Heart and Circulatory Diseases (Covid-19)

Bob Blackman Excerpts

Thursday 23rd June 2022 Commons Chamber

[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.