Heart Disease: Prevention (Hansard, 19 November 1991)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Hooper)
My Lords, the Government's policy set out in 1987 envisaged an annual increase of 2 per cent. in the number of all consultants, including heart specialists. In fact, the number of consultants in cardiology has increased by 19 per cent. and in cardiothoracic surgery by 10.4 per cent. over the past five years. However, the emphasis in combating heart disease is now on prevention and that is reflected in the Health of the Nation Green Paper.

Lord Campbell of Croy
My Lords, I am grateful to my noble friend for that encouraging reply. As so much is now known about heart disease and its high incidence in Britain, should not more medical students be encouraged to specialise in that disorder in order to produce a greater number of cardiologists in future?

§ Baroness Hooper
My Lords, the discussions on the Green Paper strategy document—the consultation period has just ended—highlight coronary heart disease as a key area for targeting. Doubtless that will influence junior doctors in making decisions about their future, and the royal colleges, which advise on medical manpower.

Lord Morris
My Lords, does not my noble friend agree that the greatest single contribution to the reduction in the number of premature deaths from heart disease has been an increase in the knowledge and practice of first aid rather than an increase in the number of specialists?

§ Baroness Hooper
My Lords, we believe that the effect of a person's lifestyle from day one throughout his or her life most influences the incidence of coronary heart disease.

§ Baroness Gardner of Parkes
My Lords, will my noble friend confirm that smoking is a prime cause of heart, cardiac and circulatory problems? We should need less heart specialists if we could reduce smoking.

§ Baroness Hooper
My Lords, yes. That is why that area [s targeted in the Green Paper.

§ Lord Walton of Detchant
My Lords, is the Minister aware that, despite the very welcome increase in the consultant grade to which she referred. report after report by the Royal College of Physicians has indicated that the number of specialists which we have in the various branches of medicine in this country in relation to unit populations is still far below that of other countries in the European Community? That applies not only to cardiologists but also to gastroenterologists, neurologists and so on. Therefore, will the Minister encourage her colleagues to do what they can to accelerate the increase in the consultant grade which the National Health Service so greatly requires?

§ Baroness Hooper
My Lords, we look very carefully at that area. We take advice from experts, including the noble Lord.

§ Lord Carter
My Lords, is the Minister aware that the British Cardiac Society and the royal colleges have estimated that there is a shortfall of 50 per cent. in the number of cardiologists as against the established requirement? Is she aware also that, even if the shortfall were filled, we should have less than seven cardiologists per 1 million of the population in England and Wales compared with 45 per 1 million in Europe and a target of 60 per million in the United States? Are the Government aware of that alarming situation and what do they intend to do about it?

§ Baroness Hooper
My Lords, I do not accept the suggestions made by the noble Lord. In fact an increase of 19 per cent. in the number of cardiologists in the past five years is a remarkable achievement.

§ Lord Carter
My Lords, those suggestions come from the British Cardiac Society and the royal colleges and not from me.

§ Lord Jenkin of Roding
My Lords, is my noble friend receiving all the support she needs from the royal colleges and the British Medical Association to speed up the appointment of a number of senior registrars to consultant posts? Is that not one way of increasing the number of consultants and offering a better career prospect for those entering into that specialty?

§ Baroness Hooper
My Lords, yes. We are considering a variety of ways to speed up the decisions in that area. However, I refer my noble friend and other noble Lords to a number of recent initiatives in addition to the normal growth, which include the appointment of an additional 100 consultants during 1987–89, an additional 100 consultants appointed to tackle waiting lists and an additional 200 consultants and 50 staff-grade doctors appointed during 1991–92 to help to reduce junior doctors' hours. That is an area to which we are giving considerable effort.

§ Lord Annan
My Lords, does the noble Baroness agree that, if we are to increase research in certain spheres, that is needed in the unglamorous areas of medicine; namely, orthopaedics, dealing with the disease of arthritis, from which millions suffer, and 815 with what is a very common disease in this Chamber —deafness? We should make our research effort in those areas.

§ Baroness Hooper
My Lords, yes. I do not necessarily agree that they are unglamorous areas. However, they are certainly important and we will of course take expert advice on the matter.

§ Lord McColl of Dulwich
My Lords, does my noble friend not agree that, in spite of what has been said, the answer is in fact DIY? The main way of reducing premature deaths from heart disease is not only complete cessation from smoking, but also reducing blood pressure, cholesterol and weight. That can be done quite simply by encouraging people not to eat too much of the gross national product.

§ Baroness Hooper
My Lords, my noble friend makes an important point. Certainly the health education authority and other Department of Health education initiatives—such as the "Look After Your Heart" campaign—are all directed at ensuring that people help themselves.

§ The Countess of Mar
My Lords, does the noble Baroness agree that, while everyone accepts that a healthy lifestyle will lead to a longer life, we receive too much conflicting information? One week cholesterol is good and the next week it is bad; next too much salt is bad and then a little salt is good. Would it not be a good idea for proper research to be conducted so that we knew what was good and what was bad? We could then abstain from the bad things.

§ Baroness Hooper
My Lords, earlier this year an important tome was produced entitled The COMA Report on Dietary Reference Values. It provides all the scientific information that one could seek. We are endeavouring to turn it into an easily digestible form for people to understand.