those with heart conditions and circulatory diseases. Does the Minister agree that what the Scottish Government are doing will help people with heart and circulatory diseases, and will she consider emulating their actions?
Madam Deputy Speaker (Dame Rosie Winterton)
I call the shadow Minister, Andrew Gwynne.
Andrew Gwynne (Denton and Reddish) (Lab)
I thank the hon. Member for Strangford (Jim Shannon)—I call him my hon. Friend because he is my friend—not only for securing the debate but for his skilful, seamless segue from Westminster Hall to the main Chamber. I join him in paying tribute to all those who work in our health and care system—from doctors and nurses through to porters, cleaners and cooks. They all keep our health and care system going, and we thank each and every one of them for the work they do.
As we heard from the hon. Members for Strangford and for Motherwell and Wishaw (Marion Fellows), who leads for the SNP on these matters, the issue of health inequalities cannot be ignored. The hon. Gentleman talked about postcodes and the workforce not being spread equally, and those health inequalities are not spread evenly across the UK. The hon. Lady mentioned some endemic health inequalities in parts of Scotland, and the same is true of every part of the UK. The maps of deprivation, of certain black and minority ethnic communities, of income levels, of education levels, of obesity and of smoking prevalence can almost be overlaid, and directly correlate, with those for the conditions that we are talking about. Those health inequalities and how we tackle them must be at the heart of everything we do, whether we are talking about the UK Government and their health policy for England, or the devolved Governments across the nations of the UK and the work they do to tackle these same health inequalities in the communities we represent. Health prevention must be at the core of what we do, and I am grateful for the insight the hon. Lady gave on the work of the NHS in Scotland and the insight that the hon. Gentleman brings on the work of the NHS in Northern Ireland. I am a big fan of the Marmot way of looking at health inequalities and how we tackle the social determinants of health. If we get that prevention policy right, we tackle the very conditions that we are talking about.
The pandemic piled massive pressure on the NHS, and indeed the motion is on the impact of the covid-19 pandemic on people with heart and circulatory diseases. But these problems did not start with the covid pandemic. They have been exacerbated massively by it, but I am afraid that we are now seeing the consequences of 12 years of Conservative Government in England: soaring waiting times, an acute staffing crisis and the worst levels of patient satisfaction since the 1950s. We went into 2020 with the NHS in crisis, and the pandemic ruthlessly exploited and exacerbated the failures. As the Culture Secretary recently admitted, a decade of Conservative rule left our NHS “wanting and inadequate” before covid hit. That is nowhere more apparent than in cardiac care. At the start of 2020, 30,000 people were waiting more than 18 weeks for cardiac care. That was already an unacceptably high figure, but it has ballooned by an unbelievable amount in the last two years. Now, 319,000 people are on an NHS waiting list for cardiac care—that is 319,000 individuals anxiously awaiting essential care, worried for their future, worried about their health and worried about their lives.
Cardiac care is time-sensitive. For example, patients with severe aortic stenosis—I will put my teeth in to say that—who are treated within two years have a 50% chance of survival, but that falls to 20% after five years. Every day that the Government fail to act, more patients face worse outcomes. About 15 million adults in the UK have high blood pressure and about 270,000 people over 65 have undiagnosed atrial fibrillation. What does that mean? It means we are sitting on a ticking timebomb, and unless we pre-emptively support people to manage cardiovascular risk factors, the system will come under even more pressure. I urge Ministers to work relentlessly to get a grip on this crisis. They need to come to terms with the fact that, on their watch, cardiac care has been allowed to falter. It is maddening that in these circumstances the Government have not set out a robust strategy for cardiac care and how they plan to address these really important issues. When the Minister comes to the Dispatch Box, will she commit to a timeline for that strategy, or will we hear more warm words with precious little action?
I want to reiterate concerns raised about urgent and emergency care. We now know that the average response time for a category 2 emergency, such as a heart attack or stroke, is more than double the target of 18 minutes. In some parts of the country, it is far, far worse than that, as we heard from my hon. Friend the Member for Wirral West (Margaret Greenwood) . Does the Minister agree that no one suffering from a heart attack or a stroke should have to wait 40 minutes or more for an ambulance? If so—I am sure that she does, as we all do in the House; nobody wants to see those failings—what discussions have she and her colleagues had to sort it out? This is a crisis on multiple fronts, and I am afraid that we need action rather than words.
From the moment a patient dials 999, they are being systematically failed. As we know, our NHS staff are heroes. Without them, the system would have buckled under the weight of incompetence and indecision during the pandemic, but they are fighting an uphill battle and the Government are letting them do it alone. That needs to change.
There is also a failure to acknowledge the role that prevention plays with health and social care. The Government have cut public health budgets here in England—that happened before the pandemic, and it is just not acceptable—and it means that only half of adults over 40 are attending regular health checks, which were introduced by the Labour Government in 2009. Those health checks have provided crucial evidence for spotting diseases early on, not least cardiovascular disease. With the fall in health checks, many opportunities to spot avoidable problems are being missed, especially among people from disadvantaged communities as I and the hon. Member for Motherwell and Wishaw outlined earlier. Indeed, the disproportionate impact of covid-19 showed starkly just how unequal a country we have become in health terms.
We also have huge numbers of people reporting difficulty in accessing primary care, as the hon. Member for Strangford referred to in his contribution. Some 40% of surveyed heart patients or those at risk of cardio- vascular disease had their appointments cancelled or rescheduled more than once. In 2019, the Prime Minister promised the British public that he would deliver 6,000 extra NHS GPs. Instead, numbers have gone down—another broken promise to add to the never-ending list of broken promises that define this Tory Government. Will the Minister explain to the House why the target is not being met and explain to patients why they are waiting longer than ever before?
We know from the Getting It Right First Time national cardiology report that the NHS needs 760 new cardiac physiologists and almost 100 consultant cardiologists to meet anticipated demand. Again, I reiterate the concerns raised about urgent and emergency care, because we need those staff in place. We need that workforce.
Mrs Drummond
The hon. Gentleman makes an interesting point, but how does he then account for the fact that in Labour-run Wales the waiting lists are even longer? I think 21% of the population are now on the waiting list, and that has extended dramatically, far more than in the NHS in England.
Andrew Gwynne
As we discussed at the start of the debate, the NHS is four systems that work together. We are here in the UK Parliament to hold the UK Government to account for the NHS in England. In terms of the NHS in Wales, the Welsh Government receive a block grant, as indeed do the Scottish Government, and they decide how to spend that money themselves.
There are some great things about the Welsh NHS, not least its leading the way on public health issues across Wales, and we can learn things from there, but I want to ensure that the promise about GP access that the hon. Lady’s Government made to the people in my constituency in England is kept. That is why I posed that point to the Minister. Again, we need the Government to outline how they plan to fill those vacancies and whether the workforce plan, when it finally materialises, will include speciality-level data and strategy to fill those gaps.
We in the Opposition have been clear. Labour would put patients first and sort out the mess that the current Government have left our NHS in. The last Labour Government brought waiting lists down from 18 months to 18 weeks, and we would do that again—[Interruption.] The Comptroller of Her Majesty’s Household, the hon. Member for Nuneaton (Mr Jones), chunters from the Front Bench, but I remind him that, while patient satisfaction is worse today than it has ever been and our waiting lists are some of the highest in NHS history, when we left office, patient satisfaction was the best it had ever been and waiting lists were among the lowest in NHS history. That is our record and I am proud of it.
That progress has been undone by this Conservative Government. Again, we are on standby to step in and protect our NHS. But we would focus on prevention. That prevention would improve outcomes and guarantee access to GP services for those who need them. We would publish a robust and comprehensive workforce strategy, and transform pay and conditions in the process. As part of that, we would support the hundreds of thousands of cardiovascular patients who are anxiously awaiting treatment. We would support health and social care staff who are shattered and demoralised after carrying us through the pandemic, and we would build an NHS that was resilient, accessible and fit for the future.
At the heart of that is a public health agenda that will seek to resolve the health inequalities that are endemic in too many parts of the country, where those health conditions are holding back the life chances of the constituents we represent and causing misery, poverty and pain. That is why a holistic approach to public health, and within that a strategy to deal with heart and circulatory diseases, is crucial. I hope the Minister understands the real importance of that. We stand ready to support her while she is in Government to get the strategy right, but getting that strategy right is crucial.
The Parliamentary Under-Secretary of State for Health and Social Care (Maggie Throup)
I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate on heart and circulatory diseases. It is vital that we keep those serious diseases on the agenda. As he alluded to, many of us have personal reasons why that is so important. My mum had two heart attacks in her 60s, though she survived another 20 years thanks to the NHS, and my father had a debilitating stroke that took away his ability to speak and to walk independently. I also thank, as the hon. Gentleman did, the charities that support patients in their time of need and continue to support their families—a huge thank you to all those charities.
I reassure the hon. Gentleman that cardiovascular disease is a key priority for NHS England. One of the ambitions in the NHS long-term plan is to raise awareness of the symptoms of CVD and ensure early and rapid access to diagnostic tests and treatment. NHS England has a programme of work to support this ambition, which is overseen by the national clinical director for heart disease and supported by an expert advisory group of clinical professionals across the country. That work remained a priority during the height of the covid-19 pandemic. Like other hon. Members, may I take the opportunity to thank all the dedicated NHS staff who worked hard to maintain services, despite the incredible challenges presented by covid, and are now working hard to restore them? Urgent hospital cardiology services were maintained throughout the pandemic.
In February, the Department of Health and Social Care and the NHS published our delivery plan for tackling the covid-19 backlog of elective care. The plan sets out a clear vision for how the NHS will recover and expand elective services over the next three years, including for cardiology. To further reduce patient waiting times, we have committed £2.3 billion to increase the volume of diagnostic activity and roll out at least 100 community diagnostic centres by 2024-25, which will provide services to support the earlier diagnosis of cardiovascular disease, including physiological measurement tests such as echo- cardiography, electrocardiograms, pathology tests and CT and MRI scans. Some £1.5 billion is committed towards elective recovery services, to roll out new surgical hubs and to increase bed capacity and equipment. That includes surgeries and treatment for cardiovascular disease.
NHS England has also established a cardiac pathway improvement programme, which is taking an end-to-end approach to the restoration of cardiac services that will deliver improved prevention, early and accurate diagnosis, reduced waits and best practice treatment and enhanced recovery. People with heart failure will be better supported by multidisciplinary teams as part of primary care networks. Greater access to echocardiography in primary care will improve the investigation of breathlessness and the early detection of heart failure and heart valve disease.
Stroke services across England also continued to provide rehabilitation and post-acute services to stroke survivors during the pandemic. In part, that was helped by innovative methods of care delivery; clinical teams used virtual rehabilitation alongside face-to-face contact to ensure that every patient got the treatment and support that they needed, and 80% of patients reported positive or very positive experiences. However, we recognise that many people will want face-to-face rehabilitation. To that end, the NHS will deliver personalised, needs-based and goal-oriented stroke rehabilitation to every stroke survivor who needs it, in their place of residence. This will be a lifetime offer with annual reviews, recognising that a patient’s needs will change over the course of their life. The national stroke service model, which was published in May 2021, summarises the gold standard of care across the stroke pathway and advises providers and commissioners on how each element of the pathway can be improved, including how services can ensure that 90% of stroke patients receive care on a specialist stroke unit.
I would like to reassure the hon. Member for Strangford that preventing CVD from developing in the first place is a key priority. One of the aims of England’s NHS health check programme is to prevent heart disease. As the Labour spokesman, the hon. Member for Denton and Reddish (Andrew Gwynne), referred to, the programme was largely suspended between April 2020 and February 2022 as a result of the pandemic and in line with national guidance from NHS England. An estimated 2 million people will have missed out on an NHS health check as a result, of whom an estimated 500,000 would have been found to have raised blood pressure and 400,000 would have been found to be at risk of a heart attack or a stroke in the next 10 years. Data for July to September 2021 indicates that local areas had begun to recover the service, with 136 of 152 local authorities reporting some level of activity. However, the number of checks offered and delivered over the period is about 40% of what was reported prior to the pandemic.
The Office for Health Improvement and Disparities is supporting local authorities to recover the health check service, including by showcasing local delivery models that demonstrate innovative approaches to reaching people at higher risk of CVD and by working with local authorities to pilot a digital NHS health check that enables people to self-complete an NHS health check at home, including cholesterol sampling.
In addition, NHS England is working with doctors and other health professionals to support patients with heart disease through the roll-out of the NHS@Home scheme. This self-management scheme enables patients with heart disease to look after themselves in their own home. Patients will be supported to understand their medications, record daily weights and blood pressure and recognise symptoms if they deteriorate. It is anticipated that that will lead to a reduction in hospital admissions, increased quality of life and improved patient and carer knowledge of managing their condition.
Members will be aware that high blood pressure can lead to heart failure, and I am pleased that NHS England plans to increase support for people at greater risk by increasing the number of people who have access to remote blood pressure monitoring and management. That will particularly apply to people with high blood pressure who are from ethnic minority backgrounds, as well as those who are clinically extremely vulnerable, from areas of higher deprivation and aged 65 years or over. This intervention will allow people to monitor their blood pressure from home, avoiding a trip to their GP practice by communicating the results to their primary care clinician via a digital platform or phone call to the practice.
GPs also have an important part to play in reducing cardiovascular disease. The quality and outcomes framework is an annual voluntary incentive programme for GP practices in England, and it contains indicators promoting high-quality care for patients with coronary heart disease or with a diagnosis of heart failure.
For the two years of the pandemic, general practice was required to release capacity to support the pandemic response and to agree an approach to prioritising care for the most vulnerable patients. QOF was reinstated in full from 1 April 2022. That means practices will be paid based on their performance, including on the indicators relating to coronary and circulatory disease, which will ensure practices are again incentivised to deliver this care.
Our upcoming national vaccination service, announced by the Secretary of State in January, will bring together all the innovation, learning and good practice from the covid vaccination programme to deliver life-saving vaccinations. We are also keen for the service to offer people wider prevention services as they are jabbed, by taking the opportunity to have conversations about their health and lifestyle, to offer public health advice and impromptu health checks, and to signpost those who may need further investigation to wider NHS services. Making sure every contact with the NHS counts can help us to spot diseases such as CVD early and ensure people get the right advice and support to hopefully prevent more serious disease.
The hon. Members for Wirral West (Margaret Greenwood) and for Strangford talked about ambulance times. The number of ambulance support staff has increased by 38% since 2010. The NHS has been provided with additional funding to address the current situation, which we know is not acceptable. NHS England and NHS Improvement are providing a range of support, including targeted support and additional funding for hospitals facing the greatest delays to help with the pressures both now and in the future. NHSE and NHSI have tendered a £30 million procurement contract for an auxiliary ambulance service.
The hon. Member for Denton and Reddish talked about health disparities. He will know—I do not think he has any doubt—that I am determined to tackle this issue. It is something I am very passionate about. Very shortly, we will be publishing our health disparities White Paper. We need to tackle obesity, smoking, alcohol and drugs, because they are factors that impact on people’s health, including, disproportionately, cardiovascular disease.
Margaret Greenwood
I am pleased to hear the Minister’s commitment. Will she then support an increase in universal credit by £20 a week? Poverty has a huge impact on people’s physical wellbeing.
Maggie Throup
I think that question should be directed at the Treasury, not the Department of Health and Social Care.
If I may continue to address questions raised, I am pleased to say that our target of 50,000 more nurses is on track for 2024. My hon. Friend the Member for Meon Valley (Mrs Drummond) made the very good point that it takes quite some time to train our amazing healthcare professionals, particularly those who are highly specialised, such as in cardiology. She also highlighted the disparity in waiting times. In England, 11.6% of the population is on a waiting list, but in Labour-run Wales, as she rightly said, the figure is 21%. We have to be careful when we make comparisons and try to criticise one nation over another. Everybody is trying their utmost to get things back on track in whatever way they can, because we know that the population’s health is a priority.
Jim Shannon
One of the questions I asked, in a constructive manner, was about the shortage of 100 consultant cardiologists. I am mindful—this was referred to by another hon. Member—that that training can take 10 to 15 years. If the Minister does not have the answer today, I am happy for her to write to let us know.
Maggie Throup
The hon. Gentleman asks a specific question, so if I may, I will get back to him.
In conclusion, I hope today I have demonstrated the Government’s commitment to improve the lives of people living with heart and circulatory disease. Our commitment is there. If we can continue to make an impact on the lives of people with these conditions with better prevention, diagnostics and treatment, it will bring significant benefits to the NHS and better health outcomes for those affected. We can all agree that that really matters. Once again, I thank the hon. Member for Strangford for bringing this very important issue to the House for debate today.
Jim Shannon
I thank all Members who contributed to the debate, in particular the hon. Member for Motherwell and Wishaw (Marion Fellows) for giving us the Scottish perspective. I always wish to hear, as we all do, what the Scottish Parliament is doing on health. SNP Members often give us examples of how we can do things, which is why I talked earlier about exchanging viewpoints.
The hon. Member for Denton and Reddish (Andrew Gwynne), the shadow Minister, is indeed a good friend. Both he and the hon. Member for Motherwell and Wishaw talked about health prevention. That is clearly what I would like to see, too. We all, including the shadow Minister and the hon. Member for Wirral West (Margaret Greenwood), referred to the ambulance shortfall. The Minister gave us some encouragement, which I appreciate, with £2.3 billion in the next three years on diagnostic activity, earlier intervention for cardiac, and a lifetime offer of virtual or face-to-face rehabilitation. On ambulance times, there was additional funding also to the auxiliary ambulance service—I think the figure was £30 million. And we are looking towards the 2024 target for 50,000 nurses.
With that in mind, I thank the Minister most gratefully for her response. I will be happy to take some of the other singular issues in a written reply, whenever she has that opportunity. Again, I thank everyone who participated. I thank you, too, Madam Deputy Speaker. It is not often said, but thank you so much for what you do.
Hon. Members
Hear, hear!
Question put and agreed to.
Resolved,
That this House has considered the impact of the covid-19 pandemic on people with heart and circulatory diseases.