Vascular Sector Reform

Jim Shannon Excerpts

Thursday 10th September 2026 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered the potential merits of reform of the vascular sector.

It is a real pleasure to serve under your chairship, Dr Huq. Last night, you were in the Adjournment debate, and today you are chairing a Westminster Hall debate. Your talents are incredible—well done to you. We appreciate all the efforts that you make for us in this House in all ways.

It is, too, a pleasure to introduce this debate on something I am particularly interested in. A number of people in the Public Gallery have much more medical talent than I have—I am interested in the subject, but in the Gallery are some of those who carry out some of the operations and so have a deep interest. I pay a special thanks to Roger Greer, who is the administrator for the all-party parliamentary group for vascular and venous disease, which I chair—I declare that interest. That gentleman and others with him make the effort on this subject matter, which I am interested in.

Back home, I have had the opportunity to visit the Royal Victoria hospital. On vascular health, unfortunately some of the statistics for Northern Ireland, which I will mention, are worrying. I suspect that they will illustrate where we are in Northern Ireland, and that what is happening there will be mirrored here on the mainland.

It is a real pleasure to see the Minister in his place. We had a wee chat beforehand, and I think—although I am not a prophet or the son of a prophet—we will all agree on the subject matter of this debate. I very much look forward to the Minister’s response, and to his encouragement in some of the responses that we need as we move forward.

I am speaking on an issue vital to thousands of families across our great nation, the United Kingdom of Great Britain and Northern Ireland, and yet one that too often remains hidden in the shadows of our health service. I just said that to the Minister before—this is one of the issues that is slightly hidden. We might not always know everything about it, unless we have a particular interest. I know that other Members present—I thank them for coming—will have a particular interest in the pressing need for comprehensive reform of lower limb vascular care.

This debate gives this Westminster Hall Chamber the opportunity to highlight an often forgotten health issue. Vascular disease affects the very network of life within us, the arteries and veins that carry blood around our bodies, and encompasses peripheral arterial disease, chronic limb-threatening ischaemia, venous disease and devastating diabetes-related foot complications. I declare an interest as a type 2 diabetic, although I Richard in the Gallery might say, “Well, after that cake you had the other day, perhaps you’re not as careful as you should be with your diabetes”—but I do try to be careful and look after it.

Those are not mere clinical terms; they represent real human suffering, unbearable pain, non-healing wounds, severe loss of mobility and, in far too many cases, major limb amputation and premature death. I will put a bit of focus on that for us in Northern Ireland, because some of the figures for amputations in Northern Ireland are scary. I think they are probably scary here on the mainland as well. We have seen inspiring progress in cardiac and stroke care, which is very much welcome, but outcomes for vascular patients have simply failed to keep pace. That is the issue I want to highlight, if I can.

The risk of developing PAD is four times higher among smokers than non-smokers, and two to four times higher among people with diabetes than people without diabetes. That is another reason for this debate and the importance of where we are. One in five people over the age of 60 is affected by PAD, and more than 80% of amputations among people with diabetes are preceded by a foot ulcer. People might say, “A foot ulcer? That is not too bad”, but it can well be. Often, it is the precipitation of a disorder in your blood, which ultimately could lead to amputation. That statistic clearly demonstrates the enormous opportunity we have in prevention and early intervention.

One of the main thrusts of my comments today will be about early intervention and how we do that. We have experts in the Chamber who will speak, and I thank all hon. Members for coming along to make their contributions.

Approximately 4,200 major lower-limb amputations are performed every single year due to PAD, each representing, I believe, a personal tragedy, and an average cost of £28,000 to the NHS. We have to consider the costs, because they are part of what the NHS has to look at. Managing CLTI alone costs our health service an estimated £244 million annually, while the overall bill for NHS wound care reached a staggering £8.3 billion in 2017-18. That included some £5.6 billion spent on wounds that failed to heal. That perhaps gives a clinical look at where we are.

The human toll, of course, is tragic. Patients suffering from CLTI with rest pain or tissue loss face a 60% risk of death within five years, a prognosis that is worse than for many end-stage cancers. Following an above-knee amputation, a quarter of patients die within 90 days, and median survival among diabetic patients is just 1.68 years. Those stats illustrate the extent of the problem and, I believe, confirm the importance of where we are.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

The statistics that the hon. Gentleman highlights should shock us all. If those were the statistics for dealing with any cancer, we would simply find them unacceptable. Does he agree that vascular disease, because it is not treated in the same way as cancer, in some cases ends up being treated as a “second-class” disease, and that we should be mindful of that?

[Jim Shannon]

I thank the hon. Gentleman for that intervention. He has rightly said that, when it comes to vascular disease, while it is equal with cancer in its severity and in the numbers who lose their lives, it is not treated the same. Today’s debate perhaps gives us a chance to illustrate that, and I am hopeful that the Minister responsible for answering can give us some encouragement in relation to it.

Furthermore, this crisis starkly reinforces health inequalities. Just as an example, among individuals aged 45 to 54, those in our most deprived communities face above-knee amputation rates nearly five times higher than those in the least deprived areas.

I thank the Library, as always, for the information that it made available to us. It said that

“gaps in vascular care are resulting in avoidable harm for patients. In particular, the report highlighted ‘delayed diagnosis, inconsistent referral pathways and variable access to specialist care’ for people with PAD, venous disease and diabetes-related foot complications. It said these problems are resulting in ‘thousands of avoidable lower-limb amputations each year.’”

If we were to achieve something from today’s debate, it would be first to ensure an improvement in vascular health, but secondly for the issue of amputations to be addressed through early diagnosis and looked at much more significantly and strongly than it has been.

As the Member for Strangford in Northern Ireland, I feel a particular responsibility to shine a light on how this national crisis presents itself in Northern Ireland. I do that because I think it will help add to the debate; I am ever mindful that the Minister here today has responsibility for the United Kingdom but not directly for Northern Ireland—I understand that—but I use the figures, stats and information from Northern Ireland as an illustration of the issue. What I want to see, and what I think the Minister will want to see as well, is an improvement in this across the United Kingdom and elsewhere.

My job is to shine a light on how the national crisis presents itself in Northern Ireland. While the briefing outlines the systemic challenges across the UK, the reality on the ground in our region underscores an even more acute urgency. Across Northern Ireland, hundreds of patients undergo limb amputations each year due to vascular complications and diabetes-related foot ulcers. In fact, diabetes prevalence in Northern Ireland continues to rise steadily, with local health trusts treating thousands of individuals at high risk of developing severe foot complications.

People sometimes think that diabetes is not that serious. I used to be almost 17 stone. I realised, when the doctor confirmed that I had diabetes some 18 years ago, that I had to lose weight. I lost 4 stone and I have kept it off, but I have to work hard to ensure I do not develop any other complications, which can quite often happen.

The stats in Northern Ireland reflect stark and unacceptable regional inequalities, and they are mirrored by the stats and figures from the mainland. On healthcare inequality, patients from the most socio-economically deprived communities in Northern Ireland face significantly higher amputation rates, nearing the alarming national trend here on the mainland, where deprivation increases the likelihood of a major amputation nearly fivefold.

Hopefully, when the Minister responds, he will tell us how the issue of higher levels of deprivation can be addressed, because it must be done. The lack of hospital bed capacity, dedicated wrapping access and community foot protection services forces vascular patients into prolonged, acute hospital stays. Managing severe vascular conditions and non-healing wounds accounts for millions of pounds annually across our health and social care costs. Those resources could be saved through early preventative community intervention. Again, that means early diagnosis, early community intervention and savings to the NHS, which can then be used in other parts of the health service.

Turning to survival rates, a patient in Northern Ireland who undergoes a major lower limb amputation faces a staggering mortality risk within their first year post surgery. It is the same across the UK. Preventative care is quite literally a matter of life and death. I could not express that any better than the hon. Member for Glasgow South West (Dr Ahmed), who underlined that in his intervention.

If we are to relieve pressure on local hospitals in the United Kingdom of Great Britain and, ultimately, in Northern Ireland and protect our most vulnerable citizens, we must ensure that any national reform framework, including the national foot attack pathway, and standardised waiting times are fully integrated across all HSC trusts, and we cannot allow postcode lotteries to dictate whether a patient keeps or loses her limb depending on where she lives.

I hope the Minister can address the issue of postcode lotteries, which seem to happen with unfortunate regularity. I know he will be keen to change that, and this House is keen to hear what he says. The cardiovascular disease modern service framework rightly focuses on shared risk factors and acknowledges PAD, but its immediate priorities lack the explicit, detailed pathways, treatment standards and outcome measures urgently required for lower limb vascular care.

To close that gap—because that is what we are trying to do—clinicians, patient representatives, professional bodies and NHS leaders across the vascular sector are coming together to publish a definitive best-practice document this autumn. I am sure that document will be made available to the Minister, hopefully in advance. I think that will be helpful for the Minister and others in this debate who want to make changes.

The APPG on vascular and venous disease has highlighted a practical programme for reform, which I endorse. Obviously, I would endorse it because I am its chairman, but it is a positive, focused vision for the future that, if delivered, could make a difference. It includes the national foot attack pathway, backed by public awareness; same day or next day triage for urgent foot issues; and a multidisciplinary foot protection service in every integrated care system linked directly to specialist arterial centres.

When I go for my diabetes test once or twice a year—I have one next Wednesday—they make me close my eyes and do that wee prick of my foot to see if I react and if I can feel it. I am glad to say that I always do. The point is that if someone cannot, that is a serious problem. That is an issue for diabetics, in particular, and it is really important that they are checked regularly, especially their feet.

Thirdly, there should be national maximum waiting times enforcing urgent vascular assessment within five days for in-patients and two weeks for out-patients. Setting a standard to be achieved and having a clear focus on outcomes that reward early diagnosis, fast healing and reduced amputations, are ultimately about patients having a better quality of life—a more normal life—without their health deteriorating. There should also be faster adoption of innovation, including community diagnostics, compression therapies and digital wound monitoring.

When it comes to research and development, the Minister is always very keen to know about advancements in vascular health and how the Government are helping. One of the people involved from one of the hospitals back home in Northern Ireland is with us today in the Public Gallery. She is clearly very aware of these issues and I thank her for her work. There is some great work being done in our hospitals, particularly in the Royal Victoria hospital back home, and in the rest of the Northern Ireland health service.

Will the Government ensure that the cardiovascular disease modern service framework includes distinct pathways and outcome measures for vascular conditions? Will the Minister support a national foot attack pathway and clear waiting time standards? With respect, standard rhetoric and warm words will not heal a failing wound; nor will they save a limb. Thousands of our fellow citizens face devastating, life-altering amputations—tragedies that are, in so many cases, entirely preventable if they are caught early enough.

As a type 2 diabetic myself, I know the personal anxiety that comes with those risks. I also know about early intervention. For me, that was losing 4 stone, taking the medication and being careful about what I eat. Cake became a once-a-week treat—my doctor told me we are allowed to have a wee treat now and again—and I am allowed to have a fry on Saturday morning, but the rest of the week it is best to abstain and not have any of those things. I know that early intervention, proper community pathways and timely care can work. They have worked for me and I know that they have worked for many others.

The Government have rightly pledged to shift the focus of the NHS from sickness to prevention and from treatment to early intervention. Today, I am asking the Government and the Minister to produce a clear and actionable blueprint to do precisely that. The vascular sector is coming forward this autumn with clear solutions, and I am very impressed by the sector’s ideas and suggestions about how to improve the strategy, including a national foot attack pathway, dedicated foot protection services and enforceable maximum waiting times, because we need to make sure that waiting times reflect the needs of those seeking help. The real test for the Minister is whether the Department can step up, grab this opportunity with both hands and deliver the system-wide reform that our patients deserve.

I thank all hon. Members for coming along to participate in the debate. I also thank those in the Public Gallery for being part of this work and for their expertise and input into the strategy. I think that the Minister will see that it can bring about the change that he and we all want.

--- Later in debate ---

[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.

[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.

[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.

[Jim Shannon]

I thank everyone for their contributions, including the hon. Member for Broxtowe (Juliet Campbell). It is perhaps disquieting to understand that the hon. Lady has four times the number of people with vascular health issues in her constituency compared with elsewhere. That indicates a level of deprivation that is seen in certain areas of my constituency, across Northern Ireland, and in Glasgow South West. I thank her for outlining those issues. The hon. Lady also said that investment needs to go further, and was very kind to share the experiences of her constituency.

We are pleased to have the hon. Member for Glasgow South West (Dr Ahmed) here. He brings vast knowledge. The great thing about these debates is that everybody brings their expertise. The hon. Gentleman has done that, and we are very pleased that he shared some of his lifetime of knowledge, which resonated with some of those in the Public Gallery. The hon. Gentleman learned the business, so to speak, and is now able to contribute to others along life’s way. That is incredibly helpful.

Glasgow has one of the largest hospitals in the country, and there is a need to ensure that some of the highest stats in Scotland are addressed, such as those relating to lower life expectancy, the diabetic foot protection service, vascular community waiting times and improvements, and pay for output and outcome. There was an incredible focus on all those things in the debate, and we thank the hon. Gentleman for that.

Over the past few days in the Chamber, the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), has made valuable contributions and proven herself be an expert on all health subjects when it comes to the Health Bill. Today, she referred to vascular disease as being as “common as cancer” and a “preventable disability”, and spoke about a “postcode lottery” of care, the issue of “delayed diagnosis” and how her county has one of the highest rates of lower-limb amputations. She also mentioned the issues of waiting times and care for those with long-term diseases.

We do not always think about the mental health impact of this issue—its impact on someone’s anxiety, depression or ability to cope with life. If someone is able to walk about and do things and then suddenly something happens and they lose a limb, their mental health will be affected.

The Conservative spokesperson, the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst), also brings his interest to this place. We spoke about this in the morning and the other day. He referred to the treatment and the access for services. He referred to the five recommendations from the APPG—getting it right first time, the foot care teams and all those things. If ICBs’ budgets are to be reduced, how will the vascular and venous strategy be delivered? The Minister gave us some indication of how that was going to happen, and there is certainly a commitment to it. We appreciate that.

When will national waiting times be addressed? When will the needed national foot attack pathway be in place? Again, it is about better use of NHS resources.

I am very pleased to have a Minister who responds to us, takes the subject matter on board and gives us the reassurance that we seek. He focused on the APPG report and committed to a national foot attack pathway, with ICBs and neighbourhood services having accountability. The Government are on the same page. The Minister talked about deprivation of access, and we all see that it is harder for people in some areas to get the treatment that they need.

I welcome the four new diagnostic centres that the Minister referred to. There will be further development and enhancement. “Digital doctor” is becoming a common phrase. I suspect we will hear it very often—I might even use it the odd time myself. The Minister is embracing innovation, as we all have to do. He spoke about prevention policy, accelerating the progress, targets set by the Government, a holistic approach, sorting out the outputs, and ensuring that we have facts about risk factors.

The hon. Member for Glasgow South West talked about the reform of systems and leadership. It is really important that the APPG focuses on that.

The APPG would be very pleased to have a meeting with the Minister—I think he will agree to that, although I will not judge him—and other Members here who have brought their expertise. That would be a beneficial meeting, because we are all on the same page, trying to achieve the same goals. If we can help the Minister to do that, we would be very pleased to take that forward.

I again thank everyone for taking part. Thank you, Dr Huq, for having patience with a fella who was supposed to have only two minutes—I think you have given me five.

Question put and agreed to.

Resolved,

That this House has considered the potential merits of reform of the vascular sector.