Cardiovascular Disease: Prevention

[David Mundell in the Chair]

15:01:00

Demonstrating my own multifunctionality, I am now going to chair but not participate in the next debate.

I beg to move, That this House has considered the prevention of cardiovascular disease. I do not know where my functionality comes into it, Mr Mundell, but we are doing two debates in a row and it is lovely to serve under your chairship. As I explained in the last debate, I am my party’s health spokesperson. I have a lot of interest in this subject; I also declare an interest as chair of the all-party parliamentary group on respiratory health. Cardiovascular disease is one of the things that the group focuses on. Back in 2019, the NHS long-term plan defined cardiovascular disease as the single biggest area where the NHS can save lives over the next 10 years. Six years on, that statement still rings true, but I am not sure whether we any closer to arriving at a conclusion. Over 7.6 million people are living with heart and circulatory diseases in the United Kingdom, and CVD is responsible for a quarter of all deaths here every year. It is one of the biggest killers. I am very pleased to see the hon. Members here, and I thank them for coming. The Parliamentary Private Secretary, the hon. Member for Glasgow South West (Dr Ahmed), is here for the Minister, and I look forward to the Minister’s contribution. I am pleased to see the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans); he and I seem to regularly share debates. I am also pleased to see the Liberal Democrat spokesperson, the hon. Member for Mid Sussex (Alison Bennett). According to predictions from the British Heart Foundation, by 2030 the prevalence of heart and circulatory conditions in the United Kingdom will have increased by 1 million. By 2040, it will rise by 2 million, due to a growing elderly population, the high prevalence of CVD risk factors and improved survival from major CVD events. Cardiovascular disease care in the United Kingdom is most certainly at a critical juncture. That was starkly illustrated by Lord Darzi’s recent independent investigation into the state of the NHS; I know that we are all aware of some of the key points of that. The investigation set out how nearly 50 years of progress to improve CVD outcomes has begun to reverse in recent years. That must not happen. I seek reassurance from the Minister that we are out to stop that reversal. The number of people dying before the age of 75 with CVD has risen to its highest level since 2010, while the association between poor CVD outcomes and health inequalities has also increased, with people living in the most deprived parts of the country being twice as likely to die from CVD as those in the least deprived. Something is seriously wrong when those who just happen to live in a deprived area have a bigger risk of dying than those who do not. The slowing of progress is creating an enormous cost for the NHS and society as a whole, including £12 billion in total healthcare costs and £28 billion across the wider economy due to premature death, long-term care, disability and other informal costs. A key challenge relates to the high prevalence of CVD risk factors such as high blood pressure, obesity, diabetes, limited physical activity, air pollution and smoking. I declare an interest as I have had type 2 diabetes for almost 20 years. Mine is controlled by medication and I thank God for that, but I understand the impact on others much worse off than I am. Raised cholesterol is another significant risk factor, associated with one in five deaths from CVD. Just over half of all UK adults are living with raised cholesterol, significantly increasing their risk of heart attack and stroke. However, due to the lack of immediately obvious symptoms, high cholesterol levels often go undetected. There are concerns that without immediate action there could be a further tidal wave of CVD deaths due to the thousands of “missing patients” living with undetected and unmanaged heart and circulatory conditions. There are similar challenges in Northern Ireland. I always give a Northern Ireland perspective, which I think replicates what happens here on the mainland; that is why I do it. An estimated 225,000 people are living with heart and circulatory diseases in Northern Ireland—remember that we have a population of 1.9 million; that gives you an idea of the proportions. Since the 1960s, significant progress has been made, with CVD death rates falling by three quarters. But that improvement has plateaued in recent years: some 4,227 people died from CVD in Northern Ireland last year, including 1,133 people under age 75. It is not just an elderly person’s disease. That has to be put on the record. Annual NHS expenditure on CVD in Northern Ireland is some £290 million—a colossal amount—and CVD’s overall cost to the Northern Ireland economy equates to some £740 million each year. Those are massive figures. I know that we should not look at health from a purely financial point of view, but those figures tell us that if we were working better to combat CVD the impact on the economy and health service would be greatly reduced. Northern Ireland faces similar problems when it comes to identification and management of CVD risk factors, with around 400,000 people living with high blood pressure, including 110,000 who are undiagnosed. Some 45% of adults in Northern Ireland are not performing enough daily physical activity. In my constituency of Strangford, the prevalence of hypertension, coronary heart disease and stroke is significantly higher than in the rest of Northern Ireland. The reason for that could well be that our population is elderly: people tend to retire to my constituency. Despite the dire figures, there are real opportunities, both in Northern Ireland and the United Kingdom as a whole, to reverse the trends and help the UK become a world leader in CVD, as at one stage it was clearly trying to do. To get there, however, we clearly have to start doing things rather differently. Recent years have seen a number of policy commitments from successive Governments, but those have not shifted the needle, focus or direction. Today’s debate is about highlighting that and seeking help to address the situation. There was the NHS long-term plan of 2019, which set out ambitions to prevent 150,000 heart attacks, strokes and dementia cases over the following 10 years. Unfortunately, in my constituency and elsewhere there are high levels of dementia cases, strokes and heart attacks. In Northern Ireland the figures are unfortunately incredibly high. Successive versions of the NHS annual planning guidance have encouraged local systems to prioritise CVD and address the significant inequalities associated with it. Although the previous Government’s major conditions strategy was not fully implemented, it set out a series of robust principles to improve CVD care, including personalised prevention, early diagnosis, effective management of multiple conditions, integration of physical and mental health services, and services tailored to individual needs. The previous Government’s strategy was clear. I think this Government’s strategy is equally clear, but we need to address some of the issues that I will come to as I go through my speech. We are lacking a deeply embedded, system-wide approach to CVD prevention that moves care upstream, is backed by sustainable, long-term funding and deploys the latest technologies and innovations. The National Audit Office’s recent report, “Progress in preventing cardiovascular disease”, provided stark evidence that such an approach has been lacking. It focused on the delivery of the NHS health check, which is one of our main tools for enabling early intervention on heart disease. It concluded: “there is currently no effective system for commissioning Health Checks, despite it being a statutory responsibility on local authorities. DHSC and local government have weak levers to encourage primary care or other services to deliver Health Checks.” That will be one of my asks of the Minister, who I am pleased to see in his place. I wish him well, and I know I will not be disappointed by his response to our requests. In 2023-24, only half of the eligible population attended a health check, and only 3% of local authorities covered their entire eligible populations. We have to change that, so my request is that local authorities, which have statutory responsibility, primary care and other services that deliver health checks increase the number of people who get checked. We need an action plan. The NAO report said: “This is not a satisfactory basis for delivering an important and potentially life-saving and money-saving contribution to population health.” Major improvements are needed, and the Government must embed them in a policy environment that promotes prevention rather than treatment. I have always been a believer in prevention rather than treatment. We must diagnose early and prevent disease at an early stage to stop the whole thing going further. The current approaches do not sufficiently take account of genetics and the role of inherited familial conditions such as familial hypercholesterolaemia and cardiomyopathy in increasing CVD risk. Children are not routinely screened, GPs often fail to take account of people’s family history, and many patients report difficulties in accessing genetic screening. Patients and doctors need to be empowered to access genetic testing, secure diagnosis and take preventive measures, which will ensure better health for the future and save money in the NHS. I am pleased that the Government have committed an extra £26 billion to the NHS, because right across this great United Kingdom of Great Britain and Northern Ireland, we will all benefit from that. Up to 80% of premature deaths from CVD are preventable—we cannot ignore that figure. Preventing those deaths must be our goal, so the importance of this issue cannot be overstated. The evidence shows that CVD prevention pays. Analysis from HEART UK estimates that merely improving the management of cholesterol, triglycerides and other lipids through increased uptake of NHS health checks and, by extension, increasing the number of patients on lipid-lowering therapies, could deliver more than £2 billion in annual savings for the NHS and wider society. I will focus on lipid-lowering therapies, because that is a solution that I am keen to see the Government take on board. Although prevention spending is often deprioritised in favour of meeting short-term measures, that is the kind of investment that we need if we are to deliver on the Government’s pledge to shift from sickness to prevention. I welcome the Government’s commitment to do that; that is what my party and I want. In recent discussions I have had with stakeholders on this area, they have agreed a number of key themes that will be crucial to delivering progress on CVD prevention. Those include securing dedicated and ringfenced funding for CVD prevention, to enable targeted prioritisation of preventive approaches; identifying at-risk patients through early detection and risk assessment strategies, including testing from birth and family cascade testing; developing comprehensive public awareness campaigns that empower patients to self-monitor—if we can have patients’ participation in this as we go forward, that will be much welcomed; increasing access to prevention services by moving them closer to home, including by delivering more community-based diagnostic services; and ensuring timely implementation and consistent application of evidence-based clinical guidelines. There is growing recognition of the potentially transformative opportunity that can be realised through wider awareness and recognition of another key CVD risk factor: lipoprotein(a), or Lp(a), which is a large lipoprotein made by the liver. Lipoproteins are parcels made of fat and protein. Their job is to carry fats around the body in the blood. Elevated levels of Lp(a) in the blood are an independent, inherited and causal risk factor for CVD, due to its pro-atherogenic, pro-inflammatory and pro-thrombotic effects. One in five people are estimated to have raised levels of Lp(a) in their blood. That equates to some 13,400,000 people in the United Kingdom—equivalent to filling every seat in Wembley stadium about 150 times. Lp(a) is associated with an increased risk of several life-threatening events and conditions, such as myocardial infarction, heart attack, stroke, coronary artery disease, peripheral arterial disease and heart failure. Sadly, those events are often premature, so we need a way of diagnosing, doing early prevention and doing things better. My ultimate request to the Minister will be that that happens. In severe cases, which applies to about 12% of the population, raised Lp(a) contributes to a two to four times higher risk of heart attack, stroke and heart disease. The prevalence of raised Lp(a) is typically greater among African and south Asian populations—a trend that is likely exacerbating existing health inequalities even further. Despite the huge numbers at risk, few people know that they have a raised level of Lp(a). If they did, preventive measures might be taken: they could get a diagnosis, and we could ensure that their lives were better and longer, as well as reducing the cost to the NHS. The awareness of the role of Lp(a) in contributing to CVD risk is low among the general public and healthcare professionals, so there is a need to raise awareness. With that significant burden comes a huge opportunity to improve outcomes for a so far largely untreated and unserved patient population. I want to mention my constituent, Dr Paul Hamilton, and also Gary Roulston. They are consultant chemical pathologists at Queen’s University Belfast and Belfast health and social care trust. They are leading pioneering work to proactively measure Lp(a) levels in patients who are at risk of CVD. I am always amazed—I always like to say this about Queen’s University, and it is right to do so—that when it comes to research and development, it is at the forefront, including on Lp(a). I encourage the Minister to interact with Queen’s University. The recent audit of its testing programme has revealed that early measuring of Lp(a) levels leads to a change in CVD management for a large number of patients. That demonstrates that Lp(a) testing and management can be implemented to improve population health and reduce the risk of CVD. When we look at those things, we see something that can be done even better. Although there are currently no specific therapies for lowering Lp(a) levels, the taskforce believes that there is a clear and growing case for taking action now to incorporate Lp(a) testing and management within mainstream CVD prevention strategies. Several new therapies to lower Lp(a) are currently undergoing late-stage clinical trials, and could well be available in the near future, pending the outcome of those trials. That is a really exciting way forward, and an exciting way to save and improve lives. It is therefore vital that steps are taken to enable system readiness for those therapies and to ensure that the NHS is in the best possible position to maximise their anticipated benefits. In the interim, there is a growing clinical consensus about the value of identifying patients with elevated Lp(a). In particular, knowing an individual’s Lp(a) can inform more intensive management of other cardiovascular risk factors, including blood pressure, lipids and glucose, and empower people to make a lifestyle change to reduce their overall CVD risk. It can also support cascade screening of family and close relatives—again, a positive way forward —given the genetic status of Lp(a). There is clearly a way to use technology and innovation to test more and to do more good for people. Tangible progress in that area could play a key role in supporting many of the key principles that have been identified as crucial to guaranteeing the future sustainability of the NHS, such as reducing pressure in the acute sector, delivering more personalised care and precision medicine, and capitalising on the pioneering innovation led by the UK’s life science sector. More broadly, Lp(a) testing can support the Government’s ambitions right here in Westminster to get people back into work, by reducing the incidence of major CVD events, which can prevent people from participating in the labour market. Diagnosis and prevention can support people. To be fair, most people want to work; they want to have a normal life. The ones I speak to are not seeking benefits for any reason other than that they are unable to work. Without formal recognition of Lp(a) in national policy, the only Lp(a) testing that takes place will be reliant on the work of proactive local clinicians. We need to make it the norm; we need to make it acceptable and the way forward. The regional variations are also not acceptable, and local systems need clear direction from the centre to encourage them to start thinking proactively about how Lp(a) testing and management could be incorporated into their local CVD prevention pathways. What are we seeking? We are looking for a review of current CVD prevention and treatment pathways, for an assessment of where Lp(a) testing could be incorporated to deliver tangible benefits now—not later, but now—and to maximise the benefits of therapies that lower Lp(a), when those become available. We are also looking for engagement with local specialist lipid clinics and clinical laboratories to assess current levels of Lp(a) testing and whether it aligns with agreed best practice and to consider what will be needed to upscale activity in the coming years. We want to encourage local CVD champions to start thinking about the role of Lp(a) in contributing to CVD risk and to disseminate information about Lp(a) within their local networks. In the taskforce’s call to action, it identified several system barriers that are holding back progress in this area; these are also applicable to the success of other health prevention strategies. They include National Institute for Health and Care Excellence procedures and methodology. NICE’s guideline methodology needs to take account of wider evidence criteria beyond the ones that apply to a specific treatment. In the case of Lp(a), although specific therapies to lower Lp(a) are not currently available, the taskforce believes that there is none the less a strong case for taking action now to proactively incorporate recommendations on Lp(a) testing and management in NICE guidance. If replicated across other disease areas, that more proactive and anticipatory approach from NICE would help to improve NHS system readiness for new innovations and treatments, encourage healthcare professionals to think more proactively about how a specific risk factor may be contributing to overall risk, and embed a more preventive mindset across the health system, reflecting the significant role of NICE in driving clinical behaviour. If it is possible to make those improvements—it is cost-effective, and early diagnosis will make things preventable—we really need to look at that. Barriers also include the accuracy of health risk assessments. Risk assessment tools, particularly in CVD, play a crucial role in supporting health prevention strategies. An accurate assessment of an individual’s risk of experiencing a major CVD event can inform the most appropriate action to proactively manage and reduce that risk through a combination of treatment interventions and lifestyle changes—each of, us individually, has to play a part. Going forward, it is vital that existing CVD risk assessment tools are updated to take account of Lp(a) and its known association with a range of life-threatening or life-changing cardiovascular events and conditions. That recognition will be essential to delivering a truly holistic assessment of an individual’s cardiovascular risk profile. It is important to look at the standardisation of testing and reporting. The success of health prevention strategies also depends on the accuracy and consistency of diagnostic processes. In the case of Lp(a), testing should be conducted according to the best practice principles set out by HEART UK. Has the Minister had a chance to talk to HEART UK, which has some great ideas and positive ways forward? It is important to work in partnership to deliver therapies, diagnoses and prevention. On emerging therapies, in particular, it is vital that there is a focus on encouraging greater diagnostic standardisation from the outset. Clinicians often get used to the numbers they first use, and it is important that they do not become entrenched in using the wrong, or indeed superseded, units. Without action in these areas, Lp(a) testing and management risks becoming another promising area of health innovation where the UK falls behind comparative systems. We need to look further afield and to work with other countries; I met the shadow Minister, the hon. Member for Hinckley and Bosworth, this morning and said the same thing to him. Prominent European and American guidelines, such as those from the American Heart Association, the National Lipid Association and the European Atherosclerosis Society, have set out the importance of considering Lp(a) screening as part of CVD prevention approaches. Some countries are even thinking practically about how universal Lp(a) screening could be introduced. The present approach therefore puts us at risk of missing a rare opportunity to save lives that may be cut short by CVD, and will be increasingly out of line with the Government’s focus on transforming prevention across the NHS. The Lp(a) taskforce is a coalition of experts from across the cardiovascular, lipid and laboratory community, with members from all four nations of the United Kingdom. They have come together to help tackle the lack of awareness and to set out the value of testing for Lp(a) in routine clinical practice to improve CVD management. Chaired by HEART UK, the group published its calls for action in August 2023, and it has since been working with key stakeholders to set out the potentially transformative role that Lp(a) could play in the future and, more broadly, to help renew the UK’s status as a world leader. We can be the world leader in CVD prevention and care. I have some questions for the Minister. Is there a willingness to meet me and representatives from the Lp(a) taskforce, as well as other Members here with an interest in the subject, to discuss the essential steps that need to be taken to ensure that the UK is in the best possible position to integrate Lp(a) testing and management as a core part of CVD prevention strategies? Further, will he commit to engaging with key system partners such as NICE, NHS England and the devolved Administrations to address policy barriers that could hold back progress? I am ever mindful that the Lp(a) taskforce already comprises the four nations of the United Kingdom. The Government must take wider action through their forthcoming 10-year health plan to secure renewed focus on CVD prevention, underpinned by ringfenced funding, enhanced early detection, expanding community diagnostic capacity, the timely implementation of evidence-based guidelines, and comprehensive public awareness and patient empowerment programmes. Will the Minister explore the scope to develop a dedicated national strategy for cardiovascular disease? We had that in 2019; I believe we need it in 2025. Reversing these worrying trends in CVD is one of the great healthcare challenges that we face in this Parliament, and it must be approached with the necessary focus and attention. The UK must be able to capitalise on new and emerging areas such as Lp(a), which will be crucial if it is to renew its status as a world leader in CVD prevention and care. Just as with cancer, one in two people in this Chamber today are likely to develop heart and circulatory conditions in their lifetime. Just like the cancer community, the CVD community would welcome a commitment from the Minister to publish a dedicated national CVD strategy. At the end of the day, that is what I am asking for.

15:30:00

I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate. Cardiovascular disease is a phrase heard far too often in family circles, large communities and even on the national scale. Cardiovascular disease is responsible for one in four deaths in the UK, and causes misery to many families. In Dudley alone, 10,000 people are living with heart conditions and circulatory diseases. Across the Black Country integrated care system, 11,000 people are waiting for cardiac treatment; nearly 5,000 have already waited longer than the NHS target. Those numbers translate into our everyday lives—in strokes, peripheral arterial disease, diabetes and heart conditions. Every delay means more emergencies and, tragically, more preventable deaths. We must act now. Prevention and early intervention are critical to combating cardiovascular disease. We know that obesity, high blood pressure and smoking are risk factors. In Dudley, 30% of adults are living with obesity—higher than the national average—and 16% are smokers still. I welcome the Government’s initiatives to tackle smoking and encourage weight loss, and I believe that addressing and diagnosing cardiovascular conditions will help our population to live healthier lives. It is not just our fantastic doctors who are experts in cardiovascular care but our allied health professionals. AHPs have a big role in diagnosing and managing cardiovascular diseases. As a physiotherapist by trade, I screen for cardiovascular conditions, which can masquerade as musculoskeletal conditions. I check blood pressure and carotid pulse, perform auscultation, check for neurological conditions, and conduct vascular exams and cranial nerve testing of the face. Physiotherapists are involved not only in assessments but in rehabilitation at places such as Action Heart in Dudley, which is inundated with referrals, and where patients get excellent care through cardiovascular rehabilitation and preventive programmes. My podiatry colleagues check for peripheral vascular disease and diabetic foot, and are a fountain of knowledge. My occupational therapist, and speech and language therapist colleagues do exceptional work with stroke patients. My radiology colleagues help with diagnosing these conditions. My paramedic colleagues manage these patients in acute care when they need it the most. An AHP myself, I could talk about AHPs all day but I want to present some recommendations for steps that the Government could take to make a big difference. First, a multidisciplinary team is important. We should ensure that AHPs are at the centre when making policy decisions and announcements, not just for cardiovascular conditions but for all conditions; they are not just tackled by doctors. Secondly, we should ensure that diagnosis and check-ups are being done in general practice. Along with GPs, we should look at first contact practitioners, podiatrists, paramedics and physiotherapists, who also work in primary healthcare; and pharmacists, who can do the simple checks to check blood pressure early on. Thirdly, we should provide substantial and ringfenced funding for local health systems to scale up successful CVD risk management programmes. That is essential for us to move forward, and should include cardiovascular rehabilitation and prescription of gym memberships in the community, to ensure that those who need care have structured, long-term support with an emphasis on healthier lifestyles. We owe it to our communities, to the NHS, and most of all to the thousands of people living with cardiovascular disease to change now. Let us not wait for more lives to be lost.

15:34:00

May I say what an honour it is to serve under the chairmanship of such a multi-talented, multi-functional Chair?

You can speak for as long as you want. [Laughter.]

I thank the hon. Member for Strangford (Jim Shannon) for securing this important debate. Cardiovascular disease changes lives, takes lives and robs families of loved ones. I speak from personal experience: my father has been gone for 29 years and my mother for 28 years because of cardiovascular disease, so I know it absolutely robs families of loved ones. Across the UK, cardiovascular disease alone is responsible for one in four premature deaths. Beyond the personal impact it has on families, cardiovascular disease also places an enormous burden on our NHS, costing more than £7.5 billion per year. Preventive medicine and early detection can save lives, keep families together and reduce the burden on our NHS. While preventive measures can take many different forms, which my colleagues have addressed today, I will focus on early diagnosis, as I know personally how critical it can be. In 2023, having cycled 85 miles on a Sunday, I felt the healthiest and strongest I had ever felt in my life, but one precautionary test taken purely to reassure myself that I was fit shattered my illusions and changed my life, but ultimately saved it. I was diagnosed with chronic heart disease. Within weeks, I had a triple heart bypass. Had I not taken that test, I believe that I would not be here today. Early detection saved my life, and it can save millions more. In my constituency of Ilford South, a community-based study was conducted across four GP practices by Dr Laskar and Professor Lloyd from Barts hospital. Non-specialist healthcare workers used handheld echocardiogram devices to screen 518 local people. The study found that 22% of those screened were referred for specialist assessments, potentially saving the lives of one in five of those screened. The study in Ilford South demonstrates how we can detect serious conditions early without requiring expensive hospital visits later. As my hon. Friend the Member for Dudley (Sonia Kumar) just said, prevention and early intervention save lives. By investing in local healthcare services and using tools such as the handheld echocardiogram device, we can catch problems sooner, treat people faster and relieve pressure on our overstretched hospitals sooner. Early diagnosis is not just a medical advantage, but lifesaving. It delivers more time with loved ones, less strain on our NHS and a future in which fewer lives are cut short. We have a golden opportunity to prolong life and to give the gift of life, and I urge the Minister to grab it with both hands.

15:38:00

It is a pleasure to serve under your chairmanship, Mr Mundell. I congratulate the hon. Member for Strangford (Jim Shannon) on his characteristically detailed and impassioned speech in opening the debate. Cardiovascular disease, or CVD, affects around 7 million people in the UK, making it a significant cause of both disability and premature death. As the hon. Member for Ilford South (Jas Athwal) just shared, its impact is felt by many of us. In my family, my paternal grandfather, Lance, died of a heart attack in his 50s, and my maternal grandfather, Bill, died of an aortic aneurysm in his 80s. Thirteen years ago my father, Hugh, had a triple heart bypass. Happily he survived, and he is doing well 13 years on. I am enormously grateful to the NHS for what it did to save my father’s life, but much more needs to be done to prevent the impacts of cardiovascular disease on so many people in the UK. We know that there is a huge variety of causes of cardiovascular disease. One cause, for which we have the solutions, is socioeconomic disparities. The truth is that those who live in the most deprived areas of our country are at far greater risk. People in the 10% most deprived communities are almost twice as likely to die from CVD as those in the least deprived areas. Clearly, there is work to do to close this gap. It is unfathomable to me that in a small and supposedly prosperous nation, a man living in Kensington and Chelsea can now expect to live 27 years longer than a man in Blackpool. That is not just alarming; it is unjust. The disparity worsens when we consider those who have severe mental illness. For people with extreme mental illness, their life expectancy is 15 to 20 years less than that of the general population, and they have a 53% higher risk of developing CVD. The previous Conservative Government’s lack of support exacerbated these health disparities. Public health funding was cut by 26% in 2015, leaving local authorities unable to provide vital services. With the new Government showing some signs of making genuine investment in the right places, I believe this situation can change—indeed, it must change. My Liberal Democrat colleagues and I are committed to creating a healthier and more equal society. The UK has long been known for its grassroots sports, high-quality food production and world-leading medical research. We should be one of the healthiest countries in the world. Under the previous Conservative Government, however, the country became sicker, lagging far behind our international peers. That is why the Liberal Democrats are calling on the new Government to take urgent action to support people in leading healthier lives by reversing the Conservative cuts to public health funding. I firmly believe that improving public health is not just about treatment—far from it, in fact. It is also about empowering people to live healthier lives, creating healthier environments and supporting communities to make decisions that improve their health. In doing these things, we will take pressure off overburdened systems and create a more resilient population. There are several steps that we propose to address the current situation. First, there should be a reversal of cuts to the public health grant, enabling local authorities to provide essential preventive services. Secondly, a proportion of the public health grant should be set aside for those experiencing the worst health inequalities in order to co-produce plans for their communities. Thirdly, a health creation unit should be established in the Cabinet Office to lead work across Government to improve the nation’s health and tackle health inequalities. Our vision for the future also includes tackling the obesity crisis. The National Institute for Health and Care Excellence found a direct correlation between deprivation and obesity in both adults and children. That is why we are calling for an end to the two-child limit and the benefits cap, which would lift over 500,000 children out of poverty. We would also expand free school meals to all children in poverty and work to ensure that every child in primary school has access to a healthy meal. We must also protect our children from the harmful effects of ultra-processed food advertising, and encourage healthier lifestyles by supporting walking and cycling. Our transport networks need to be redesigned to prioritise active travel and road safety, ensuring that every community can access safe spaces for walking and cycling. My Liberal Democrat colleagues and I are committed to making the UK a healthier and fairer place to live. We know that investment in prevention, public health and primary care is key to tackling the root causes of cardiovascular disease and improving the lives of millions across the nation. This issue is solvable and we have the answers. We just need to act.

15:44:00

Before I start my speech, I think it was Gandalf who said: “A wizard is never late…Nor is he early; he arrives precisely when he means to.” I think it is correct protocol to be here at the start of a debate, although I for one would certainly like to see the Minister sprinkle his magic on this topic, because I hope that he will provide some enlightening answers in response to such an important debate. Once again, I thank the hon. Member for Strangford (Jim Shannon) for his industrial strength in always securing these debates. I believe it is said that the man who moves a mountain begins by carrying away small stones; the hon. Member for Strangford is moving the metaphorical health mountains, one Westminster Hall debate at a time. I raise my hat to him, because I have had the chance to respond to a debate of his at least half a dozen times. He always conducts himself in an incredible manner and provides incredible detail, so I thank him for that. If we can tackle the risk factors behind cardiovascular disease and identify it at an early stage, we can make a significant difference by reducing the number of people lost to premature deaths every year. The hon. Member for Ilford South (Jas Athwal) spoke movingly about his mother and his father. That was followed up by the hon. Member for Mid Sussex (Alison Bennett), who spoke about her father 13 years on; her father will be very proud to see his daughter in this debate. I am sure the parents of the hon. Member for Ilford South would be proud of his achievements as well, and the fact that he is raising such an important topic. I come to this topic as a GP, and this is pretty much the bread and butter of life for a GP: advising on healthy lifestyles, and managing blood pressure, angina, obesity, smoking, heart failure, strokes and many more conditions. I pay tribute to the hon. Member for Dudley (Sonia Kumar), who pointed out how important that is. It is not just the doctor’s role any more; this is the MDT approach, and actually a quality MDT really helps the GP to understand where they need to look and to manage their workload, which is so important not just for clinicians but, most importantly, for the patients. It is an honour to take part in this debate and to help to shape it. From a public health perspective, the last Government made significant progress on things such as calorie labelling, salt and sugar reformulation and smoking cessation, which are all contributors to cardiovascular disease. It was just three years ago that the NHS published its CVD prevention recovery plan, which set out four high-impact areas for every part of health services to focus on risk factors, detection and management. Examples include the rolling out of blood pressure checks in high street pharmacies and allowing people to measure blood pressure at home. The NHS long-term plan set out five ambitions to detect and treat people at risk of developing CVD. The plan has been revised twice, in 2022 and 2024. This work was reinforced by the introduction of the NHS digital health check in spring 2024, which aimed to prevent 400 heart attacks over four years. The National Audit Office report into CVD, which was published in November 2024, said the disruption to the NHS caused by the covid pandemic has had substantial impacts on elective care, and this has undoubtedly had an impact on the prevention and treatment of cardiovascular disease. We do not have to look back too far to think about lockdown and the effect that that had on people’s physical activity, their ability to seek help and some of the preventive and advisory medicine that would have normally taken place. Following the NAO report, the Government committed to reviewing the NHS health check programme. Will the Minister confirm the timescales for the review and when the reports on the outcome will be published? The hon. Member for Strangford rightly pointed to cholesterol and lipids. Lipids are often not given the attention needed; they are hugely important when addressing cardiovascular disease, so I thank the hon. Gentleman for mentioning them. I have done constituency casework on this topic as a Back-Bench MP. He mentioned lipoprotein(a), and I have been questioning Ministers about the development of genetic testing for familial hypercholesterolaemia and the development of a familial hypercholesterolaemia service in Leicestershire. Although this is a complicated and involving space, given the great advances in the testing and understanding of lipids, it is really important that we get to the bottom of it to understand the environmental impacts that are causing this, as well as the genetic ones at play. To that end, work has also included looking at how bodies can track patients and the difficulties that familial hypercholesterolaemia services have in cascading to local people’s relatives, which I think is what the hon. Member for Strangford was pointing to. This is probably beyond the scope of this debate, but given the hon. Gentleman’s success with this debate, it would be great if he were to secure a Back-Bench debate on lipids. Will the Minister consider asking the Department to look at improving the clinical pathways for familial hypercholesterolaemia and the possible roll-out of screening for both patients and family members? I appreciate that this has to be done through an evidence-based approach. More people are living with multiple long-term conditions; that is no different for many people living with CVD, who are also living with other conditions, such as diabetes. That is why the last Government were developing the major conditions strategy to try to improve outcomes across major conditions, including cardiovascular disease, as well as cancer, diabetes, respiratory disease, mental health and musculoskeletal disorders. Since the general election, Ministers have decided to go in a different direction, so will the Minister reassure me that the NHS 10-year plan will address the impact of those long-term conditions? As the hon. Member for Mid Sussex pointed out, inequality plays a role when it comes to cardiovascular disease, so I would be grateful if he would comment on that. I think the quote goes, “Study the past if you would divine in the future,” and I am always keen to gain insight from across the House of what has previously happened. I note that almost a year ago today, there was a debate held in the main Chamber on the topic of heart and circulatory diseases by the then MP for Watford, the brilliant campaigner Dean Russell, who talked about his experience of having a heart attack. Of course, the debate was just a few months before the general election, but it gives us a good insight into what the then shadow Health team were thinking before they came into government, which they were successful in doing. The then shadow Minister, now the Minister for Secondary Care, was responding. She said: “Labour has a mission to reduce deaths from heart attacks and strokes by a quarter within 10 years…Under our ‘Fit for the Future’ fund, we would double the number of scanners—speeding up heart and circulatory disease diagnosis”. What is the amount in that fund? Has it been deployed, and what is the timescale? What scanners were specifically commissioned for cardiovascular disease? The then shadow Minister went on: “We would also incentivise continuity of care in general practice, which would improve care in our communities for people living with heart and circulatory disease.”—[Official Report, 22 February 2024; Vol. 745, c. 940.] No one has to tell me, as a GP, about the importance of continuity of care, so will the Minister explain what this would look like in the GP contract? What incentivisation is being considered for GPs? The then shadow Minister went on: “That is why Labour will introduce a child health action plan that will put prevention at the top of the agenda”. Forgive me, but looking on the Government’s website and speaking to the House of Commons Library, I cannot see a report or plan on this topic; if I have missed it, will the Minister provide it? If there is not one, will the Minister set out the goals and timelines for achieving the plan, if the Department will provide them, and place it in the House of Commons Library? On research, the then shadow Minister went on: “That is why Labour’s regulatory innovation office would make Britain the best place in the world to innovate by speeding up decisions and providing a clear direction based on our modern industrial strategy, alongside a plan to make it easier for more patients to participate in clinical trials.”—[Official Report, 22 February 2024; Vol. 745, c. 941.] Eight months into the new Government, I believe a chair has not been found, so will the Minister update me on when the role will be filled? Given that this was the stated aim of the Labour party in the CVD debate, what conversations is he having with the Department for Science, Innovation and Technology about speeding up cardiovascular trials? I thought it fitting in closing to use the lines of Dean Russell, who used his closing remarks back then to point to the importance of data, education, protection and research in dealing with cardiovascular disease. I think the entire House can get behind that. The story of the hon. Member for Ilford South is a testament to the life advice that Dean gave to us then: “if anyone at home is worried, they should get checked. If they are concerned that they have symptoms, they should get them looked at. It is better to get rid of fears before the event than to wait for them to become a reality and have to deal with the outcomes of that.”—[Official Report, 22 February 2024; Vol. 745, c. 944.] I think we can all agree on that, too.

I am sure that the Minister will begin with an apology to me, to Mr Shannon, as the Member in charge, and to all other participants, because it was very clear on the Order Paper that these proceedings would begin at 3 pm.

15:54:00

It is a great pleasure to serve under your chairship, Mr Mundell. I am indeed starting with an apology. I am very embarrassed by the fact that the debate was put by my officials in my diary as starting at 3.30 pm, and it is completely unacceptable that I arrived late. I apologise to you, Mr Mundell, and to the hon. Member for Strangford (Jim Shannon). It is a very embarrassing situation, and I am not happy about it at all. I thank the hon. Member for Strangford for securing this debate on such an important issue and for the vital work he does as the chair of the APPG on vascular and venous disease. For their excellent contributions, I also thank my hon. Friend the Member for Dudley (Sonia Kumar), who spoke powerfully on the basis of her extensive real-world experience and expertise, my hon. Friend the Member for Ilford South (Jas Athwal), who spoke so movingly about his family and personal experiences, and the hon. Member for Mid Sussex (Alison Bennett), who spoke passionately about the shocking health disparities that blight our country, caused by 14 years of Tory neglect and incompetence. Before I begin my remarks, I want to pay tribute to people working in local government, our NHS staff and GPs up and down the country for their efforts to find, treat, and manage people at risk of cardiovascular disease—also known as CVD. As hon. Members will know, health is a devolved issue, so my remarks will be limited to matters in England; however, I am happy to pick up on many of the broader points that the hon. Gentleman for Strangford has made. The last Labour Government made significant progress on reducing premature deaths from CVD through the introduction of big-hitting interventions such as the ban on smoking in public places and increases in statin prescribing. However, as the hon. Member for Strangford said, among the many appalling findings of Lord Darzi’s report, there is clear evidence that progress on CVD stalled, and even went into reverse in some areas, between 2010 and 2024. That is why it is this Government’s mission to invest in the health service, alongside fundamental reform to the way that healthcare is delivered. We will build a health and care system fit for the future by moving from sickness to prevention, hospital to home, and analogue to digital. Tackling preventable ill health is a key part of these shifts. As part of our 10-year health plan, we are committed to helping everyone to live a healthy life for longer, and as the hon. Gentleman also outlined in his remarks, too many lives are cut short by heart disease and strokes. In 2022, one quarter of all CVD deaths in the UK occurred among people under the age of 75. Tackling CVD is not just the right thing to do for patients; CVD is also having an impact on growth. People with CVD are more likely to leave the labour market than people with poor mental health, and we must dispel the fiction that people with CVD are always old and infirm. Around one in three people who have a heart attack, one in four people who have a stroke, and two in five people with coronary heart disease are of working age. The hon. Gentleman referred to premature deaths, and we know from the most recent figures that I have, from 2023, that in England alone over 130,000 people died from CVD and over 30,000 people died before they turned 75. The best estimates show that the annual cost of CVD to the NHS is a staggering £8.3 billion, with knock-on effects of £21 billion to the wider economy. This is a huge challenge, which is why we are meeting it with great ambition: to reduce premature deaths from heart disease and stroke in people under 75 by one quarter within a decade. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton), will be spearheading our work in this area, and will also be picking up on many of the issues that the hon. Gentleman raised in his speech. We know that around 70% of the CVD burden is preventable and due to risk factors such as living with obesity, high blood pressure, high cholesterol and smoking—all of which can be reduced by behaviour changes, early identification and treatment. In England, the NHS health check is a free check-up for people between 40 and 74. The NHS health check is a wide-reaching programme delivered by local authorities in England. This CVD prevention programme aims to prevent heart disease, stroke, diabetes, and kidney disease—and also dementia for older patients.  In the very short period of time that I have left, I just wanted to say that the hon. Member for Strangford called for the introduction of Lp(a) tests. As I understand it, lipoprotein(a) measurement is not currently recommended by NICE guidance, and there are no treatments available that specifically target Lp(a).  Instead, our focus is to improve the uptake of lipid-lowering therapies for prevention of CVD and to treat people with established CVD to NICE treatment targets. We will look closely at new tech and innovation and the essential role they will play in reducing health inequalities.

I apologise, but at the end of my speech I asked for three things. I asked whether there would be a willingness to meet me and representatives from the Lp(a) taskforce to discuss the essential steps that are needed, and that—

Mr Shannon, I remind you that these proceedings go on to 4.30 pm, so there is no need for you to try to speak in a very short period of time.

I will not test your patience by speaking till 4.30 pm, Mr Mundell—I would test everybody’s patience if I were to do that—but could I sum up, if that is okay?

Yes. That is what I was saying, but I felt you were summing in a way that anticipated that we were concluding at 4 pm.

I would have asked to intervene, but the Minister had sat down. First, I thank all Members for coming along. The hon. Member for Dudley (Sonia Kumar) set the scene incredibly well with her knowledge and experience through her work—I think the Minister also referred to real-world experience. I thank her for her contribution; she is certainly establishing a name for herself in the Chamber. There is no better way of illustrating a point than by telling a personal story, as the hon. Member for Ilford South (Jas Athwal) did. It reminds me of one of my constituents who came to see me one day; he is a man I know very well, although he is in a different political party. I asked him how he was and he said, “Jim, I went to see my doctor; I thought I was okay, but before he finished the tests on me, he gave me a bit of paper. I said, ‘What’s that for?’ and he said, ‘You have to go hospital right now.’” He went and had a quadruple bypass—he thought he was perfectly healthy, and did not know that he was not. I thank the hon. Member for Ilford South for sharing his story earlier. The hon. Member for Mid Sussex (Alison Bennett) very clearly underlined the differential—that someone in Kensington and Chelsea can live for 20 years longer than someone in Blackpool. That has got to be wrong; we have to address those issues. She also mentioned the issue of obesity in children, and said that better food and school meals would improve public health and help to deliver more resilient people. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), referred to genetic testing and to the cascading of those tests right down through families, which is one of the things that I asked for. He referred to the 10-year plan, of which the long-term condition of CVD needs to be a part. The aims of the Government seem to indicate that there will be a wish to do those things in relation to CVD, and we very much hope that the Minister can do them. I thank the Minister for arriving—look, things happen in life. Sometimes I am late as well, which is probably my fault on most occasions and I take the blame. On this occasion, I asked the Minister for three things, and I will repeat them now. Is the Minister willing to meet me and representatives from the Lp(a) taskforce to discuss the essential steps that need to be taken now to ensure that the UK is in the best possible position to integrate Lp(a) testing? Will he commit to engaging with key system partners such as NICE, NHS England and the devolved Administrations to address relevant policy barriers that could hold back progress? I am ever mindful that the Lp(a) taskforce has already integrated the four nations of the United Kingdom in what it is doing. I always try to be positive—you know the person I am, Mr Mundell. My objective is not to catch anybody out; I only want positivity and a solution-based approach to what I am asking for. My last question was: will the Minister explore the scope to develop a dedicated national strategy for cardiovascular disease? Those are my three requests, which I put forward genuinely, sincerely, honestly and kindly. I ask the Minister to let us all know his response and his policy, because I think that other Members, from all parties, would also like to know.

I am sure the Minister will have heard the three points that Mr Shannon raised. On that basis, I will put the Question.

On a point of order, Mr Mundell. In perfect symmetry, this debate has taken a somewhat different procedural pathway than usual; that is indeed what can happen to patients with cardiovascular disease—things surprise them, although we have systems for dealing with cardiovascular disease. My concern is that some of the questions I raised on behalf of His Majesty’s Opposition have not had the chance to be answered. I would be grateful if the Minister would take them away and write to me—perhaps I could put them in a letter. Would it be within the scope of the Chair’s powers to allow that to be the case, Mr Mundell?

That is not technically a point of order, but I am sure the Minister has heard what you have had to say. I am sure he and, indeed, the hon. Member for Glasgow South West (Dr Ahmed)—who was here from the start—will have noted all the points that Mr Shannon raised. If the points that Mr Shannon raised at the end—and indeed earlier, in his contribution before the Minister spoke—were unaddressed, I am sure that the Minister will write to him.

I absolutely will. I would be happy to complete my remarks, but I do not know that would work, given that Mr Shannon has made his second contribution.

I will make the determination that Mr Shannon’s contribution was an intervention—although an excessively lengthy one, which he will not repeat at the conclusion of the debate.

This has been an interesting debate on so many levels. I thank you for that clarification, Mr Mundell. I was just talking about the fact that around 70% of the CVD burden is preventable, and that the causes include obesity, high blood pressure, high cholesterol and smoking. All those factors can be reduced by behaviour changes, early identification and treatment. In England, the NHS health check is a free check-up for people between 40 and 74. It is a wide-reaching programme delivered by local authorities in England. This CVD prevention programme aims to prevent heart disease, stroke, diabetes and kidney disease, as well as dementia for older patients. It engages over 1.4 million people a year and, through behavioural and clinical interventions, prevents around 500 heart attacks or strokes annually. I agree with the hon. Member for Strangford that the National Audit Office report shows that there is still so much more to be done. That is why we have asked officials to be more ambitious, developing policy proposals for how that programme can go even further. In the meantime, we are focused on delivering a new digital NHS health check, available through the NHS app, so that people can assess, understand and act on their CVD risk at home. We want to make it easier for people to access that programme, especially our constituents who have caring or childcare responsibilities, or cannot easily get to their GP surgery during opening hours. The creation of a state-of-the-art national digital NHS check service will improve access to this lifesaving check. The hon. Member was right to mention diabetes as a key risk for CVD. Each year, the NHS health check identifies 22,000 people with high blood sugar who are referred on to primary care for further assessment and management. GPs can refer people at risk of developing type 2 diabetes into the Healthier You NHS diabetes prevention programme. The programme has been highly effective: some 35,000 people have been referred to it by their GP, and over 20,000 have started the programme since September 2020. For people who complete that programme, it can cut the risk of developing type 2 diabetes by 37%. For those who already have diabetes and are overweight or obese, the NHS type 2 path to remission programme is available. This joint initiative between NHS England and Diabetes UK aims to support eligible people with type 2 diabetes to achieve clinically significant weight loss, improve blood glucose levels and reduce the need for diabetes-related medication. A recent study found that almost a third of patients with type 2 diabetes who completed the programme went into remission. Around half of heart attacks and strokes are a result of high blood pressure. A third of adults have high blood pressure and, worryingly, almost a third of these conditions are currently untreated, meaning that over 4 million people do not know that they have high blood pressure. It is often referred to as the silent killer, as high blood pressure is largely symptomless. The tragedy is that the treatment is so cheap and effective. We could prevent around 17,000 heart attacks and save more than £20 million in healthcare costs alone over three years just by treating 80% of patients on target. The hon. Member for Strangford also mentioned high levels of cholesterol as a key risk factor in CVD. For every three NHS health checks delivered, one person is found to have high cholesterol, and there are well-known health inequalities in CVD affecting underserved communities in England. Addressing undetected and poorly managed high blood pressure and raised cholesterol is key to preventing CVD and reducing health inequalities. There are effective drug treatments. Statins are readily available and very cheap. They can reduce an individual’s risk of CVD in four to six weeks. If we improve treatment rates for people with CVD to 95%, more than 18,000 CVD events, such as heart attacks and strokes, may be prevented over three years. We will look closely at how we can get that done. The hon. Member for Strangford called for the introduction of Lp(a) tests. As I mentioned, that is not currently recommended by NICE guidelines. I have taken account of his other remarks, including his request for a meeting and engagement with system partners. The Minister for Public Health and Prevention will take all those requests on board. She is the right person for him to meet, given that she leads in this policy area. Smoking costs health and care services £3 billion a year—resources that could be freed up to deliver millions more appointments, scans and operations. The cost of smoking to our economy is even greater, with around £18 billion lost in productivity every year. Smokers are a third more likely to be off work sick, which is why we introduced the Tobacco and Vapes Bill: the biggest public health intervention in a generation. It will break the cycle of addiction and disadvantage, and put us on track towards a smoke-free UK. That will make a real difference in constituencies where smoking contributes to the cycle of poverty and ill health. We are also supporting local stop smoking services with an additional £70 million this financial year. Today’s debate has shown what a challenging and complex area this is. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), raised a range of issues. I will ask the Minister for Public Health and Prevention to write to him on all his points, many of which I think would be best dealt with in correspondence.

The Minister makes powerful points. Does he agree that we should consider a wider, holistic approach, taking into account planning and advertising—for instance, children going to school and having access to the proliferation of chicken shops and fast-food shops, and being exposed to, on average, 13 to 15 junk food adverts? That would help to limit the number of heart diseases later down the line.

My hon. Friend is right that prevention should focus on as early as possible in the life of our young people. Bad habits form at early ages. That is not helped by the behaviour of some aspects of our economy, and the way in which products are advertised. It is essential that we move to a model of prevention that is a partnership between the Government, our communities and business. We are taking action against the advertisement of certain products before the 9 o’clock watershed. We are also cracking down on energy drinks, which are really pernicious in terms of the amount of sugar, caffeine and other deeply unhealthy components they contain. My hon. Friend is right that we are genuinely all in this together. We need that partnership with the private sector, and a change in mindset around healthy and nutritious food. That needs to be put into schools through community health, and through working with parents and communities to change the habits of our country. We have a gargantuan challenge ahead of us, but our Government are absolutely committed to facing it, and that prevention strategy will be at the heart of our 10-year plan. It is one of the key shifts from sickness to prevention. That leads me to my closing remarks. We have seen today what a challenging and complex area this is. It is a challenge that requires sustained action on a number of risk factors, but I assure colleagues that this Government will leave no stone unturned in getting premature deaths from heart disease and stroke down by a quarter for people under the age of 75 within the next year. In my contribution, I have sought to demonstrate our commitment to getting on with the shift from sickness to prevention with our cast-iron commitment to expanding NHS health checks, the shift from hospital and community by making it easier for people to get checks at their convenience and at home, and the shift from analogue to digital through an innovative and expanded digital service. I once again thank the hon. Member for Strangford for securing this important debate, and thank all hon. Members across all parties for their excellent contributions. Watch this space: we will continue to work on this issue with focus and at pace.

Mr Shannon, do you wish to make a final contribution?

16:16:00

I am not quite sure what happened today, but I thank everyone—the Minister, all the hon. Members who made a contribution and the Backbench Business Committee for making this possible. We look forward to the delivery that the Government have indicated for the years ahead, on which all the nations of this great United Kingdom of Great Britain and Northern Ireland can work together.

It has been a little unconventional, but we got there in the end. Question put and agreed to. Resolved, That this House has considered the prevention of cardiovascular disease.

16:16:00