Atrial Fibrillation

Dan Poulter Excerpts

Wednesday 12th March 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship for the second time, Mr Turner. It is also a pleasure to congratulate the hon. Member for Huddersfield (Mr Sheerman) on securing the debate, and to thank my hon. Friend the Member for Montgomeryshire (Glyn Davies) for his important contribution about his own experiences of atrial fibrillation and its consequences. Although he spoke about the cardioversion treatment he received for sudden onset AF, much of the debate today has been about those who have chronic AF, which is often undiagnosed. The debate provides a good opportunity to raise such issues and ensure that those who are listening—in particular, bodies such as the Royal College of General Practitioners —take away messages about what more they can do to support GPs in earlier detection and diagnosis, where that is possible, and to make sure that the right treatment pathways and proper medications are provided to patients.

It may be useful if I talk briefly about the condition. The heart is not my area of medical expertise, but as a junior doctor I looked after several patients with AF, some of whom came through the front door of the hospital in a similar condition to that described by my hon. Friend the Member for Montgomeryshire, so I have seen it at first hand. AF is the most common sustained heart rhythm disturbance, and it occurs as a result of rapid, disorganised electrical activity in the heart’s upper chambers—known as the atria, hence atrial fibrillation—which results in an irregular heart rhythm. As we have heard, AF is a major predisposing factor for stroke and it accounts for approximately 14% of all strokes.

[Mr Sheerman]

On that point, would it not be a fine idea for the Minister or one of his colleagues to write to every Member of Parliament with the statistics? In the Calderdale and Huddersfield NHS Foundation Trust in my constituency, liaison between hospitals and GPs is not as good as it should be. When someone such as the hon. Member for Montgomeryshire (Glyn Davies) comes out of hospital after having an episode, there is no linkage of treatment between the hospital and the GP. Would it not be a fine idea to send a letter to every Member of Parliament giving them the statistics and urging them to talk to their clinical commissioning groups and GPs about the matter?

[Dr Poulter]

The hon. Gentleman is absolutely right about the importance of raising awareness of AF. He is also right to point out that co-ordination between primary and secondary care is not always as strong as it could be, not only in this area but throughout the NHS. Part of the reason the Government are investing in the £3.8 billion integrated health fund is to ensure that health and social care are better joined up, to achieve a more co-ordinated and holistic approach that is about individuals’ needs.

If someone has been diagnosed in hospital, it is important that they are given the right support in general practice and in the community. There is a lot of good practice out there, and there are a lot of good and well informed GPs. NICE is producing new guidelines and new draft recommendations on treatment—it has been looking at issues such as the use of anti-coagulants—and it is important that that information is disseminated quickly and effectively. My commitment to the hon. Member for Huddersfield is that I am happy to write to NHS England, which oversees CCGs, to raise the matter and ask it to disseminate NICE guidelines to CCGs and ensure that they are mindful of them.

[Mr Sheerman]

That is excellent news, but as someone with medical training, is the Minister not shocked that 36% of those with AF are being prescribed nothing or aspirin? Was he shocked to find out that rather than the 20% that NICE expected, only 3.4% of sufferers were on the new anti-coagulants?

[Dr Poulter]

The statistics that I am aware of are slightly less positive than those that the hon. Gentleman has cited. It is not for us in this place to micromanage medical professionals or to do their jobs for them. However, it is our job to raise legitimate concerns about care for AF or any other health conditions. We must do our best, as stewards of the health system, to push for good local commissioning that is mindful of best practice. I have undertaken to write to NHS England about that, and I will be happy to share the reply that I receive with the hon. Member for Huddersfield and other hon. Members and hon. Friends.

The exact causes of AF are unclear, but it is important to get the diagnosis right and to diagnose the condition as quickly as possible. We believe that some 18% of cases of AF are undetected, so there is more work to be done. NHS England has recognised that, and has suggested that CCGs should work with local practices to target people who are at risk from AF. The issue is already on NHS England’s radar, but I will write to obtain further assurances that it is being taken as seriously as it should be; I am sure that that is the case.

Research is under way into the condition. The National Institute for Health Research is funding a study into automatic diagnosis of AF in primary care using a hand-held device, which may help identify more patients who have AF and reduce the number of related strokes. If someone does not know that they have the condition, they do not know that they need to see a GP to get help. We must do as much as we can to support people to recognise that they have a medical condition and that help and treatment are available. I hope that the research into that technology provides better early detection of AF, and that that comes forward in a rapid and timely manner.

[Glyn Davies]

I thank the Minister for giving way and allowing me to correct an omission in my contribution. Does he agree that the excellent work of the Atrial Fibrillation Association in promoting knowledge of the disease has had a hugely positive impact, which we should all appreciate?

[Dr Poulter]

My hon. Friend is absolutely right to highlight that work. When NICE draws up guidelines, it consults best practice and tries to engage with key stakeholders. In addition, the Royal College of Physicians has developed some national clinical guidelines for stroke with the objective of encouraging higher levels of anti-coagulation. That is directly linked to some of the things we have debated today.

It is a testament to the work of groups such as the Atrial Fibrillation Association that we are helping to raise the profile of the condition and to get early support and help for people. There is clearly more to do, and NICE must continue to develop strong guidelines to support understanding of the best care and pathways for people who have AF. NICE is updating guidelines at the moment and developing a quality standard on AF, which will set out what a high-quality AF service should look like and drive improvement locally by helping local commissioners and CCGs understand what good looks like in AF care.

[Mr Sheerman]

Before the Minister, who is uniquely qualified to have an opinion, sits down, does he agree that more people should be on the new generation of drugs that will keep them alive and prevent them from having strokes?

[Dr Poulter]

It is not my medical specialty, but if new medication is developed, we need to evaluate it. The priority must be to give treatment according to clinical need. I, as a doctor, the Government and hon. Members on both sides of the House believe that it is right to treat patients according to clinical need and clinical priority. It is for CCGs to work with national guidelines, and we look forward to seeing the NICE quality standard on AF, which I hope will put CCGs in a much better position. I have already committed to writing to NHS England to ensure that it puts the matter high on its priority list, and that it supports and encourages all clinical commissioning groups to take AF seriously and make it a priority across the country.