Asked by: Henry Smith (Conservative - Crawley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he has made of the effect of primary care networks on rates of detection of heart valve disease.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
No assessment has been made of the effect of primary care networks (PCNs) on rates of detection of heart valve disease.
Asked by: Henry Smith (Conservative - Crawley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to section 3.70 of the NHS Long Term Plan, what plans the Government has for the appointment of a national cardiovascular disease policy lead to support primary care networks in establishing greater community detection of heart valve disease.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
NHS England has appointed a National Clinical Director for cardiovascular disease prevention and a National Clinical Director for heart disease.
They are working closely with the NHS England and NHS Improvement primary care contracting team, to develop the draft specification for the Cardiovascular Disease Prevention and early diagnosis Primary Care Network Directed Enhanced Service which will support primary care networks to improve community detection of heart valve disease.
Asked by: Henry Smith (Conservative - Crawley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to ensure that people with heart valve disease symptoms are able to access (a) diagnostic assessments and (b) treatment during the covid-19 outbreak.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
Primary and secondary care have remained open throughout the pandemic and patients have been encouraged to access these services.
Since 29 April NHS England has prioritised the reintroduction of non COVID-19 services with the aim of recovering as much performance as possible before winter. To aid this, new COVID-19 secure hubs for surgery and diagnostics have been established.
Further planning is underway to ensure critical services, such as cardiac surgery, are maintained during any future waves.
Asked by: Lord Campbell of Pittenweem (Liberal Democrat - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they are taking to ensure cancer and heart disease patients are able to access hospital treatment during the COVID-19 pandemic.
Answered by Lord Bethell
The National Health Service has continued to provide urgent and emergency services throughout the outbreak and has run the ‘Open for Business’ media campaign to encourage people with potentially serious health issues to continue to seek medical advice, particularly those with symptoms of cancer, heart attack and stroke.
NHS trusts and Cancer Alliances are working to identify ring-fenced diagnostic and surgical capacity for cancer so that they can deliver cancer surgery and treatment at cancer hubs, which have been set up to treat patients in non-COVID-19 environments. Full use is also being made of independent sector hospital and diagnostic capacity.
Referrals for cancer treatment from general practitioners (GPs) to hospital continue to go ahead and the NHS is working hard to increase these to pre-COVID-19 levels.
To ensure patients with heart disease are given the care they need, hospitals are prioritising capacity for cardiac surgery, cardiology services and neuroradiology. Secondary care is prioritised for patients with heart failure, valve disease and arrhythmia services.
Further cardiac and stroke services continue to operate throughout the COVID-19 response and GPs continue to refer into these services.
Asked by: Paul Farrelly (Labour - Newcastle-under-Lyme)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to ensure that the National Implementation Framework of the NHS Long Term Plan facilitates delivery of (a) improved equity in access to treatment for heart valve disease, (b) additional funding for treatment of heart valve disease to enable healthy ageing and (c) increased NHS capacity for multidisciplinary teams providing care to all heart valve disease patients.
Answered by Seema Kennedy
The NHS Long Term Plan outlines NHS England and NHS Improvement’s commitment to improve the prevention, early detection and treatment of cardiovascular disease. As part of this, local systems will work to better support people with heart failure and heart valve disease through multi-disciplinary teams as part of primary care networks.
To improve early detection of heart failure, pilot schemes will be established in 2020/21 and 2021/22 to increase access to echocardiography, ahead of a wider rollout. Greater access to echocardiography in primary care will improve the investigation of those with breathlessness, and the early detection of heart failure and valve disease.
There are published service specifications that promote network working to ensure cardiac pathways are well-defined.
The Specialised Commissioning Cardiac Improvement Programme is also focusing on improving multi-disciplinary team working, including the use of technology to optimise the available resource within clinical teams.
Asked by: Jonathan Ashworth (Labour (Co-op) - Leicester South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to increase the early detection of heart valve disease in primary care settings; and what assessment he has made of trends in the level of stethoscope usage in every NHS Health Check for people over 65 years old.
Answered by Seema Kennedy
The NHS Long Term Plan sets out the National Health Service’s commitment to provide greater access to echocardiography in primary care to improve the early detection of heart valve disease, and advises that people with heart failure and heart valve disease will be better supported by multi-disciplinary teams as part of primary care networks.
In relation to stethoscope usage, Public Health England has advised that the NHS Health Check does not currently include formal assessment of heart sounds. Therefore, stethoscopes are not used for this purpose in the programme.
The NHS Health Check is made up of three key components: risk assessment, risk awareness and risk management. During the risk assessment, standardised tests are used to measure key risk factors and establish the individual’s risk of developing cardiovascular disease. The outcome of the assessment is then used to raise awareness of cardiovascular risk factors, as well as inform a discussion on, and agreement of, the behavioural and medical approaches best suited to managing the individual’s health risk.
Asked by: Steve McCabe (Labour - Birmingham, Selly Oak)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what steps he is taking to encourage (a) clinical commissioning groups and (b) primary care clinicians to tackle variations in access to transcatheter aortic valve implantation procedures throughout England.
Answered by Steve Brine
NHS England commissions transcatheter aortic valve implantation (TAVI) and has a published policy which is consistent with National Institute for Health and Care Excellence (NICE) guidance, and access to TAVI is increasing year on year since it was first commissioned by NHS England.
Whilst clinical commissioning groups (CCGs) do not commission TAVI, they do play a part in encouraging primary and secondary care services to increase rates of diagnosis for aortic stenosis and refer onwards for management as appropriate.
In addition, NHS England is working in collaboration with NHS Improvement’s Getting It Right First Time team on a range of topics including TAVI. The review will consider current and potential future demand, waiting times, and pathway optimisation. As part of this process, a clinical lead has been identified to head up a policy working group which will review NHS England’s current policy for TAVI commissioning, in light of a number of new randomised control trials and updated guidance from national and international bodies.
Furthermore, NICE has been asked to develop a guideline on the management of valvular heart disease which should increase awareness of these conditions, including aortic stenosis.
Asked by: Derek Thomas (Conservative - St Ives)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 22 February 2017 to Question 63752, on heart diseases: medical treatments, what the timeline is for the publication of the (a) national cardiac review and (b) transcatheter aortic valve implantation pathway.
Answered by David Mowat
NHS England has advised that they are in the process of examining the evidence for extending access to transcatheter aortic valve implantation (TAVI).
In June 2016 it hosted a Clinical Summit to examine the issues relating to aortic valve disease. This reviewed the growth in the use of TAVI, and possible reasons for variation in use.
The outcomes from this summit are now part of the work plan for the Cardiac Services Clinical Reference Group and are being considered within the scope of the specialised cardiac review in 2017/18 . This review will include an analysis of current clinical commissioning policy, the evidence base, and the cost-effectiveness of different interventions; and will inform future commissioning position.
The reasons for the increase in demand and variation are multifactorial, and for this reason, a review of the wider aortic stenosis pathway is the most appropriate approach. The review will include the medical therapy and traditional surgical pathway and will also include specialised centres, secondary care and primary care clinicians.
The review is currently in its scoping phase. The timescales, format and the duration of the associated consultation will be dependent on the agreed scope of the review, which is expected to be finalised in summer 2017. The timelines for reviewing TAVI will be confirmed in line with the timelines for the cardiac review and high cost devices programme.
The approach to phase two of the commissioning of high cost devices is still being finalised but is expected to include engagement with stakeholders from patient groups, industry and industry bodies.
Asked by: Derek Thomas (Conservative - St Ives)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 22 February 2017 to Question 63752, on heart diseases: medical treatments, what plans his Department has to engage with (a) patients and (b) industry stakeholders as part of NHS England's consultation on phase two of the new regime for the commissioning of high-cost devices.
Answered by David Mowat
NHS England has advised that they are in the process of examining the evidence for extending access to transcatheter aortic valve implantation (TAVI).
In June 2016 it hosted a Clinical Summit to examine the issues relating to aortic valve disease. This reviewed the growth in the use of TAVI, and possible reasons for variation in use.
The outcomes from this summit are now part of the work plan for the Cardiac Services Clinical Reference Group and are being considered within the scope of the specialised cardiac review in 2017/18 . This review will include an analysis of current clinical commissioning policy, the evidence base, and the cost-effectiveness of different interventions; and will inform future commissioning position.
The reasons for the increase in demand and variation are multifactorial, and for this reason, a review of the wider aortic stenosis pathway is the most appropriate approach. The review will include the medical therapy and traditional surgical pathway and will also include specialised centres, secondary care and primary care clinicians.
The review is currently in its scoping phase. The timescales, format and the duration of the associated consultation will be dependent on the agreed scope of the review, which is expected to be finalised in summer 2017. The timelines for reviewing TAVI will be confirmed in line with the timelines for the cardiac review and high cost devices programme.
The approach to phase two of the commissioning of high cost devices is still being finalised but is expected to include engagement with stakeholders from patient groups, industry and industry bodies.
Asked by: Derek Thomas (Conservative - St Ives)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health, pursuant to the Answer of 22 February 2017 to Question 63752, on heart diseases: medical treatments, if he will ask NHS England to accelerate the routine commissioning of transcatheter aortic valve implantation as part of the Right Care programme.
Answered by David Mowat
NHS England has advised that they are in the process of examining the evidence for extending access to transcatheter aortic valve implantation (TAVI).
In June 2016 it hosted a Clinical Summit to examine the issues relating to aortic valve disease. This reviewed the growth in the use of TAVI, and possible reasons for variation in use.
The outcomes from this summit are now part of the work plan for the Cardiac Services Clinical Reference Group and are being considered within the scope of the specialised cardiac review in 2017/18 . This review will include an analysis of current clinical commissioning policy, the evidence base, and the cost-effectiveness of different interventions; and will inform future commissioning position.
The reasons for the increase in demand and variation are multifactorial, and for this reason, a review of the wider aortic stenosis pathway is the most appropriate approach. The review will include the medical therapy and traditional surgical pathway and will also include specialised centres, secondary care and primary care clinicians.
The review is currently in its scoping phase. The timescales, format and the duration of the associated consultation will be dependent on the agreed scope of the review, which is expected to be finalised in summer 2017. The timelines for reviewing TAVI will be confirmed in line with the timelines for the cardiac review and high cost devices programme.
The approach to phase two of the commissioning of high cost devices is still being finalised but is expected to include engagement with stakeholders from patient groups, industry and industry bodies.