Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, with reference to page 122 of the NHS Atlas of Variation in Healthcare, published by Public Heath England in September 2016, what steps he is taking to encourage (a) clinical commissioning groups and (b) primary care clinicians to tackle variations in the provision of transcatheter aortic valve implantation procedures in (i) Rother Valley constituency and (ii) England.
The initial diagnosis and follow-up of those with heart valve disease across England is commissioned by clinical commissioning groups. NHS England is the commissioner of cardiac valve surgery and Transcatheter Aortic Valve Implantation (TAVI).
Service specifications and policy for the surgical and interventional treatment of heart valve disease are published by the NHS England Cardiac Clinical Reference Group (CRG), which is chaired by the National Clinical Director for Heart Disease, Professor Huon Gray. These are important in clearly defining what NHS England expects to be in place for providers to offer evidence-based, safe and effective services.
NHS England hosted a Clinical Summit in June 2016, bringing together cardiologists and cardiac surgeons and commissioners to examine the issues relating to aortic valve disease, including variations in provision. The outputs from this meeting are now part of the CRG work plan and will be likely be part of a national cardiac review in 2017/18. This will support the review of current clinical commissioning policy, will seek to address variation, clinical and cost-effectiveness and inform the future commissioning position.
TAVI has been demonstrated to be an effective intervention and the reasons for increase in demand and variation are multifactorial. The CRG have agreed that a review of the wider aortic stenosis pathway will be an appropriate way to address the issues. This will include the medical therapy and traditional surgical pathway and will include specialist centres, secondary care and primary care clinicians.
In relation to the Rother Valley, a review of variation in implant rates for TAVI was undertaken by the Yorkshire and Humber specialised commissioning hub. This has resulted in the commissioning of an additional centre to extend access.