Heart Disease: Treatment (Hansard, 8 February 1995)

§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, the information is not available in the form 211 requested, but in 1992–93 there were 660,000 admissions to NHS hospitals for all forms of heart disease. Initiatives include Health of the Nation targets to prevent heart disease, reducing waiting times for treatment, issuing guidance to health authorities and funding initiatives on training, audit and information systems.

§ Baroness Fisher of Rednal
My Lords, is the noble Baroness aware of the initiative of my local national health hospital in Birmingham, the Selly Oak Hospital, which has set up a one-day examination programme for GP patients? The patients go through the whole process of testing for heart failure, including an echocardiogram. Is she aware that that has saved the hospital a considerable amount of money? Will she look at that example to see whether national guidelines can be drawn from it to the benefit of patients and the health service generally?

§ Baroness Cumberlege
Yes, my Lords, I shall certainly do what the noble Baroness requests. Clinical guidelines are currently being drawn up by a joint audit committee of the Royal College of Physicians and the British Cardiac Society. I would expect the committee to take that example on board. I shall draw it to its attention in case it has not.

§ Lord Carr of Hadley
My Lords, does my noble friend agree that if we are to reduce the scourge of heart disease in terms of both death and disability in this country, early detection of any tendency to the disease is of the utmost importance? In that connection, has she considered, or will she consider, the possibility of an increased role for the technique of nuclear magnetic resonance scans as a means of identifying such tendencies in a non-invasive way? Will she also consider the possible use of mobile units which could go round the country to different hospitals and reduce the enormous capital expenditure involved in introducing such scanning units hospital by hospital?

§ Baroness Cumberlege
Yes, my Lords. That is a very good suggestion. I know that mobile units in other spheres, such as scanning for breast cancer, have been very valuable. As to early detection and prevention, as Valentine's Day is less than a week away it is important that your Lordships should look after your hearts, even if you do not wish to give them away.

§ Lord Dean of Beswick
My Lords, is the Minister aware that the black spots with a high ratio of heart disease are all to be found in inner city areas in cities such as Manchester, Sheffield, Leeds and Liverpool? As the figures in those areas are still frightening, can she give any indication whether there is any possibility of targeting increased resources to those black spots?

§ Baroness Cumberlege
My Lords, those figures are taken into account when resources are allocated to different health authorities. The noble Lord is absolutely right. The variation across the country is considerable. 212 But we are aware of that and we try to target resources. We know that lifestyles in particular are very important in this issue.

§ Baroness Masham of Ilton
My Lords, is the Minister aware that this very morning I spoke to the world famous professor of thrombosis, Professor Kakkar? Is she aware that he told me that at King's College Hospital they sometimes have to cancel operations at the last minute because the intensive care beds are taken up by victims of acts of violence such as stabbings, and therefore the heart cases have to wait? Is that not a terrible waste of talent and resources?

§ Baroness Cumberlege
My Lords, this Chamber is a power house of information. I was not party to the conversations that the noble Baroness had with members of the public, but I am always willing to learn.

§ Lord Ennals
My Lords, in view of the figure mentioned by the Minister, which illustrates the enormous size of the problem, and the point made by the noble Lord on the Bench behind her concerning the urgency of obtaining rapid diagnosis, can the noble Baroness say what priority is being given by the department to ensuring that the type of facilities at Selly Oak to which my noble friend referred are available in other parts of the country?

§ Baroness Cumberlege
My Lords, it is up to health authorities to decide where to spend their resources in the light of the needs of their particular populations. We do not think that it is appropriate for Ministers or managers to make those decisions; it should be for clinicians to decide. The incidence of heart disease in this country is still too high, but the number of people who suffer from the disease is reducing.

§ Baroness Gardner of Parkes
My Lords, is it not a fact that the Royal Brompton Hospital already has mobile units? Is it not also a fact that the best approach is prevention through the health education system? Can the Minister tell us how effective the health education programme for the prevention of heart disease has been?

§ Baroness Cumberlege
My Lords, yes. We have set out targets in The Health of the Nation policy to reduce the incidence of coronary heart disease. We are more than meeting those targets. Increasingly health authorities are aware of effective programmes to reduce coronary heart disease and are investing in them.

§ Lord Molloy
My Lords, will the Minister take this opportunity to congratulate Britain's heart surgeons on the remarkable job they do throughout the country under difficult situations? With regard to some of the big hospitals, perhaps a small adjacent building or even an empty shop could be taken over to enable those surgeons to carry out their operations. Patients would not then have to wait too long, as they may do in a larger hospital. That idea has been put to me by a number of heart surgeons. Perhaps it could be examined by the department.

§ Baroness Cumberlege
My Lords, cardio-thoracic units have to be extremely sophisticated. There are only about 41 in the country. Increasingly more and more 213 people are seeing cardiologists and we are seeking to get cardiac services into the districts. The idea of carrying out such operations in a corner shop is not very appealing.

Earl Jellicoe
My Lords, in asking a question, I declare that I am President of the British Heart Foundation in order to put at rest the mind of the noble Lord, Lord Lester.
Why is the incidence of heart disease in the United Kingdom among the highest, if not the highest, in the world, while the lowest in the world is, I understand, in Japan and France? Is it attributable to genetic reasons, or to dietary reasons—perhaps wine? Such incidence is a remarkable fact. Is it not worth considering that more research should be directed to the matter?

§ Baroness Cumberlege
My Lords, I should like to pay a tribute to the British Heart Foundation. It is an extremely well established, progressive organisation which invests £30 million a year in research into heart disease.
I believe the reasons for coronary heart disease need further investigation. We know that they are partly to do with diet, lifestyle and whether or not people smoke. But I suspect that other factors are involved such as genetics or heredity.

§ Lord Annan
My Lords, does the noble Baroness agree that we spend a great deal of money on heart treatment and research whereas hundreds of thousands of people suffer from rheumatic and arthritic conditions, very often for many years? Should not more money be spent, not on heart surgery or cancer research, but on research and treatment which helps those living in pain every day who are suffering from orthopaedic and other problems including, I may say, deafness?

§ Baroness Cumberlege
My Lords, a quarter of all deaths are caused through coronary heart disease, so it is the biggest killer in this country. That is why we put so much effort into trying to reduce it. The noble Lord is absolutely right. There is a huge number of calls on the National Health Service. There is a great deal of pain and discomfort that 'we should be tackling. But the National Health Service is, of course, limited in its resources.

§ Lord Rea
My Lords, does the noble Baroness realise that the recognition and treatment of heart failure is a basic part of good medical training? If the situation is as my noble friend suggested, perhaps the profession may be missing some diagnoses. I am in a delicate position as a doctor. Perhaps the answer lies in postgraduate education arid medical audit, to which the noble Baroness referred and preferably not through drug representatives, who call on GPs and are very clever at persuading them that they should use the latest and most expensive form of drug for heart failure rather than the cheaper and more widely used and well tested remedies which are available and are perfectly effective for most cases. Does she agree that the real answer lies in 214 preventing the development of coronary heart disease, which is behind most cases of heart failure these days? As my noble friend suggested—

Noble Lords
Order!

§ Lord Rea
As my noble friend suggested, does the noble Baroness realise that the situation is related to social deprivation, a factor not referred to in the White Paper, The Health of the Nation?

§ Baroness Cumberlege
My Lords, 'I entirely agree with the noble Lord on postgraduate education. Indeed, the Royal Colleges, the General Medical Council, and others are responsible for that area.
I have to say that without the investment which the drug companies put into research this country would be a much poorer place.