COMMENTARY

Will NHS England's Long Term Plan Improve the Nation's Cardiovascular Health?

Mamas A. Mamas, BM, BCh, MA, DPhil, FRCP

Disclosures

January 28, 2019

My name is Professor Mamas Mamas. I'm professor of interventional cardiology based at Keele University in the United Kingdom and today I'm going to discuss the NHS Long Term Plan.

So the NHS has been in existence now for 70 years. But rather than look backwards, the Government has decided to unveil its long-term plan for the NHS and its services looking forwards over the next decade.

Patients are getting older, more comorbid. There's increasing financial pressures on the NHS and also issues around workforce recruitment and maintaining workforce.

And so the Government has put together a long-term plan about how it envisages delivery of healthcare services and investment in healthcare services over the next decade. This contains many different components to the plan. So for example, it talks about staffing and the challenges of staffing, how to retain staffing, the recruitment of nursing staff, doctors. It talks about funding. It talks about inequalities and healthcare provision, but also how to utilise digital technologies in optimising delivery of healthcare provision.

Plans for Heart Health

I'm going to focus today mainly around cardiovascular aspects of the long-term plan. So they talk about cardiovascular disease. It's an important cause of morbidity and mortality in the United Kingdom. Even though over the last 20 to 30 years there's been a halving of all cardiovascular deaths, nevertheless, 1 in 4 premature deaths in the United Kingdom is because of cardiovascular disease. So there’s still a lot of work to do.

So they talk about various aspects of cardiovascular care. First and foremost, one of the areas that they focus on is the early detection and treatment of cardiovascular disease.

We know that some of the biggest killers in cardiovascular disease, such as AF, hypertension, hyperlipidaemia, are often undetected until it's too late, you know the first time the patient is detected of having AF, or diabetes, or hypertension, is when they have that first incident cardiovascular event. So central to this is around using other community services such as pharmacies, and developing genetic testing for familial hypercholesterolemia, and other means, so using digital health technologies in protecting patients at risk from cardiovascular disease.

You know, digital health is one of my interests. They talk about utilisation of digital health, but they don't really talk about how it's going to be funded. Because often there's an upfront cost associated with digital health technologies. Is this going to be additional funding streams? Is there going to be funding from other sources? So it's all well and good to talk about digital health in this document, but I think we need more details about exactly how this will be done.

We talk about public health - public health is a very strong component of the NHS plan. They talk about reducing obesity, cutting salt in diets, but again, the devil's in the details so you know, voluntary reductions in salt have been not as successful as perhaps hoped for. So is there going to be some sort of salt tax similar to the sugar tax? I think this would be very much a good way forwards and addressing the problems in high-salt diets in the United Kingdom.

Heart Failure

Other areas that they talk about are heart failure. Heart failure is one of the most important causes of hospitalisation in the United Kingdom. And we know that referral services, such as heart failure services are associated with reductions in mortality for these patients. So they talk about these patients being better supported by a multidisciplinary team as part of primary care networks, earlier access to nurse-led heart failure clinics, and reducing inequalities in patients' care received during the treatment of heart failure.

CPR and More

I think a very important part of the NHS plan is focused around cardiac arrest treatments and management. So they talk about fast and effective action to help save lives of patients developing cardiac arrest.

We know that, you know, what proportion of individuals that can undertake resuscitation, and the access to defibrillators is very patchy in different parts of the United Kingdom. And the national health care plan talks about developing the national network of community first responders and defibrillators, and they aim to help support 4000 lives each year by 2028.

I think certainly on Twitter there has been a lot of discussion around education of CPR in schools particularly, and I think, you know, this is very much a right step, you know, teaching young children how to undertake CPR. Again, people in the workplace having courses for CPR, but importantly, having widespread access of defibrillators in public places. And then knowing what to do with these patients once they've been successfully resuscitated, you know, so there are a number of trials ongoing around direct access of situations to heart attack sensors or cath lab sensors.

So I think that's very much an area under development.

Stroke

With regards to stroke, they talk about having increasing uptake of thrombolysis. We know that only a very small proportion of patients with a stroke will get timely thrombolysis. So developing stroke networks, having 24-7 processes, and really developing thrombectomy. I think one of the challenges that we're going to face is a workforce challenge. Clearly, there's not enough neuroradiologists to develop this modality of treatment. So I think it's going to be really important to try to think about how best and who best will be placed to deliver such care. But I think it's probably going to be a mixture of interventional cardiologists, radiologists, possibly even stroke physicians.

Digital Health

So finally, the area that I think is quite exciting is digital health. Certainly there's a lot of discussions over social media around whether we have to actually see patients face-to-face over follow-up. My view is with secure digital platforms, you can certainly do a lot of follow-ups over FaceTime or Skype, or other modalities, and that would reduce or increase capacity to be able to focus on more complex patients that need face to face discussions rather than digital health.

As I mentioned earlier, there is always the issue of upfront costs about introducing these technologies, but also privacy, security, and where is the data going to be stored? How can we access the data as healthcare providers? We know that the infrastructure from the IT perspective has been a bit of a disaster in the National Health Service. So I think you know that there really does need to be real thought about how this can be optimised before we can start to see realistic use of digital health in the service.

So I think overall it's an exciting document. It's a document that recognises many challenges, around staff training, around funding, around inequalities, and also around service delivery and provision. I think the challenge though, is in the detail, how are we going to achieve many of this these aspirations over the next 10 years?

So thank you for joining me on Medscape. I'm wearing my red tie today because it's Go Red for Women in February where we focus around women's cardiovascular health. So I hope that you will join me in raising awareness for that as well. Thank you.

You can follow Mamas Mamas on Twitter

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