Heart and Circulatory Diseases (Covid-19)
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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.