Patients with Heart Failure

Jo Churchill Excerpts

Thursday 11th March 2021 Westminster Hall

[The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I thank the hon. Member for Strangford (Jim Shannon) for securing the debate, and for his tenacity in waiting a year before we could be here to discuss what is an incredibly important subject. He is right: it is vital that we keep this serious disease on the agenda.

I was interested in the comments from the hon. Member for Birmingham, Selly Oak (Steve McCabe), who was also in the Chamber with us for the last debate, about his own experience in 2012. I am glad to see that he is a living testament to how well people can recover from heart incidents with the right treatment and in the way they live their lives.

Although in recent years we have made enormous progress in understanding more about heart disease, I acknowledge that it remains high on the list of biggest killers in England, and there is still a lot of work to do. I would like the hon. Member for Strangford to extend my good wishes to his constituent Tara, about whom he spoke. Key to improving the quality of life that we want to see for everybody is ensuring that those who are diagnosed younger and who probably do not have the co-morbidities that we have spoken about in others have access to those good services.

We must, in particular, ensure that we intervene earlier, that we have the right care, and that we have the right rehabilitation services and support. I hope to explain what we are doing, and I am more than happy to have further conversations with the hon. Members for Strangford and for Birmingham, Selly Oak in their capacity as chairs of the APPG, and knowing their keen interest in health matters in particular.

I want to extend my thanks to all those on the frontline who have worked so hard, particularly in the area of cardiac services. They did recover, but they have dropped again during this second wave, so we know there is work to do. Heart failure is a key priority for NHS England and Improvement. One ambition in the NHS long-term plan is to raise awareness of the symptoms of heart failure and to ensure early and rapid access to diagnostic tests and treatments. The British Heart Foundation report found that people are still concerned and worried about coming forward, so if anyone is worried about any symptoms, I very much urge them to come forward. The NHS is open and is here to help.

NHSE has a programme of work to support the ambition, overseen by clinical professionals from across the country. It remained a priority during the covid-19 pandemic. We know that cardiac rehabilitation saves lives. It improves the quality of life and reduces, as several Members have said, the hospital admissions that occur when people do not access services. In scaling up and improving the promotion and awareness of cardiac rehabilitation, we aim to improve quality of life and to reduce hospital admissions.

In the long-term plan we set out steps to ensure that by 2028 the proportion of patients accessing cardiac rehabilitation would be among the best in Europe, with 85% of those eligible accessing care. It is a long way from where we are now and will need a lot of hard work in the intervening years. We estimate, however, that this will prevent up to 23,000 premature deaths and 50,000 acute admissions over a 10-year period. NHS England and NHS Improvement is developing cardiac networks that will support the regional delivery of the long-term plan ambitions and address the regional variations in health inequalities that the hon. Member for Strangford alluded to throughout his speech.

The long-term plan also commits to improving rapid access to heart failure nurses so that more patients with heart failure who are not on a cardiology ward can receive specialist care and advice. Better personalised planning for patients will reduce nights spent in hospital and also reduce drugs spend. NHSE is accelerating some of the positive lessons learnt from the pandemic, such as the enhanced use of digital technology for cardiac rehabilitation and the greater application of remote consultations, enabling us to bring forward the delivery of some of the ambitions for patients with heart disease.

NHSE is working with Health Education England to develop a new e-learning for health course, which aims to support healthcare professionals in learning more about heart failure and heart valve disease so that they can better recognise the symptoms of heart failure and diagnose, manage and support patients further. We anticipate this will be made available on digital platforms in late summer this year, so they are working at pace.

We are also establishing community diagnostic hubs to more rapidly diagnose heart failure patients, which will include echocardiograms, blood tests and NT-proBNP testing, making sure that that NT-proBNP testing is available to all general practices.

Hon. Members will be aware that high blood pressure can often be a component factor of heart failure. To increase support for people at greater risk, NHSE plans to increase the number of people who have access to remote blood pressure monitoring and management. The NHS at home programme remains committed to addressing health inequalities, and we have introduced targeted blood pressure monitoring systems for patients who are clinically extremely vulnerable and have high blood pressure, including individuals from black, Asian or ethnic minority backgrounds in areas of high deprivation. We are making sure that we target communities who are worst affected because, as we know, the statistics are often worse in areas that are socially and economically deprived and where health inequalities are greater.

We are also targeting those aged over 65 because age is a large component here. This intervention will allow people to monitor their blood pressure from their home, which is something that we know they prefer, and to avoid trips to their general practice by communicating results to their primary care clinician via a digital platform or, for those who may not have access, a phone call to the practice. From April 2021, a further 198,000 blood pressure monitors will be available for primary care.

The NHS at Home scheme is a self-management scheme to enable patients with heart failure and heart valve disease to look after themselves in their own home. However, they will work with a specialist clinician, and patients will be supported to understand their medications, how to reduce their salt intake, and how to monitor and record their daily weight and blood pressure, as we know that fluid retention is associated with the disease. They will also be helped to recognise—this is really important—symptoms if their condition is deteriorating, so that they seek help in a timely manner. We know that many people wait too long before they reach out for help and services.

Where patients have suffered heart failure, doctors, nurses, the valuable pharmacists who we spent the previous debate talking about, and allied health professionals can provide support to patients in the multidisciplinary teams that the hon. Member for Strangford spoke about. It is anticipated that this will lead to a reduction in hospital admissions and increased quality of life, which is a key component, with better patient and carer knowledge about how to manage their condition. It will also improve primary, community and specialist team communication.

From 1 July 2019, all patients in England have been covered by a primary care network, and the development of the primary care network directed enhanced service for cardiovascular disease prevention and diagnosis is ongoing, with the phased implementation of new PCN services expected in 2021-22. This emphasises the importance of early diagnosis in the management of patients with heart failure and heart valve disease in primary care, in line with the published NICE guidance.

The quality outcomes framework—QOF—is an annual reward and incentive programme for general practice surgeries in England. Although the specific requirements were stepped down in 2021 to release general practice capacity in order to support the pandemic response, I am pleased that the QOF will be returning later in 2021. This will include the updates that were previously agreed to support moves towards earlier diagnosis and management. GP surgeries are asked to capture data in order to evidence that they have fulfilled the QOF requirements, which encourage the earlier confirmation of heart failure diagnosis and improve pharmacological management.

As several Members have said, data is absolutely key in this space for making sure that we know where patients are and that they are being managed. I am pleased to say that this update also means that patients with heart failure can have an annual review in order to enable better management of their care, which goes to the point about making sure there is sufficient contact. NHS England has had sight of the British Heart Foundation report and thanks it for sharing it, and I have been assured that the national medical director has written back on the matters that were included.

I hope that I have demonstrated that the Government, the long-term plan and the workforce have a key ambition to improve the lives and health outcomes of people living with heart failure in this country. Everybody has to play a part, including the individual. As the hon. Member for North Ayrshire and Arran (Patricia Gibson) said, lifestyle plays an important part, so making changes that can help prevent heart failure—healthier eating, reducing salt intake and exercising more—is particularly important. As several hon. Members have said, it is often a disease with comorbidities, and many of those changes will help health overall.

We can all agree that this agenda really matters. Once again, I thank the hon. Member for Strangford for highlighting this important issue. If we continue to make an impact on the lives of people with heart failure, there will be significant benefits for the NHS and, mostly, enormous benefits for those who are affected. To conclude, I say to people that, if they have any of the signs—breathlessness and so on—or any worries at all, they should come forward to seek help.