Premature Deaths: Heart and Circulatory Conditions

Lord Markham Excerpts

Tuesday 6th February 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government are committed to reducing premature deaths from cardiovascular disease. The NHS long-term plan aims to prevent 150,000 heart attacks, strokes and dementia cases by 2029, as well as preventing up to 23,000 premature deaths and 50,000 acute admissions over 10 years. The major conditions strategy will look at how best to tackle the key drivers of ill health and increase the healthy years of life for people with major conditions such as cardiovascular disease.

[Baroness Merron (Lab)]

My Lords, the Office for Health Improvement and Disparities reports a persistently high number of excess deaths involving cardiovascular disease since the beginning of the pandemic, avoidably cutting short more than 100,000 lives in England alone. What are the urgent plans for treating the thousands who are waiting for healthcare? How will the Government extend the roles and joined-up working of a range of healthcare professionals beyond GPs to support the millions who are living with an undiagnosed risk of high blood pressure, raised cholesterol, diabetes and obesity?

[Lord Markham (Con)]

I thank the noble Baroness and draw attention to my register of interests: I am a shareholder in a small health company that does high-end heart tests for the private sector.

It is fitting that February is Heart Month. The concern that the noble Baroness raises is exactly the one that noble Lords will have heard me speak about. This is precisely the concern that Chris Whitty, our Chief Medical Officer, was worried about during Covid, with missed appointments because people stopped going to see their doctor meaning that we missed things such as high blood pressure and high cholesterol. To tackle the problem urgently, as the noble Baroness suggests, we have put 7,500 blood pressure checkers in pharmacies. They have done 2 million checks to date. We have sent 270,000 blood pressure monitors to houses and have instigated mid-life NHS health checks to look specifically at early heart indicators so that we can try to tackle the problem that the pandemic caused.

[Lord Patel (CB)]

My Lords, we have had lots of plans and initiatives for reducing deaths from heart disease. Despite that, variation in both preventive care and outcomes have persisted for years now. They are exaggerated by deprivation and ethnicity.

Let me give two examples. First, 40% of people with high blood pressure have failed to be diagnosed— I know that the Government have an initiative for pharmacies checking blood pressure—and, even when they are diagnosed, 10% of them do not get the appropriate medication. Secondly, there are examples of people suffering from atrial fibrillation not getting the appropriate anti-coagulation treatment; we then find that 60% of the strokes that occur in these patients are because they have not been properly medicated.

It is these variations in care and prevention that we need to tackle. It is disappointing to see that some of the ICB plans do not take on the need to reduce this variation, particularly in deprived areas.

--- Later in debate ---

[Lord Markham (Con)]

I agree with the noble Lord. We violently agree that it is all about early detection. That is why we have not just put it in pharmacies but have had mobile units going to leisure centres and high streets: so that we can catch people early, whatever their background or ethnicity, because that is the key starting point.

Digital is the way of the future in this. We are introducing digital health checks from the spring. Again, these will open it up to a wider bunch of people. Early detection is key.

[Lord Allan of Hallam (LD)]

My Lords, the relationship between cardiovascular disease and poverty is clear and well documented. What specific steps are the Government taking to encourage take-up of the new screening programmes, which the Minister talked about, in poorer communities where people are at higher risk? Will the Minister commit to publishing data so that we can understand whether the screening programmes are reaching everyone or just people in wealthier communities?

[Lord Markham (Con)]

First, I am happy to commit on the data front, because data and giving results always shine a light and will always help in these situations. On outreach to all these communities, the noble Lord might be aware that, on top of the pharmacies and leisure centres, we have been incentivising GPs. As an example, being in the right age group I have numerous texts and messages from my GP about getting those check-ups done. It is those sorts of measures that we are trying to use.

[Earl Attlee (Con)]

My Lords, is the Minister aware that many of us strongly support his efforts to deter youngsters from starting to smoke because of the adverse effect it has on the circulatory system?

[Lord Markham (Con)]

Yes. I thank my noble friend. Prevention is absolutely key, as is tackling things such as smoking—the smoke-free legislation will do this for a new generation—obesity, and high levels of sugar and fat in foods. These are all key parts of our armoury.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I was a member of the Times Health Commission, which today published a report in which we highlight that a large proportion of disease is lived with silently, long before it presents. Therefore, prevention for cardio- vascular problems needs to start right from school age; simply screening people later in life is already too late. When people have an out-of-hospital cardiac arrest—I think there are about 30,000 a year—they have only a one in 10 chance of surviving. Will the Government undertake to work much earlier with schools and universities and young people to help them identify whether they are at particular risk through smoking, inappropriate alcohol use, living with obesity, inappropriate diets and so on, which will stack up problems into the future?

[Lord Markham (Con)]

Yes. Those are all key measures that we need to take and, I like to think, are making progress on. I thank the noble Baroness for her work and all the noble Lords who have been working on the Times Health Commission, which is a valuable contribution to this debate. I mentioned digital health checks. I have seen technology where holding your phone up in front of you can test your blood pressure and your heart rate. We need to verify that, but I think that is definitely the way of the future as well.

[Lord Brooke of Alverthorpe (Lab)]

Can the Minister say why the Government are refusing to review the regulations governing children’s meals? We know that the sugar content in them is too high and that our children are eating too much sugar. This needs to change, yet the Government refuse to look at the regulations and enforce them properly.

[Lord Markham (Con)]

I am not quite sure that I agree with the word “refuse”, but I agree with the noble Lord that healthy food in all environments is a good thing. I know that the delay happened because it was originally planned for 2020 or 2021, I think, and then the pandemic got in the way. I freely accept that the review now needs to take place. We are not refusing to do it, because it is an important part of the armoury.

[Baroness Bull (CB)]

My Lords, many noble Lords have mentioned the importance of early years interventions, not smoking, diet and so on. Does the Minister agree about the importance of exercise and of cultivating the habit of exercise, not just in early years but ongoing throughout later years?

[Lord Markham (Con)]

Absolutely. These are all key parts of a good, healthy lifestyle for mind and body—for mental health as well. Social prescribing is important for all this as well.

[Lord Bethell (Con)]

My Lords, following the appointment last year of Professor John Deanfield as the champion for personalised care, can my noble friend the Minister please update the House on the progress of his report on radical approaches to prevent life-threatening cardio- vascular disease?

[Lord Markham (Con)]

I will need to come back in writing to my noble friend on this. I take this opportunity to thank him for his work on the Times Health Commission and for generally pushing forward the whole prevention agenda.

[Baroness Boycott (CB)]

My Lords, following on from the Times Health Commission today, the Food Foundation has also produced a report on childhood obesity. The single biggest factor for preventing childhood obesity and thus adult obesity is breastfeeding. It reduces it by a figure of 25%, as the WHO has found from a worldwide study. To put that into context, all the reformulation of soft drinks has achieved only an 8.3% reduction in obesity in 11 year-olds. This is massive, yet as a country we have the lowest breastfeeding rate because we give the lowest amount of support to women when they have given birth. Not only do we get not that much time off work but there is very little support. My daughter has recently had twins, and the comparison between now and when I had her 40 years ago is really shocking.

[Lord Markham (Con)]

I agree with the noble Baroness. I am sure we all agree that breastfeeding is a really healthy start to life. I think the family hubs are trying to address these sorts of matters. Clearly, this is a point for education as well.