(4 weeks, 2 days ago)
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It is a pleasure to serve under your chairship, Dame Siobhain.
I congratulate the hon. Member for South Ribble (Mr Foster) on securing this important debate and talking about his personal circumstances. It is always a very moving moment when colleagues talk about things that are so very personal to them. I also pay tribute to the wife of my right hon. Friend the Member for Rayleigh and Wickford (Mr Francois) for the work that she and her team do. It was fascinating to listen to my right hon. Friend. There may have been a bit more detail than I would have wanted to hear, but it told us a lot about the importance of that treatment.
I share an ambulance region with the hon. Member for North West Leicestershire (Amanda Hack), so I know exactly what she is talking about and how important it is. I thank her for her work with the APPG, and particularly for highlighting the issue for young people. It is important to remember that heart disease and stroke affect all age groups.
I thank the hon. Member for Strangford (Jim Shannon) for his work on the APPG and for his kind words. I visited his constituency when I was a Minister. If only I could have as much love as he gets from his constituents—he is hugely respected.
I feel like we will all have to club together to get a bat-phone for the hon. Member for Southport (Patrick Hurley). He made some incredible points, particularly about smoking. I confess that I gave up smoking in February. It was hard, but I know how important it is.
I declare an interest. I, too, want to pay tribute to the British Heart Foundation, which was the first charity I worked for in my charity career. I saw at first hand the incredible work it does, particularly on research. I thank it and all the other charities and organisations that are active in this space.
As we have heard so often today, heart disease and stroke continue to take people from their families far too soon. The hon. Member for Strangford spoke so powerfully about the 350 people in his area who are no longer around the table. Behind every statistic is a life cut short and a family left grieving, in too many cases in the knowledge that earlier action might have changed the outcome. A person’s chances of surviving heart disease or stroke should not depend on their postcode, income, sex, ethnicity or ability to navigate the health service. If we are serious about reducing premature deaths, the focus must be on prevention, earlier diagnosis, timely treatment, reducing inequality and proper support after the patient leaves hospital.
We must begin with prevention, because high blood pressure and high cholesterol can exist without obvious symptoms. People may feel perfectly well while living with a condition that substantially increases their risk of heart attack or stroke. By the time somebody becomes seriously unwell, an opportunity to intervene may have already been lost.
Prevention cannot simply mean advising people to live healthier lives. It means identifying those at risk, ensuring that NHS health checks reach the communities that need them most, and making full use of GPs, primary care teams and community pharmacies. Those services need the workforce, the time and the technology to identify risk and manage it properly. Detecting and treating high blood pressure and raised cholesterol must be regarded as core NHS work. The Government inform us that the NHS health check programme prevents about 500 heart attacks and strokes each year, which really is welcome, but the question is whether it reaches those at the greatest risk, including people in deprived areas.
We must also recognise the close relationship between cardiovascular disease and kidney disease. Kidney disease affects an estimated 7 million people in the UK. About 60% of kidney patients are diagnosed only in the later stages, when their cardiovascular risk is highest. About 20,000 kidney patients die from cardiovascular disease each year. Early testing for people with diabetes, high blood pressure and cardiovascular disease can identify kidney damage before it progresses. Indeed, Kidney Research UK suggests that less than one in five patients with chronic kidney disease receive SGLT2 inhibitors, despite their potential to reduce major cardiovascular events. Will kidney disease therefore be explicitly included in the modern service framework? What action will the Government take to improve early diagnosis and equitable access to proven treatment?
Early diagnosis is just as important for heart valve disease. In the UK, 1.5 million people live with that condition. Again, however, symptoms such as breathlessness, fatigue and dizziness are too often mistaken for the ordinary effects of ageing. That can mean that diagnosis comes only after the disease has become severe, and after irreversible heart damage has begun. Listening to the heart with a stethoscope remains a simple and low-cost first step. Where heart valve disease is suspected, patients need timely access and a clear route to specialist services. Will heart valve disease be explicitly included in the framework? And will the Government consider a single point of access for referrals to specialist valve services?
We must also confront the inequalities experienced by women. Cardiovascular disease kills more than 80,000 women in the UK each year, yet women are less likely than men to have their risk factors assessed, slower to receive a diagnosis, less likely to be referred to a cardiologist and also less likely to receive cardiovascular medicines or interventions. Women’s symptoms may simply be dismissed or attributed to stress, hormones or ageing, and women have been consistently under-represented when it comes to cardiovascular research.
The Government’s renewed women’s health strategy recognises some of those problems, and the commitment that publicly funded research should properly consider sex-based differences is really welcome. However, such recognition must translate into practice. Will the framework include measurable action to reduce sex-based inequalities in prevention, diagnosis, referrals, treatment and outcomes? And will women’s specific cardiovascular risk factors, including pregnancy history, gestational diabetes, menopause and autoimmune disease, be considered more consistently in NHS health checks and other assessments?
As we have heard, every minute matters for stroke patients. The speed of recognition, ambulance response, brain scanning and access to thrombolysis and thrombectomy can profoundly affect a person’s chances of survival and recovery. However, 24-hour coverage has still not been achieved, as my right hon. Friend the Member for Rayleigh and Wickford mentioned. The Government say that progress is being made, but patients need to know when every part of England will have reliable access to this life-changing treatment. Will the Minister set a firm date for that full 24/7 coverage, and will she explain how progress will be maintained while NHS England’s responsibilities are being transferred?
For many years, stroke units have had access to thrombolysis—or “the shot”, as it is known in the trade. However, that is a very rough way of doing it, and it can have side effects and impede a patient’s recovery. Mechanical thrombectomy is a far more accurate way of solving a stroke problem, and with far less risk of subsequent side effects. That is why we are so keen to see its use grow, and I second my right hon. Friend’s request to the Minister.
My right hon. Friend is so right. When he was describing its importance, I was thinking about one of my very dear friends who suffered quite a debilitating stroke. I thought, “If only that had been available for him, how different his life might be now.” I thank my right hon. Friend for raising that.
Care should not end when a patient leaves the acute ward. Someone who has survived a stroke might need to relearn how to walk, speak, eat and carry out other basic daily tasks. Rehabilitation and continuing community support are essential if people are to regain their independence and reduce the risk of another stroke. The same is true after a heart attack. Cardiac rehabilitation, medication reviews and support to manage risk factors can prevent further illness and save lives, yet access to rehabilitation remains uneven and too many patients experience a cliff edge between hospital and community care.
The Government have committed to reducing premature deaths from heart disease and stroke by 25% within a decade. That is a serious ambition, and, where they are taking practical actions to achieve it, they will absolutely have our full support, but it is important that that ambition is matched by a credible plan. In a letter dated 28 May, the Minister said that the framework we are expecting would be published in the spring. That deadline has now passed, so, like others, I again ask when that will be published. Will it contain clear milestones against which that 25% commitment can be judged? Will the Minister commit to regular, transparent reporting to Parliament so that Members can see whether earlier diagnosis, access to treatment and premature mortality rates are genuinely improving?
There is much on which Members across this House should agree. We all want fewer families to lose someone they love before their time; we all want patients to receive help before a manageable risk becomes a medical emergency; and we all want NHS staff to have the tools and capacity to provide the care their patients need. Reducing premature deaths from heart disease and stroke is achievable, but only through earlier identification of risk, faster diagnosis, timely treatment and rehabilitation that is available wherever a patient lives. Targets matter, but patients will judge success by whether they receive the right care in time, and that must be the measure of genuine success. They and their families deserve nothing less.