Aortic Dissection: Patient Pathways and Research Funding

Debate between Pauline Latham and Steve Brine

Tuesday 13th December 2022 Westminster Hall

[Mrs Latham]

I thank my hon. Friend for his intervention, knowing as he does what it is like to work in an emergency department. A lot of people come through the department, but the study he refers to about the abdominal aortic aneurysm was only for men of a certain age. This affects people from 17, or even younger, to 90. Although that sounds like a good idea, I am not sure that it would work in practice. We need more CT scanners used more frequently in emergency departments, and that is what is missing in part from emergency medicine settings.

The next phase in the patient pathway for those who have been correctly and speedily diagnosed is treatment. As I mentioned, 80% of those diagnosed survive. That is not enough and research is ongoing into better methods of treatment. However, one area where we can certainly improve is long-term treatments that do not require further medical interventions. There is currently a call for research proposals into that from the National Institute for Health and Care Research. That is excellent news and I encourage the Minister to make as much money as possible available for this area of research.

After treatment, it is imperative that the follow-up treatment for aortic dissection patients and their families is of the highest quality. Two thirds of survivors of aortic dissections have some kind of post-traumatic stress disorder. They need specialist treatment by somebody who understands their conditions. Furthermore, aortic dissection survivors have a long-term condition that places them at risk of future complications. They need to be monitored by specialist teams and currently, that provision is highly variable. Teams exist in some specialist hospitals, but not all patients are reliably followed up, and too often that is a failure to take a holistic approach to follow up. The employment of specialist nurses in every aortic centre, similar to those in cancer and palliative care, would greatly strengthen follow-up.

The massive improvement in the patient pathway would not be expensive. Although I understand that every penny is being counted in the current situation, to provide a specialist nurse in each of the 29 NHS centres in the country that deal with aortic dissection, for two days a week, would cost less than £400,000 in total per year. The charity has explored the replication of the Macmillan nursing model for aortic nurses and, with funding, would be well positioned to support the design and roll-out of that initiative. Given the enormity of the NHS budget, I hope that is something that the Minister will confirm that she will look into.

The final stage of the patient pathway is genetic screening. About a third of patients who suffer an aortic dissection have some sort of genetic predisposition to the condition. That is why I welcome funding. Screening relatives of sufferers can detect those at risk and proactive treatment can significantly reduce their risk. However, that requires specialised clinical genetics input, access to which is, again, very variable. The technology exists to do that, and it would certainly save lives every single year.

There are two steps the Minister could take to improve this stage of the patient pathway. First, the employment of the specialist nurses I mentioned would be of great assistance. They would lead on the patient’s follow-up plan, part of which would include screening for their relatives. The second step would be for the Minister to facilitate a series of meetings between the relevant professional societies and appropriate NHS staff, to agree and implement a set of NHS guidelines for genetic screening for those suffering aortic dissection and for their relatives.

As I have set out, there are improvements to be made all along the patient pathway, which would go a long way towards saving many of the 2,000 patients every year who would otherwise die from aortic dissections. If nothing is done, that number will only increase in the coming years, so it is crucial that we act now.

Turning to the opportunities for investment in research, which would make a huge difference to the diagnosis and treatment of aortic dissection.

[Steve Brine (Winchester) (Con)]

On the point about genetics and screening, the Health and Social Care Committee, which I chair, will be doing a big inquiry next year on prevention, and one of the things we will be looking at is upstream prevention for cancers and some of the other big killers. I extend the offer to my hon. Friend and the charity to get in touch with us when we launch that inquiry to give evidence on the screening that they are proposing. We would be interested in looking at that and to take evidence in written or oral form. That inquiry is all about saving lives. What she has said makes a lot of sense to me—it could do just that.

[Mrs Latham]

I thank my hon. Friend. I am sure the charity would be delighted to come and give evidence. This is a condition that nobody has ever heard of; it is not just about raising awareness, but changing outcomes, and I hope that the Committee’s inquiry into saving lives can help to save some of those 2,000 people. Obviously, they will not all be saved, but 2,000 is a huge number—it is not a very rare condition, but nobody knows about it until it devastates their family. I am delighted to accept that offer on behalf the charity.

Two studies that the charity is supporting known as DAShED—diagnosis of aortic syndrome in the emergency department—and ASES, the aortic syndrome evidence synthesis, are looking at the development of decision tools for use in emergency medicine to ensure that aortic dissections are diagnosed as quickly as possible and can then be effectively treated. These studies are designed to look at the available evidence to improve diagnosis of aortic dissection. Once concluded, there will need to be a second round of funding to measure the impact of implementing those recommendations. Studies that focus on improved diagnosis, while important, are just the first step. The critical breakthrough will be made by the identification of biomarkers and artificial intelligence to detect unusual patterns of presentation of aortic dissection. This research has the potential to save 10 lives a week according to the charity, and I hope that the Minister will comment on what her Department is doing to increase the funding available for research into better diagnosis for aortic dissection.

As I mentioned, this is not just about diagnosis but about treatment. The NIHR has issued a call for research proposals into methods of treatment that would reduce the need for further medical intervention down the line. I know that budgets are likely to remain tight for some time, given the current economic conditions, but I repeat my plea for the Minister to find some money and recommit to the importance of research funding. We must improve how we diagnose and treat these conditions. Of course, the better we diagnose and treat aortic dissection, the less money we will spend in future on treating so many cases. Some 45% of people who have an aortic dissection are under the age of 60, so being diagnosed and treated early allows them to live a life with their family and continue to contribute economically to society.

It is not an exaggeration to say that the improvements I set out both in the patient pathway and on research funding have the potential to save hundreds of lives a year. As I have explained, the number of aortic dissections will only increase with our ageing population, so it would be wise to act now. The charity is partnering in the implementation roll-out of the NHS aortic dissection toolkit across the country, and it has already received a positive and enthusiastic response, but there is more to be done. As I mentioned, there is an opportunity for the Minister to endorse the design and implementation of further toolkits to address the current challenges with diagnosis, elective surgery follow-up and aftercare, covering those aspects of the patient pathway that are not included in the existing toolkit. Improvements in the patient pathway and research funding, such as those that I have set out, are greatly needed, and I hope that the Minister can carefully consider all the recommendations.

Too often in government and in this place, we speak about tragedies in terms of scale—of the numbers of lives lost or numbers of people affected by a catastrophe—but it is all too easy to forget that behind every single statistic there is a family whose lives have been upended by these terrible events. While 4,000 aortic dissection patients a year is a huge number, we must remember that it is much more than that: it is 4,000 people with a family—parents, children, husbands, wives, siblings, relatives and friends. None of them are likely to be aware of aortic dissection before it happens. In Ben Latham’s case, the family was mine, and every single one of us is still feeling the effects of this awful condition that we did not know existed. It has been important for me, as for the other trustees and ambassadors of the charity, to do everything we can to improve the survival rates and treatment of future sufferers, so that other families do not have to go through what we have been through.

Oral Answers to Questions

Debate between Pauline Latham and Steve Brine

Tuesday 15th January 2019 Commons Chamber

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

What advice can the Minister give to elderly and vulnerable people who missed out on the first wave of flu jabs? Are they still available?

[Steve Brine]

Yes, they are still very much available. People should make an appointment through their GP or their wonderful pharmacist.

Acquired Brain Injury

Debate between Pauline Latham and Steve Brine

Monday 18th June 2018 Commons Chamber

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

I beg to move,

That this House has considered acquired brain injury.

After the last three hours, I think the expression is—and now for something completely different.

For the past hour and a half, some of us English Members have endured watching the match—Tunisia 1: Spurs 2; I mean, England 2. It is a pleasure to be in the House, and we are very grateful to SNP Members for enabling us to watch the match.

I rise to speak to the motion in the name of my right hon. Friend the Prime Minister. I pay tribute to the hon. Member for Rhondda (Chris Bryant) and my right hon. Friend the Member for South Holland and The Deepings (Mr Hayes) for their persistence at business questions and elsewhere, and for securing this debate in the House. Brain Injury Awareness Week took place last month, which makes today’s debate especially timely.

Let me first recognise the important work of organisations such as Headway and the United Kingdom Acquired Brain Injury Forum in raising awareness and in providing information and support to those living with acquired brain injury and to their friends, families and carers. I know that some of them are with us this evening, and I thank them for their persistence during the family dispute we have had in the Chamber for the past three hours.

Acquired brain injury—ABI—is an injury that takes place after birth in an otherwise healthy brain. It includes traumatic brain injuries such as those caused by road traffic accidents, falls or assaults, and non-traumatic brain injuries related to illnesses or medical conditions, including meningitis, stroke or brain tumours. While prevalence estimates for ABI are quite hard to make, the number living with it is thought to be over 500,000 and could be as high as 1 million people. The total cost of brain injury in the UK has been estimated by our officials to be at least £1 billion per year.

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

My hon. Friend talks about the cost of brain injuries. My constituent Stuart Tranter asked me to lobby the Government to put more money into brain tumour research, which has been very much the poor relation, and I have been successful. I congratulate the Government on having doubled that money since Tessa Jowell, who used to serve on the Opposition Benches and then went to the House of Lords, died. I am very grateful to the Minister and the Department for putting so much money into that much needed research.

[Steve Brine]

I thank my hon. Friend. This is the first time I have been at the Dispatch Box since Baroness Jowell passed away. As I said during the debate when she was sitting in the Under Gallery with her lovely family, I did not know her well but the one time I met her I was left in no doubt about her determination on this subject. It is great that we are able to do so much. I pass on my condolences to Jess, her daughter, whom I have got to know a little, and her family. The trauma of the immediate is horrible and it goes on for a long time. Our thoughts are with them. I thank my hon. Friend for what she has said. We will do well by Baroness Jowell, especially through the money that we will put into research to try to instigate new research projects, which have traditionally been thin on the ground in this area. We are hoping to stimulate the research market.

ABI can have a devastating impact on our constituents’ lives; even minor head injuries can cause short-term impairment. Those surviving more severe injuries are likely to have complex long-term problems affecting their cognitive and functional ability, personality, close relationships and ability to return to any form of independent life.

Oral Answers to Questions

Debate between Pauline Latham and Steve Brine

Tuesday 6th February 2018 Commons Chamber

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

12. What plans he has to expand the services provided by pharmacies to assist GPs.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

It is good to be back.

As I have repeatedly said at the Dispatch Box, pharmacies are a vital frontline service for our NHS, with over 1.2 million health-related visits every day. Community pharmacies have again stepped up during this winter period, and I thank them for their hard work. They have vaccinated more than 1 million people against seasonal flu since October. The Government are committed to ensuring that pharmacies and pharmacists are further embedded in the wider health service.

[Mrs Latham]

I thank the Minister for that answer. Will he come to Derby to meet a constituent who has pharmacies that are working very hard to keep patients out of hospital, therefore saving the NHS money through their innovative ideas?