Dr Neil Shastri-Hurst

It is a pleasure to serve under your chairmanship this afternoon, Dr Huq. As the hon. Member for Glasgow South West (Dr Ahmed)—I call him my hon. Friend—pointed out, I have a particular interest in this subject. It is a number of years since I held a licence to practise, but the debate has taken me back to clinical days. Even worse, it took me back to vivas for Royal College examinations—I am still a member and am proud to support that community. I start by thanking the hon. Member for Strangford (Jim Shannon) for securing this debate. I congratulate him and the APPG on vascular and venous disease on their work. As has been noted, vascular disease perhaps does not attract quite the same attention as cancer or heart disease. However, that does not make it any less serious. The consequences for patients can be extreme. We have heard about pain, loss of mobility, prolonged hospital stays and, in the worst cases, amputation. What makes this particularly frustrating is that a great deal of this harm is avoidable. The problems identified by the APPG are not especially complicated. There are delayed diagnosis and treatment, inconsistent referral pathways, variable access to specialist care and fragmented services. The result is that patients who might have retained their limb and their independence do not always do so. The APPG’s report therefore makes five fairly practical recommendations: the national foot attack pathway, with same-day or next-day triage; community-based foot protection services in every integrated care system; maximum waiting times for vascular assessment and revascularisation, with national reporting; commissioning that rewards outcomes rather than simply activity; and faster adoption of proven innovation. None of those propositions strikes me as particularly revolutionary. Indeed, much of the thinking behind them is not new. The “Getting it right first time” programme established under the previous Conservative Government produced a vascular surgery report in 2018, which recommended a hub-and-spoke model to improve early diagnosis, specialist decision making and timely intervention. The NHS long-term plan subsequently committed to universal access to multidisciplinary foot care teams. In 2022, NHS England introduced a two-year commissioning for quality and innovation scheme intended to encourage timely revascularisation for patients with chronic limb-threatening ischaemia. The Government have said that they welcome the APPG’s report. They have said that the Department of Health and Social Care and NHS England have engaged with stakeholders, and that recommendations will be considered as part of the cardiovascular disease modern service framework. That sounds encouraging, but there is a rather obvious difficulty: although it is welcome that the modern service framework, which was published in July, contains considerable material on cardiovascular disease, it contains no specific reference to vascular or venous disease. If the Government accept that vascular disease is an important part of the cardiovascular picture, why does their new modern service framework not specifically address it? If the answer is that the framework is intended to cover vascular disease through its wider approach to cardiovascular risk, that poses a second question: where precisely are the specific standards against which vascular services are to be judged? The APPG has given the Government some specific proposals, and it would be helpful if the Minister could tell us which of the five recommendations the Government accept and, perhaps more importantly, which they reject. The question then is who will deliver the services? The Government have embarked on a major reorganisation of the NHS, including the abolition of NHS England, and a substantial reduction in the size and cost of integrated care boards, with the Government saying that ICB budgets are to be reduced by 50%. How does the Minister expect ICBs to deliver these additional responsibilities at precisely the point when their budgets and staffing levels are being substantially reduced? Has his Department assessed the effect of those reductions on the commissioning of vascular care and foot protection services? I am far from opposed to reducing bureaucracy in the health service, but the test of any NHS reform has to come down to patient outcomes. I hope the Minister will also address the question of clinical leadership in this area. Currently, although there are clinicians with huge experience and expertise in the field, including vascular clinical leads for GIRFT, there is no national clinical director specifically responsible for vascular and venous disease. The Government have previously said that national clinical directors play an important role in policy development and implementation, which is right, but we know that the future role and responsibilities of national clinical directors are being reconsidered as part of NHS reorganisation. Could the Minister set out the Government’s position on future clinical leadership for vascular and venous disease after NHS England has been abolished? Will a clearly identified senior clinical voice continue to be responsible for that important area, and if not, who will have responsibility for ensuring that the specific recommendations on vascular care are implemented? It is helpful that the national vascular registry already collects data on major vascular procedures, including bypass surgery and major lower-limb amputations, and there has been some improvement in the proportion of vascular providers meeting the relevant CQUIN framework, but we need to be careful not to confuse the mere collection of data with improvements in care. Will the Government therefore introduce national maximum waiting times for vascular assessment and revascularisation? If they do not propose to do so, why not, and if they do, when will it take place? Returning to the national foot attack pathway proposal, the principle behind it seems difficult to argue with. Where a patient presents with a potentially serious foot problem, particularly in the context of diabetes or vascular disease, as we have heard, they should have a clear route to an appropriate specialist assessment. Will the Government commit to establishing such a pathway nationally? Will the Minister ensure that data on performance against that is published? The same principle applies to innovation. The NHS has no shortage of good ideas, but it has traditionally lacked a reliable mechanism for taking an idea that works in one hospital and making it available elsewhere. Therefore, the APPG’s recommendation to make greater use of mechanisms such as the NHS innovator passport is sensible. However, what happens at the other end? If a technology is demonstrated to be clinically effective and cost-effective, does an NHS organisation have an obligation to consider adopting it? How will the Government prevent another postcode lottery, where an effective treatment is available to patients in one part of the country but not in another? In this debate, there is not much disagreement on the broad objectives: we all want to see earlier diagnosis, faster treatment and fewer amputations, as well as better use of NHS resources. Any disagreement is about whether the Government have set out a sufficiently specific plan for achieving those objectives. It is easy to welcome a report or publish a framework; it is much harder to deliver it. The Government have a genuine opportunity to take the practical recommendations of the APPG and turn them into measurable outcomes. That is the test: will they do that, or will they just allow vascular services and vascular disease to remain a subsidiary issue within the much broader context of cardiovascular disease and hope that local services are simply able to deal with it?