NHS: Standards

Health written question – answered on 3rd June 2009.

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Photo of Nicholas Winterton Nicholas Winterton Conservative, Macclesfield

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

Photo of Ann Keen Ann Keen Parliamentary Under-Secretary (Health Services), Department of Health

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

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

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

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


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


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

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

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


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

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

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

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

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