Heart and Circulatory Diseases (Covid-19)

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.

We also need to know where the gaps are regionally. While one postcode area may be exceptional, others may not be. While there might be a shortfall in England, we need to know what is happening in Northern Ireland, Scotland and Wales. The number and type of cardiac health workers is not spread evenly across the UK. The greatest number and range of workers is concentrated in large urban areas in England, meaning that many rural areas find themselves at a disadvantage. I hope the Minister can give us some idea of what can be done to improve the situation. The areas with the most workers are not necessarily the areas with the highest rate of cardiovascular diseases, or the poorest outcomes. We need to reappraise how that is done.

The British Heart Foundation is conducting a research project designed to further pinpoint gaps in the cardiac workforce and predict where they may come in future. I wish the BHF all the best as it carries out this vital informative work. That research project might be helpful to the Department; I hope the Minister will be able to tell us what discussions she has had with the BHF on that.

If we address the issue of workforce, we can start addressing waiting lists, primary care and ambulances, and start saving more lives. Let us not forget that the NHS long-term plan identified cardiovascular disease as the single biggest area in which the NHS can save lives over the next decade. We all want to save lives and if there is a way of doing so, the Government need to grasp that. This House and our constituents need to see a clear plan.

So there we have it—I have encapsulated the debate over a bit longer time than I thought I might, but it is an important issue. We need a UK Government strategy specific to cardiovascular disease that addresses the cardiac workforce crisis, the disparity across the United Kingdom and provides sufficient resources for the delivery of cardiac services.

Cardiac care cannot wait, because those suffering from cardiovascular diseases deserve better. In this place, every one of us can be a part of life-changing post-covid changes for the better. I hope that today’s debate is another step in that programme to change things. I look forward to the contributions from other Members. I thank those who have already intervened. I look forward to the responses from the shadow Ministers and especially to that from the Minister.

I am pleased that the Scottish Government are taking action on tackling heart disease in Scotland and have published an updated heart disease action plan. The covid-19 pandemic has brought the need to address heart disease in Scotland into even sharper focus, having had a significant impact on people with heart disease and on the services that support them. The heart disease action plan sets out the Scottish Government’s vision of minimising preventable heart disease and of ensuring timely and equitable access to diagnosis, treatment and care. The vision of the plan is to minimise preventable heart disease and ensure that everyone with suspected heart disease in Scotland gets what they need. We need to identify ways to support people with the emotional and psychological impacts of heart disease, giving as many people as possible access to specialist support, including vital rehabilitation services, and, where necessary, supporting access to palliative care. Addressing inequality will be monitored and considered carefully throughout the implementation of the plan. In Scotland, one of the things we are really good at is listening to a wide range of voices in efforts to create pathways and reshape models of care. The use of technology and care closer to home has also been vital to maintain care throughout the pandemic and has important lessons for delivering person-centred care in future.

Cardiovascular disease is one of the main causes of death and disability in the UK, but it can often be largely prevented by leading a healthy lifestyle, and the Scottish Government are supporting people to make healthier choices. It is not always good to talk about what has happened but good rather to think about how we can prevent it happening in future. Many people in Scotland live with cardiovascular risk factors such as high blood pressure or high cholesterol that place them at increased risk of heart disease or stroke. Health-harming products—alcohol, tobacco and unhealthy food and drinks—contribute to widening of health inequalities. Improving diet and levels of healthy weight is a public health priority. The Scottish Government are taking wide-ranging action to support healthier choices, as they have set out in “A healthier future: Scotland’s diet and healthy weight delivery plan”. The Scottish Government are shifting the emphasis from dealing with the consequences of obesity to tackling the underlying causes, which includes: ending poverty; supporting fair wages and families; and improving physical and social environments. The Scottish Government are committed to introducing during this Parliament a Bill that includes powers to restrict the promotion of food and drink that are high in fat, sugar and salt. They have long advocated that TV and online advertising of foods high in fat, sugar or salt should be restricted to give children the best start in life. The SNP welcomes the fact that the UK Government have now moved in line with the Scottish Government’s position, although it is disappointed at the delayed implementation.

The Scottish Government’s tobacco control action plan sets out the priorities for reducing smoking rates to 5% or less by 2034. Their alcohol framework sets out priorities for preventing alcohol-related harm, and it contains 20 actions, building on existing action to change Scotland’s relationship with alcohol, including Scotland’s world-leading minimum unit pricing policy.

The Scottish Government are investing in health and are committed to significantly reducing health inequalities. There is no doubt that covid-19 has had a disproportionate impact on people living in areas of socio-economic deprivation. The Scottish Government’s programme for Government includes commitments to improve life expectancy and to tackle health inequalities.

The Scottish Government are committed to ensuring appropriate staff resources and training to deliver timely and equitable services across Scotland for people with heart disease. Under the SNP, Scotland has record health funding: a total health portfolio funding of £18 billion, with resource funding up over 90% in cash terms under the SNP since 2006-07. Frontline health spending is £111 higher per head in Scotland than in England. That is important because the Scottish Government recognise that we start from a lower base of good health, and they are committed to improving health. As I have said, disease prevention is a big factor.

We now have higher staffing per head than NHS England. We have a record number of GPs working in Scotland, with more per head in Scotland than the rest of the UK. The Scottish Government’s NHS recovery plan, which is backed by more than £1 billion, sets out plans for health and care over the next five years. They are creating a network of national treatment centres, increasing capacity for more than 40,000 additional planned elective procedures and diagnostic care across 12 different specialities. They are also targeting improvements designed to maintain the 31-day standard and achieve the 62-day standard on a sustainable basis. They are also scaling up the use of NHS Near Me, which is a really good initiative and supported by £3.4 million a year. They are providing general practices and their patients with support from a wide range of healthcare professionals in the community. My own GP practice uses such healthcare professionals and it is really effective.

The Scottish Government also recognise the negative impact that long covid can have on the health and wellbeing of those affected, so they are spending more money to improve the care and support available for people with long covid across Scotland. The Scottish Government’s chief scientific officer is funding nine Scottish-led research projects on the longer-term effects of covid-19, which will also impact on those with heart conditions and circulatory diseases. Does the Minister agree that what the Scottish Government are doing will help people with heart and circulatory diseases, and will she consider emulating their actions?

Cardiac care is time-sensitive. For example, patients with severe aortic stenosis—I will put my teeth in to say that—who are treated within two years have a 50% chance of survival, but that falls to 20% after five years. Every day that the Government fail to act, more patients face worse outcomes. About 15 million adults in the UK have high blood pressure and about 270,000 people over 65 have undiagnosed atrial fibrillation. What does that mean? It means we are sitting on a ticking timebomb, and unless we pre-emptively support people to manage cardiovascular risk factors, the system will come under even more pressure. I urge Ministers to work relentlessly to get a grip on this crisis. They need to come to terms with the fact that, on their watch, cardiac care has been allowed to falter. It is maddening that in these circumstances the Government have not set out a robust strategy for cardiac care and how they plan to address these really important issues. When the Minister comes to the Dispatch Box, will she commit to a timeline for that strategy, or will we hear more warm words with precious little action?

I want to reiterate concerns raised about urgent and emergency care. We now know that the average response time for a category 2 emergency, such as a heart attack or stroke, is more than double the target of 18 minutes. In some parts of the country, it is far, far worse than that, as we heard from my hon. Friend the Member for Wirral West (Margaret Greenwood) . Does the Minister agree that no one suffering from a heart attack or a stroke should have to wait 40 minutes or more for an ambulance? If so—I am sure that she does, as we all do in the House; nobody wants to see those failings—what discussions have she and her colleagues had to sort it out? This is a crisis on multiple fronts, and I am afraid that we need action rather than words.

From the moment a patient dials 999, they are being systematically failed. As we know, our NHS staff are heroes. Without them, the system would have buckled under the weight of incompetence and indecision during the pandemic, but they are fighting an uphill battle and the Government are letting them do it alone. That needs to change.

There is also a failure to acknowledge the role that prevention plays with health and social care. The Government have cut public health budgets here in England—that happened before the pandemic, and it is just not acceptable—and it means that only half of adults over 40 are attending regular health checks, which were introduced by the Labour Government in 2009. Those health checks have provided crucial evidence for spotting diseases early on, not least cardiovascular disease. With the fall in health checks, many opportunities to spot avoidable problems are being missed, especially among people from disadvantaged communities as I and the hon. Member for Motherwell and Wishaw outlined earlier. Indeed, the disproportionate impact of covid-19 showed starkly just how unequal a country we have become in health terms.

We also have huge numbers of people reporting difficulty in accessing primary care, as the hon. Member for Strangford referred to in his contribution. Some 40% of surveyed heart patients or those at risk of cardio- vascular disease had their appointments cancelled or rescheduled more than once. In 2019, the Prime Minister promised the British public that he would deliver 6,000 extra NHS GPs. Instead, numbers have gone down—another broken promise to add to the never-ending list of broken promises that define this Tory Government. Will the Minister explain to the House why the target is not being met and explain to patients why they are waiting longer than ever before?

We know from the Getting It Right First Time national cardiology report that the NHS needs 760 new cardiac physiologists and almost 100 consultant cardiologists to meet anticipated demand. Again, I reiterate the concerns raised about urgent and emergency care, because we need those staff in place. We need that workforce.

At the heart of that is a public health agenda that will seek to resolve the health inequalities that are endemic in too many parts of the country, where those health conditions are holding back the life chances of the constituents we represent and causing misery, poverty and pain. That is why a holistic approach to public health, and within that a strategy to deal with heart and circulatory diseases, is crucial. I hope the Minister understands the real importance of that. We stand ready to support her while she is in Government to get the strategy right, but getting that strategy right is crucial.