Vascular Sector Reform

James Frith Excerpts

Thursday 10th September 2026 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Mr James Frith)]

It is a genuine pleasure to serve under your chairship, Dr Huq, and to join you again in Parliament. We worked together before and it is an honour to be here today.

As is customary, I would like to thank the hon. Member for Strangford (Jim Shannon) for securing this important debate and for his insights. Some of us were wondering if he would write one of his famous letters of congratulations and courtesy to himself; we hope that somebody else will step up and show him the same courtesy that he affords us all by being so generous in his support of colleagues across the House.

I also thank my hon. Friend the Member for Glasgow South West (Dr Ahmed), who spoke so well and with such insight, for the leadership and expertise that he showed in pulling together the Government’s ambitions for not just the 10-year plan but, as has been mentioned, the cardiovascular framework. I am of course minded to listen to anything further that he says. On his point about Scotland, he is right that I also have responsibility for the devolved nations in a seemingly ever-growing brief—he will have sympathy with me over that. I am happy to have those conversations to ensure that we learn from the Scots and that the successes here can be transported north of the non-border to which he rightly referred.

The report published by the APPG earlier this year sets out suggested actions for improving vascular care. The Opposition spokesperson, the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst), is right that there is much in this debate on which we agree. The calls to action include reducing waiting times, reforming commissioning, accelerating innovation, and establishing a national foot care pathway and community-based foot protection services in every local system. I commend the APPG for focusing their challenges on structural reforms and system changes, and not on simply making a new request for funding.

We can all agree with the improvements the actions intend to deliver, which are,

“earlier diagnosis, reduced travel and access barriers for patients, and relieving pressure on acute services by preventing deterioration and avoidable hospital admissions.”

That is crucial. At the election, I was pleased to stand for a party that wanted, when in government, to bring its power and might to bear on the biggest killers. The Government very much intend to deliver those improvements through the core shifts set out in the 10-year plan for the NHS.

For patients with vascular disease, that will mean fewer trips to hospital as we shift care closer to home and into the community. It will mean better use of digital technology—my hon. Friend the Member for Glasgow South West referred to the innovation part of my title, and there is more to come on that—to identify vascular disease, monitor its progression and, finally, stop it from developing or worsening.

In preparation for this debate, I have been encouraged—mercifully, I am pleased to say—to use my remarks reflect the call to action from the APPG.

[Dr Ahmed]

The Minister is making a powerful case that to govern is to make decisions. Does he agree that when it comes to the NHS, while we talk a lot about money, input and investment, today we are ultimately talking about reform, taking different decisions and showing leadership? Does he agree that, given the situation in Scotland and my constituency of Glasgow South West, where there is more money and more staff, it is quite obvious that it is political will that ultimately makes the difference?

[Mr Frith]

I concur fully with my hon. Friend’s point. I noted his earlier remark about the commissioning of outcomes, and I think that one of the developing themes adjoining my own thinking and my brief is the need to get better at commissioning outcomes, considering whole populations, communities and places, and determining how we spend our money based on outcomes, not just activity. My hon. Friend makes a very powerful point with his question.

The hon. Member for Strangford and other members of the APPG feel strongly about the establishment of a national foot attack pathway. The Government’s ambition for integrated care boards to act as strategic commissioners focused on the needs of local populations is very much determined to assist that. The prevalence of vascular disease is not evenly distributed, as the hon. Member for North Shropshire (Helen Morgan) mentioned. ICBs are expected to use their nationally supported local commissioning power and their local data and intelligence, which includes user feedback and outcomes data, to develop a deep understanding of local need as well as local plans to develop and deliver.

[Jim Shannon]

I thank the Minister very much for that response; it is incredibly helpful. There seems to be a postcode lottery, where those who need care get it in some places but not in others. Does the Minister feel that his policy will ensure deliverability across all postcodes, not just in single places?

[Mr Frith]

That is a very fair and right challenge. This is not about endorsing patchwork provision; it is about understanding that, whether because of the physiological, social, environmental or behavioural differences that exist, care is not evenly distributed. We should have standards that we expect nationally, but we should also commission and empower local ICBs to commission, and we should hold them accountable through the frameworks and the work that we do in the Department.

[Helen Morgan]

I agree with the Minister that services should be locally commissioned, particularly where there is a high prevalence of a certain type of disease or condition, because it allows for the shaping of those services to local circumstances. There is evidence, is there not, that local commissioning has not given us a consistent level of service across the country. What steps are the Government taking to ensure that that does not become more entrenched as we empower ICBs even more through the Health Bill?

[Mr Frith]

I hope that my further remarks will address that very point; I am happy to pick it up with the hon. Member in due course if they do not satisfy.

ICBs will use national modern service frameworks set by the Government and guidance to create the right services for their areas. That means local systems coming together to create neighbourhood services that reform the health and care system and are rooted in the needs of people and communities.

On the issue of maximum waiting times for vascular disease, this Government recognise that it is imperative that any patient requiring a vascular assessment receives that in a timeframe that reflects their condition and enables the best possible health outcome. The Government are committed to making progress on NHS waiting times, including returning by March ’29 to the NHS constitutional standard of 92% of elective care patients’ waiting times from referral to treatment being within 18 weeks. Of course, that includes those patients waiting for vascular services.

The NHS met the first interim target of 65% in March ’26, and we are now focused on driving improvements to achieve our second interim target of 70% by 2027. To help support the commitment to reduce waiting times, the podiatry workforce pipeline is currently being strengthened through NHS England’s focus programme for small and vulnerable professions, with the NHS workforce plan to be published shortly.

The health service also has clear guidance on what is required in delivering services for people with vascular disease or at risk of developing it. In March ’26, NHS England published guidance on standardising community health services. That guidance identifies podiatry, diabetes and tissue viability, and wound care as core components of ICB-funded community provision. People who need urgent wound assessment—for example, those with suspected infection, rapid deterioration, or diabetic foot ulcer—should be seen within 24 hours. The guidance also makes it clear that routine assessments should occur within five to seven working days, with data collected on healing and complications. The purpose and goal of community health services must be to support people as well as to avoid their needing to be admitted to hospital and, critically, the need for amputations.

[Jim Shannon]

I thank the Minister for his generosity in giving us a chance to ask questions. One of the areas that the APPG and we elected representatives have identified is that there are areas of deprivation where levels of vascular ill health and amputations are higher. What can be done to reduce that in areas of deprivation? I know I have them in my area. I am sure the hon. Member for Glasgow South West (Dr Ahmed) and others have them in theirs. I would like a focus on that, please, if the Minister does not mind.

[Mr Frith]

The hon. Member is absolutely right. We have to keep ICBs and their commissioning powers accountable to local jurisdictions. I will say a bit more on that in due course, but we are on the same page.

To facilitate faster assessments we also need to speed up and make earlier diagnoses, which is why the Government plan to open four new community diagnostic centres during ’26-27. That expanding capacity will help meet our March ’29 target that no more than 1% of patients should wait over six weeks for a diagnostic test.

On reforming commissioning to reward outcomes, as set out in the 10-year health plan, we want to develop new ways to pay healthcare providers based on clinical practice that maximises productivity and outcome, as my hon. Friend the Member for Glasgow South West mentioned. Under the best practice tariffs, providers receive payment when they follow agreed standards of care. On the adoption of proven innovation, the APPG report rightly identifies the importance of the NHS being able to quickly adopt new innovations.

As part of my responsibility to oversee further development and enhancement of the use and usability of the NHS app, one development coming through the House at the moment is the creation of the single patient record. The future exciting development of NHS online, or digital doctor, as I might yet call it, is about the digitisation of our NHS service—embracing innovation, personalising healthcare and responsive to individual need—as well as the innovator passport, delivered through a phased approach to accelerate access to and adoption of technologies.

The APPG’s report says that preventing vascular disease and its deterioration should be at the centre of the system, and I agree. Identifying people with vascular diseases and providing care centred on their needs is critical to ensuring vascular disease does not progress to the point where somebody needs incredibly serious interventions, such as a leg needing to be amputated. In this modern era, such amputations are wholly avoidable and should be prevented.

The distinction between the APPG’s report and the Government’s most recent announcement of the MSF has been mentioned. I was delighted to join the British Heart Foundation yesterday at the celebration event for the MSF ahead of the delivery plan later in the year. It is a reasonable challenge to ensure that we distinguish between conditions, a point made by the Opposition spokesperson, the hon. Member for Solihull West and Shirley. It was a point made to me—and a point I thought was likely to be raised with me—by stroke and diabetes charities at the event yesterday. We are on the same page on that. He made an excellent point and challenge on the distinction that is needed.

As hon. Members will know, prevention is at the heart of the Government’s health agenda—the prevention of health conditions and the prevention of them worsening. The cardiovascular disease modern service framework, which was published in July, sets a clear direction for how health and care systems should accelerate progress on the Government’s ambition to reduce premature mortality from heart disease and stroke by a quarter within a decade.

My hon. Friend the Member for Broxtowe (Juliet Campbell) talked about irregularity and different areas having different levels of heart failure, which she said was four times more likely in the area she represents. I would be very happy to have conversations about how we can embrace that insight and intervene. Prevention is fundamental to the Government’s efforts around an annual heart failure review, improving access to rapid diagnosis and embedding heart failure support in cardiac rehabilitation, as well as the wider Government goal to reduce premature mortality by a quarter within the next decade.

Central to the cardiovascular disease modern service framework is a holistic approach with a strong focus on reducing inequalities. The principles apply here, too: the missing millions; the need for healthy intervention and to understand the difference between the physiological, behavioural, environmental and social; an appreciation that living standards and the cost of living have as much impact as any knowledge of what to eat and when; and looking after each other. It is about commissioning for outputs, not just diktat, which means recognising that several conditions and risk factors share common causes and contribute to most heart attacks and strokes. Members have described them in their speeches: high blood pressure, smoking, diabetes, high cholesterol, unhealthy diet and lack of exercise.

At its core, the framework is about a fundamental shift towards proactive, whole-person, preventive care that is located in communities and neighbourhoods and makes better use of hybrid, traditional, in-person and digital models to increase uptake and treatment. Podiatry and related foot-health services align with the shift towards local community hub delivery. The framework’s approach is backed by wider Government, including the creation of the first smoke-free generation, which began under the Conservative Government.

[Dr Ahmed]

I will be quick, because I know the Minister wants to wind up and I am sure he has plenty of things to do. He is talking powerfully about the digital offering that the Labour Government are providing to patients today in England and, more importantly, our ambitions for the digital offer in the future. This will seem like science fiction to many of my constituents in Glasgow South West, where we have no NHS app and very little digital connectivity in the healthcare system. Will the Minister please take the learning and markers of quality—particularly the digital quality markers—that he is describing in the modern service framework to our friends and colleagues in the Scottish Government? My constituents cannot wait any longer.

[Mr Frith]

In the humblest of terms, I would be very happy to visit and speak to my Scottish counterparts to ensure that they take that opportunity, and that any development, whether on compatibility, operability, the learnings from the NHS app in how we then develop NHS Online—that sounds a bit too much like building a website; we have to be more ambitious and describe it as what it is, which is the digitalisation of our NHS—helps to ensure that our brothers and sisters in Scotland get the same level of digital access that we expect to deliver across the NHS in England.

[Jim Shannon]

The hon. Member for Glasgow South West (Dr Ahmed) has nabbed my request—it is not about green cheese, by the way, Minister. My request is that the kindness the Minister has extended in respect of the hon. Gentleman and the Scottish health service is also extended to us in Northern Ireland, because expertise gained here can be shared so that we can all benefit.

[Mr Frith]

I will take any excuse I can to come to Northern Ireland, and I hope my private office has noted that.

In closing, our approach to improving the treatment of vascular diseases is closely aligned with the reforms in the APPG report and the APPG’s ambitions. I know that, of course, there will be other areas in which the APPG, and the hon. Member for Strangford, will rightly continue to push for further progress. I thank hon. Members for their contributions, and I thank the APPG for its important work and report. I look forward to continued dialogue on this issue to improve the NHS, especially services for vascular disease.