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NHS: Standards

Volume 493: debated on Wednesday 3 June 2009

To ask the Secretary of State for Health what information his Department holds on England’s position among Western European states for (a) prevalence of and (b) treatment standards for (i) heart, (ii) kidney disease and (c) stroke; and what plans he has to improve this ranking over the next 10 years. (276976)

Data from the 2006 Health Survey for England suggest the prevalence of coronary heart disease (CHD) in England was 6.5 per cent. in men and 4.0 per cent. in women. Prevalence rates increase with age, with more than one in three men and around one in four women aged 75 and over living with CHD.

Overall we estimate that there are just over 1.1 million men living in the United Kingdom who have had angina and around 970,000 who have had a heart attack and around 850,000 women who have had angina and around 439,000 who have had a heart attack. Combined, these estimates suggest that 2.1 million men and 1.3 million women, around 3.4 million adults, in the UK reporting angina and/or a heart attack. This is likely to be an overestimate as those suffering from angina are not an independent group to those suffering from a heart attack.

Comparable data on prevalence of the cardiovascular diseases are difficult to access. At present there is no routinely updated source of Europe-wide data.

With regards to plans for tackling heart disease, the Department is commissioning an external review of the implementation and delivery of the Coronary Heart Disease National Service Framework. We are also undertaking an analysis of the trends in the burden of cardiac disease including patient expectations and needs, technology and working practices and how these are likely to affect future demand and patterns of service provision.

We understand that a report on Access to Cardiac Care in the UK commissioned by the Cardio and Vascular Coalition, the British Heart Foundation and the British Cardiovascular Society was launched on 2 June 2009, which includes some comparison with other European countries. This will be a helpful contribution to our work on future needs.

The Department contributed information to the Euro Consumer Heart Index in 2008, which provides comparisons between European countries across a number of indicators including access to treatment, prevention, national guidelines and outcomes. In this index, the UK ranked 9 out of 29 European countries. No separate score was available for England.

The number of people with chronic kidney disease (CKD) is not accurately known, because a lack of symptoms in the early stages means it often remains undiagnosed. However, a survey of blood samples in South East England in 2000-01 indicated the prevalence of CKD to be 5,554 per million population. Also the introduction of CKD into the Quality and Outcomes Framework has determined that there are 1.5 million people with CKD stages 3-5 (5 being established as renal failure).

Part 1 of the National Service Framework for Renal Services, published in January 2004, sets five standards and identifies 30 markers of good practice in the areas of dialysis and transplantation, aimed at improving fairness of access, patient choice about the type of treatment they receive and reducing variation in the quality of dialysis and kidney transplant services. These standards and markers of good practice will help the national health service and its partners to manage the increasing demand for renal services.

Future plans for renal services are to identify people at risk of kidney disease in a timely manner to optimise care, ensure kidney patients receive high quality care and to offer patients a choice of all forms of replacement therapy.

Stroke is the third leading cause of death and the leading cause of adult disability in England, with over 110,000 strokes happening every year.

The National Stroke Strategy for England (December 2007) sets 20 ‘quality markers’ which outline the features of a good service in the assessment and treatment of strokes, and those support services needed for stroke survivors to return to as full as possible a life in their community.

The National Stroke Strategy was launched on 5 December 2007 following extensive consultation. It provides a 10-year framework setting out key elements of an improved stroke service. At the launch of the strategy, my right hon. Friend the Secretary of State for Health (Alan Johnson) announced £105 million of central funding over three years would be spent to support implementation.

To ask the Secretary of State for Health what assessment has been made of inequalities in the (a) prevalence and (b) treatment of (i) cardiac and (ii) vascular diseases between (A) the sexes, (B) geographical areas, (C) social groups, (D) economic groups and (E) ethnic groups; and what projects (1) are in place and (2) are planned to reduce such inequalities over the next decade. (276977)

The Government have made tackling health inequalities a top priority, and have set a challenging target to reduce inequalities in infant mortality and life expectancy. The most comprehensive programme ever in this country is in place to address them. This draws on a wide range of data and analysis, some carried out within the Department and the national health service and some carried out by academic units.

Cardiovascular diseases (CVD) account for about a third of the gap in life expectancy and a range of programmes are reducing deaths and closing the inequalities gap.

In 1999 a target to reduce the mortality rate from CVD (coronary heart disease (CHD), stroke and related diseases) by at least 40 per cent. in people under 75 by 2010 was established. This has been the subject of annual monitoring. Data from 2004-06 indicate that this target was met five years early and the mortality rate has now fallen by 44 per cent. when compared to the 1995-97 baseline. The gap in death rates from CVD between the most health-deprived areas and the national average has narrowed by 36 per cent. over the same period, and we are on track to deliver the 2010 target of at least a 40 per cent. reduction in the gap.

With regard to cardiac disease, a major assessment of the burden of CHD informed the development of the Coronary Heart Disease National Service Framework (CHD NSF) published in March 2000. The findings of this assessment are included in the first chapter of the NSF ‘Modern Standards and Service Models’. A copy has already been placed in the Library and is available online at:

A key project to address the inequalities recognised in the NSF has been a major investment programme of £735 million in facilities and equipment aimed at improving and increasing access for appropriate cardiac interventions. Full details are available in the 2007 CHD NSF progress report, ‘Building for the Future’. A copy has been placed in the Library and is available online at:

Progress on the standards in the CHD NSF has been monitored annually including the impact on inequalities.

The Department developed a National Service Framework for Diabetes in 2003 and a National Service Framework for Renal Services in 2004. In 2007, the National Stroke Strategy was published. The implementation plans for all three include a strong focus on tackling inequalities.

A range of other initiatives to tackle inequalities is being taken forward. For example, the Department has commissioned the Improvement Foundation to work in the 20 areas with the worst health status to improve the identification and treatment of people at risk of cardiovascular disease:

In addition to this the primary care trusts (PCTs) in the most deprived areas are working with the National Health Inequalities Support Team. Using the Health Inequalities Intervention Tool they are being supported in priority setting (including prioritising vascular conditions), planning and commissioning of services.

On the prevention front, from April 2009, the NHS has been asked to start implementing a systematic and integrated vascular risk assessment and management programme—the NHS Health Check programme. This will provide a mechanism to identify earlier people who are at risk of heart disease, stroke, diabetes and kidney disease and support them to reduce their risk through the provision of lifestyle advice and interventions, and preventative medication, for example statins. Before the implementation of this programme, the Department undertook an Equality Impact Assessment. This assessment used existing evidence that gave details of inequalities in the prevalence of vascular disease of both genders, people of transgender, by age, sexual orientation, geographical regions, socio-economic groups, ethnic groups and disability. The programme has significant potential to narrow inequalities and many PCTs are using it as a major tool in tackling health inequalities.

The Department is also funding a number of third sector projects to deliver work focused on particular minority communities. These include nine stroke projects including the Stroke Association's ‘Blood Pressure Awareness—African Caribbean and South Asian Communities’, Connect’s ‘Provision of training and support for people with Aphasia’ and the Afiya Trust's ‘Stroke Awareness for Black and Minority Ethnic Communities’. For renal services, the Department is funding a project managed by the Black Organ Donor Association that will promote awareness of the need for organ donation in black and minority ethnic communities.

With regard to longer term plans, the Department is commissioning an external review of the implementation and delivery of the CHD NSF. In addition to this, we will undertake an analysis of the trends in the burden of cardiac disease and look at how patient expectation and need, technology and working practices are likely to affect future demand and patterns of service provision. We will also continue to develop our cross-vascular work programme. We will feed our findings to the Department's National Quality Board, which has been set up to oversee the priorities for the service in the future.