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Backbench Business
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
HIV Testing Week
(1 week, 3 days ago)
Westminster HallRead Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
David Mundell (Dumfriesshire, Clydesdale and Tweeddale) (Con)
I beg to move,
That this House has considered HIV Testing Week.
It is a great pleasure to serve under your chairmanship, Dr Allin-Khan. I am grateful to the Backbench Business Committee for granting this debate during National HIV Testing Week in England. Each year, the campaign funded by the Department of Health and Social Care, and delivered by the Terrence Higgins Trust as part of the national HIV prevention programme in England, brings us together to raise awareness of HIV and to promote regular HIV testing, in particular among the groups most affected by HIV. It is always the way that Parliament works that this debate coincides with a debate on LGBT+ History Month, although the two subjects are so linked.
Over the Christmas recess, I was reading Alan Hollinghurst’s book “The Line of Beauty”, which brings home the fact that, at that time in the 1980s, a test was potentially a death sentence. People dreaded going for one, because of the result it might bring and the impact on their life and the lives of their family and those close to them. We have moved on to be able to say with 100% certainty that, if someone gets a positive result from an HIV test —which people can do in their own home—treatment means they can have a normal life expectancy and cannot pass the virus on. That remarkable fact is what makes this a generation that can end new HIV cases across this country.
I encourage everyone in the Chamber, across Parliament or watching these proceedings to take part in the current campaign and to order a free HIV test. I was particularly pleased to see the Prime Minister take a test and demonstrate how straightforward and lacking in process it is. Many people still think a test might involve needles and health service professionals, but a test can be taken at home with an easy-to-access kit.
Florence Eshalomi (Vauxhall and Camberwell Green) (Lab/Co-op)
I thank the right hon. Member for his excellent opening remarks. Does he agree that the Prime Minister taking that test in Downing Street highlights the issues around stigma and the fact that people can test safely within the confines of their own home, without anyone else or the glare of a clinic? It is that person and the test kit, with sample results.
David Mundell
I absolutely agree with the hon. Lady, who is one of my co-chairs on the all-party group on HIV, AIDS and sexual health. She has done so much to promote this issue, particularly among difficult-to-reach groups in the black and minority ethnic community and among women, and I commend her for that. I agree absolutely: taking a test, as I have done many times, is a routine matter that, in essence, involves merely pricking a finger and delivering a small amount of blood. That can be returned anonymously, and the result comes back without anyone else being involved. Were any issues to arise from the test, the person would know that proactive and supportive contact would generally be made with them.
Normalising HIV testing is crucial if we are to find the 5,000 people across the UK living with undiagnosed HIV. Central to that is opt-out testing in emergency departments. I am proud that with parliamentary colleagues on the all-party parliamentary group, and with the help of Sir Elton John and the amazing campaigning of HIV charities, we won the case for a £20 million investment in opt-out testing in England in 2021 and for a further £20 million for expansion to 47 more A&Es in 2023.
Since its routine introduction in 2022, opt-out testing has been an incredible success in normalising HIV testing in the health sector. Across 34 emergency departments over just two years, nearly 2 million HIV tests have taken place. In its first 18 months in London, Brighton, Blackpool and Manchester, more than 900 people were newly diagnosed with HIV or were found, where they had been lost to HIV care. A further 3,000 were found to have hepatitis B or hepatitis C.
This approach also relieves pressure on the health service. Data from Croydon university hospital found that when it first started opt-out testing, the average hospital stay for a newly diagnosed HIV patient was almost 35 days. Within two years, the average stay was just 2.4 days.
I am proud that the last Government were the first to fund opt-out testing. I am also pleased that in November the Prime Minister announced further funding to extend the testing intervention period. That will bring to 89 the number of hospitals funded to routinely test for HIV anyone who has their blood taken in the emergency department.
As a Scottish MP, I want to be able to tell hon. Members how we are leading the way in addressing the HIV epidemic in Scotland, but unfortunately that is not quite the case. There are good news stories. Early action to make pre-exposure prophylaxis—PrEP—freely available on the NHS has helped to drive down new transmission of HIV in Scotland. Year round, everyone in Scotland has access to free at-home HIV testing, which is made available through the Terrence Higgins Trust testing service and funded by the Scottish Government. In 2023, a landmark campaign delivered by the Terrence Higgins Trust addressed the stigma that we all know surrounds an HIV diagnosis. It is astonishing that that campaign was the first of its kind since the tombstone adverts four decades ago. I hope that that important work to combat HIV stigma continues in Scotland and across the rest of the UK; it cannot be a one-off.
However, for all this success, the reality is that progress towards achieving the historic feat of ending new HIV cases in Scotland by 2030 is now at risk. I have mentioned the resounding success of emergency department opt-out testing in England, and the role that that will play in helping to get the NHS in England back on track towards reaching zero new HIV cases by 2030. The clear evidence is that opt-out testing works, yet Scotland is still to adopt the same universal approach to HIV testing. As it stands, no area designated as high prevalence, such as Glasgow and Edinburgh, is benefiting from the opt-out testing programme. I have again written to Scotland’s Health Minister, Neil Gray, to ask that that be reconsidered.
An estimated 500 people are living with undiagnosed HIV in Scotland, and a growing population of people are living with diagnosed HIV but are no longer accessing vital treatment and care. If we are to succeed in getting to our 2030 goal across the UK, we must reach each and every one of those people. Every day that emergency department opt-out HIV testing is not on offer, opportunities to find and support people living with HIV are being missed.
Although Scotland is clearly not within the Minister’s remit, I hope that she, the public health Minister and the Health Secretary will use opportunities to raise this issue with the Scottish Government and to highlight their own successes. As she may know, the Scottish Government are keen to highlight what they perceive to be health failures in England. This is a great opportunity to highlight a health success and to call the Scottish Government out on their own approach.
That also applies to HIV testing week. For this week to be most effective, it should apply across the United Kingdom, so that we can benefit from the positive publicity that came from the Prime Minister’s test. That is not available to people in Scotland, because HIV testing week is not happening there this week, despite my calls last year for it to be extended to Scotland. There is a testing week in Wales, but it is not as co-ordinated on a UK basis as we would want to see. Such co-ordination would allow everyone to benefit from promotional campaigns such as the excellent one in Parliament this week, which the Terrence Higgins Trust facilitated for Members of the House.
I very much recognise the work of Terrence Higgins Trust Scotland and Waverley Care, which I had the great pleasure of visiting at its premises in Edinburgh recently. They are doing a great job, but when we have National HIV Testing Week, it needs to be across the whole United Kingdom. Testing is the only way we know to find a person’s HIV status, and that is why the current campaign, testing week and interventions such as opt-out testing are so integral to our HIV response.
We are now five years away from 2030, and in no part of the UK are we on track to achieve our goal of ending new cases of HIV. Getting there will require cross-party working, and we have always worked cross party on the all-party parliamentary group, which has the highest number of members of any APPG in this Parliament and has been around for over 30 years. Many Members across Parliament work tirelessly in that group to ensure that we reach the 2030 goal, and I am sure the Minister will tell us more in her response about what is being done to achieve that.
I know that this is not directly within her remit, but it would be remiss of me not to mention testing in other countries. We have heard about HIV testing week here in the UK, but poorer countries rely on the Global Fund to Fight AIDS, Tuberculosis and Malaria, and particularly the United States President’s Emergency Plan for AIDS Relief, which it funds along with the US to deliver testing and treatments. We know that the future of US funding is, at best, uncertain. This country has always been at the forefront of the Global Fund, and leadership on this year’s replenishment is important. I was pleased to hear what the Prime Minister had to say yesterday about Gavi and vaccinations, and I hope he will be able at some point to give a similar commitment on the Global Fund. I hope all Members would agree that it would be quite wrong if we were to achieve the target in the UK, but just left poorer countries and the rest of the world to get on with it and, in fact, go backwards as a result. I make that call in relation to the wider issue.
I encourage anyone to take a test. It is very straightforward and easy, it will help to identify those we do not know about and it will help us to achieve that 2030 goal.
Several hon. Members rose—
Dr Rosena Allin-Khan (in the Chair)
I remind Members that they should bob—as they are doing—if they wish to be called in the debate. Given the number of Members who wish to speak, and to ensure that everybody gets to say what they wish to, I suggest an approximate time limit of five minutes. We will move to the Front-Bench spokespeople at about 2.28 pm. I call Jim Dickson.
Jim Dickson (Dartford) (Lab)
It is a pleasure to serve under your chairship, Dr Allin-Khan. I pay tribute to the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for securing this important debate and for his excellent speech.
We are here because of the work done by the excellence Terrence Higgins Trust, which, with the Department of Health and Social Care, runs the vital National HIV Testing Week campaign. It provides a vital staging post towards the goal, which we all share, of ending new HIV infections by 2030. This week, as the right hon. Member said, anyone can order a free postal HIV test, and I encourage anyone listening to do so. I was pleased to be able to take a test myself just next door, on Tuesday, at the excellent event run by the Terrence Higgins Trust.
I welcome the goal set by the last Government to end new HIV cases by 2030, and I am pleased that the new Labour Government have commissioned a new HIV action plan for England, which is expected to be published in the summer, to make that a real prospect as we approach 2030. As I am sure other hon. Members will agree, if we are to meet this ambitious target, it is crucial that we find the estimated 4,700 living with undiagnosed HIV in England, as well as those across the UK, and ensure that they are getting the lifesaving treatment they need and cannot inadvertently pass on the infection. It is clear that that will happen only through testing.
In my previous life as cabinet member for health in Lambeth, we worked very closely with the Elton John AIDS Foundation to introduce the world’s first social impact bond focused on bringing people living with HIV into care. We worked with a coalition of third-sector organisations across the three boroughs of Lambeth, Southwark and Lewisham to ensure that health settings earned outcome-based payments each time they identified someone either newly diagnosed with HIV or someone who had stopped treatment, and linked them back into care. Our brilliant GPs across the three boroughs carried out opt-out testing to accompany this set of changes. The results were dramatic: over three years, more than 265,000 people received HIV testing, and more than 460 south Londoners living with HIV entered treatment. More than 200 people received a new HIV diagnosis and attended their first treatment, and 250 who had stopped treatment returned to care.
I am proud of the work done across local government in the fight against HIV/AIDS. In Lambeth, for instance, the council has led London boroughs on commissioning of the London HIV prevention programme. We were in the forefront of the successful campaign to get PrEP provided free on the NHS for all those who needed it, and the council continues to jointly commission, with our neighbouring boroughs, work with marginalised groups to reduce stigma and thereby increase awareness of HIV and the need to take tests.
I support the Government’s aim of ending new HIV cases in England by 2030, supplemented, it needs to be said, by the Mayor of London’s great work in ensuring that the capital is a fast-track city. However, that date is only five years away and, like the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale, I worry that without a dramatic increase in testing, we will not get there. I was pleased therefore that last month the Government announced an expansion of the number of hospitals carrying out HIV opt-out testing, including Darent Valley hospital in Dartford, in my constituency. I welcome the service that will be made available to my residents as a result.
I hope that the new HIV plan for England, expected this summer, will build on that expansion and bring the increase in opt-out testing we need to find all those unknowingly living with HIV. The incredibly welcome 5.4% increase in the public health grant for 2024-25—that is £200 million, which is the biggest increase for many years—will strengthen this work, alongside so many other areas in which we need to tackle health inequalities.
I would like to end by paying tribute to all the charities working so hard to tackle this issue, including but not limited to the Terrence Higgins Trust, the Elton John AIDS Foundation and the National AIDS Trust.
Bell Ribeiro-Addy (Clapham and Brixton Hill) (Lab)
It is a pleasure to serve under your chairpersonship, Dr Allin-Khan. I congratulate the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on bringing forward this important debate and on the work he continues to do with my hon. Friend the Member for Vauxhall and Camberwell Green (Florence Eshalomi) on the APPG.
While we will spend most of this afternoon’s debate speaking about the goal to end new HIV transmissions by 2030, I feel it is important to recognise just how far we have come in our understanding of HIV and treatments for it, and in our education and awareness raising. We have seen so much progress in the fight against HIV since the 1980s crisis. Although there is still a way to go, it is through open discussions, such as the one we are having today, that we have been able to reduce the number of HIV cases in the UK down to an estimated 113,500. But it is thought that 4,700 people are unaware that they are living with HIV, and that is why it is vital that we continue to push to increase testing. We know that when caught early HIV is treatable and that the quality of life of those living with HIV is far better than it was back in the ’80s. Unknowing carriers risk not only not getting the treatment they need or getting it too late, but unknowingly infecting others. Testing is easy, quick and can save lives.
We know that testing among men who have sex with other men is high. This is incredibly encouraging, but we must do more to increase testing among heterosexual men, heterosexual and bisexual women, and the trans and non-binary community. The stereotype that HIV is only something that affects men who have sex with men is not true. In fact, the increase in infections in 2023 was attributed to sex between men and women, with a 35% increase among heterosexual men and a 30% increase among heterosexual women.
We should be doing more to encourage testing among all groups. That means greater investment in local and community-based public health initiatives, so I am pleased that the Government are investing in local government public health. I am particularly pleased to hear about the £38 million that is being awarded to my borough of Lambeth, which will go a long way towards supporting people with HIV, preventing HIV and funding other public health initiatives that the borough runs.
My hon. Friend the Member for Dartford (Jim Dickson) spoke about the important role that councils play, and it is a crucial role indeed. They encourage testing and are well-poised to target the right communities and areas to increase awareness, and they can tailor messaging in the way that is needed. The work of local councils and community-based organisations has really helped to increase testing rates and reduce stigma. It has also helped to ensure that as many people as possible know their HIV status, and the recent round of Government funding will continue supporting that work.
I hope to see more from the Government on the international front. We must actively look to support international efforts to stop HIV transmissions, especially at a time when President Trump is running his reckless review of American aid and has put the future of the US President’s Emergency Plan for AIDS Relief in the balance. Any credible attempt to end HIV transmission must include a global response. When it comes to ending HIV transmission, we are not an island. Ending new cases here will only last for so long if we are not contributing to efforts to end them abroad. Where the US is stepping down from efforts to tackle global HIV transmissions, we should be stepping up.
As it stands, we are already not on track to reach our target of ending new cases by 2030, but I hope that today we will hear insights from the Minister on the steps the Government are taking to increase testing and to end new cases in the UK and abroad. As I am sure other hon. Members do, I eagerly await the Government’s new HIV action plan in the summer.
Siân Berry (Brighton Pavilion) (Green)
It is a pleasure to serve under your chairship for the second time this week, Dr Allin-Khan. I thank the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) and the co-chairs of the APPG for all the work that they do.
I also echo calls from hon. Members for the funding for global work that is being shamefully cut back by the new US Government to be found from within this country. I ask the Minister to look at the pressure that is also being put on, and the funding that is being withdrawn from, wider rights-based groups, which we spoke to yesterday in a fantastic and interesting roundtable. There are many groups working in the global south to support LGBT rights and reproductive rights, which include healthcare. The impact of the cutback more widely will be on health, and we owe it to those groups to ensure that we are doing what we can to make up for what the American Government are so awfully doing.
I am pleased to join this important debate and to support HIV testing week. I absolutely commend the efforts being made by so many MPs, including the Prime Minister, to promote HIV testing. That is great to see. As an MP for Brighton, I am proud of the work of the Terrence Higgins Trust—which is partly based in my constituency, not far from my office—for making this a bigger event every year, and more and more inclusive. I recently visited THT to see first-hand the incredible work it is doing to end new transmissions of HIV, supporting people to live well with HIV, and challenging the stigma and all the things that go around that. Its work with partners in my city, like the pioneering Lawson unit at the Royal Sussex County hospital and the local HIV charity, the Sussex Beacon, is all so exciting.
Opt-out testing was mentioned. The emergency department at the Royal Sussex has been doing that testing since March 2022. It has since been rolled out nationally in areas of very high HIV prevalence. In Brighton, the team at the Lawson clinic has identified 16 new HIV diagnoses in recent years. That sounds like a small number, but the impact for each individual is absolutely massive. They are all people whose HIV will almost certainly have gone undetected up until then. All the work that is being done to normalise testing as part of a trip to A&E, when blood is drawn, does so much to reduce HIV stigma, help people, and save and improve lives.
Brighton also has some groundbreaking digital pathway work happening. The locally co-designed HIV app EmERGE has been a big success. It is a European project centred in Brighton, and I am told that people absolutely love it. There are about 720 people using it for PrEP access, appointments and support. This innovative approach has helped ease the pressure on local services and freed up about 1,000 local appointments per year. That is fantastic work, making all our money go further and helping people to cut their transmission risk without fuss and bother. That is what we all need to be working towards.
Let us be clear: zero transmission of HIV is possible by the target date of 2030. The work in Brighton that I have just described proves that. I truly believe that Brighton could be the first place in the UK to achieve that target, given the comprehensive work going on. I know that hon. Members in the Chamber are aware of all of that, and I hope the Minister will set out how a roll-out of that model across the UK will be funded.
Dr Rosena Allin-Khan (in the Chair)
In order to get all Members to speak in this important debate, I gently suggest a time limit of three and a half minutes.
Paul Davies (Colne Valley) (Lab)
It is a pleasure to serve with you in the Chair, Dr Allin-Khan. I will certainly try to keep to three and a half minutes.
As we mark National HIV Testing Week, we unite to promote regular HIV testing, particularly among those most affected. Despite significant progress, we are advised by the Terrence Higgins Trust, the National AIDS Trust and the Elton John AIDS Foundation that, as has already been said, we are not on track to meet the goal of ending new transmissions of HIV by 2030.
The latest data from the UK Health Security Agency shows a plateau in the decline of transmissions among gay and bisexual men, and a rise in new transmissions outside of London. To reverse the trend, we must scale up HIV testing and find the estimated 4,700 people living with undiagnosed HIV in England. The Brunswick Centre in my area plays a pivotal role in this effort. Its work in providing support, education and testing services is of huge value. It offers a safe space for individuals to get tested and receive the care they need. By partnering with local communities, the Brunswick Centre ensures that everyone has access to lifesaving information and services. I join the HIV community in calling on the Government to invest in year-round online HIV and STI postal testing services, and to continue opt-out HIV testing in emergency departments.
We must also address the stigma that prevents many from seeking care. Everyone living with HIV deserves to feel safe and supported in every healthcare setting. On the issue of stigma, I commend my senior parliamentary officer and the secretariat for the APPG on HIV, AIDS and sexual health for their outstanding work in combating stigma and educating us on the actions we must take to address this crucial issue. Together with the dedication of organisations like the Brunswick Centre, the Terrence Higgins Trust and others, we can achieve the goal of ending new HIV cases by 2030 and be the first in the world to do so. Let us make HIV testing a routine part of healthcare and ensure that no one is left behind.
Florence Eshalomi (Vauxhall and Camberwell Green) (Lab/Co-op)
It is a pleasure to see you in the Chair and to serve under your chairship this afternoon, Dr Allin-Khan. I thank the Terrence Higgins Trust for partnering with the Labour African Network to host a fantastic event on Monday that highlighted why it is so important for us to continue testing, and especially to get the communities that do not often come forward to test. It was good to hear so many people at that event highlighting why that is so crucial. That was the first engagement of the new Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire (Ashley Dalton); it was a really good event for her to attend.
I also want to highlight the visit to University Hospital Lewisham that I conducted in February 2022 to look at its opt-out testing with my hon. Friends the Members for Clapham and Brixton Hill (Bell Ribeiro-Addy) and for Lewisham East (Janet Daby). I was struck by the age of someone that had been lost to HIV; she was an elderly woman in her 80s. That is why it is so important to test.
I thank all hon. Members for their comments and my wonderful APPG co-chair, the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell), for his opening speech. I want to focus my remarks on a critical issue that affects our communities: HIV and its impact on the black communities in the UK. Despite significant advancement in HIV prevention and treatment, black communities continue to face disproportionate rates of HIV diagnosis and late detection. That disparity is not just a statistic; it represents the lives affected by systematic inequalities, stigma and a lack of culturally appropriate services.
I want to highlight the work of the London HIV Prevention Programme, which is taking vital steps to address the disparities through new outreach work aimed at black Londoners. Under the banner of Do It London, that programme is designed to increase HIV awareness and encourage regular testing to provide robust support for those living with HIV. By partnering with trusted communities, it ensures that its efforts are culturally sensitive and effective.
I want to give a shout-out to Marc Thompson, the lead commissioner for LHPP. He brings his personal passion and lived experience to that initiative. As a black, queer Londoner and HIV activist, Marc understands the unique challenges that our communities face. His dedication is a testament to the importance of having voices from within the community leading the charge.
I also want to put on record my thanks to Fast-Track London, One Voice Network, NAZ, LGBT HERO, METRO, Positive East, Sophia Forum and the 4M network for the work they do to provide services not only in my constituency, but right across London. We need an approach that is informed by the communities affected. Do It London is leading the way by allowing black Londoners to shape the services designed for them.
We must also recognise that HIV is not just a health issue, but a social issue. Black communities have historically been under-represented in prevention and support. We must build trust and address black HIV services and outdated stigma. By prioritising those efforts, we can reduce HIV rates and improve health outcomes for black communities. Together we can create a service that works towards the goal of no more HIV by 2030.
Jim Shannon (Strangford) (DUP)
I congratulate the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on leading today’s debate. I am my party’s health spokesperson, so I make it my business to come to health debates. Indeed, I think I have missed only one debate on HIV in the 14 years that I have been here.
Health is a devolved issue, so there may be different guidelines surrounding access to testing and to testing itself, but we all have the same goal wherever we are in this great United Kingdom of Great Britain and Northern Ireland. England could be the first country in the world to reach the goal, but we are currently not on track, so perhaps the Minister will tell us what action will be taken to ensure that happens.
In Northern Ireland, there has been a significant increase in testing in recent years. Efforts have been made to promote early intervention and treatment. The Public Health Agency in Northern Ireland revealed that in 2023, a record 92,635 tests were conducted. Given that the population is 1.9 million, I think that is very significant. That is a 5% rise on 2022, and it is the result of a massive commitment by us—health is devolved to us—to ensure early detection.
On the other hand, the number of new HIV cases has also risen. In 2023, there were 101 cases—67 men and 34 women—which was a 41% increase on 2021. I know the numbers are small, but the percentage is quite worrying. It is alarming that some of those cases were linked to injecting drugs, so will the Minister give us some idea of how we will address that issue? It is not just about physical exchange; it is also about the use of drugs, so what can be done to stop that? Sharing a needle is a cause of HIV for some drug users, and that concerns me.
The right hon. Gentleman referred to the ’70s and ’80s—I am of an age that I can remember them very well. Historically, HIV was a stigma, and it was Princess Diana who helped to take away some of that. I always remember that she met people with HIV, sat alongside them, shook hands with them and drank out of the same teacup, and that dispelled some of the concerns that people had, so we are thankful for that.
Testing for HIV of course must be discreet. There are numerous sexual health clinics across Northern Ireland, and indeed across the United Kingdom, that offer sexual health advice and testing. In addition, more discreet, self-testing kits are available, so we should be looking at some of those things.
Early diagnosis is key to ensuring that treatment can be started quicker. Treatment can reduce the viral load, which means that the disease becomes untransmissible. The hon. Member for Vauxhall and Camberwell Green (Florence Eshalomi) and the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale mentioned HIV in third-world countries, and I agree with their sentiments entirely. The Elim church in my constituency of Strangford deals with people with HIV in Swaziland in Africa, and a choir comes over every year to do some fundraising. Every one of those young children with lovely voices received HIV from their parents when they were young, but the good thing is that they are now HIV-free as long as they have the drugs, so there is a way of going forward.
Charities, agencies and church organisations do their best to provide support. I have seen and understand what they can do. I very much look forward to hearing from the Minister. I hope she can work in parallel with her counterparts in the devolved nations to ensure that we tackle HIV together and meet our 2030 goals.
Mr Alex Barros-Curtis (Cardiff West) (Lab)
It is a pleasure to serve under your chairship, Dr Allin-Khan. I pay tribute to the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for his speech and for securing this important debate. It is indeed an honour to take part in it, particularly during National HIV Testing Week, and to follow such excellent contributions from Members from both sides of the room.
I am the Member of Parliament for Cardiff West, so it would be remiss of me not to discuss the proud role that Wales has played in responding to the AIDS epidemic and providing ongoing support to people living with HIV. Indeed, the Terrence Higgins Trust gets its name from a Welshman, who once worked in this place for our friends in Hansard. It was co-founded by another Welshman, Martyn Butler OBE, and continues to be the leading charity for supporting people in Wales who are living with HIV, all without an ounce of Welsh Government funding. Without the Terrence Higgins Trust, Wales would not have an HIV action plan and its important 30 actions; without the Terrence Higgins Trust, we would not have this National HIV Testing Week, which brings us together today. So, I pay tribute to the work that the staff and advocates of the Terrence Higgins Trust do.
As has already been said in this debate, what the Prime Minister did this week has set a huge example, not just here in the UK but around the world. By taking an HIV test and destigmatising it by talking about the importance of taking it, he has used his good offices to speak to everyone in our country and around the world, taken down some of the barriers to ordering an HIV test, and let people know that these tests are available.
When the Terrence Higgins Trust polled the general public, 80% of those polled were unaware that testing at home, using a kit sent through the post, was even possible. But when offered that choice against others, home testing was by far the preferred option. Thankfully, in Wales we now have the Labour-run Welsh Government, who provide at-home self-testing kits all year round. Contrast that with England, where such kits are only available nationwide for one week of the year, or, as was said earlier, authority by authority as budgets allow.
Our friends at Public Health Wales are going above and beyond to get kits to people and providing charities, communities and pharmacy partners across Wales with take-home kits that people can send off to receive their results. This is a great innovation that others can learn from. Additionally, in my area GPs are going through their patient lists and texting people to offer tests to those who want them. The Welsh Government have also committed to funding Fast Track Cymru, in order to establish networks across all health boards.
However, one area where Wales is falling behind England is in respect of opt-out testing. Thanks to the Prime Minister’s World Aids Day announcement of £27 million in funding, over 50 accident and emergency departments in England are routinely testing for HIV and hepatitis, and that number will rise to 90 by the summer. However, not one A&E department in Wales is yet doing that remarkable and innovative work. So, I ask the Minister if she can join me in working with the Welsh Government to endeavour to change that approach.
I will finish my contribution today with a call for the Minister to unlock a UK-wide problem, namely getting PrEP available outside of sexual health clinics. In Wales, 5,157 people have been prescribed PrEP at some point since 2009, but sexual health is a bottleneck service to start PrEP. For many people, PrEP could be provided online, but for too many people in Wales it is not available online. There are rules and regulations stopping PrEP from being dispensed or even prescribed in community pharmacies. So, I ask my hon. Friend to examine this issue and to use her good offices to tear down these barriers. Otherwise, the 2030 goal will be missed.
Kevin McKenna (Sittingbourne and Sheppey) (Lab)
It is a pleasure, Dr Allin-Khan, to serve under your chairmanship.
I say a massive thank you to the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for securing this debate. I thank everyone involved in the all-party parliamentary group on HIV, AIDs and sexual health, and every organisation that has already been mentioned today, from the Terrence Higgins Trust to the Elton John AIDS Foundation. Actually, I also thank all those small, everyday champions: people who are positive; people who have been allies of people who are positive; everyone who has worked in the bioscience sector; and everyone who has worked in the health sector. This has been a collective effort, involving thousands and thousands of people in this country, to get us to a point where we are potentially only a few years away from eradicating all new transmissions of HIV.
As the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale said in opening this debate, we are also in LGBT+ History Month. In the LGBT community we are used having a lot of clashes, such as Pride happening at the same time as Wimbledon and Glastonbury; we are just used to it.
This debate has put me in a very reflective mood, as did being elected to Parliament and moving from nursing into this world. I was 11 when I realised I was gay; that was in 1985. It was just as everything was hotting up around the AIDS pandemic. It was a pretty scary world to step into. By the time I was properly coming out in the early 1990s, I met lots and lots of friends, including friends and lovers who had AIDS or HIV. I spent a lot of time going to hospitals, and it was there that I realised nursing would be something that suited me. So, it was partly in response to the AIDS epidemic that I was driven along the career path that I was. I also remember the abject terror of getting early HIV tests, particularly before I became a student nurse; a positive test could have stopped that career dead in its tracks at that point.
I will not comment on the age of everyone in this room, but I think like many people in this room I have lived right the way through this pandemic. Of course, by the time I was finally diagnosed with HIV it had changed again, but that was still 20 years on. So I have lived for a long time as an HIV-positive man. There was a time in my life when friends were taking tablets that did have quite severe side effects, some of which were actually very unpleasant and led to them still suffering from HIV and then AIDS. Now, it has whittled down to one tablet a day, and as I get into my 50s it sits alongside my statins and my arthritis medication—all the other medications that we all have at a certain point in our lives. That is the difference.
Florence Eshalomi
I commend my hon. Friend so much for his passionate speech and his lived experience. Earlier this week I attended another event, and the Elton John AIDS Foundation was there. Richard Pyle, one of its directors, mentioned how great it would be if in a few years we could have an injectable form of PrEP. Does my hon. Friend think that that is the advancement we need to see to help address HIV/AIDS?
Kevin McKenna
We already have injectable forms of HIV medication, particularly for people with chaotic lifestyles. They only need to take a jab once every couple of months. It is a real way forward, which will further help us eradicate this.
I have also been reflecting on, in my nursing career, those patients I have nursed for who did not know that they were positive, who became incredibly sick. They developed AIDS without knowing they were positive, coming straight into an intensive care unit and waking up to find out that they were positive. It was a massive disruption to them and their families, and it was stigma that was driving that. People do not have to live that way; people do not have to suffer that way.
A very strong message today is: everyone, just get tested. Everyone, do it. It is absolutely fine; it is just a little scratch on the finger. There should be no stigma. You will not pass this disease on when you are treated, you will not actually suffer and, honestly, it is boring and mundane. In the community of gay men, it has been very boring and mundane for quite some time. In wider communities, just catch up with the rest of us, frankly. If everyone is tested, we will get there.
The one thing I would say to Ministers is that opt-out testing has been extremely successful. There are diseases out there such as hepatitis C that can be completely eradicated. People do not have to be on a tablet for their whole lives; the course is just a few weeks. If we can identity those people through opt-out testing, we can tackle several diseases with one effort and eliminate those as well. I would like to hear that from the Minister.
Steve Race (Exeter) (Lab)
It is a pleasure to serve under your chairship for the first time, Dr Allin-Khan. I congratulate my good friend the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this debate.
The world is a difficult place for many in the LGBT+ community today, at a time when solidarity is necessary and progress is needed. I hope beyond hope that young people in Exeter are not experiencing what I remember as a young gay man before we made such progress under the last Labour Government.
I am heartened that schools such as West Exe school in my constituency have their own Pride celebrations, but I look with sadness at America, where I know that people who are LGBT feel under siege once again. It feels hard, but on a daily basis we remind ourselves that we are not America, we do not live there and he is not our President—in fact, we have very different leadership here. While Donald Trump is showing the example of American power, our Prime Minister is showing the power of our example. I was proud that this LGBT+ History Month and this National HIV Testing Week, my right hon. Friend the Prime Minister took an HIV test for the world to see. Not only has that been covered on every channel here, but it has been broadcast across the globe.
Let us be clear. We must tackle HIV infections here in the UK, and this Government are taking a pioneering approach, but it is equally important to tackle infections globally. That relies on an unflinching commitment to defending and extending human rights. The global HIV pandemic has demonstrated the importance of addressing human rights violations as a central pillar of driving down HIV rates.
Studies have consistently found that HIV policies that are grounded in human rights achieve superior results over those that are not rights-based. Among gay men and other men who have sex with men, HIV prevalence is five times higher in countries that have criminalised same-sex sexual acts than in those that do not. Access to testing has improved with decriminalisation. In sub-Saharan Africa, gay men and other men who have sex with men have double the odds of ever taking an HIV test in countries that have legalised same-sex relations, compared with countries that have not.
Human rights are increasingly under attack from authoritarian Governments and otherwise democratic Governments whose elected leaders choose to vilify minority groups for political gain. That makes it all the more important that the UK Government take a global lead in advocating for human rights, if we want to reach our commitments on eradicating HIV transmission. The UK should work with other like-minded donors, including France, Canada, Germany and the European Commission, to fill some of the gaps in funding that may emerge in the global response. That means ensuring that strong commitments are made to the Global Fund to Fight AIDS, Tuberculosis and Malaria. On the subject of the Global Fund, I welcome the fact that the Prime Minister stated in an answer just this week to the right hon. Member for Sutton Coldfield (Mr Mitchell) that he has
“long supported it and will continue to support it” —[Official Report, 12 February 2025; Vol. 762, c. 258.]
I am glad that the Prime Minister also said that he would “share details” as soon as he could.
The UK could help to fill the global gag gap and agree a joint plan to respond by focusing aid and diplomacy on human rights and building inclusive healthcare systems. The UK could commit to adding HIV to the agenda of meetings with other world leaders throughout 2025. That could include a meeting with President Ramaphosa on the sidelines of the Canadian G7 to agree how best to use South Africa’s G20 presidency to turbocharge prevention of HIV and AIDS. The Government could empower UK ambassadors and high commissioners to prioritise the protection of universal human rights as part of their commitment to tackling HIV/AIDS, and to global health security.
I pay tribute to the Terrence Higgins Trust for the amazing work it does, not only in getting the Prime Minister to test, but in its efforts to get the country back on track to end new HIV cases by 2030. Imagine the victory it would be if we ended this epidemic in the UK—we would be the first country to do so. It would change many lives forever and inspire action everywhere around the world.
James Asser (West Ham and Beckton) (Lab)
It is a pleasure to see you in the Chair, Dr Allin-Khan. I thank the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for securing the debate and for all the work he does on this; it is very much appreciated. We have just had another successful National HIV Testing Week, and I join others in paying tribute to the Prime Minister for his participation. That will be a huge boost in awareness-raising. I also thank the Terrence Higgins Trust for its work on this, and for focusing us on the 2030 goal.
My own campaigning journey started at university more than 30 years ago as we worked to fight the stigma around HIV in what was a very different era, as my hon. Friend the Member for Sittingbourne and Sheppey (Kevin McKenna) so effectively outlined. Mine—ours—is the generation that came out just after the one that had lost so many to AIDS, into a world before effective treatment where so many were still losing their lives. We were, however, on the cusp of the era that now knows living with HIV to be living with a long-term condition. Yes, progress is often fraught with challenges and difficulties, but if we test people, find people who were previously undiagnosed and treat them, they will have a normal life expectancy. How things have changed.
The magnitude of the 2030 goal should never be lost on us. To be a country that ends the onward transmission of HIV is a massive task. Think about how it will change dating and relationships in this country, and think about how it might change how we treat each other. To think that we could be the first country in the world to make that happen—that would have seemed like a miracle to all my friends when I turned 18. It would show British excellence on a global stage, and it would be social justice that was impact-aligned. If we were to achieve such a remarkable goal, it would be the first time we had stopped the onward transmission of a virus without a vaccine and without a cure. We cannot afford to fail.
There is a lot that we should be encouraged by. The proposal has cross-party support, and that is welcome. I pay tribute to the previous Government, which did much to enable opt-out testing in A&Es across the country. We are all delighted to see the new Government back that up with the £27 million announced in December, which will enable this highly effective programme to take place in 90 A&Es from this summer. However, we must acknowledge that our friends in the voluntary sector must continue to reach targets with fewer and fewer resources. We all know the pressures they are under.
Compare the infrastructure for this National HIV Testing Week with what was available when Labour last left office. At that time, the Department of Health and Social Care was making available £4 million for HIV prevention in our communities. Today, the Terrence Higgins Trust and its 30 local partners run everything we see for National HIV Testing Week with just £1.1 million a year. That follows a period in which we have had a cost of living crisis and double-digit inflation. Those are impressive efforts, but they are, ultimately, not sustainable over the longer term.
It is welcome that the Department of Health and Social Care website states that the programme will be commissioned for a further two-year period, but the budget is tight, the pressures are there and we need more than two years. I understand that that is the situation that my hon. Friend the Minister has inherited, but as we get nearer and nearer to 2030, this programme cannot stop. It needs to be ramped up if we are to reach the epic goal and leave no one behind.
I am extremely optimistic about what we can achieve. I know that the Government are committed to achieving more, and I know that my hon. Friend is absolutely dedicated to that. I always like to leave things with a request to the Minister—I know they are all thrilled when I do that—so I urge my hon. Friend to look at what can be done to provide more resources and finances to ensure we hit that vital 2030 target.
Dr Scott Arthur (Edinburgh South West) (Lab)
It is a pleasure to serve under your chairmanship on the last day before recess, Dr Allin-Khan. I thank the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for securing this debate. The fact that he opened the debate is a reminder that HIV is not just an issue in our big urban centres.
In October, I visited Waverley Care’s headquarters in Firrhill in my constituency of Edinburgh South West, and I was deeply impressed by their work. Established in the 1980s, Waverley Care bravely opened the UK’s first purpose-built AIDS hospice, Milestone House, in response to the emerging HIV/AIDS epidemic in Edinburgh. Milestone House faced initial opposition, reflecting the fear and stigma surrounding HIV/AIDS at the time, which we have heard about. I have heard first-hand accounts of that, including from a former Firrhill high school pupil, who recalled visits to the centre and the subsequent backlash in the media. Work placements had to be ended because of the misleading reporting.
It pains me that, back then, some of the LGBT community found that hate was a barrier to seeking help and testing. It really pains me that today some of the trans community face the same bigotry, and for them it is a barrier to seeking testing and PrEP. We must acknowledge the courage of individuals at the time, and I include in that Councillor John Allan, who represented Oxgangs ward. He wanted the hospice to come to his ward when other councillors were doing all they could to stop it coming to theirs, so I thank him for his leadership.
The turning point in local opposition to the centre came with Princess Diana’s visit. She visited many hospices. Her simple act of sharing a cup of tea with a visibly ill young woman sent a clear signal: the patients faced death, but they were still people and worthy of our respect. I do not compare the Prime Minister to Princess Diana, of course, but what he did this week was exactly the same. We who have tested this week and are telling our constituents about it are doing exactly the same—although I have to say that it was harder to get blood out of my finger than I expected.
Since then, remarkable medical advances have transformed HIV/AIDS from a death sentence to a manageable condition. Milestone House is no longer a hospice; it is a hospital. However, as the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale highlighted, the fight is not over. Shamefully, HIV testing in Scotland has decreased by 19% since 2019, and diagnoses are on the rise. Scotland lags behind England, lacking a dedicated HIV testing week and opt-out testing in our high-risk urban centres. The prevalence of HIV in Glasgow and Edinburgh is more than double the trigger level for opt-out testing in England, but that facility is not provided.
Waverley Care rightly highlights that while LGBT communities have strong awareness, heterosexual transmission is now the most common route, often because of lower testing rates. That is why a dedicated testing week and opt-out testing are so important in Scotland. Waverley Care, in partnership with THT, is leading the charge for opt-out testing and an HIV testing week in Scotland, and it has written to the Scottish Government. Those measures have been proven to be effective in England. Having read the testament from Waverley Care and the Terrence Higgins Trust, I cannot see how Scotland can meet its target of no HIV transmissions by 2030—it just cannot be done. I can only conclude that that is going to make it much harder for the UK Government to hit their own target. Will the Minister therefore write to the Scottish Government to make clear the benefits of an HIV testing week and opt-out testing in our big urban centres, and asking the Scottish Government to follow the UK Government?
Alison Bennett (Mid Sussex) (LD)
It is a pleasure to serve under your chairmanship, Dr Allin-Khan. I congratulate the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on his opening remarks and on bringing this debate to the Chamber.
In the UK alone, around 17,000 lives have been lost to this disease, and despite what many might think, the crisis is not over. We have seen an alarming increase in diagnoses since 2021, and between 2019 and 2023 they rose by 56%. The situation is particularly striking in London. In 2023, our capital recorded the highest new HIV diagnosis rate of any region in England, with 980 people diagnosed for the first time. A further 563 people were diagnosed after initially being diagnosed abroad. The latest estimate is that approximately 107,000 people are living with HIV in the UK, and around 5,000 of them remain undiagnosed and unaware of their condition.
Meanwhile, even though testing rates improved by 8% between 2022 and 2023, they remain 4% lower than pre-covid levels. Although testing among gay and bisexual men has reached record levels, testing rates for heterosexual men are 22% lower than before the pandemic. For women, the picture is not much better: rates are still 10% lower across the board than pre-pandemic levels.
Globally, the situation is critical. We have made significant progress—new HIV infections have dropped by 60% since the peak in 1995—but 39.9 million people were still living with HIV in 2023. Tragically, 1.3 million people were newly infected last year. If we need a reminder that the battle is far from over, that is it. The majority of new infections are concentrated in poorer regions, with sub-Saharan Africa bearing the heaviest burden. In every week of 2023, 4,000 adolescent girls and young women between the ages of 15 and 24 were infected globally, with the majority in sub-Saharan Africa. There is also a disturbing link between conflict, sexual violence and the spread of HIV. In Rwanda, for instance, the prevalence of HIV in rural areas surged from 1% before the 1994 conflict to 11% just three years later. We know that that kind of impact will be felt for generations.
The good news is that there is much we can do, but we have to get on with it. At home, dying from AIDS is no longer an inevitable outcome—indeed, organisations that the hon. Member for Brighton Pavilion (Siân Berry) mentioned, such as the Sussex Beacon, which serves both her constituents and mine in Mid Sussex, are now looking to reconfigure services to adapt to changing patient needs—but the alarming rise in HIV diagnoses demands stronger action to expand access to testing, treatment and education for those most at risk. My Liberal Democrat colleagues and I have long called for equitable access to PrEP for all those who can benefit from it, but the Conservative Government’s cuts to the public health grant undermined the delivery of vital sexual health services. The Liberal Democrats are committed to reversing those cuts and investing £1 billion annually to strengthen public health programmes. Among other things, that would help to ensure that we can eliminate HIV transmissions in England by 2030.
We are campaigning for five key things: first, universal access to HIV prevention and treatment; secondly, the eradication of stigma and discrimination tied to HIV and HIV testing—I commend the Prime Minister for making progress on that this week by taking an HIV test, as many hon. Members have mentioned—thirdly, widespread testing and education about HIV; fourthly, a clear path to the elimination of transmission in England by 2030; and fifthly, crucially, the restoration of the public health grant, which was slashed by a fifth under the Conservative Government.
To tackle this problem effectively, we must also look beyond our borders. Despite being preventable and treatable, AIDS remains one of the world’s leading killers. The Global Fund has saved millions of lives, but we must keep up the momentum if we are to defeat these diseases for good. The Labour Government have reneged on their manifesto pledge, cutting spending on international aid from 0.58% to 0.5% of gross national income. UK foreign aid has been a lifeline for millions of vulnerable people around the world. Cutting back on that aid is not just a budgetary decision; it is a matter of life and death.
The Government must commit to restoring the aid budget. That is true now more than ever, for over the course of the last month, President Trump has wreaked havoc on the international development space, withdrawing funding and dismantling long-standing international institutions. The harsh reality—that the US can no longer be relied on as an effective partner in delivering support to the areas that need it most—means that the UK must step up.
My Liberal Democrat colleagues and I firmly believe in global solutions to global problems. We believe in the power of international development in building a more peaceful, healthy and prosperous world. Cutting foreign aid is a failure not just to support the world’s poorest, but to uphold human rights, and it does not benefit us. The Liberal Democrats remain committed to spending 0.7% of GNI on aid, prioritising developments that help the most vulnerable and align with our strategic objectives, such as gender equality, human rights and access to HIV treatment and sexual health services. The fight against AIDS and HIV is far from over, but by working together and investing in testing, treatment, education and international co-operation, we can and will save lives.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
It is a pleasure to serve under your chairmanship, Dr Allin-Khan. I congratulate my right hon. Friend the Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) on securing this important debate, and I thank the hon. Member for Sittingbourne and Sheppey (Kevin McKenna) for sharing his lived experience of this condition.
As we mark National HIV Testing Week 2025, we should be proud of the progress we have made since the ’70s and ’80s in raising awareness of the disease and reducing stigma, but we must reflect on the great challenges that remain in the battle against HIV and AIDS. I pay tribute to charities such as the National AIDS Trust, the George House Trust and the Terrence Higgins Trust, whose work has been at the forefront of the fight against HIV and to improve the nation’s sexual health.
The campaign strapline for National HIV Testing Week is “I test”—a message that cannot be repeated enough. Public campaigns such as this have helped to normalise HIV testing as routine and beneficial to both the individual concerned and society at large. Testing is quick, easy, confidential and free. It is the gateway to prevention and treatment and, ultimately, to ending new HIV transmissions. During National HIV Testing Week, anyone in England can order a free postal HIV test, funded by the Department of Health and Social Care and delivered by the Terrence Higgins Trust, as part of the national HIV prevention programme for England. I encourage anyone who is concerned to get such a test and take it.
There has been encouraging progress in reducing the prevalence of HIV across England in recent years. In introducing a national HIV action plan, the last Government sought to achieve an 80% reduction in new infections by 2025. Remarkably, the UK achieved the UNAIDS 95-95-95 targets back in 2020: 95% of individuals living with HIV were thought to be diagnosed, 99% of them were on treatment and 98% were achieving good viral suppression.
A growing proportion of HIV testing has been taking place by post or at home—44% in 2023 compared with 19% in 2019—which shows that the tests are acceptable to the public and welcomed by them. There has been a substantial increase in the number of tests taking place in emergency departments, with 857,000 in 2023 compared with 114,000 in 2019, mostly because of the opt-out testing introduced by the last Government.
We cannot be complacent. Although there have been areas of progress, in recent years we have seen a reversal of hard-won gains in reducing HIV transmission. Data published by the UK Health Security Agency in 2024 shows that the number of heterosexual men and women in England newly diagnosed with HIV has increased by more than 30% since 2022. Around 5,000 undiagnosed people are currently living with HIV in England.
HIV and AIDS cannot be solved in the UK without acknowledging the global context. Last year, AIDS-related illness claimed as many lives as the total of all wars, homicides and natural disasters that have ravaged our planet. In parts of southern Africa, in countries such as Botswana and Zimbabwe, more than a fifth of the adult population is living with HIV. Such figures remind us that the global fight with HIV is far from over.
I was troubled to hear in a House of Lords debate earlier this week that the head of UNAIDS has warned that global HIV infections could increase by more than 600% by 2029 if the US continues to suspend the UN HIV/AIDS programme. That will mean higher infection rates here in the UK, as communicable diseases do not recognise national borders.
Florence Eshalomi
I thank the shadow Minister for highlighting that. Does she share my concern that data and research from the Elton John AIDS Foundation shows that almost 228,000 people a day will miss out on HIV testing due to the pause in US aid? What should we do collectively, on a cross-party basis, to call that out?
Dr Johnson
The key is to ask the Government what support they will give to the UN and what conversations they are having with their US counterparts about the benefits to people both overseas and at home of ensuring that the battle against HIV and AIDS is won.
Florence Eshalomi
The hon. Lady was formerly the public health Minister, so I know she cares passionately about this issue. Does she agree that HIV has to be a cross-party issue, and that both the Government and the Opposition should be calling out the US pause?
Dr Johnson
It is clear that the battle against HIV is a cross-party issue. We have seen strides and improvements over the years under Governments of different colours. Yes, I was the public health Minister, and we met at an event where I announced the results of the first year of the opt-out testing and its success in reducing infections.
HIV testing is really important. I was pleased to see the Prime Minister test earlier this week; that is helpful in reducing the stigma associated with testing. It showed that anybody in any circumstances can have a test. Opt-out testing has identified cases where people who were thought to be very low risk unexpectedly turned out to be HIV-positive. When we brought in the opt-out testing, we targeted first the A&Es in areas of the highest risk, and we need to continue to target those highest-risk areas.
In October 2024, the Department of Health and Social Care revealed that over half of those with HIV had been previously diagnosed abroad. Will the Department consider the implications of these trends when it puts together its new HIV action plan in order to achieve the goal of no new HIV transmissions in the UK by 2030? Countries such as Australia and New Zealand require applicants to take an HIV test before they obtain a visa. Have there been any discussions between the Department of Health and Social Care and the Home Office about introducing such a requirement in the UK, as we have for tuberculosis?
Guidance from the Office for Health Improvement and Disparities—the Government’s own guidance, effectively —suggests that all men and women, and recently arrived children, known to be from a country of high prevalence should be recommended a test. It might be helpful if the Government followed their own guidance, because if we test the high-risk population, we stand more chance of picking up more cases, which would be beneficial.
Under the opt-out testing scheme brought in by the Conservative Government, a patient can explicitly decline instead of explicitly accept an HIV test. It has been rolled out in many A&Es across the country, and I am pleased that it will be coming to more. It has identified hundreds of people who were undiagnosed or lost to follow-up for treatment for HIV, and includes hepatitis B and C. Identification of those cases helps the individuals concerned and helps to reduce transmission across the wider population.
Between 2019 and 2020, the estimated number of diagnosed cases in England declined. However, somewhat counterintuitively, opt-out testing suggests there are more cases than we realise. Does the Minister have plans to re-estimate the number of undiagnosed HIV cases that may be out in the community waiting to be treated, in the light of the evidence from opt-out testing? The Opposition welcome the Government’s commitment to fund opt-out testing until March 2026, but NHS services need clarity on funding beyond that point. Will the Minister clarify whether long-term funding for opt-out HIV testing will be considered as part of this year’s spending review?
HIV prevention goes beyond testing. A perennial issue is access to PrEP treatment, to maintain the reduction in HIV cases in England. PrEP has been described as a miracle drug, which prevents HIV-negative people from acquiring the virus, and is a key tool to stop new HIV transmissions by 2030. However, waiting times for PrEP are too long—at one point, they were measured in months rather than weeks. What steps is the Minister taking to improve that? The last Government improved access to PrEP across the country by setting up the PrEP access and equity task and finish group. What steps have been taken to implement the group’s recommendations since the Government took office?
We have only one Parliament left to finally eradicate new cases of HIV by 2030. We owe it to everyone who has lost their life to this virus, everyone who has faced the stigma—thankfully, that is reduced but it still exists—of being HIV-positive and everyone who is living with HIV today to end new transmissions once and for all. I hope the Government continue the progress of the last Government with their new HIV action plan, and I hope that it will be developed soon. The former Minister, the hon. Member for Gorton and Denton (Andrew Gwynne), said in November that the plan was in production. I hope that it is getting closer to completion and that the Minister can give us an idea of when it will be complete. I hope that today’s debate will inspire thousands of people to get themselves tested.
The Minister for Secondary Care (Karin Smyth)
It is a pleasure to serve for the first time under your chairship, Dr Allin-Khan. This is such a marvellous debate to be part of. The Secretary of State asked me to respond to it on behalf of my hon. Friend the Member for West Lancashire (Ashley Dalton), who has been attending events this week and unfortunately could not be here today. I have known her a long time and I know that she will be a fantastic champion in this area, coming to the Department every day to do battle on people’s behalf.
I am grateful to the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale (David Mundell) for securing this important debate and for his continued work in this area. I join my hon. Friend the Member for Colne Valley (Paul Davies) in commending the work of the APPG. I know that many hon. Members are caught in the dilemma of the two debates today, and many other people would be here, but I know that they will be listening to the debate with great interest on the fourth day of National HIV Testing Week.
This debate gives me the opportunity to thank all the amazing charities and organisations that are playing such a huge part in making this week a success—the Terrence Higgins Trust, National AIDS Trust, and the Elton John AIDS Foundation, which we have heard about today, to name just a few. I also want to add my voice to the enthusiasm I have seen in my time—nine years now—across all parties on this issue. There has been a long period of cross-party collaboration. I hope that that continues and that we continue to base our work on evidence and care. It is what has got us here today. My hon. Friend the Member for West Ham and Beckton (James Asser) made that point very well and asked for more resources, so well done him. I will perhaps come on to some of that.
In national testing week, we are making great strides towards the goal of no new transmissions in England by 2030. We are, as many members have said, at a crucial point in that journey. HIV testing has been revolutionised. It is now fast, free and available in the privacy of our own homes—even when our home is No. 10 Downing Street, as the Prime Minister showed us on Friday. I know that that is a powerful message not just in this country but globally, as my hon. Friend the Member for Exeter (Steve Race) highlighted.
When we normalise testing, we normalise prevention, treatment and care—and we normalise saving lives. I thank every colleague who attended Tuesday’s drop-in. It is so important for all of us in this place and elsewhere to help smash the stigma however we can, transform perceptions, and drive us closer to no new transmissions.
Florence Eshalomi
I thank the Minister for making an impassioned speech; she is doing an excellent job. She has highlighted the importance of testing and the fantastic work all the different organisations do in pushing it. Does she agree that for us to reach the vital goal of no new transmissions by 2030, we should be following Wales’s example of having year-round access to online testing to help more people test and to eradicate HIV by 2030?
Karin Smyth
I thank my hon. Friend for her comments and her great leadership in her work through the APPG. Some of that work looks very successful, and I will comment on it shortly, because we do need to learn and share from each other.
When it comes to reducing stigma, we have all exposed how old we are in this debate today. I am as old as the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale and perhaps the hon. Member for Strangford (Jim Shannon) and some others. I worked in the health service through the late ’80s. It was a gay man who started raising awareness to me about stigma around HIV and AIDS, and we have come an awful long way. The hon. Member for Strangford and my hon. Friend the Member for Edinburgh South West (Dr Arthur) rightly talked about the role of the stigma, and that iconic moment with Princess Diana was so important. It was so long ago but to some of us it seems like yesterday.
I can give some updates to colleagues. So far this HIV testing week we have given out 13,308 testing kits. That is 13,308 people who now have the power to know their status, take control of their health and contribute to the fight to end new HIV transmissions in England. Last year, National HIV Testing Week delivered more than 25,000 testing kits, achieving great results among communities disproportionately affected by HIV. For example, the uptake of testing kits for black African communities has tripled since 2021. My hon. Friend the Member for Vauxhall and Camberwell Green (Florence Eshalomi) made excellent points about that.
The right hon. Member for Dumfriesshire, Clydesdale and Tweeddale and my hon. Friend the Member for Edinburgh South West tempt me to comment on the Scottish Government’s role in this area. Politics aside, they highlighted a serious point about sharing good practice. My hon. Friend the Member for Cardiff West (Mr Barros-Curtis) made that exact point about the role of the Terrence Higgins Trust. I do not think I knew that Terrence Higgins was Welsh, and I am married to a proud Welshman—something that we share, Dr Allin-Khan —so that looks bad on me. My hon. Friend the Member for Cardiff West made an excellent point about the role of Terrence Higgins’s leadership and the people that came after him to lead that organisation. We need to learn from and work with each other. On behalf of the Department, I commit to continue our work across the United Kingdom to share and learn from best practice. I think that my colleagues across the United Kingdom, whatever political party they belong to, would echo that.
As the Minister here in England, I know that the campaign would not be possible without HIV Prevention England, the national HIV prevention programme, which is funded by the Government and delivered by the Terrence Higgins Trust with local partners. The programme aims to promote HIV testing in communities that are disproportionately affected by HIV, bringing down the number of undiagnosed and late-diagnosed cases. Every year, it runs National HIV Testing Week, a summer campaign to raise awareness of HIV and STI prevention and testing, and much more. We are committed to building on those successes, which is why we have extended the programme for a further year until March 2026, backed by an additional £1.5 million.
Looking to the future, we are making progress to end new transmissions before 2030, but we know that much more work needs to be done to reach our goals. We have had some excellent contributions on that today. Our work is not over until every person, regardless of race, sex, sexuality, gender or circumstances, has access to testing without barriers. I hear the comments made by my hon. Friend the Member for Exeter and others about fear and the historic fear that people have felt. We will not stop until every test is met with care, every diagnosis with treatment and every individual with dignity and respect, regardless of who they are or their HIV status.
Steve Race
Does the Minister agree that although we have a cross-party consensus here today and I accept the words of the hon. Member for Sleaford and North Hykeham (Dr Johnson) at face value, the history of HIV action in this country over the last 10 to 15 years paints rather a different picture? We might be closer to eradicating HIV transmissions if the public health grant, which was set in 2014, had had any increases until this Government increased it by 5.5% this year; if the national HIV prevention programme, which started out with a budget of £4 million in 2010, had not had only a £1.1 million budget by last year; if the funding for the HIV helpline had not been abolished in 2012; and if the HIV innovation fund had not been abolished somewhere among the Johnson, Truss and Sunak psychodrama.
Karin Smyth
I thank my hon. Friend for that intervention. My hon. Friend the Member for West Ham and Beckton made similar points. The level of cuts to our public services and, by implication, to third sector organisations and their contribution to the fabric of our society—they do work that the public sector cannot get to with groups of people that it cannot get to—is shocking. It was shocking as we went through it. Lord Darzi has given us a good diagnosis of some of those problems. We want to take forward the good work that has been done, but we have inherited a landscape that I wish we had not.
We are very much committed to making progress because we want to build a future where testing is routine, treatment is available to all, PrEP and post-exposure prophylaxis are accessible and no one is left alone in their journey. My hon. Friends the Members for Dartford (Jim Dickson) and for Clapham and Brixton Hill (Bell Ribeiro-Addy) talked about the important role of local government and had some fantastic examples.
To support improved PrEP access and many other critical HIV prevention interventions, the Government have provided local authority-commissioned public health services, which include sexual and reproductive health services, a cash increase of £198 million compared with 2024-25—an average 5.4% cash increase and a 3% real-terms increase. That represents a significant turning point for local health services: the biggest real-terms increase after nearly a decade of reduced spending between 2016 and 2024, as my hon. Friend the Member for Exeter highlighted. I hope that starts to put us back on track.
We are pushing that commitment forward by engaging with a range of system partners and stakeholders to develop our new HIV action plan, which we will publish this year. A number of points have been made about what should be included in that plan, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for West Lancashire, will hear that and will work with colleagues here and in the Department to ensure the plan is effective.
I extend my sincerest thanks to Professor Kevin Fenton, the Government’s chief adviser on HIV, who is hosting engagement sessions and roundtables in parallel with external stakeholders, including the voluntary and community sector, professional bodies, local partners and others. We are also working alongside the UK Health Security Agency, NHS England and a broad range of system partners to inform the development of the new action plan, and guarantee that it is robust, inclusive and evidence-based. This collaboration is essential, because we are fighting not just HIV, but the barriers that keep people from knowing their status. We are fighting stigma, misinformation, and inequality in access to treatment and care.
Achieving these goals requires action, because the future is not just something we wait for; it is something we create. That is why, in December last year, the Prime Minister committed to extending the highly successful emergency department HIV opt-out testing scheme, backed by an additional £27 million, as the right hon. Member for Dumfriesshire, Clydesdale and Tweeddale noted. During the past 34 months, more than 2.5 million HIV tests have been conducted through the scheme, indicatively finding more than 1,000 people who were undiagnosed or not in care. These are not just numbers; they are people we might never have reached who are now empowered with access to critical sexual health services. Increasing testing across all communities is a cornerstone of our new action plan and essential to ending HIV transmissions. That is why we must harness the power of HIV testing week.
Before I wrap up, I join the hon. Member for Sleaford and North Hykeham (Dr Johnson) in paying tribute to my hon. Friend the Member for Sittingbourne and Sheppey (Kevin McKenna) for sharing his own experience, which, in motivating his career in nursing—and now his new career—he used to serve and help others. He did that excellently today.
Today, testing is not just about detection; it is about connection. It is about linking people to the care, support and community they need to thrive. It is about ensuring that no one is left behind—and that includes globally. We have committed to supporting the international effort to ending HIV and AIDS, with £37 million towards increasing access to vital sexual and reproductive health services, including HIV testing, prevention and management services for vulnerable and marginalised people across the globe.
Our commitment is unwavering, and our mission is clear. This National HIV Testing Week, let me be clear: a single test can save a life, so let us make testing the norm, the expectation and the action that drives us to a future with no new HIV transmissions.
David Mundell
I do apologise for the length of my constituency’s name, because otherwise we could have had a longer debate. It has been a good debate with some powerful contributions. I, too, commend the hon. Members for Sittingbourne and Sheppey (Kevin McKenna) and for West Ham and Beckton (James Asser) for reflecting on their personal experiences. It is so important that we do so, and both hon. Gentleman show that it is possible to move on, as someone who is HIV-positive, to play a full part in the world and in Parliament.
I particularly want to refer to a point made by the hon. Members for Clapham and Brixton Hill (Bell Ribeiro-Addy) and for Vauxhall and Camberwell Green (Florence Eshalomi), which was that this is not just about gay men. There is a stereotype that this is all about gay men. It is not. As we have heard, the statistics show that gay men are among the most prolific in having tests. It is about other communities, and it is about women. That is the message that we have to get across, and that is why opt-out testing is so important.
The hon. Member for Cardiff West (Mr Barros-Curtis) raised my pet subject, which is PrEP. It is ridiculous that, during this debate, I could have emailed somebody in India and obtained PrEP, but I could not go up Victoria Street into a pharmacy and do that. As well as making sure that we continue with the testing initiative, let us make PrEP more readily available.
Motion lapsed (Standing Order No. 10(6)).
Cardiovascular Disease: Prevention
(1 week, 3 days ago)
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David Mundell (in the Chair)
Demonstrating my own multifunctionality, I am now going to chair but not participate in the next debate.
Jim Shannon (Strangford) (DUP)
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.
Sonia Kumar (Dudley) (Lab)
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.
Jas Athwal (Ilford South) (Lab)
May I say what an honour it is to serve under the chairmanship of such a multi-talented, multi-functional Chair?
David Mundell (in the Chair)
You can speak for as long as you want. [Laughter.]
Jas Athwal
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.
Alison Bennett (Mid Sussex) (LD)
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.
Dr Luke Evans (Hinckley and Bosworth) (Con)
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.
David Mundell (in the Chair)
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.
The Minister for Care (Stephen Kinnock)
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.
Jim Shannon
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—
David Mundell (in the Chair)
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.
Jim Shannon
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?
David Mundell (in the Chair)
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.
Jim Shannon
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.
David Mundell (in the Chair)
I am sure the Minister will have heard the three points that Mr Shannon raised. On that basis, I will put the Question.
Dr Evans
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?
David Mundell (in the Chair)
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.
Stephen Kinnock
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.
David Mundell (in the Chair)
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.
Stephen Kinnock
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.
Jas Athwal
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.
Stephen Kinnock
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.
David Mundell (in the Chair)
Mr Shannon, do you wish to make a final contribution?
Jim Shannon
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.
David Mundell (in the Chair)
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.