Musculoskeletal Conditions and Employment

Debate between Jim Shannon and Margaret Greenwood

Wednesday 10th January 2024 Westminster Hall

[Margaret Greenwood (Wirral West) (Lab)]

I beg to move,

That this House has considered musculoskeletal conditions and employment.

It is a pleasure to serve under you chairmanship, Dame Caroline. Musculoskeletal conditions can be devastating for those affected. They can cause pain, reduce mobility, diminish self-confidence and lead to isolation. They can also lead to extended periods of absence from work and, in some cases, people giving up work altogether. Instead of enjoying a productive working life, people can find themselves unemployed and impoverished. In addition to the terrible human cost, MSK conditions bring substantial costs to the state in the form of social security and NHS spending.

Conditions include osteoporosis, rheumatoid arthritis, traumatic fractures, osteoarthritis, rheumatic rheumatoid arthritis, traumatic fractures and a range of conditions that cause pain in the lower back, the neck and parts of the arms and legs. The workplace can be a source of such conditions through injuries sustained from one-off accidents or through poorly managed working practices that lead to conditions developing over time.

The Health and Safety Executive has noted that MSK conditions can be caused by a number of things, including, but not limited to: lifting heavy loads, working with handheld power tools, long-distance driving or driving over rough ground, working with display screen equipment, and repetitive work that sees an individual using the same hand or arm action over a period of time. HSE statistics show that the industries with the most reported incidents of musculoskeletal disorders are agriculture, construction, health and social care, and transport and logistics.

It is clearly important to ensure that healthy working practices are the norm and that mitigations are put in place where such movements are required. That might include ensuring that there are sufficient breaks from routine activities. The Health and Safety Executive has reported that 35.2 million days were lost due to work-related ill health in Great Britain in 2022-23. MSK disorders accounted for 6.6 million of those lost days and was the second highest cause after stress, depression or anxiety. Research from the charity Versus Arthritis suggests that over 20 million people—around a third of the UK population—live with an MSK condition. For current UK employees, the figure is one in 10.

Of course, we have to remember that a lot of people have to give up work precisely because they have an MSK condition. According to the Government's statistics, the employment rate for people who have an MSK condition and are classified as disabled was 57.5% in 2022-23. In contrast, the employment rate for the whole population was much higher at 75.7%. Versus Arthritis estimates that the cost of working days lost due to osteoarthritis and rheumatoid arthritis, which are just two of the many types of MSK conditions, was £2.5 billion in 2017, and that that figure will rise to £3.43 billion by 2030. In 2022, the Government’s Office for Health Improvement and Disparities stated that musculoskeletal conditions represent the third largest area of NHS spend, costing around £5 billion a year. The report cited a 2016 study based on 2012-13 costs, and so is not recent. It would be helpful if the Government could revisit this and provide a more up-to-date figure.

The scale of the problem demands a clear and focused response from the Government. In short, the Government should come forward with a cross-departmental MSK strategy. That strategy must set out how the Government will seek to promote good MSK health, reduce the risk of accidents and practices in the workplace that lead to or exacerbate MSK conditions and ensure that support is there for people who need it through positive workplace practices and, where appropriate, the use of equipment, devices and assistive technologies. They should also invest far more in the provision of leisure centres and swimming pools, particularly in deprived areas, so that people can manage and improve their health, and should increase investment in research into MSK conditions. Ministers should consult with stakeholders including clinicians, health and safety experts, trade union health and safety representatives, employers and employees when coming up with this strategy.

Those who are in work need the right support so that they can remain in work, and those who are looking for work need to know of the support that is available to help them get back into employment. Modern design and technology can improve working conditions for people with some MSK conditions, yet people can often feel awkward asking for such adjustments.

[Jim Shannon (Strangford) (DUP)]

I commend the hon. Member for Wirral West (Margaret Greenwood) for bringing this important issue forward for us to consider. I apologise to you, Dame Caroline, and to the hon. Lady because, unfortunately, I cannot be here for the debate because I have to attend a Northern Ireland Affairs Committee session. I will just make this point: in Northern Ireland, we have almost half a million sufferers of MSK. That equates to a quarter of the population. Does the hon. Lady agree that we need to enable working people to continue working by providing support and help? I think she does, and I believe that the Minister will as well. The Government must offer support to small businesses to ensure that they know how to make a reasonable adjustment to allow someone who wants to work to do so, rather than having to take sick leave, which they do not want to do.

[Margaret Greenwood]

The hon. Gentleman is absolutely right. Support is needed particularly for small businesses who may struggle to understand and source what is required to support people, and to have the confidence to do so and the understanding that it is a positive investment in their workforce. He makes a really important point. I am also very glad that he cited the scale of the issue in Northern Ireland. One in four is incredibly high, so we need a focused response as a matter of urgency, and I thank him for that point.

There should be absolutely no stigma around having an MSK condition, nor for asking for help in relation to it. For example, in an office environment, it should be common practice that employees are made to feel comfortable in speaking up if they face issues, and that adjustments and equipment such as sit-stand desks, voice recognition software, a vertical mouse, split keyboards and other ergonomic computer equipment are made available to people if that would support their MSK health.

The strategy to which I have referred should be launched alongside a large public awareness campaign so that everyone can be involved and benefit. The Access to Work scheme provides important support for people who are disabled or have a health condition that impacts on their ability to get work or stay in work, but it seems that not nearly enough people know about it.

There has been much evidence to suggest that many people who could benefit from the scheme do not know that it exists. Indeed, I have heard it referred to as the Government’s best-kept secret. In 2021-22, only around one in eight—just over 4500 people—who received support from Access to Work had an MSK condition. The Work and Pensions Committee has highlighted that the application process can be complex and difficult for people to navigate. We therefore need a much greater effort from the Government to raise awareness of the scheme and the benefits that it can bring.

For example, the Government could make it a legal requirement for all employers to inform new and existing employees about Access to Work and to provide a point of contact for any employee who thinks they might benefit from it. This would highlight and promote the scheme, and it would give the opportunity for expertise to be developed within workplaces to support MSK health.

The Government must also give thought to the fact that over 7 million adults in England have very poor literacy skills. It is vital that information about the scheme is presented in a way that is easy for them to understand. Last year, the Government published their “Transforming Support” White Paper, which, among other things, pledged to pilot a new Access to Work enhanced package for people who need more support than the existing scheme can provide. How does the Minister envisage that that will benefit those with MSK conditions specifically? The White Paper also spoke of Access to Work developing an innovative digital service. Will the Minister guarantee that changes will be mindful of the fact that so many adults struggle with literacy and digital skills?

It is disappointing that the Government are failing to administer the Access to Work scheme promptly. In a response to a written question from my hon. Friend the Member for Lewisham, Deptford (Vicky Foxcroft), who will respond on behalf of the Opposition this morning, the responding Minister said that 21,780 applications were outstanding on 5 September last year. That is 21,780 people waiting to receive support for their health condition. It is completely unacceptable. I ask the Minister to update the House on the current state of affairs.

The last Labour party manifesto committed to help disabled people who want to work by bringing back specialist employment advisers and introducing a Government-backed reasonable adjustments passport scheme to help people move between jobs more easily. In their White Paper, the Government said:

“Access to Work is supporting a series of Adjustment Passport trials. The Adjustment Passport will provide a living document of the disabled person’s workplace adjustments, general working requirements and signposts adjustment support at every stage of the journey into work.”

Will the Minister give more information on these trials and how they are going? Can she say what actions her Department has taken to ensure that the passports are user-friendly for people who have problems with literacy?

The Government can promote MSK health and prevent issues from arising through specific campaigns developed with the expertise of health professionals and occupational therapists. They can also legislate for good working practices. It is important that the Government lead on creating positive workplace cultures around promoting MSK health, but for this to be most effective, they need to look at the issue from the employee’s perspective. Under the Equality Act 2010, employers must make “reasonable adjustments” to workplaces, working practices and policies or procedures, to remove or reduce any disadvantages faced by workers that are related to their disabilities. However, it can be difficult for people to raise concerns in the workplace, especially if their job is insecure. People on zero-hours contracts are a particular risk in this regard.

One of the key sectors in which MSK has an impact is transport and logistics, and we know that many delivery drivers are on zero-hour contracts. Health and care is another key sector affected; again, many in the care sector are on zero-hour contracts. Clearly, then, banning zero-hour contracts, as Labour would do, is important not just to ensure that people know that they have stable work and a reliable income, but to prevent a race to the bottom in health and safety at work. The Health and Safety Executive is responsible for inspecting organisations and enforcing statutory duties in relation to health and safety law. The HSE can investigate businesses and has the power to bring enforcement proceedings, including prosecutions, in cases of serious failures. Its work is incredibly important, yet the HSE’s funding has been savagely cut since 2010.

Analysis last year from the Prospect trade union found that Government funding for the HSE decreased by 45% in cash terms between 2010 and 2019, from £228 million to £126 million. Funding increased to £185 million in 2022, but this still represents a huge decrease from 2010 levels. Prospect’s research also highlighted staff cuts of 35% across the HSE since 2010, while the number of inspectors has fallen by 18%. These cuts are an attack on the health and safety of all of us, and I call on the Government to review the needs of the HSE and restore funding to at least 2010 levels. We cannot allow the Government’s obsession with austerity to damage our health and safety.

The Government could also promote MSK health and prevent issues from arising by supporting the “Better Bones” campaign, which is led by the Royal Osteoporosis Society and the Sunday Express and backed by many organisations, including the Federation of Small Businesses, Parkinson’s UK, Coeliac UK and a number of unions and royal colleges. Some 50% of women and 20% of men over the age of 50 will have a fracture caused by osteoporosis—staggering rates. A third of those who have a fracture and have osteoporosis will have to leave their jobs.

Fracture liaison services can do invaluable work in identifying whether people have osteoporosis. However, only 51% of NHS trusts in England have them. As a result, many people will break bones and go to A&E, and will be seen without their underlying osteoporosis being diagnosed and treated. That leaves a massive risk that they will suffer further, more serious fractures in the future. As a result of this postcode lottery, around 90,000 people a year are missing out on important diagnosis for a condition for which they could otherwise receive medication that would reduce their risk of further fractures.

The “Better Bones” campaign is calling for access for all over-50s to fracture liaison services with dedicated bone specialists, £30 million a year of extra investment to make fracture liaison services universal in England, Wales and Scotland, and the appointment of a fractures tsar for each British nation. It was therefore extremely disappointing that there was no extra funding in the autumn statement for fracture liaison clinics, despite the Minister in the Lords saying in September:

“We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality. NHS England is also setting up a fracture liaison service expert steering group”.—[Official Report, House of Lords, 14 September 2023; Vol. 832, c. GC241.]

That is especially disappointing from a Government who claim that they want to try to help people over 50 to get back into work. It is disappointing too that, in July, the then Secretary of State for Health and Social Care said that the Government planned to spend more than £8 billion from 2022-23 to 2024-25 to support elective recovery, with NHS England prioritising fracture liaison services in its elective recovery plan. However, in the end, fracture liaison services were not even mentioned in the elective recovery plan.

The Government must address the shortcomings in fracture liaison services, which would contribute to helping over-50s back into work, and I ask the Minister to press this point with ministerial colleagues. As the Federation of Small Businesses said of the “Better Bones” campaign, it

“is more than a health initiative—it’s a matter of economic vitality. We need to address the increased numbers of those who have left the workplace as employees, self-employed or small business owners themselves due to sickness. This campaign is one of those steps.”

The Government can support workers with MSK conditions, too, by ensuring flexible working from day one, as a Labour Government would do. We also need to see action from Government on people’s general health and MSK conditions through investment in the health and wellbeing of all communities.

Versus Arthritis argues that being overweight or obese increases the risk of developing arthritis conditions such as osteoarthritis and gout. It also points out that swimming is a good exercise for people with musculoskeletal conditions, such as arthritis or back pain. The water helps to support the weight of the body, which reduces strain on painful joints. The Government should also promote MSK health by ensuring people can access facilities such as swimming pools and leisure centres.

Sadly, central Government cuts to local government since 2010 have resulted in many pools and leisure centres closing across the country, including in my own constituency of Wirral West. During the campaign to save the Woodchurch Leisure Centre and swimming pool, I remember people telling me how they used the pool to cope with arthritis. The loss of this facility has been devastating for many people trying to manage MSK conditions in my constituency and it is doubtless the same for people across the country.

Government strategy must look at the impact of austerity policies on sport and leisure facilities and at the impact that this has on the health of the population. Musculoskeletal issues cause serious problems for millions of people and can have a devastating impact on an individual’s working life. The high prevalence of such conditions warrants a high-profile, cross-departmental policy intervention. I to pay tribute to all those who work so hard to promote safe and healthy working environments, including the HSE professionals, occupational therapists and of course hard-working trade union health and safety reps who do such invaluable work in identifying workplace issues and campaigning for greater safety for working people.

The Government must bring forward a cross-departmental MSK strategy with clear goals to improve prevention and to support those with MSK conditions. Failure to do so will only lead to continuing costs to people’s health and happiness and continuing costs to the Exchequer for NHS and social security spending. The benefits of taking action on MSK are clear to all, and I call on the Government to do just that.

Heart and Circulatory Diseases (Covid-19)

Debate between Jim Shannon and Margaret Greenwood

Thursday 23rd June 2022 Commons Chamber

[Jim Shannon]

I thank the hon. Gentleman for his kindness. The Backbench Business Committee is kind to everyone who applies for a debate, so I am always very pleased to do so, and on a regular basis. It will not be too long before I am back looking for more debates.

On this debate, I put on the record my thanks to the Committee. I am pleased to see that Members from across the House are involved, although I am mindful that today right hon. and hon. Members have many other engagements that mean they are unable to be here, even though the debate is in the main Chamber.

It is just over two years since the start of the lockdowns, and a little more since the pandemic first arrived. Life changed for everyone—I do not think there is anyone in the United Kingdom of Great Britain and Northern Ireland who did not have a life-changing moment—and for some of us it may never be the same as it was. It will never be the same for those who have lost loved ones; that is very real for every one of us. Some of the changes that took place due to the pandemic and covid-19 were cosmetic, but others have been life changing, and it is those changes that we need to address.

I want to say a massive thank you to all the doctors, nurses, auxiliary staff and cleaning staff—there are so many to name—who have been outstanding. There is nobody in this House who does not know some of them, has not spoken to them and does not also want to put that on the record as well. I thank them at the beginning of this debate.

During lockdown, barriers and obstacles to providing care for heart patients and all patients rocketed. I know that happened across all health departments, but in particular I thank the British Heart Foundation and the Stroke Association for all the information, detail and evidence they sent to me and others for the debate. We are very pleased to have that.

Some of those efforts by doctors were heroic; I do not use that word often, but on this occasion it is a word that aptly describes their efforts. Despite those heroic efforts of doctors, nurses and other key workers in our health systems, however, we have seen cardiovascular services disrupted so greatly that people are still feeling the effects today.

I am beyond thankful for every NHS staff member who went ahead with emergency surgeries. The reality of life for elected representatives is that we do not get many people coming and saying, “Thank you very much for that.” We get the complaints, but that is what we do. We are a conduit for their complaints and concerns. Some of the people were waiting for emergency surgery were not sure whether they would pay a price for that, so again for that I sincerely say a big thank you.

We are all aware of the waiting lists, reduced access to primary care and the pressures on urgent and emergency care. They all have real consequences for people’s health. That is why hon. Members pushed for this debate and why we are so pleased to have the opportunity to hold it today in the main Chamber. I feel incredibly privileged, honoured and humbled to be able to present this case—not for me, because I am not important, but on behalf of our constituents who have experienced hardship because of those things.

Those problems have also had real consequences for families’ lives, their relationships and the happiness of their families. Very often, the issues for those who were ill reflected back on the families, who were under incredible pressure to deal with circumstances that would be difficult to deal with normally but that, with covid-19 and the pandemic, escalated even more. There are 11,000 people living with heart or circulatory diseases in my constituency. I know the Minister does not have responsibility for Northern Ireland, but I will provide examples from Northern Ireland that are relevant across the whole of the United Kingdom of Great Britain and Northern Ireland. There are 2,000 stroke survivors and 13,000 people who have been diagnosed with high blood pressure.

Long waits, difficulty accessing routine medical services and long ambulance response times make life more difficult for the 7.6 million people living with heart and circulatory diseases in the UK. I mention those issues not as a criticism, but to highlight them and raise awareness. Ambulance response times in many parts of the United Kingdom, including in my own constituency, have been difficult, as have been the waiting times outside accident and emergency departments, with ambulances in place. That is happening not just in Northern Ireland but elsewhere, as I am sure other hon. Members will confirm.

Someone in the UK dies from a heart or circulatory disease every three minutes. This debate has been going for six minutes, so that means two people will have died from heart disease since it began. By the time the debate is over—it is a stark headline, unfortunately—as many as 20 people will have passed away. That statistic reminds us of the fickleness of life. It also reminds us of what this debate is about and why we are here. Someone is admitted to hospital due to a stroke every five minutes. Indeed, someone will have been admitted to hospital since this debate began. Two thirds of patients leave hospital with a disability. Stroke as a standalone condition costs the UK economy £26 billion annually, yet it is largely preventable and recoverable.

I look forward very much to hearing the response to the debate from the Under-Secretary of State for Health and Social Care, the hon. Member for Erewash (Maggie Throup). I know she is very committed to her job and has a deep interest in it, so I look forward to what she has to say in response to the questions we will ask her today. I also look forward to hearing from the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), who is a good friend and with whom I seem to be in debates all the time. If we were not in the Chamber today, we would be in Westminster Hall.

Northern Ireland Chest, Heart and Stroke highlights that there were 15,758 recorded deaths in 2019. That is some figure and it is worrying. The top three causes were cancer, circulatory diseases and respiratory diseases; together, those accounted for 64.3% of all deaths in Northern Ireland. That figure reminds us of just how fickle life is and that we are just a breath away from passing from this world to the next. They have been the three leading causes of deaths since 2012. Deaths due to chest, heart and stroke conditions, when combined, are the No. 1 cause of death, at 36%. As I said earlier, that reminds us why this debate is so vital and why we look to the Minister for a response that can help us, encourage us and give us some hope for the future.

These are some of the most prevalent, serious and life-altering conditions that anyone could have the misfortune to suffer from. They touch everyone’s lives, be they in Northern Ireland, where my Strangford constituency is, Scotland or Wales—or England, with whose health matters this House is primarily concerned. I also very much look forward to hearing from—I apologise; I should have said it earlier—the hon. Member for Motherwell and Wishaw (Marion Fellows) on behalf of the SNP. She has a deep interest in health, too, and I look forward very much to her contribution.

Every one of us has a neighbour, a friend or a loved one who has problems with their heart. Those problems do not halt at any border. They do not even, dare I say it—rather mischievously, perhaps—stop at the Irish sea border, which is able to prevent most things from crossing over. What prevents them from getting the care they need? The most obvious issue is undoubtedly waiting lists, which are at record levels. One of the questions I would like to ask the Minister—I always ask such questions constructively; that is my way of doing things—is: what is being done to reduce waiting lists and to provide some hope? According to NHS England, only this month the queue for NHS care stood at 6.5 million, the highest number on record ever. The number of patients waiting more than a year to be seen has increased to 323,000, which is a massive number. These are record levels as the health sector recovers from the impact of the pandemic.

Although the pandemic has hugely affected waiting lists, the issue predates the pandemic. At the start of 2020, around 30,000 people were waiting more than 18 weeks for cardiac care. This problem was not caused by covid, but it was exacerbated and worsened by covid. If it was bad before, it is much worse now.

The pandemic has had a seismic effect. In April 2022, two months ago, 170 times more people in England were waiting more than a year for heart procedures than in February 2020. I look for an indication of how we can reduce that number, and I know there is a strategy. I am putting this constructively, because I believe there are ways to do it, and the hon. Members for Denton and Reddish and for Motherwell and Wishaw, other Members and I are keen to hear what they are. Waiting lists for cardiac care have also hit record levels, rising to 319,000 people. In Northern Ireland there are 31 times as many people waiting more than six months for cardiac surgery compared with the end of 2019.

And it is not only life-saving surgery, as some of this surgery is about people’s quality of life. Waiting times for echocardiograms, a kind of heart ultrasound used to diagnose a range of conditions, have risen, too. More than 170,000 patients were waiting for an echocardiogram at the end of April 2022, with 44.6% of them—almost half—waiting more than six weeks. That is a 32% increase on the year before. The covid-19 pandemic has increased those numbers, and I am not blaming anyone for that, but we need to address these issues, both as a Government and collectively, in a way that gives succour and support to our constituents.

In Northern Ireland, the number of people waiting more than six months for a cardiac investigation or treatment reached a new record in March 2022. That is the responsibility of Robin Swann, the Health Minister in the Northern Ireland Assembly, and I know he has taken steps to try to address it, but this is a general debate about how we address heart and circulatory diseases across the whole United Kingdom of Great Britain and Northern Ireland following covid-19.

Nearly three quarters of people in Northern Ireland waiting for an echocardiogram have waited longer than the recommended clinical maximum. A number of worried, heartbroken family members have come to my office to say that covid is killing their loved ones, even though they did not have covid themselves. The delays were and continue to be a threat to life. Covid-19 does not seem to result in the number of hospital cases that it once did, which is good news.

Although an echocardiogram is not open-heart surgery, delays still cause increased anxiety for patients and delay the treatment they need. Taken as a whole, cancelled operations risk a rise in avoidable deaths and disability, and they cause anxiety and put physical pressure on people with heart problems.

What can we do about this? The British Heart Foundation is watching this debate, and I thank it for giving me most of my information. I also have a staff member who is qualified in this, and she has given me some information, too. I am proud to work with the British Heart Foundation, which has welcomed the additional funding for the NHS and the announcement that 95% of patients who need diagnostic tests will receive them within six weeks by 2025. It is good news that we have a target but, with respect, that target is a few years away. We need to consider how we address the situation over the intervening three years. The foundation has also pushed for an accompanying Government strategy for cardiovascular disease to take us beyond recovery and address the problems that existed before the pandemic.

With all that in mind, we need to think about how we can do better and support those who need help today. The NHS long-term plan identifies cardiovascular disease as

“the single biggest area where the NHS can save lives over the next 10 years.”

If there is one issue I would love us to tackle, it is how we can save lives. I am ever mindful of the statistic I cited earlier that every three minutes someone dies as a result of heart problems. If we can save lives, that is what we want to be doing. We know that the NHS is doing all it can to deliver cardiovascular services, but without a properly funded cardiovascular disease strategy, it cannot meet its targets and deliver adequate care. When will a strategy be put in place to address the issues in the short term?

What else would such a strategy address? Cardiovascular diseases have many and varied impacts on patients, who need different forms of care as a result. Access to primary care is integral to the identification and management of heart conditions. When people cannot access primary care, opportunities to prevent heart attacks and strokes are lost, and more problems are caused for those who are already under pressure. How do we address that issue?

A 2021 survey of 3,000 heart patients found that 12% had a routine medication or condition review cancelled or rescheduled in the first year of the pandemic. I understand that the pandemic was not the Government’s fault; the Government are to be complimented and thanked for how they responded to it, because we are all beneficiaries of the vaccination programme and it is probably why some of us are alive today. However, the cancellation or rescheduling of routine medication or condition reviews explains the longer waiting lists. Four patients in 10 have had appointments cancelled or rescheduled more than once. I know people back home who have actually fasted for an operation and then been told that it would not go ahead, which has caused anxiety and worry.

Health Foundation analysis shows that 31 million fewer primary care appointments were booked between April 2020 and March 2021 than in the previous 12 months. The pandemic has also had an impact on how patients with heart and circulatory disease interact with primary care. Some people say that there are lies, damned lies and statistics, but statistics prove a point: there were 5 million fewer face-to-face GP appointments in 2020 and in 2021 than in 2019. We understand the reasons why, but we have had a lot of debates in this Chamber and in Westminster Hall about GP appointments, and there is not one of us who would not wish for the number of appointments that we once had. My constituents tell me that, and I am anxious and keen for appointments to return.

Many people welcome the flexibility and safety that remote appointments bring, but they can mean that healthcare professionals lose the opportunity to collect information that they usually gain through physical examination. Constituents have told me that their ailments and problems would be better assessed physically. The quicker we move back to physical assessments, the better. Someone cannot really be diagnosed at the other end of a Zoom call; they can say what their issues are, and by and large the doctor may get a fair idea, but in many cases it takes a physical examination. The situation is no one’s fault, but it may lead to a delayed or even missed diagnosis of a condition such as high blood pressure. I take a Losartan tablet for my blood pressure every day; I was told by my doctor not to worry about it, but after he told me I would have to take it every day, he said, “By the way, you can’t stop it.” At that stage, I realised that it is necessary to keep me on the straight and narrow and keep me breathing, so perhaps in a small way I understand the need to control blood pressure.

We do not know for sure how many missed diagnoses there have been but we do know that the NHS issued 470,000 fewer prescriptions for preventive cardiovascular drugs between March and October 2020 than in the same period of the previous year. The Institute for Public Policy Research forecasts that if those missing people with high-risk cardiovascular conditions do not commence treatment there will be an additional 12,000 heart attacks and strokes in the next five years. I ask the Minister what is being done to find those who have not been prescribed these preventive drugs over the last period of time, mindful that the unfortunate end result of that is more heart attacks.

This is a ticking time bomb, and we need to defuse it if we are to meet NHS long-term plan aspirations to prevent 150,000 heart attacks, strokes and dementia cases by 2028-29 and, more importantly, if we are to be able to look those families in the face. Behind every person who dies of a heart attack there is a grieving family; we know that probably personally and certainly from constituent cases. As the Good Book says, we have threescore years and 10; we might get less than that or we might get more, but one thing we do know is that our time will pass. We must address the issue of preventing heart attacks, strokes and dementia.

At least half of the 15 million adults in the UK who have high blood pressure are undiagnosed. We all need a bit of stress; it is part of life, and I thrive on a bit of stress, but we can only take so much and it is important to find the right balance. Many of those with high blood pressure are not receiving effective treatment. It is vital to find people early and support them to manage cardiovascular risk factors such as atrial fibrillation. The Automated External Defibrillators (Public Access) Bill was introduced in the House not long ago, with support from all parties; I hope the Government will support its progress so its measures can be introduced in health and education settings. Finding the people with conditions early is vital; we must try to help people manage conditions such as raised cholesterol and hypertension so they can longer and healthier lives.

However, we cannot do that if we do not know who they are, which shows that data is important; it comes up in almost every health debate I participate in. To be fair, the Government and the Minister understand this, as data helps to focus on the right strategy and develop it in a constructive way based on evidence. I ask the Minister to put on the record where we currently are in relation to the collection of data, as it will point the way forward.

Some patients do not need to be found, however, as they or a loved one call 999 because of a medical emergency. For cardiovascular conditions, that normally means they have had a heart attack or stroke. A fast response that gets the right person to the right hospital department at the right time in an ambulance can be the difference between life and death. The newspapers often present examples of ambulances not arriving in time for whatever reason and people passing away. Unfortunately, in England the average response time in May for a category 2 emergency such as a heart attack or stroke was almost 40 minutes; we must do better. The target is 18 minutes; it is not being met.

I did not manage to source the corresponding data for Northern Ireland, but I know personally of one 70-year-old lady who had called believing her husband was having a stroke. She was told to give him an aspirin to chew and that the ambulance was delayed. She was then told in another phone call, which was fairly frantic, that if possible she should bring him herself to hospital, so she dragged him to the car—he is a fairly big man—and arrived at the hospital crying and begging passers-by to help. This man was diagnosed with some form of hernia which presented like a heart attack, and I thank God for that because he could have died waiting on the ambulance and then waiting on his elderly wife to trail him to a car and on to a hospital; that is simply not good enough.

Owing to the scale of current ambulance and A&E delays, we will see more disability and deaths from heart and circulatory disease that could otherwise have been avoided, but if we can avoid them—if we can do things better—the debate will have achieved its goal. This is happening despite NHS workers and paramedics going above and beyond the call of duty to help those in need. I used the word “heroic” earlier, and I use it again now. It is not a word that is taken out of context when I apply it to those workers. Ambulance delays are the symptom of a system that is under immense pressure at every level. Problems in one part of the NHS affect other parts. Problems with accessing primary care lead to more emergencies, which means that, again, there is a greater demand for ambulances.

[Margaret Greenwood (Wirral West) (Lab)]

The hon. Gentleman is making an excellent speech, and I commend him for securing the debate. He mentioned the waiting times for category 2 emergencies. A constituent of mine lost her mother because the ambulance took more than an hour to arrive. This is a heartbreaking situation, and no family should have to go through it. Does the hon. Gentleman agree that we need urgent action to improve ambulance attendance times?

[Jim Shannon]

I certainly do, and I am sorry to hear of the passing of the mother of the hon. Lady’s constituent. If the ambulance had arrived earlier, perhaps she would be alive today. That example is probably replicated throughout the United Kingdom of Great Britain and Northern Ireland; I know that it is in my constituency, and indeed elsewhere. Perhaps when the Minister responds to the debate, we will hear some indication of how this could change.

A holistic response is needed. The NHS cannot begin to address this crisis, the very crisis to which the hon. Lady has just referred, without significant help from the Government—again, I look to the Minister—in the form of a cardiovascular strategy covering the whole patient pathway, as has been called for by the British Heart Foundation, which is also calling for a similar strategy in Northern Ireland. While the BHF wants the strategy in England, of which the Minister will be aware, to be replicated in Northern Ireland, I suspect that the same applies to Scotland and Wales.

The UK strategy, at its core, needs to address the issue of the workforce. Just as workforce shortages are key to issues involving waiting lists, access to primary care and ambulance delays; solving those shortages must be key to the response. I know from statements that Ministers have made, both in the Chamber and in Westminster Hall, that they are committed to increasing the number of nurses, doctors and other staff in the NHS, and the figures are certainly very encouraging. We have not yet reached the targets of 50,000 nurses and 20,000 GPs, but the Minister may be able to give us some timescales and some idea of when the Government hope to achieve those targets.

People who are at risk of cardiovascular diseases, and those already living with them, are supported by a diverse range of health professionals—paramedics, cardiographers, and specialist cardiac nurses—but the 2021 “Getting It Right First Time” cardiology report estimates that the NHS is short of nearly 100 consultant cardiologists; there are currently about 1,700. Perhaps the Minister will be able to tell us when those 100 vacancies will be filled. I ask these questions with the aim of being constructive and ensuring that our constituents throughout this great nation have a better idea of what is going to happen. It is said that we also need 760 new cardiac physiologists to meet the demand over the next decade. Is there a strategy and a recruitment plan? If there is, we will be greatly encouraged. I look forward to the Minister’s response.

[Margaret Greenwood]

I thank the hon. Gentleman for being so generous with his time. He has talked about shortages, and how we should plan for the future. A number of my constituents have written to me about the financial difficulties experienced by medical students, particularly during the final two years of their training. Does the hon. Gentleman agree that the Government really need to come up with a plan to protect and support student doctors, so that we can have the workforce that we need for the future, and ensure that people from all backgrounds can have a career in medicine?

[Jim Shannon]

I thank the hon. Lady for that helpful intervention. I am glad that she mentioned that: it should have been in my notes and she has reminded me. We do need to have a plan to help those students who wish to pursue a future vocation as consultant cardiologists. If we can recruit them now, it will take three, four or even five years before they are ready. I am not sure whether it is the Minister’s responsibility, but perhaps she could give us some idea of whether there is a plan to give students some financial assistance. I have asked the question before, and the answer would be very interesting. If people make a commitment to staying in the NHS for that period of time, perhaps the Government can make a financial commitment to them.