Cardiovascular Illnesses

Question for Short Debate

13:00:00

Asked by

To ask His Majesty’s Government what plans they have to improve the detection, prevention and treatment of cardiovascular illness.

My Lords, the idea for this debate came about at the end of January, when I was lying in a hospital bed, where I had been for nearly four weeks receiving treatment for my heart. Those were the later stages of what had been a long journey for me since 2011. One surgeon described me as an interesting case, so I intend, with the indulgence of the Committee, to tell you about my heart history, as it is important. When I came into House last year, I was told that our individual expertise and experiences should form part of what we do here. It is an area that I intend to pursue further. Since I initiated this debate, I have received lots of representations from different groups; before then, I did not appreciate the significance of cardiovascular disease and its causes, which are considerable. It is very difficult to talk about your own health; it is a very un-British thing to do. I saw on Facebook earlier this week when someone asked, “What do we do as the British?” an answer was that we say, “I’m fine, thank you”. That is how we tend to react to things. I find coming out to Peers and telling them about my heart and health issues far more difficult than I did the more traditional way of coming out, which I did many years ago. My heart issues began in 2011, when I was at the peak of my business career. I was fit and healthy; I went to the gym three times a week. I was floored by an illness called endocarditis, an infection that goes around the heart valve. Its detection was very difficult, as were the subsequent detections of the other heart-related illnesses that I have had. I intend to talk about the good, the bad and the ugly, because there have been some very good and very bad responses from clinicians, and I have seen some very ugly things in hospitals in the United Kingdom. In 2011, I suffered a flu-like illness, getting fevers and sweats at night. I went to my GP, who basically told me that I probably had the flu and that I should go away, rest and take a couple of paracetamols. Unfortunately, that persisted over a number of days, and I presented myself to accident and emergency. There, I was again told that I probably had flu and that I should go away. It was not until a week later, when my partner insisted that I go back to accident and emergency, that we began to have some results. If I had not seen a young African lady doctor, who was brought up and trained in Africa, the endocarditis would not have been recognised, because it is not very common in this country. It is increasingly common; in Africa, malnutrition causes endocarditis, and in this country, it is more common for people on drugs because, as they progress with serious drug taking, they become malnourished too. That was my first episode, in 2011. As a result of that, I had angiograms and all sorts of heart checks. They decided that I had had a bicuspid valve from birth. I do not know whether noble Lords know this, but valves in the heart are tricuspid—they have three chambers. However, it is not uncommon for people to have bicuspid valves; 10% to 15% of people do. It is not recognised when you are younger, because you are fit and healthy, but it becomes prevalent as we get older and everything begins to clog up inside. That necessitated a valve replacement. In May 2012, I had a tissue valve fitted—I chose that rather than a metal valve because the thought of something ticking in my chest horrified me, and still does. That was a life-changing event. I was at the peak of my business career, but major open-heart surgery—I am a member of the “zipper club”—makes you think about everything you are doing in your life. I retired, and we decided to move from where we lived in Brighton to Cornwall. The finances worked out, as in those days it was much cheaper to live there, and the treatment with the valve was at the time very successful. I then entered what I call the fallow years for my heart, which lasted until much more recently. The only medical interventions I had were in 2015, when I had my left hip replaced, and 2017, when I had my right hip replaced. That is part of the reason why medical people say that I have an interesting history. In 2022, one Monday morning, I woke up and literally could not move. I was in utter agony. If I tried to move my leg one inch, all the muscles in my leg spasmed. A lady doctor later told me that I had discitis, which she described as like being permanently in birth for six weeks—the pain was that bad. It was at the tail end of lockdown; I managed to get the local hospital to acknowledge my illness, which was again a difficult process, over about 10 days, and I went in. Yet again, the discitis may also have been endocarditis, because the treatment for the two is the same—six weeks of intravenous antibiotics four times a day. The hospital was in lockdown, so they were not prepared to move me around the hospital to find out whether I did have endocarditis. At the end of that, in 2023, I had a TAVI valve fitted, which is a sleeve that fits inside another valve, because the discitis, and possible endocarditis, was caused by my artificial heart valve leaking. The TAVI valve goes inside. They hoped that the sleeve inside the valve would solve the problem, which it did, so I was very lucky to come out in one piece again. That was the cardio side of it. The vascular side started in 2023 when I went to my GP complaining of pains in my legs—in my calves—which were sometimes really bad and made it virtually impossible to walk. They did various tests, but did not find anything at that stage. They sent me for scans, which showed that I had a narrowing of the arteries in the leg, which was causing the pain. It is known as intermittent claudication, which is named after the Emperor Claudius, who limped. I beg your Lordships’ indulgence for a slight amount more; I know that I am coming to the end of my time. As part of the treatment, I was fitted with a heart monitor at the beginning of this year. I was called two days later and told that I had to go into hospital to have a pacemaker fitted. The long and the short of it is I went into hospital and they did the tests for the pacemaker. It was found that I needed two stents. I then acquired a massive hospital infection. I collapsed at home the day after, which is why I was in hospital for nearly four weeks, after which time I had the pacemaker fitted. That is the history. It is quite complicated. I had intended to go on and talk about all the other people who have sent me information, but I see that I have reached my 10 minutes, so I will cease shortly. My questions to the noble Baroness are on whether we could look more at prevention and diagnosis. I was failed in diagnosis in primary care, so can we look more at diagnosis? The treatment that I had—the surgeries—was excellent, but I found a failure in the aftercare in all the processes that I went through. I am a minute over time, so I will finish now. I appreciate your Lordships’ indulgence.

13:11:00

I congratulate the noble Lord, Lord Booth, on securing this debate, on his very personal account of what he went through and on sharing with us his experiences and what we can learn from them. As a former Health Minister who had some responsibility in this area, I know that cardiovascular illness can be particularly prevalent in areas of high deprivation. NHS figures show that, in 2023, the most deprived 10% of the population were almost twice as likely to die of cardiovascular disease compared to the least deprived. An NAO report published in 2024 said that, in 2020, deaths in those aged under 75 due to cardiovascular disease were four times higher in the most deprived areas compared to the least. I recently attended an event organised in Parliament by the All-Party Parliamentary Group on Vascular and Venous Disease, where I was particularly struck by the points made about those regional variations—not just in death rates but in treatment and prevention. In the South Yorkshire ICB area, only 3.1% of the population received a health check in 2023-24, despite 32% of adults being obese and 23.5% being physically inactive. There are also worrying disparities in amputation rates. In Yorkshire and Humber, there are 12.6 amputations per 100,000 people, which is almost double that of London; only the north-west and north-east of England have higher amputation rates. I know that the British Heart Foundation has welcomed the Government’s recognition of CVD as one of the UK’s biggest killers and their ambition to reduce premature deaths from heart disease and stroke by 25% in the next decade. The foundation has also called for a national cardiovascular disease plan. I wonder if, in her closing remarks, the Minister might address whether the Government are looking at that idea to bring together areas that need to be tackled, such as obesity, smoking, air pollution and increased research. In the time I have available to me, I want to make a few practical points that could address some of these disparities. Health checks are so important, but the 2024 NAO report said that there was “no systematic” way of “targeting … those most in need of” health checks, as well as little incentive for primary care providers to provide them. It also said that “DHSC and local authorities cannot … access data … so cannot assess the impact” that health checks are having. Perhaps my noble friend could address this or write to me if she does not have the information to hand. The all-party group has made a number of points. For example, appointing more nurse practitioners would enable what it called hot clinics. In many ways, this would help to reduce the length of waiting times. At present, there are patients who are at risk of amputation of their legs. Obviously, they need to be prioritised. A hot clinic could do this by having nurse practitioners who could assess the patients, compare their blood pressure on the arm and on the leg, see how bad their condition is, then fast-track them through the system. That is one suggestion from the APPG. Also, appointing multidisciplinary team co-ordinators could greatly assist in keeping track of patients, moving them through the system and reducing the time that consultants have to spend on doing this. Co-locating services is also vital. For example, if there were ultrasound scanners and access to sonographers in out-patient departments, they could increase the number of out-patients because patients would not have to go back and forth to and from hospital. This would improve the patient journey. Hybrid theatre facilities would allow consultants to do a range of services in the same space, again, without having to duplicate services and the patient having to go backwards and forwards for different appointments. That brings me nicely on to the fact that, as my noble friend the Minister knows, the Doncaster Royal Infirmary is greatly in need of some investment. The recent announcements of an increase in NHS capital spending are very welcome. Part of the plans would be to help in this important area, so I hope that she might cast a sympathetic eye over the points that I have made.

13:18:00

My Lords, I start by expressing my gratitude to and respect for my noble friend Lord Booth for being so honest and brave with us in this Committee about his experience. I know that we all wish him well. I intend to concentrate on the prevention of cardiovascular illness and the importance of regular physical exercise in the overwhelming majority of cases of CVD; physical exercise is widely considered the most effective preventive measure against CVD. I declare my interests in this subject as a former Minister for Sport and as the chairman of the British Olympic Association in the build-up to, and during, 2012. Also, thanks to the work of the noble Lord, Lord Aberdare, I fortunately succeeded in a campaign to make defibrillators available in every school. Unless we address prevention with as much urgency as detection and treatment, we will be left lagging behind other countries in a critical area of health policy where we have no excuse not to lead. For, as has been evidenced in multiple randomised controlled trials, systematic reviews and meta-analyses, it is indisputable that exercise reduces the risks of hypertension, cholesterol, BMI values and diabetes, all of which are linked to the development of CVD. After the first major lockdown of 2020, Sport England commissioned the Sport Industry Research Centre at Sheffield Hallam University to assess the social impact and economic importance of sport and physical activity in England. There were two fascinating parts to the research. Part 1 measured the social impact of sport and physical activity, including on physical and mental health, and part 2 measured the economic importance. The results showed that, for every £1 spent on community sport and physical activity in England, an economic and social return on investment of £3.91 is generated. From the point of view of the NHS, the report stated that a huge £9.5 billion was generated through the physical and mental well-being impacts, which included the prevention of 150,000 cases of heart disease and stroke, 900,000 cases of diabetes and 8,500 cases of cancer. It is important to look at why there are various barriers to achieving activity levels, including motivation, perceived capability and lack of facilities, because the landscape of the UK’s level of physical fitness is bleak and deteriorating. We face high and growing rates of inactivity among both adults and children—both aligned to a growing obesity problem. Although there are tangential positive trends, such as increased gym membership and the rise of digital fitness, a significant proportion of the adult population in England is classified as inactive. What is worse is the growing representation of health disparities, as the noble Baroness, Lady Winterton, pointed out in her excellent speech. It is the relatively well-off who join gyms. It is the independent sector of education that has overwhelmingly provided the best sports facilities for young people. It is the private sports clubs that have been the backbone of UK sport. Therefore, it is no surprise that we face what is known as the Jubilee line of health inequality, where life expectancy decreases as you travel east along the Jubilee line from Westminster to Canning Town, and where approximately one year of life expectancy is lost for every two Jubilee line stops heading east. Socioeconomic conditions, access to healthcare, environmental factors and the inequalities that arise from a lack of school and local authority sports facilities, along with a lack of a national culture of sport, health and well-being, drive the high level of cardiovascular illness. Prevention is essential. In Committee on the Children’s Wellbeing and Schools Bill, the noble Baroness, Lady Grey-Thompson, the noble Lord, Lord Addington, and I are proposing a national school strategy for sport, health and well-being. After all, well-being is in the title of the Bill, yet in this key cornerstone of the Government’s schools policy there is not a single mention of physical education, physical fitness or sport. A National Plan for Sport, Health and Wellbeing, published by your Lordships’ ad hoc Select Committee in 2021 stated: “We are concerned about the high levels of inactivity at the grassroots level, particularly among women, ethnic minorities, disabled people and those with long-term health conditions, the elderly, and people from less affluent backgrounds … Numerous underwhelming attempts to boost activity rates and improve population-level physical and mental health and wellbeing have not been as successful as hoped … Our overarching recommendation is the need for a new ambitious national plan for sport, health and wellbeing and a new approach within Government to deliver and fund it”. That is why the committee on which I sat believed that sport should be moved from the DCMS and placed at the centre of the Department of Health and Social Care. There, it should be aligned with health and well-being at the epicentre of government. Today, we have rightly focused on the gravity of the CVD problem. Yet we are doing nothing to match or exceed the CMO’s physical activity guidelines, which would prevent many cases of CVD. More than a quarter of adults in England, some 11.9 million people, are classified as inactive. A further 5.1 million average 30 to 149 minutes of activity a week. In a country that has prided itself on sport, fitness and well-being over the generations, successive Governments seem blinded into passive acceptance that 17 million adults in this country do not meet the CMO’s basic recommendation for physical activity. What is in some ways worse is that 30% of children do fewer than 30 minutes of exercise a day and a further 22.7% average between 30 minutes and one hour. This means that more than half our children, some 3.9 million, do not meet the CMO’s recommendation. It is time to act. It is time to elevate the importance of this subject, which was so well introduced by my noble friend Lord Booth.

13:25:00

My Lords, I thank the noble Lord, Lord Booth, for securing this debate. I say as an aside to his opening remarks that if the most common British response is, “I feel fine”, the greatest fear any British person has is of asking someone how they feel and actually getting a detailed response. The significance of CVD is unanswerable. It is responsible for about one-quarter of deaths in this country and is probably the biggest single contributor to premature deaths and to people leaving the workforce early. It plays a key role in the level of economic inactivity in this country. In pure economic terms, different figures have been put about, but the British Heart Foundation calculates the cost to the UK as £29 billion a year. Beyond the societal and economic impacts, every statistic that we will cite in this debate today represents an individual and an individual family. We are also faced with the major challenge that whereas mortality rates for CVD dipped in 2019, the figures seem to have begun to rise again after having largely been level over the past decade or so. There is a key challenge about how we can start to drive those down. I suspect that all of us will be united about what we are hoping to achieve—a reduction in the incidence, impact and level of deaths—so it is a question not of what, but of how. I will be interested in the Government’s response on a range of issues. First, the 10-year plan for the NHS is the correct approach to look at this strategically, and I hope that it will lead to more holistic, joined-up approaches and mean that when it comes to budgeting we can look at things much more strategically. However, it has been highlighted by a range of key stakeholders in this field that there is a need for a specific cardiovascular disease plan. I would be interested in hearing the Government’s response on how we can balance the specifics of a plan with the more general strategic direction that we are seeking for the NHS. Similarly, we know that emerging technologies can play an important role, from AI to data science. Any information that the Government can give on how specifically they intend to harness those in the fight against cardiovascular disease will be critical. Secondly, as highlighted by the noble Lord, Lord Moynihan, and others, prevention is the critical element to this. For many people who suffer from cardiovascular vascular disease, the first symptom is a major event, a stroke or a heart attack. It is quite often symptomless. Within that context, we know the range of risk factors, from smoking to obesity, alcohol and air pollution. I know that the Government are taking action on some of these fronts but, again, there is a concern, particularly given the figures, that we are starting to get diminishing returns on certain elements of behavioural aspects. It will be critical to say that in educating on the risk factors, we can act as a driver to harness that and make a real difference to people’s lives. Thirdly, on testing, it is important that, for example, blood pressure tests are expanded and rolled out more. We know that NHS health testing could have a critical role in prevention and diagnostics, yet we see a mixed bag of take-up of those tests. In particular, we know that men can be more prone to cardiovascular diseases and have a higher incidence level but are perhaps more reluctant to go to a doctor to get those tests. This can also apply to a range of ethnic-minority groups such as the black and south Asian communities, who have statistically higher levels of CVD. I would be interested to hear how the Government can ensure that we better target testing and perhaps look at the commissioning of testing, and how we can incentivise primary carers to encourage people much more to do testing. Fourthly, we need to raise our ambitions beyond simply the mortality rates. For strokes, for example, there is a target of a 25% reduction in deaths. I would like to see—and I ask the Minister whether there is an intention to have—a similar target of 25% in reducing severe disabilities as an impact of strokes. Allied to that is a key role for improving review and rehab facilities to ensure that, once someone has suffered a stroke or a cardiac event, it does not reoccur and we are not left with a far worse situation. Finally—and this is not unique to CVD—there is the question of how we can have a level of consistency. I have mentioned testing already and the need for greater levels of use of community pharmacies, for instance, for blood testing. For something such as thrombectomy, the rates are very different. If you are in London, their usage is at around 10%; at the other end of the scale, in the east of England, it is about 1%. There is a range of issues around how we can drive greater consistency in treatments in the health service. I look forward to the Minister’s response.

13:30:00

My Lords, I also congratulate the noble Lord, Lord Booth, on securing the debate. After listening to his story, I am rather glad that we were able to listen to him today. I have also listened to grieving families, passionate campaigners and dedicated cardiologists, each of them urging us to act more boldly on the issue of sudden cardiac arrest in the young. Earlier this year, I had the privilege of co-hosting a symposium with the Italian embassy and Ambassador Lambertini. We brought together leading cardiologists and sports scientists from the UK and Italy to share insight, evidence and experience on preventing sudden cardiac death in young people. Tragically, it is not a marginal issue. Every week in the UK, at least 12 young people—children, students and athletes—die from sudden cardiac arrest. That is the equivalent of a full secondary school wiped out every year. What is more disturbing is that 80% of those young people had no prior symptoms. They were seemingly healthy, vibrant and active. Sport can exacerbate hidden conditions, putting young people at three times greater risk, yet 80% of these deaths occur in sleep, which means that defibrillators, while essential, cannot be the whole answer. We must move from crisis response to prevention. I have campaigned alongside Mark King, who tragically lost his son Oliver at just 12 years old during a swimming lesson at my old school—King David High School in Liverpool. Together we pushed for greater access to defibrillators in schools and public venues, but even more pressing is the need for screening to detect these conditions before they claim a young life. One mother, Hilary Nicholls, shared with me the story of her daughter Clarissa. She was just 20 years old, full of promise, physically active and with no diagnosed heart condition or health issues. Her sudden death from an undiagnosed cardiac condition was devastating. Tragically, her story is not unique, so the case for widened access to ECG screening is clear. In elite sports such as football and rugby, we have mandatory screening in place, led by UK-devised international ECG protocols. But, beyond elite sport, there is a vacuum. Students, grass-roots athletes and local community clubs are largely left unprotected. Compare that to Italy, which I recently travelled to with Hilary to see the model in action. For over 40 years, it has had a mandatory pre-participation screening programme. Young people must present a certificate before taking part in organised sport or joining a gym, and the result is an 89% reduction in sudden cardiac deaths. While I acknowledge that there are different views across Europe on the rigidity of such systems, the outcome speaks for itself. Italy shows us what can be done when there is political will, public buy-in and healthcare alignment. I also pay tribute to CRY—Cardiac Risk in the Young—and its chief executive, Steven Cox, for the excellent work the charity does in raising awareness. It has been doing so since it was founded by Alison Cox in 1995. I do not propose a copy/paste solution, but I urge the Government and my noble friend the Minister to act on what we already know. What is needed is modest and actionable: first, more specialist training to interpret ECGs in fit and active young people; secondly, increased local capacity to carry out screenings in schools, universities and community sport—I urge the Minister to meet Hilary to look at some of the remarkable programmes in testing that Clarissa’s friends have put in place at Cambridge University; and, thirdly, greater education around cardiac health, defibrillator use and prevention woven into our schools and clubs. We must listen to families; we must act on evidence; we must catch the condition before it catches our children. These are preventable deaths. Let us not look back in five years and say that we could and should have done more. Let us act now to save young lives.

13:35:00

My Lords, we are all grateful to the noble Lord, Lord Booth, for arranging this Question for Short Debate on cardiovascular disease and for sharing his emotional and personal experience. The statistics about cardiovascular disease paint a stark picture of a health crisis that demands urgent and comprehensive attention. My thanks go to the British Heart Foundation, the Stroke Association, Diabetes UK and the House of Lords Library for excellent briefings. The facts are that every day in the UK 240 individuals wake up to the catastrophic reality of a stroke. Stroke remains the fourth-leading cause of death in our nation and a primary cause of disability. Every three minutes, a family loses a loved one to cardiovascular disease and CVD causes more than a quarter of all deaths in the UK. However, nearly nine out of 10 strokes are preventable, often associated with modifiable risk factors such as high blood pressure, smoking and physical inactivity. High blood pressure alone is the largest risk factor for stroke, contributing to 50% of all strokes. The number of people living with diabetes, or pre-diabetes, now exceeds 12 million in the UK, equivalent to one in five adults. Their risk of death from CVD is 4.2 times higher than for those without diabetes. Each week, diabetes leads to 812 strokes and 568 heart attacks. It is therefore vital that we optimise the detection and management of high-risk conditions such as high blood pressure, atrial fibrillation and high cholesterol. As part of that, we need strongly to support the measures in the Tobacco and Vapes Bill to further reduce the prevalence of smoking in this country, as we have done through successful regulatory measures over the past few decades. We need to support the reduction of other modifiable risk factors, including drinking alcohol to excess and obesity. The measures put forward by the House of Lords Select Committee on Food, Diet and Obesity, which was chaired by my noble friend Lady Walmsley, need to be given much more respect by the Government than has so far been the case. The current system for health checks, such as NHS Health Check, has the potential to screen for conditions such as diabetes, but more needs to be done to expand those checks, particularly to those at highest risk, including individuals under 40. It remains alarming that millions of people with diabetes are missing essential health checks annually which are crucial for detecting and preventing serious long-term complications. Beyond prevention, we need to consider many issues concerning treatment and care. There is still a critical lack of imaging capability for diagnostic testing, all of which delays patients’ access to specialist stroke units and time-sensitive treatments such as thrombectomy. We need to ensure 24/7 access to acute stroke treatments, including thrombectomy and thrombolysis, through pre-hospital video triage and access to specialist stroke units. We need a dedicated plan to drive action to address CVD and its risk factors. I know that the Government have committed to a 25% reduction in deaths from CVD and stroke by 2035 but, to achieve this, we need steps to reduce disability. Scientific research and innovation are the basis of progress in this field. The British Heart Foundation, a leader in cardiovascular science, funds more than half of independent cardiovascular research in the UK. It has powered advances that have nearly halved the number of people who die each year from cardiovascular disease. We are in an era of immense scientific opportunity, with revolutionary advances in areas such as artificial intelligence, genomics and regenerative medicine. BHF-funded scientists are already using AI to better predict heart attack or stroke risk. For those who have suffered a stroke, prioritising and investing in rehabilitation, in line with national guidelines, is critical to prevent recurrent strokes, as one in four survivors will experience another one within five years. Every stroke survivor should be offered a six-month post-stroke review to tailor recovery plans. Beyond this, we must continue to inspire the nation to learn CPR and continue to ensure greater provision of public-access defibrillators, as survival rates for out-of-hospital cardiac arrests are significantly higher in countries where bystander CPR is more prevalent. We must address the basic glaring issues of health inequalities in order to address these problems.

13:42:00

My Lords, I begin by thanking my noble friend for securing this important debate and, as other noble Lords have said, for sharing his own experience in a very moving way. It really brought home to us that this is about not just figures or statistics but the human side of this story. I thank all noble Lords who have contributed to this debate. It is not a particularly political debate; across the political spectrum, we can agree that we should work as constructively as we can together to try to address these issues. As the noble Lord, Lord Weir, reminded us, cardiovascular disease is the cause of one in four premature deaths in England. More than 6.4 million people suffer from it and it has resulted in 1.6 million disability-adjusted life years. According to the British Heart Foundation—many noble Lords will have read the excellent briefings that we have received from many organisations, to which we are grateful for informing us—this disease may be inherited or it may develop later in life. As the noble Baroness, Lady Winterton, said, those in the most deprived 10% of the population are twice as likely to die prematurely from these diseases than those in the least deprived 10% of the population. The highest premature mortality rate is in the north-west region, and men are twice as likely as women to die prematurely from this disease. As the noble Lord, Lord Rennard, said, the NHS has identified high blood pressure, smoking, high cholesterol, diabetes, kidney disease, inactivity—to which my noble friend Lord Moynihan referred—and obesity as risk factors. We also know that those at increased risk of developing this disease include people of south Asian and black African and Caribbean backgrounds. The King’s Fund think tank has estimated that there are 220,000 admissions for coronary heart diseases and 100,000 admissions for stroke a year, costing the NHS an estimated £10 billion and the economy £24 billion, so the human and financial cost are alarming. We must think about how we can work on this together, across the spectrum, to improve our use of resources and to reduce the number of deaths. As noble Lords discussed, in January 2025 the Select Committee on Health and Social Care considered the NAO’s report, alluded to by the noble Baroness, Lady Winterton, on progress in preventing cardiovascular diseases. Following this, a letter of recommendation was sent to the Parliamentary Under-Secretary of State for Public Health and Prevention on improving data collection on cardiovascular disease. When we were in government, we set out ambitious plans in the NHS long-term plan to detect and treat people with the risk factors of developing these diseases. This is not party political; any Government would have done that, because it is important. It included the NHS health check and face-to-face check-ups for adults aged between 40 and 74 in England. It was commissioned through local authorities and delivered through GP surgeries, to help spot early signs of heart disease. Indeed, many noble Lords spoke about how we identify and diagnose, as well as how we prevent. We also introduced a digital NHS health check to operate alongside the in-person NHS health check, to reduce the pressures faced by GP surgeries, particularly as more people now are aware of digital technology and are happy using it. These Benches also welcome the current Government’s manifesto commitment to deliver a renewed drive to tackle the biggest killers—cancer, cardiovascular disease and suicide—while ensuring that people live well for longer. I understand completely that the Government are in their early days, but, unfortunately, we are yet to see action in some of those areas. I admit that we were slightly disappointed that the new Government scrapped the major conditions strategy. I also understand, however, that we are waiting for the 10-year plan, and if these issues are integrated into the 10-year plan, as I hope they will be, that might be a better approach. As the noble Lord, Lord Weir, said, we should look at these things not in isolation but as part of an overall integrated plan. We would welcome any announcement from the Government on whether and how they would form part of the, I hope, more integrated 10-year plan. Like many other noble Lords, we eagerly await its publication. I conclude by asking the Minister some specific questions. How do the Government plan to improve support for vulnerable communities who are at a higher risk of developing cardiovascular diseases, including men, those in more deprived areas and people of south Asian and black African or Caribbean backgrounds? On 18 June, I will host an event with BRITE Box, a wonderful prevention charity that helps families from deprived areas to budget and to cook healthily on a budget, as a family together, to improve their health. I thank the Minister for agreeing to speak at that event. What specific programmes are the department aware of to improve this sort of prevention, including healthy diets and physical activity? How are the Government working with non-state, local community civil society organisations, such as BRITE Box, to make sure that we tackle these issues? My noble friend Lord Moynihan spoke about the role that physical activity plays in support and prevention. What other specific steps are the Government taking to close the health inequalities of communities in the most deprived areas, especially those faced by some ethnic groups? What progress have the Government made to ensure that those commissioning and delivering health checks are obliged to collect and report on the demographic data so that we can improve the data on age, gender, ethnicity and socioeconomic status, so that we can target better? My noble friend Lord Polak spoke about Cardiac Risk in the Young. I was slightly disappointed that when I wrote to one of the Minister’s colleagues in the department, they declined to meet with Hilary Nicholls, whom I had met to hear her daughter’s story and those of other people. I hope that the Minister and her officials will be able to accept the invitation from my noble friend Lord Polak, so that at least one person from the department can speak to Hilary Nicholls and Cardiac Risk in the Young. I hope that the Minister can confirm that this will be part of the overall 10-year plan. I understand that I have asked lots of questions and gone over time, as usual in my typically Socratic way, like other noble Lords, but I look forward to the Minister’s answers. If she does not have them now, I know that, thanks to the wonders of technology and her wonderful officials, she will write to us.

13:48:00

My Lords, I associate myself with the congratulations to the noble Lord, Lord Booth, on securing such an important debate. I am very grateful to him for doing that on the back of his personal experience. It shines a light and, while I realise that it is difficult, what he has done is worthwhile. Many of us will be affected by cardiovascular disease, either directly or indirectly, which is why we heard the noble Lord’s message so clearly. As we have all said, too many lives are cut short by CVD. In 2023, an estimated 6.4 million people were living with cardiovascular conditions and almost a third of CVD-related deaths in England occurred among the under-75s, which gives us the scale of the challenge. Over 1 million people report cardiometabolic conditions as being the main or secondary reason for being out of work due to long-term sickness. This is a challenge on so many levels. I thank the noble Lords, Lord Kamall and Lord Weir, for understanding that this requires a systematic approach across government, which we seek to have. In seeking to build a health and care system that is fit for the future, we are shifting the focus of our NHS from sickness to prevention. That is supported by the investment and direction of the Chancellor’s spending review of just yesterday. It is also why our health mission sets out an ambition to reduce premature mortality from heart disease and stroke by a quarter within a decade. It is important to go straight to the points that have been raised. Many noble Lords rightly raised prevention. As they are aware, around 70% of CVD cases are linked to preventable risk factors such as obesity, high blood sugar and smoking, to mention but a few. The noble Lord, Lord Moynihan, talked about the importance of exercise and I certainly share his view on that. I assure him that we work across government on this and I take his point that this is not particular to my department. We work very closely with the DCMS to ensure a joined-up approach. I remember hearing the noble Lord’s solution some years ago, I think on the Health and Care Bill. We have not committed to it, but the principles behind what he says are absolutely right. For example, we are working on better health resources, which include free evidence-based apps, websites and other digital tools, which will help people make and sustain improvements to their health. To take one example, I know the popularity of Couch to 5K. We will continue this work. The noble Lord, Lord Rennard, referred to the landmark Tobacco and Vapes Bill that is progressing through your Lordships’ House, which will help deliver our ambition for a smoke-free UK. We need to remember that smoking still claims some 80,000 lives every year. It is a cost not just to individuals and their families and communities but of some £3 billion to the economy, yet this is a preventable cause of death. Noble Lords will have heard in yesterday’s spending review that we are investing at least £80 million per year in tobacco cessation programmes and enforcement to support the Bill. The noble Lord also referred to obesity. There is a wide range of weight management services, from behavioural support in the community to hospital-based specialist services. This year, we will extend the NHS digital weight management programme to people living with obesity and awaiting knee and hip replacement surgery, which picks up on his point about preparation for treatment where necessary. The noble Lord, Lord Rennard, expressed disappointment in the Government’s response to the Lords committee report on food and nutrition, which I very much welcomed. I am sorry that he is disappointed, but I have drawn to the attention of his noble friend the noble Baroness, Lady Walmsley, that, just this week, following a recent Question in the Chamber, there was a change in the advice given by the department on the use and appropriateness of prepared baby foods, which she was rightly concerned about. A number of noble Lords talked about the NHS health check. It supports people to manage their risk through referral to weight management or smoking cessation. It is free and aimed at those aged between 40 and 70. It prevents around 500 heart attacks or strokes a year. It is about identifying early. I absolutely accept the points made by my noble friend Lady Winterton and the noble Lord, Lord Kamall—I am particularly interested in this matter—about the National Audit Office report and the Health and Social Care Committee’s inquiry on doing more to extend engagement with and take-up of the check. One of the things is a new development that will be piloted from this summer: a new NHS health check online, which people can complete at home. It will be piloted through the improved NHS app and, specifically, we will be independently evaluating the impact on equalities to inform the development and rollout. We have also engaged community pharmacy by investing heavily in blood pressure checks. Nearly 3 million checks have been delivered in over 9,000 pharmacies in the past year, and we are also embarking on new trials. So we are looking at ways in which we can engage better and, if I may say so, improve the NHS check as well. The noble Lord, Lord Weir, rightly raised the great potential of AI and technology. I can tell him that a considerable announcement on this was made just this week when I was in Cambridge. We are slashing red tape that currently inhibits innovation while protecting patient safety and encouraging innovation—something for which the industry and many others have been calling for some time. We are also getting the regulatory regime in the right place and investing in research, innovation and being up to date. Some years ago, we could not have dreamed of regulating AI but, now, we are absolutely right to look at how we do that. As the noble Lord said, technology and AI are absolutely key. I turn to the points on inequalities made by the noble Lords, Lord Weir and Lord Kamall, and my noble friend Lady Winterton. Our approach is called Core20PLUS5 and it is a national approach to support the reduction of healthcare inequalities at both the national and the local system levels. One of the five clinical priorities in that framework is the treatment and management of high blood pressure, which is, of course, a key risk factor for CVD. That is just one of the areas. Noble Lords, in particular my noble friend Lady Winterton and the noble Lord, Lord Weir, asked whether we would commit to a CVD action plan. We have already set the ambition. We are committed, as noble Lords are aware, to publishing a 10-year health plan in the not-too-distant future and to delivering that shift from sickness to prevention. In all of that, we are considering policies—along with, of course, our workforce plan, which will be published in the summer on the back of the spending review, as well as all that will follow from that. We are carefully considering the policies, including those that have an impact on people with CVD, as we develop the plan. The noble Lord, Lord Weir, rightly raised that men may be less likely to come forward to seek advice. We are in the consultation phase of developing a men’s health strategy, to which I hope he will contribute, and part of that is about recognising the point that he made. We are determined to close the gender gap in care. We also know that, among people with CVD, women are less likely than men to achieve target cholesterol levels. That has to change, so we will pursue it. I congratulate the noble Lord, Lord Polak, on his work in this area. I believe he introduced me to Hilary in the House. I heard his request for a meeting, and I will pick that up with the department. While I never like to disappoint him, the position at the moment follows the advice given by the UK National Screening Committee, which concluded that introducing population-level screening for sudden cardiac death in young people would run the risk of causing more harm by misdiagnosing some people and by providing false reassurance to those at risk of sudden cardiac death whose risk may not be picked up by screening tests. However, I am sure we will have the opportunity to pursue this further. A number of other points were raised, which I will of course review. In closing, I say to the noble Lord, Lord Booth, that I absolutely hear what he said about recognition, diagnosis and issues in aftercare. We will address this through the number of future developments that I referred to and the NHS long-term plan that is already in existence. I hope that he will be less disappointed should he or a loved one have to seek treatment, care or aftercare in the future, and I thank him.