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Cardiac/Vascular Health

Volume 491: debated on Wednesday 22 April 2009

Mr. Pope, may I say what a pleasure it is to serve under your chairmanship for the first time? Normally, at this time on a Wednesday afternoon we are both in the Select Committee on Foreign Affairs. A change is as good as a rest, so they say, so I am delighted to have the opportunity to speak in this important debate. I am most grateful to colleagues for turning up on the busiest day, in parliamentary terms. I imagine that we have all had a rushed lunch. I thank all hon. Members for coming.

Let us first remind ourselves of the facts. Cardiac and vascular conditions are those affecting and related to the heart and to blood vessels throughout the body. They include heart attack, stroke, diabetes and chronic kidney disease, affect the lives of more than 4 million people in England, cause 170,000 deaths each year and are responsible for about one fifth of all hospital admissions. The challenge posed by those conditions is stark: cardiac and vascular disease remains the number one cause of death and disability in the United Kingdom. The death rate for coronary heart disease and stroke in men and women is still higher in the UK than in comparable western European countries. It was primarily to address that serious challenge that the national service framework for coronary heart disease, a 10-year plan of action, was launched in 2000. In England, it certainly has delivered significant progress in the fight against coronary heart disease.

The national framework for CHD, with the additional arrhythmias chapter added in 2005, led the way as one of the first national plans developed to take a root-and-ranch approach to improving the treatment and care of people with a particular condition and to take action on prevention. Progress reports have shown the following: first, the target of reducing deaths from cardio-vascular disease in people under 75 by 40 per cent. was met five years early; secondly, the number of people suffering a heart attack who received thrombolysis within 60 minutes of a call for help increased from 24 per cent. of patients in early 2001 to almost 70 per cent. in 2007; and thirdly, the waiting times for heart surgery dropped dramatically, from more than 5,500 people waiting more than three months for heart surgery in 2000 to none in 2007. However, we must not risk failing to build on what we have achieved to date. It is vital that these achievements and those of other strategies for stroke, diabetes and kidney disease are sustained and built upon. Simply to rely on a project-based approach is not enough.

I thank the hon. Gentleman for not being party political and for giving the Government full credit for our achievements to date. Does he agree that they reflect the Government’s investment in increasing health funding from £33 billion in 1997 to more than £100 billion today, and that we need to keep that investment in place for the future to build on our successes?

I think that I agree with the hon. Gentleman. In his statement today, I think the Chancellor indicated that health spending would continue along the lines that had been built in some years previously. However, the achievement in relation to cardiac and vascular disease over the past nine years is more to do with the focus that the Government brought to bear on that wide-ranging issue. That is just as important, of course, as the money that brought it to fruition.

Although I want to be non-partisan, I fear that we need to point out some failings. Does my hon. Friend agree that it is a scandal that we do not have a national programme for screening for abdominal aortic aneurism, for example, given that the national screening committee said years ago that that should happen? We continue to lose hundreds of men over 65 for want of a simple screening procedure that would probably save more lives than breast cancer or cervical cancer screening, yet Ministers continue to drag their heels.

My hon. Friend raises an important point. The Prime Minister himself announced not long ago that a special check system was to be put in place for that problem, which causes deaths in the over-60s and over-65s in the male population in particular. I thought that pilot schemes were due to start in the south-west as early as last year, but I am not aware—the Minister will probably say—that those pilot schemes for checks are in place yet. No doubt, the Minister can throw more light on that.

In fact, we do have a strategy for aortic aneurism screening and we started that in April this year. That was the date that we announced and it has happened. We need to keep to the facts.

Perhaps my hon. Friend would like to reflect on the fact that the announcement was made by the Prime Minister back in January 2008 and it has taken 15 months even to get the triple-A screening pilots started.

Another fact has been added to the record.

Some risk factors for cardiovascular diseases, particularly obesity and a lack of physical activity, are increasing. On current trends, 60 per cent. of males and 50 per cent. of females will be obese by 2050. If unchecked, it is predicted that that will lead to a massive increase in type 2 diabetes, with the current trend indicating that more than 4 million people in the UK will have that condition by 2025. That will result in a large increase in the number of patients who require medication to prevent cardiac and vascular events.

The number of people requiring kidney dialysis is set to double by 2014 to more than 45,000, but growth in the prevalence of cardiovascular disease and diabetes could increase the number still further. With a population that is ageing and increasingly overweight and obese, prevalence of cardiac and vascular conditions, and their associated treatment costs, will only increase. We must therefore ensure that the health service is ready and prepared for the extra demands it will face. Investment now to prevent premature chronic illness will lead to savings in the future.

The success of the national service frameworks means that more people survive acute cardiac and vascular events. Of course, that is good news, but it means that more people are living with cardiac and vascular disease, and it is vital to plan for that. However, although the Department of Health has recognised, in its recent progress report on the national service framework for CHD, the case to build services around all cardiac and vascular disease, it remains unclear how exactly it plans to deliver that integrated approach. For that reason, the Cardio and Vascular Coalition, or CVC as I shall refer to it from now on, has published key recommendations for a new integrated approach to cardiac and vascular conditions for policy makers to consider.

The 41-strong membership of the CVC is a who’s who of organisations with an interest in cardiac and vascular disease, ranging from large representative organisations, such as the British Heart Foundation, the Stroke Association, the British Cardiovascular Society and the Royal College of General Practitioners, to smaller organisations representing rehabilitation and congenital heart disease—areas poorly served by the original NSF for coronary heart disease. Those organisations have come together to make a combined case for a renewed approach to cardiac and vascular conditions. Having one cardiac and vascular disease commonly predisposes people to another.

I congratulate the hon. Gentleman on his initiative in seeking the debate, and convey to him the thanks of many of my constituents. Many of my constituents signed the British Heart Foundation’s petition, which, as he knows, attracted 130,000 signatories. Will he share his thoughts on how a national strategy should develop, and does he welcome the way in which the Government have sought to ensure that, in an era of devolution, the four Administrations work together for an effective UK-wide strategy?

I am grateful for the hon. Gentleman’s intervention, and I agree that there should be a co-ordinated approach, which the Government have shown to date. I hope that as a result of this debate and pressure from both sides of the House—this is an all-party subject of great interest—they will look ahead and continue their good work. I shall discuss the petition later.

As I said, having one cardiac or vascular disease commonly predisposes people to another—for example, people with diabetes or kidney disease are at much greater risk of developing heart disease. The shared risk factors, related pathology and possible co-morbidities of those conditions support the development of a consistent approach to the management of cardiac and vascular conditions.

It is report, “Destination 2020: A plan for cardiac and vascular health”, the CVC urges the Government to commit to a proactive and co-ordinated approach that builds on the success of the work done so far and meets the challenges of the future. That should incorporate coronary heart disease and the other cardiac and vascular diseases—stroke, diabetes and kidney disease—when appropriate. It should address key areas requiring further progress and those that were not considered in the existing national service frameworks, including cardiac and vascular disease prevention, congenital conditions, rehabilitation, emerging needs for acute and chronic conditions and, finally, end-of-life care.

A key area where gaps remain is prevalence of disease and equality of access to services. The prevalence of coronary heart disease in men in England increases markedly with deprivation. The rate is one third higher among men in the most deprived group compared with the least deprived group. The difference is even greater in women, and those in the most deprived group have a rate of heart disease at least 50 per cent. greater than the least deprived group. It is clear that there is still inequality of access to cardiac interventions, and “Destination 2020” addresses how those inequalities in the prevalence and treatment of cardiac and vascular disease can be reduced.

Another important area of unfinished business is cardiac rehabilitation—measures to ensure sustained recovery and improvements in health and well-being following a cardiac event. Effective rehabilitation can bring about significant improvements in the lives of people who have had a heart attack or stroke, and reduce disability. Despite a target of 85 per cent. of eligible patients being offered cardiac rehab in the national service framework, a recent national audit of cardiac rehabilitation warned that only 47 per cent. of eligible patients receive that life-saving treatment. Cardiac rehab has been highlighted as a key area where further progress is needed.

Other areas that “Destination 2020” says should be addressed include planning for an increase in acute events, such as a heart attack or stroke, as a result of the risk factors that I outlined—many of the patients affected will be older and likely to have complex vascular disease requiring greater supportive care, as well as a longer hospital stay than is currently the case. The report recommends further development of child-specific services to prevent future cardiac and vascular disease, and the inclusion of children and adults with congenital heart disease in future planning—an area that is absent from the original national service framework for coronary heart disease. The CVC also calls for more long-term treatment and care services for those living with cardiac and vascular disease, to take account of anticipated increases in numbers; and, finally, better end-of-life care services for patients with cardiac and vascular disease. Those patients currently receive less specialist care than those with other conditions, most notably cancer, despite mortality and disability associated with some cardiac and vascular diseases, such as severe heart failure, exceeding that of most common cancers.

The hon. Gentleman has given a comprehensive list of areas for improvement, and I congratulate him on that. Will he join me, as chair of the all-party group on heart disease, in asking the Minister to meet the group to discuss his suggestions in detail?

That is an excellent idea. Perhaps the hon. Gentleman would like to invite the Minister to address our next meeting.

One nil, I think.

“Destination 2020” outlines the aims and principles that should underpin a renewed strategic approach to tackle cardiac and vascular disease in the next decade—for example, aims such as those relating to carers, third-sector organisations, and prevention. A person with cardiac or vascular disease should be placed at the centre of service and treatments with their carers and family. The aim should be to develop true partnerships between people with long-term conditions and the professionals and volunteers who care for them, underpinned by care plans and better patient information.

Carers play a crucial role in the ongoing care, rehabilitation and recovery of patients. They should be supported to provide that assistance, but a recent survey commissioned by the CVC showed that only 5 per cent. of carers had had a formal assessment of their support needs. Third-sector organisations representing patients with cardiac and vascular conditions and those around them should be encouraged to play a greater role in ensuring that their needs are addressed in policies and services.

I welcome the way in which the hon. Gentleman has emphasised the importance of carers. As chair of the all-party group on carers, I extend to his group the opportunity of having a joint meeting on this crucial issue. Will he respond positively to that?

Zero one, I think. The answer, of course, is yes, but the chairman of my group is sitting next to the hon. Gentleman, and all he needs to do is ask him.

Prevention measures should be at the heart of future planning for cardiac and vascular conditions, as they are ultimately the most effective way of reducing illness and preventing premature deaths. Comprehensive cardiac and vascular risk assessment and prevention measures should be encouraged, with particular emphasis on further progress in smoking prevention and cessation and reducing obesity.

“Destination 2020” also recommends measures to ensure that commissioning supports the provision of the resources, services and staffing required to implement a renewed strategy aimed at tackling cardiac and vascular disease. It supports the promotion of evidence-based practice and measures to maintain and strengthen the UK as a world leader in clinical trials in cardiac and vascular diseases to be conducted by both NHS and non-NHS research bodies. The Government's welcome NHS health checks programme aims to identify many of the major risk factors for cardiac and vascular diseases, and should form part of a wider focus on prevention.

It is essential that adequate plans and resources are put in place to meet the needs of the large number of people identified by the NHS health checks programme who will require follow-up. The shift towards prevention and the checks themselves are very welcome, but some questions require clarification. I did not give the Minister sight of those questions before the debate, and she may or may not have time to answer most of them, but no doubt any unanswered questions will be dealt with in correspondence in the usual way.

I thank the Minister in advance. The questions are as follows. The pace, scale and model of implementation appears to be decided by each primary care trust. Surely there is a risk that that will increase inequalities, as a result of variable implementation at local level. Will that be centrally monitored and action taken if necessary?

Accessibility to heath checks for patients is, of course, crucial. How is that best to be achieved? Will PCTs be ultimately responsible? Will the services be confined solely to GP practices, or will we set up specialist clinical centres? What will be the role of community pharmacies? There is no doubt in my mind that in community pharmacies we have a fairly universal and readily accessible professional resource that could play a key role in the health check programme. That new role seems to have been actively encouraged by parts of the NHS, but not universally. Some PCTs seem reluctant to embrace that great potential, through ignorance, professional opposition, lack of focus or simple tardiness. More centralised focus and targeting by the Department of Health may be required.

It is vital that those identified as being at risk of vascular disease or as already having a condition receive the best treatment. Does the NHS have a prediction of the numbers from both those groups that health checks will pick up? There is little point in identifying those at risk but being unable able to intervene effectively. What additional resources have been allocated for prevention interventions and the treatment of those identified as having a vascular disease? Are funds being ring-fenced for that purpose? Beyond smoking cessation, what evidence-based prevention interventions are available for PCTs to use?

How will PCTs’ success in providing the health checks be assessed and poor performance tackled? How will central Government ensure accountability for local delivery? The programme will yield huge amounts of data that will be invaluable for research and providing the evidence base better to inform commissioning in the future, but what plans are there to collect and use those data effectively?

It appears that two risk engines will be used to calculate people’s risk. Ideally, a national programme would be delivered locally using the same tools. Has the Department any plans to use one system only? It is good news that the Department is beginning to look across all cardiac and vascular conditions for the checks. If someone is identified as having multiple risk factors, are there plans in place to manage those risk factors holistically?

There is a clear groundswell of public opinion behind the calls for a renewed strategic approach to cardiac and vascular disease. The British Heart Foundation reports that the CVC’s case for a new plan has been backed by more than 135,000 people—a figure mentioned by the hon. Member for Aberavon (Dr. Francis)—who have signed the petition. That is a formidable voice, comprising 41 respected and authoritative organisations and tens of thousands of members of the public. They are asking not for a new national service framework or a replica of the current one, but for a clear vision of where we are going in the next 10 years.

This debate was inspired in part by the fact that the national service framework for coronary heart disease—a 10-year programme of action—is almost a decade old. Given changes in the health service, growing demands and changing priorities, we surely require a renewed strategic approach for the next 10 years, dealing with areas of unfinished business and ensuring a consistent approach across all cardiac and vascular conditions. That call for a renewed strategy is not unique. Such a strategy would be entirely consistent with the Department’s announcement that it intends to publish a new strategy for mental health. The national service framework for mental health, which is also a 10-year strategy, is due to end this year, and the Department accepts that it needs renewal.

I am aware that the Department recently issued an update report on the national service framework for coronary heart disease. There was much to welcome in that document, including commitments, first, to address inequalities further; secondly to work across cardiac and vascular conditions; and, thirdly, to address unfinished business, including cardiac rehabilitation. The update rightly records progress made in the fight against coronary heart disease, and there is recognition that now is the time to build on the progress achieved, yet the report leaves some questions unanswered.

When will the promised reviews of the implementation of the current national service framework and the future of cardiology be delivered and how will they be applied to improve services? What is the Department’s vision to build on progress in combating inequalities across cardiac and vascular conditions? What exactly does the Department mean by “working across conditions” when it gives the impression that it will treat heart disease, stroke, diabetes and renal disease under separate programmes?

The fundamental concern about the update document was that, of its 20-plus pages, only one was devoted to future planning—for 2010 and beyond. The report is heavy on what has been achieved, but does not acknowledge that the growing burden of people living with heart and circulatory conditions requires a renewed vision for the next generation.

The health service looks very different now from how it looked 10 years ago, when the national service framework for coronary heart disease was first developed. Without a new national strategic approach to cardiac and vascular health in England, we run the risk of progress slipping away. We need a coherent integrated plan covering cardiac and vascular disease, with the experience of the patient, through prevention to palliative care, at the centre. That plan should embrace current initiatives and address remaining gaps in services, so that we can better meet the new challenges that we face, further improve the health of the nation and reduce the incidence of cardiac and vascular disease in England to one of the lowest levels in western Europe.

The CVC has produced a vision for a new comprehensive approach to all cardiac and vascular disease. Will the Minister commit seriously to considering the CVC’s “Destination 2020” document and working with the voluntary sector to plan the next phase of the fight against cardiac and vascular disease?

It is a great pleasure to serve under your chairmanship, Mr. Pope. I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing the debate. I was very pleased that he mentioned the importance of the care of, and a proper strategy for, those who suffer from congenital heart disease. It is perhaps a testament to the Government’s success that so many babies survive with that condition. It is notable, though, that not all the recommendations in the Monro report were implemented, due partly to the fact that clinical expertise is spread rather thinly across the service. A group chaired by Dr. Patricia Hamilton is re-examining these issues and I hope that early recommendations will be made such that sufficient specialist staff can be trained. A larger number of children with congenital heart disease are surviving to adulthood, and clearly resources are needed to ensure that doctors and nurses with specialist knowledge of adults with such a condition are appropriately trained. When the Minister replies, I would be interested to hear about the approach being taken to congenital heart disease and how that policy is distinguished from the rest of the policies regarding the treatment of coronary heart disease.

This debate is about the treatment of those with cardiac and vascular disease, which many of us will have experience of in the coming years. I am particularly concerned to spend some time considering the expectations of the 380,000 residents of Croydon and what they will face in the context of proposed changes in provision for stroke victims. As the hon. Member for North-East Cambridgeshire said, early treatment is very important when a stroke strikes. It is also a great testament to improvements in the service that 70 per cent. of stroke victims are now treated within 60 minutes—and very important that is too, given that for every hour that treatment is delayed, brain cells are haemorrhaging away at a rate normally experienced over 3.6 years.

In Croydon, the Mayday hospital treats 500 cases of suspected acute stroke each year; at present, we have a nine-to-five, Monday-to-Friday capability for dealing with such cases. However, Healthcare for London proposes that such provision should be provided solely at St. George’s hospital. Healthcare for London is, in some ways, setting up an artificial choice between Mayday and St. George’s. As we heard, it is important that treatment is given within 60 minutes; even with their blue lights, and despite what the London ambulance service might say, it is extremely difficult to get to St. George’s from many parts of Croydon. It is appropriate to say that the population of south-west London would be better served by having two acute stroke units.

It is suggested that St. George’s would be the best location, but Mayday’s proposals to Healthcare for London were made in partnership with St. George’s, the latter saying that the ideal scenario would be to have a joint acute unit with two front doors—at Mayday and at St. George’s. Only under the artificial construct by which Healthcare for London pitches hospital against hospital for the right to receive one of eight acute stroke units in London does it make no sense to retain Mayday’s hyper-acute provision. After all, the unit in Croydon is performing well; indeed, it has been commended on its strong performance. Its thrombosis treatment is reaching levels provided by the very best in Europe, including in Helsinki. It seems odd to propose removing the excellent provision provided at Mayday yet at the same time to propose endowing Princess Royal university hospital in Bromley with such provision, given that the latter does not have a distinct record in stroke treatment.

I am concerned that as many as 20 per cent. of those presenting with symptoms of stroke are suffering mimic stroke. Taking such patients on the long journey to and from St. George’s could put great stress on the London ambulance service. Mayday has experienced significant difficulties in the quality of liaison—it is now becoming a main general hospital—with tertiary centres. I was grateful for the interest shown by the Secretary of State in two cases that seemed to show real difficulties in communication between the hospitals.

More than 1,000 signatures have been added to a petition on the matter. I cite two residents who expressed concern. Given the expected traffic difficulties of travelling across south-west London, Peter Mason quite rightly says:

“Less miles means more lives are saved.”

Heather Bain said:

“My mother had a stroke and the only reason she is still mobile is that Mayday was so near to our home.”

It is important to consider Croydon’s demographics. It is notable that the Healthcare for London bid consultation document cited a 60 per cent. greater incidence of strokes in the black African and black Caribbean populations, which is exacerbated by social deprivation. That is an important concern for Croydon, which has a higher than average population in that respect compared with London and England. It may not be obvious at the moment, but we have a dynamic community. It is changing greatly, and that change will be further driven by migration flows, as Croydon becomes host to the Border and Immigration Agency. That sector of the population—the BME community, and particularly the black Caribbean groups—is now ageing and is much more likely to be exposed.

St George’s hospital has explicitly stated it does not have the capacity to take all acute stroke patients. Its bid identified a maximum capacity at the prospective unit of 20 beds, with a preferred bed complement of 14. The Healthcare for London tender made under the consultation suggests that 26 beds are needed for south-west London. It would be appropriate for St. George’s and Mayday hospitals to share that provision.

Given the configurations considered in the consultation, it would be somewhat safer to have a stroke in Westminster or other parts of central London. It is partly to do with history and the quality of hospitals in the central area, but coverage in London’s periphery seems rather sparse. Although it is never the Government’s intention to discriminate against the suburbs, disjointed decisions made in different parts of the public sector have resulted in discrimination against Croydon.

I warmly congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing this important debate. He is known to be a fair-minded man, and he delivered merited praise to the Government when justified. He also presented a thoughtful analysis and an objective critique when appropriate. All in all, his contribution was delivered in a non-partisan manner, despite provocation from the Taliban tendency of the Conservative Front Bench.

The Cardio and Vascular Coalition’s excellent “Destination 2020” strategy, to which the hon. Member for North-East Cambridgeshire referred, is both timely and significant. The aim is to reduce rates of cardio and vascular disease in the United Kingdom to one of the lowest in western Europe. That is a commendable aim, and we should have no trouble in welcoming and supporting it, and taking the appropriate decisions to ensure that it is delivered. As the coalition readily acknowledges, the Government have made important progress, tackling these generally fatal diseases through the national service frameworks to which the hon. Gentleman referred. That is particularly so for coronary heart disease, kidney disease, stroke and diabetes.

Vast improvements have been made to the way in which the NHS diagnoses and treats cardiac and vascular diseases, but although everyone in Parliament should be proud of that, it is vital to recognise that it is only a stepping stone to better health outcomes throughout society. In my view, the key areas for improvement are preventing cardiac and vascular disease and the rehabilitation of patients.

The hon. Member for Croydon, Central (Mr. Pelling) gave a helpful and encouraging speech. I declare an interest as chair of the Ibstock stroke club. The hon. Gentleman was talking about specialist stroke units. We have one in Leicester general hospital, which serves getting on for 1 million people in the city and the county. A feature of its care is the rehabilitation offered as an intermediate step at community hospitals in the county, including at my community hospital at Coalville. I hope that the Minister, who is an able, approachable and articulate member of the ministerial team, will accept an invitation to visit the Coalville hospital to see the work done in the stroke rehabilitation unit. Such an offer is probably difficult to refuse.

I return to the thrust of the debate. Lord Darzi’s review of the NHS will undoubtedly lead to fundamental changes to the organisation and commissioning strategies of the national health service. I am a confessed sceptic of the personalised health budget, polyclinics and the choice mantra—I hope that the Minister has not already cancelled her ticket to Coalville. Lord Darzi’s emphasis on local commissioning has the potential to continue the Government’s record of improving standards and patient outcomes in the NHS. However, in an era in which local health authorities are commissioning rather than providing primary health care, it is vital that the Government retain a strategic view of prevention, diagnosis, treatment and rehabilitation for cardiac and vascular patients, and for all other long-term chronic conditions.

As the report “Destination 2020” spells out, and as the hon. Member for North-East Cambridgeshire said, project-based approaches on their own will not necessarily realise our ambition of reducing the number of cardiac and vascular disease patients or improving their care pathway. The Government need to spell out their strategic policy—I guess that we will hear something about that in the Minister’s reply—and the changes to the NHS proposed in the Darzi review must fit around that policy, not the other way around.

I want to focus my main comments on the third principle outlined in “Destination 2020”, which talked about the CVC’s ambitions being delivered through standards of excellence, a patient-centred approach, effective commissioning, research, addressing specific areas of need and particularly by a new focus on prevention. At this point, I should declare an interest as the chair of the all-party group on smoking and health, and that is the issue to which I now wish to turn.

The Government’s Health Bill, which is proceeding through the House, is key to a new approach to preventing the diseases that we are discussing. There are overt links between smoking and many fatal diseases, such as cancer, and deaths from coronary heart disease are about 60 per cent. higher in smokers. That means that tobacco smoking accounts for more than 30,000 deaths from cardiovascular disease in the UK every year. As a result of smoking, 100 people will die from CVD today, 14 or 15 of them in the city of London.

Smoking is a major cause of death from CVD and of the morbidity associated with it, although its prevalence is decreasing, which has made a significant contribution to decreasing CVD rates. It has been estimated that about 48 per cent. of the decline in coronary heart disease mortality in England and Wales between 1981 and 2000—a period of 20 years—was attributable to the reduction in the prevalence of smoking. Smoking rates have declined since my teens and 20s—that was 40 years ago—when about half the adult population probably smoked, although prevalence varied widely by social class and age. None the less, as the Minister well knows, more than 20 per cent. of the population still smoke, and the figure is significantly higher in deprived communities. We therefore need to maintain momentum and to continue to recognise smoking as a risk factor that can and, indeed, must be minimised. It is important to recognise that even by the most optimistic estimates of smoking cessation rates, there will still be at least 5 million smokers in the UK in 10 to 12 years’ time, when a fifth Labour Government will be coming to a very satisfactory conclusion.

Even a temporary cessation in smoking improves health outcomes. Crucially, the ability of cardiovascular patients to survive surgery and avoid post-operative complications improves significantly. I do not know whether my hon. Friend the Minister, who is a London MP, was aware of this, but the London Health Observatory reached the following conclusion in its 2006 report on the short-term benefits of pre-operative smoking cessation in London:

“If patients admitted for planned surgery were to stop smoking prior to operation 2,500-5,300… post operative complications would be avoided each year, and the NHS would make the following savings: 2,600-4,000 bed days could be saved; £0.5-£1.1 million each year across London’s PCTs could be saved”.

In addition, a sum of between £1 million and £3 million could be saved across London’s hospital trusts. Those are significant figures in financial and health terms. If they were extrapolated to the rest of the country, that would result in hundreds of thousands of bed days being freed up and hundreds of millions of pounds being saved.

The risk of CVD increases in young smokers. It has been shown that people under the age of 40 have a five times greater risk of heart attack if they smoke. The immensely successful and well-organised pressure group, Action on Smoking and Health, to which I pay tribute, recently conducted work on the issue. Its report, “Beyond Smoking Kills” found that smoking accounts for 16 per cent. of circulatory disease treatment costs for patients aged 35 and over and for more than twice that figure— 34 per cent.—in the 35 to 64 age group. Coronary heart disease caused by smoking accounts for £180 million— 20 per cent.—of all CHD treatment costs for patients aged 35 and over, and the figure rises to 41 per cent. for those under 65.

We know that prevention must start early—we often say that and we know that it is common sense—but it must start even earlier where tobacco is concerned. The best way to minimise smoking as a risk factor in CVD is to prevent children from taking it up at all. Most smokers start before the age of 18, and most will never manage to quit. Smoking is a childhood addiction, not generally an adult choice. The Health Bill, which is currently in the House of Lords, is an important part of our prevention strategy. Encouragingly, it proposes a ban on point-of-sale display and on the sale of tobacco from vending machines, as well as plain packaging for tobacco products. I hope that all three of those initiatives survive through to Third Reading in the Commons.

During the Bill’s earlier stages in the Lords, the tobacco industry used front groups—a common tactic for the industry—to promote scare stories about costs, which are not justified by the facts, and to undermine this important public health measure. Ending the display of tobacco in shops will, like the ban on tobacco advertising, help to ensure that tobacco is not seen as normal for our children and that it is not seen and bought alongside sweets and newspapers. Smoking accounts for half the difference in life expectancy between the richest and the poorest in our nation. Breaking the cycle of addiction in the poorest parts of society is the only way seriously to reduce and eventually end such health inequalities. Population-level prevention measures have been shown to work, and the proposed legislation will work across all our communities to help put tobacco out of sight and out of the reach of our children.

When the Bill comes to the Commons, I hope that there will be cross-party consensus in voting to support bans on point-of-sale display and tobacco vending machines, as well as the introduction of plain packaging. I am sure that the hon. Member for North-East Cambridgeshire will raise such issues with the leader of his party, who refreshingly confessed to his personal experience of the difficulties of giving up smoking. I hope that the Leader of the Opposition will be persuaded of the significance of the measures in the Bill and support the CVC’s vital ambition of ensuring that the Government adopt a new approach to preventing the diseases that we are discussing. Worthy as they are, however, and highly likely though they are to be effective, the proposed measures will not work in isolation and must be part of a comprehensive approach. Such an approach should be supported and linked to a CVD strategy of the type outlined in the excellent and concise report “Destination 2020”, which the Minister will have read.

I have two final points to make. First, the provision of appropriate smoking cessation services in secondary care—the hon. Member for North-East Cambridgeshire mentioned this briefly—must be a standard part of care for all those with CVD or CVD risk factors. That must be an element of our strategy. Secondly, second-hand smoke makes its own deadly contribution to CVD. We banned smoking in enclosed workplaces only in July 2007. Evidence from Scotland, which implemented the measure rather earlier, shows that smoke-free legislation does lead, has led and will lead to fewer heart attacks across the population and that second-hand smoking is often a serious risk factor for those with a pre-existing CVD condition.

The Minister has readily assented to a meeting with the all-party groups that have an interest in this issue, and I hope that we can talk to her. As I said, she is a very approachable Minister, and we have confidence that she will be able to carry forward some of the things that we say to her. Everyone on both sides of the Chamber—there is no serious political divide on this issue—wants to build on the Government’s progress to date. The Department of Health would do well to root its future cardiovascular disease strategies deeply in the work that the coalition has recorded in its very clear and concise document. We all—politicians and the general population alike—owe it a debt of gratitude for that work. I hope that the Minister will give her personal, professional and political response to the contents of what is a very useful document for framing the health policy of the next 10 to 15 years and more.

I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) on securing the debate. It is a timely one and I welcome his commitment to the issue. We had a bit of political knockabout early in the proceedings, which I found interesting, because to try to get an idea of what all the parties are doing we had tried to find out Conservative policy on the matter, and could find only one reference:

“The Conservatives have committed to lowering the number of premature mortality from stroke and heart disease to below the EU averages by 2015.”

That is from a document called “Delivering Some of the Best Health in Europe: Outcomes Not Targets.” I suppose it is a start, but I have a slight problem with it because one is not quite sure where to aim without knowing where the rest of Europe is going. Anything that makes a comparison with a basket of other countries is almost destined to fail. It is much better to have a clear target that says, “This is where we want to be.”

It is important to be fair and acknowledge that things are much better now than in 2000, when I was elected. There has been a lot of progress in the area we are discussing. In 2000 the Government produced the national service framework for coronary heart disease, which was a 10-year plan. We do not have anything against which to monitor its progress. It was really a framework to build on; but at the time it gave a clear direction. I am sure that the Minister will give us full details—probably quoting from the progress report for 2008, which we all received fairly recently. Credit where it is due: the target for decreased numbers of deaths was met five years early and waiting times for surgery have decreased—that is partly due to increased use of statins and emergency thrombolysis.

However, in January 2008 the Prime Minister set out—I am not sure whether it could be called another example of a rushed announcement like yesterday’s on Members’ expenses—plans to extend dramatically the availability of predict-and-prevent checks. Those are meant to give people information about their health, to support lifestyle changes, and to offer early interventions, when those are deemed necessary. The checks were to be systematic ones for people in the age group 40 to 74. It was not a bad announcement, but as so often happens something seems to have gone slightly awry, because vascular screening was supposed to have been up and running this April.

Over Easter I took the opportunity to discuss the issue with a doctor from my local medical committee, who said he had received no guidance yet. It would be useful if the Minister would explain or outline the guidance that primary care trusts and commissioners will receive. I am pleased to say that those concerned have not been idle on the matter; they have been talking to the local pharmaceutical committee, which is something that does not happen everywhere. A provisional system was arrived at by which the two professions—pharmacy and the GPs—would work together so as not to duplicate effort, and to avoid treading on people’s toes. It was a quite simple idea: the surgeries would produce lists of the patients most in need of a check, rather than a blanket list of everyone in the relevant age group, some of whom would already be in a doctor’s regular care, and the people in question would be directed to a pharmacy for a vascular screening check. That seemed to me a quite grown-up way for professions to come to a practical solution, each doing the work they are best placed to carry out, without antagonising each other in the process. In health, things sometimes get a little territorial between the professions.

I was pleased that the hon. Member for North-East Cambridgeshire mentioned pharmacy. I should declare an interest as a fellow of the Royal Pharmaceutical Society. It is worth mentioning that 96 per cent. of the population live within 20 minutes of at least one pharmacy and I echo the hon. Gentleman’s comment that pharmacy is currently an under-utilised resource. In addition to vascular checks, pharmacies can help with smoking cessation—which was mentioned just now by the hon. Member for North-West Leicestershire (David Taylor)—diabetes screening and management and weight management services. They can sometimes be of most use to the groups that are harder to reach, such as men who do not go regularly to the doctor but who might live near a pharmacy and be able to pop in on a Saturday. Sometimes members of ethnic minority groups, and particularly women, may shop in the local pharmacy, but be less likely to go to the surgery. Pharmacies such as the Green Light Pharmacy in London have done a huge amount of work with diabetes in ethnic minority communities, to the extent that local consultants noticed that something was going on and worked back to trace the source of the improvement to Green Light’s work. We need to examine those examples of best practice and build on them. Even with such a stunning example of success, however, Green Light Pharmacy does not always find it easy to persuade the PCT to commission services.

I welcome the Cardio and Vascular Coalition’s document, which acknowledges what has been done and serves as a useful focus on what should happen next. No one can really argue with its list of ambitions, which include reducing the incidence of cardiac and vascular disease to among the lowest in western Europe within a generation. I have the same slight reservation I mentioned before, about the difficulty in knowing how to target where one is going, without knowing where everyone else is going as well. Hopefully movement will be in the right direction, but I should like something a little more specific. The ambitions also include the reduction of inequalities and better integration across health and social care. I cannot, either, argue with the general framework, which is about adopting the best evidence-based practice. It should be patient-centred, with a focus on prevention, and there should be effective joined-up commissioning of services. There is also the standard request for more research.

How is it all going to be achieved? If it were easy it would all have been done by now, and that is part of the problem. To start by thinking about inequalities, in its report the Select Committee on Health did a thorough job of examining the barriers that mean people do not get access to care. It is clear that there are still wide inequalities in this country, whether in the context of class, educational attainment, gender or ethnic minorities.

I was a little concerned about the idea in the document that awareness-raising campaigns are a useful tool. Those campaigns are very difficult to carry out. When politicians try to raise awareness of something that we are doing in a community it takes many different approaches and a lot of time and effort in different media to achieve the desired level. The new buzz phrase is social marketing, but I have yet to be convinced that it works. There is a lot of emphasis on TV and newspaper campaigns, but a lot of younger people today do not even watch much TV. They do not read newspapers. They get all their information from the internet, where it is much more difficult to target an awareness-raising campaign.

It would be more effective if, instead of wasting resources on advertising, they were put into the quality and outcomes framework, so that general practitioners could identify the patients most at risk. Most surgeries have extremely good database information on their patients, and some have put much time and effort into identifying at-risk patients and even more time and effort into making contact. Usually, they invite them in to see a doctor, but if they do not go, somebody will try and make contact with the patient themselves to provide help and advice. That seems to be a much better use of resource than marketing campaigns.

Another interesting aspect of the Select Committee report dealt with the better integration of patient pathways. It talked about health and social care, which was music to my ears because it is a Liberal Democrat policy. However, before moving to that, there is a problem with co-ordination between primary, secondary and tertiary care. Quite often, local commissioners are very focused on primary care but do not—many doctors have told me this—consult enough with the secondary care level to ensure that the whole approach is joined up. One of the biggest hurdles facing my local medical committee, who I met recently, is the lack of continuity between hospitals and communities. When somebody is discharged with a new medication regime, information does not always follow in a timely manner. Mistakes are quite often made upon discharge. No mechanism is in place for checking that.

There is the quite simple idea of patient-held record cards. I wondered whether that was the result of exasperation with the non-appearance of the NHS IT system, which stills seems some years away from being joined up. However, we should not knock old-fashioned card and pen. Using maternity services, pregnant women keep records of what is going on, because they come into contact with a number of different practitioners. It would be useful if patients felt more empowered and had something to which they could refer and of which they were custodians.

Prevention is the key. Much has been said about healthy lifestyles. We all know what foods we are supposed to eat, that we are not supposed to drink too much, that we are supposed to exercise and that we are not supposed to smoke. Knowing is one thing, but putting it into practice is another. I do not think that anyone has cracked that one yet. Much emphasis is placed on food and diet, but we are not actually eating that much more than we did decades ago, although we might be eating slightly differently and consuming more fat. However, we are exercising less. We need a greater focus on exercise, because what is good at fighting cardiovascular diseases has also been shown to be beneficial in preventing cancer and other diseases.

That would be a useful focal point, particularly from a preventive point of view. However, if a condition develops we must ensure that the earliest and best treatment is provided. For example, diabetes can go undetected for up to 12 years, and people will often have developed complications by the time that it is diagnosed. Indeed, the complications are often diagnosed first and then the diabetes is discovered. Again, prevention is the key message, but equally, if we get better at early diagnosis, we can save the health service a huge amount of money. It is very cost-effective.

Twenty thousand strokes could be avoided through preventive work on high blood pressure, regular heartbeats, smoking cessation and improved statin use. The Stroke Association is calling for a more co-ordinated and strategic prevention programme that brings all the varied initiatives together and recognises the commonalities of cardiac and vascular conditions. It also wants early and full implementation of the 20 quality markers in the 2007 national stroke strategy. It would be useful to know how the Government plan to evaluate its implementation. When will the Department of Health commission an evaluation process, what form will it take and when can we expect the results? I again acknowledge that progress has been made in this area, but as budgets tighten, it would be useful to have an indication of where priorities lie and which areas will be resistant to any budget restrictions. We need national leadership, and the excuse that it is up to the local PCTs to set priorities will not, in this case, suffice.

I am pleased to serve under your guidance, Mr. Pope. I, too, congratulate my hon. Friend the Member for North-East Cambridgeshire (Mr. Moss) on securing this important debate, which he introduced in an extremely articulate, comprehensive and detailed way, setting out clearly the issues that the Government need to address. Congratulations must also be offered to the Cardio and Vascular Coalition for the excellent work of its disparate groups and for the production of the report, which will enable a continued focus to be placed, quite rightly, on this area of the provision of health care services in the forthcoming months and years.

I want to give the Minister plenty of time to respond to this afternoon’s excellent debate. However, while clearly progress has been made—my hon. Friend was right to emphasise that—issues remain to be addressed. I was slightly surprised by the hon. Member for Romsey (Sandra Gidley), who was completely dismissive of any sort of European comparators. For example, the UK is significantly behind France in respect of mortality rates. Indeed, only two countries on mainland and western Europe have worse rates than us—Finland and Ireland. Although progress has been made, significantly more needs to be done.

Additionally, the prevalence of illnesses is likely to increase as the population age, as other Members have said. We need to ensure, therefore, that the requisite resources are put into this area, especially given that cardiovascular illnesses will be exacerbated by rising obesity levels and reducing levels of physical activity. The Foresight report concluded that, on current trends, by 2050, 60 per cent. of males and 50 per cent. of females will be classified as obese. Irrespective of which political party we belong to, we all have a collective and significant role to play in trying to ensure that the country’s population get the message about the importance of lifestyle changes.

I do not necessarily agree with the hon. Lady’s analysis. People understand that smoking is bad for them—the hon. Member for North-West Leicestershire (David Taylor) made a powerful case for the need to do more on that. However, I do not think that people necessarily understand that the significant lifestyle choices they make about, for example, diet, drinking too much and lying in the sunshine for too long also have very significant negative health impacts. Central Government and other bodies have a role to play in disseminating that very important information.

The initial national strategy framework pulled together for the first time all the inherently linked problems associated with cardiovascular diseases such as kidney disease. That focus in 2000, along with the additional resources funded by British taxpayers’ money, has made a difference, and we recognise the improvements made. However, in order to ensure improved delivery and patient outcomes, the Government still need to focus on specific areas on which, arguably, they have not focused sufficiently over the past decade or so.

The first area is prevention. It is clear that the Government have not done enough to raise awareness of the risk factors, causes and symptoms of cardiovascular illness. Although we welcome, for example, the recent FAST campaign on stroke awareness, we believe that both primary and secondary prevention must be more prioritised, which is why we have pledged to have a much greater focus on public health, with ring-fenced public health budgets, locally appointed directors of public health and an enhanced role for the chief medical officer’s department, with a specific focus on this area.

The second area that we need to concentrate on is health inequalities. It is well documented that the prevalence of cardio and vascular illnesses is significantly higher in areas of socio-economic deprivation. For example, women in the most deprived areas have a heart disease rate 50 per cent. greater than those in the least deprived areas. Health messages about such illnesses should be targeted at the most at-risk groups to reduce health inequalities. Excellent work is being done by primary care trusts to address some of those areas, but it is very patchy and it needs to have greater priority across the board. Moreover, things are being done in other countries that we could do in the UK to improve and reduce health inequalities.

Thirdly, significant regional variations were clearly highlighted in the Destination 2020 report. In particular, there were variations in access to cardiac care with relation to revascularisation and National Institute for Health and Clinical Excellence care. We cannot just wait for people to come to the health service; we must take health care out to people in the form of outreach. The hon. Member for Romsey was right about that. Money is often wasted on marketing when it could be used in significantly different ways. In some pockets around the country and in Scotland, such an approach is already under way.

Let me mention the NHS health checks. At the beginning of the debate, we had a party political exchange in which the hon. Member for North-West Leicestershire referred to me as part of the Taliban. That slightly surprised me because I have never been referred to in such a way before. I am sure that the hon. Gentleman will be the first to acknowledge that that exchange was started by one of his own colleagues, rather than by my hon. Friend the Member for North-East Cambridgeshire or myself. For the benefit of patients and patient outcomes, Opposition Members should pressurise the Government to deliver as fast as possible what the Prime Minister promised in January 2008.

Most people in this place would not see me as a boneheaded loyalist, but as far as the NHS is concerned, the Government’s record of the last 12 years stands in stark contrast to the 18 years that preceded it. I am referring here to investment, success and changes in outcome. That is the point that the hon. Member for North-East Cambridgeshire (Mr. Moss) brought out clearly in his positive and objective remarks.

Obviously I was not in the House in the 18 years of the previous Conservative Administration, but I say that we need to look forward. We have clearly said that the health service will be our No. 1 priority in government. We will continue to increase in real terms the investment going into the health service, but we will ensure that taxpayers’ money is used to maximum effectiveness to deliver patient outcomes. In the past 12 years, that has not happened in the way in which it should have done. We would do things differently—for example, by focusing on patient outcomes rather than on process-driven targets.

I urge the Minister to ensure that the policies that were announced in January 2008 are delivered as fast as possible. Triple A screening, for example, should be delivered across the country because it would save a significant number of lives a year. My hon. Friend the Member for Westbury (Dr. Murrison), who is no longer in his place, was right to raise the issue. He has been an assiduous and continuous advocate of rolling out the triple A screening programme. Moreover, there are issues related to peripheral arterial disease, such as the rise in amputation rates. The UK has the lowest number of PAD patients referred to vascular specialists per head of population of any major country in western Europe. Therefore, the Government must focus on that particular issue as well.

One of my final points before the Minister winds up relates to NICE guidance. Although I do not urge the Minister to pressurise or get involved with NICE—that is certainly not her role—it is essential that once NICE guidance has been issued, it should be implemented as fast as possible for the benefit of patients.

The final area that the Government should consider—we are looking at it in great detail—is information. Information should be easily accessible and communicable to the patient. Patients need the information to make choices about not just where they receive their treatment but the type of treatment they receive, so that it best suits their particular circumstances.

In conclusion, I was very pleased to read this excellent report. Many of its principles fit very comfortably with the Conservative party health policy. We have long been calling for a patient-centred national health service with a greater focus on public health, on prevention and on stronger and more effective commissioning closer to the patients. I am very pleased that the report confirms and agrees with much of what we have been saying in the past few months.

May I say what a pleasure it is to be under your chairmanship today, Mr. Pope? I congratulate the hon. Member for North-East Cambridgeshire (Mr. Moss) most sincerely on his success in the ballot, which has enabled us to have this very important debate in Westminster Hall today.

Cardiac and vascular health is very important to us all. I learned that as a young nurse in the health service. I spent much of my 30 years in the health service as a cardiac nurse. Sadly, my father died in his 50s of his third myocardial infarction. With today’s treatment and expertise, he would not have died so young. As we have heard in this debate, cardiovascular conditions account for a very significant burden of disease and premature mortality. We have demonstrated our commitment to tackling such conditions by developing the national service frameworks for coronary heart disease, diabetes and renal disease and the national stroke strategy. They have been developed with active input of the NHS, the third sector, patients and carers.

I understand why hon. Members have to be elsewhere on Budget day, but I am sorry that they are not here. I should like to thank them on behalf of the Government and the Department for the work that they do with carers and with the group nationally in an all-party way. Such strategies have helped to drive the excellent progress we have seen across the NHS in cardiac and vascular services. I would particularly like to pay tribute to the role of the third sector in supporting progress in those services.

During this debate we have heard many mentions of the British Heart Foundation, which has made enormous contributions across the whole range of cardiac services. The Department of Health has enjoyed a good relationship with the BHF over the years and we have worked on many projects together. For example, the Department of Health worked with the BHF on developing its genetic information service. I should like to congratulate the British Heart Foundation on the development of such a service.

I need to tackle a few things that have come out in this debate. Perhaps we should start with screening. Triple A screening is essential. The Prime Minister announced our strategy in 2008, but those who understand how the health service works will know that one cannot make an announcement and press a button and get everyone to start such important screening. Triple A screening is very complex and any programme would need careful development, involving cardiologists and specialists.

There are important patient safety considerations, too. We must be sure that we can provide the correct treatment at the highest standard. It is essential that we put it on the record that the health service, the clinicians and others concerned with this screening have to have the right training to ensure that the right standard of safety care is always in place. The same applies to vascular screening. The next steps guidance was issued in November 2008 and was accompanied by a primary care service framework. Best practice guidance was issued in April 2009. Both guidance documents have drawn on input from not only the NHS, but PCTs, pharmacists, all the other groups that have been mentioned in the debate, and especially the learning network that has been operating since 2008.

The hon. Members for Romsey (Sandra Gidley) and for North-East Cambridgeshire mentioned targets on a few occasions in their contributions. Of course targets make a difference. I am pleased to see two—if not three—converts to targets today.

The hon. Member for Croydon, Central (Mr. Pelling) talked about congenital heart defects. We recognise that services for people with congenital heart disease need to be different from those for acquired heart disease. I will be happy to write to him with a more detailed response—I am not able to deal with it in the time available in this debate. However, on his final point on any proposed reconfiguration, I urge and encourage him to engage with his constituents. The NHS in London is currently consulting on its proposals for the future of stroke and trauma services, which is exceptionally important. I understand that he met the Secretary of State recently; such consultation should continue.

I should also like to address the call for a further strategy document. I understand where Members from within the coalition of all-party groups are coming from, but we believe that our NSFs have stood the test of time. Some elements of the guidance have been updated over the years by NICE, as we envisioned from the outset. However, the hon. Member for North-East Cambridgeshire would find the standards in the NSF and the markers of quality element of the stroke strategy hard to improve upon.

I was overwhelmed with invitations at the beginning of the debate—my hon. Friend the Member for North-West Leicestershire (David Taylor) was exceptionally complimentary. I am happy to commit to discussing the way forward. The hon. Member for North-East Cambridgeshire will also find that the Government have never said that the NSF will not run after its 10th birthday. We tend to talk in terms of those horizons, saying things like “Over the 10 years” and the like. It is a convenient round number and people can consider what will happen when the 10 years are up. I accept hon. Members’ concerns, but I think we can put them to bed.

Will the Minister explain the fundamental difference between the renewal of the mental health strategy and the renewal of the cardiac and vascular health strategy?

The hon. Gentleman makes an interesting point. Mental health is not within my portfolio, so it would be unfair to the Minister with responsibility for it if I were to comment on it. As I said, I can see why people have the 10 years figure in their heads. Our recently published 2008 progress report for the CHD NSF stated that we must continue not only to build on the success that we have realised so far, but to consider where we need to do better. There is no doubt that we need to focus relentlessly on improvement and on making quality the organising principle of the NHS.

I should now like to reflect on the successes of our NSFs and the progress that has been made on the implementation of our national stroke strategy. Our greatest achievement in cardiac services has been getting waiting times down. That has been acknowledged by hon. Members today, for which I thank them. That was achieved with a massive increase in cardiologists and other key staff and a 50 per cent. increase in capacity thanks to a £735 million capital investment programme.

The improvements in recent years could not have happened without the hard work and commitment of NHS staff. Cardiologists, cardiothoracic surgeons, cardiac nurses, technicians and rehabilitation specialists have all played their part. I have the great good fortune to meet front-line workers in the health service frequently. I visited St. Peter’s hospital in Chertsey, where I saw the angiography suite, which is a very impressive nurse-led unit, and in November last year I was able to accompany the Prime Minister on a visit to Harefield Heart Science Centre, which is led by the eminent cardiologist, Professor Sir Magdi Yacoub. I saw the energy of the young scientists in the centre. They look at stem cell research and other things to research the causes and nature of heart disease and, of course, they consider the importance of its prevention and treatment. I also visited the cardiac catheter laboratory and the walk-in emergency centre at Harefield, which is led by another eminent cardiologist, Dr. Charles Ilsley, and I witnessed a cardiac catheter angioplasty being performed at King’s college. I pay tribute to all those people.

We have tried very hard not to have a party political, partisan debate, but I should like to give the hon. Member for Boston and Skegness the opportunity to dissociate himself totally from the remarks made by Daniel Hannan, a Member of the European Parliament, to Fox News. He told those he called his “friends in America” not to go down the same route as us. He said that the NHS was “a mistake” that

“we have lived through for 60 years”

and that it

“has made people iller”.

Would the hon. Gentleman like to dissociate himself from those remarks?

I am grateful to the Minister for giving me the opportunity to do so. It is clear that we do not agree with those remarks. The NHS has just had its 60th birthday and we were keen to celebrate it. Since I have the opportunity, I, too, should like to thank and congratulate the hard-working NHS staff, who do such an excellent job every day of the year.

I hope the hon. Gentleman will ask his party leader to do as he has just done and dissociate himself from the MEP who made such scurrilous remarks about our NHS.

We are planning two pieces of work for the CHD NSF. First, we are commissioning an external review of its implementation and delivery to understand better what has gone well and, more importantly, what has not gone well and, more importantly still, why. Secondly, we will undertake an analysis of the trends in the burden of heart disease and how they, combined with changing patient and public expectations, and technological and medical advances, are likely to affect future demand and patterns of service provision. We aim to make that analysis available alongside the external review.

The CVC report offers the most helpful contribution to our thinking about future burdens. We are happy to continue to discuss the matter and to work with our third sector partners to ensure that the development of heart services continues to improve and that the momentum we have generated in the past 10 years is not lost. One direction that we are keen to pursue is a more integrated cross-vascular approach. There are close links between the risk factors for heart disease, stroke, diabetes and kidney problems. Our recently launched NHS health checks programme demonstrates our desire to pursue such an approach and our commitment to focus increasingly on prevention.

In the brief time remaining to the Minister, will she address the key points that several hon. Members made on the significant role that pharmacies could play in improving and delivering care and prevention for those with cardiovascular problems?

I mentioned that. I said that we have consulted pharmacies particularly on vascular checks. They are aware of their important role.

We can also look at healthy lifestyles and address the inequalities in health. Those words were not allowed to be used in the Department of Health prior to 1997, so I am pleased that that has changed. A wide range of the Department’s health promotion initiatives contribute to vascular health. As was mentioned in the debate, obesity is the common risk factor across the range of vascular diseases, which is why our healthy weight, healthy lives strategy is focusing on helping people to maintain a healthy weight by promoting healthier food choices and physical activity. Eat less, move more, live longer is the message.

The combination offers a really powerful mechanism for embedding quality as the organising principle of the NHS, whether it is through prevention or looking at the science of the disease. It is important because it affects us all, especially our constituents in more deprived areas. We have much more work to do, and I look forward to working with the coalition.