My Lords, to accelerate the 10-year health plan ambition to reduce premature mortality from heart disease and stroke by 25% and to tackle unwarranted variation across the country, this year we will publish a new cardiovascular disease modern service framework. It will support consistent, high-quality and equitable care while fostering innovation across the cardiovascular disease pathway.

My Lords, to accelerate the 10-year health plan ambition to reduce premature mortality from heart disease and stroke by 25% and to tackle unwarranted variation across the country, this year we will publish a new cardiovascular disease modern service framework. It will support consistent, high-quality and equitable care while fostering innovation across the cardiovascular disease pathway.

I thank my noble friend the Minister for her response. The guidelines of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery suggest that the UK is falling behind in terms of diagnosis and treatment for heart valve disease. Can she give an assurance that the new framework will take full account of these guidelines and pay particular attention to the diagnosis and treatment of older people?

I thank my noble friend the Minister for her response. The guidelines of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery suggest that the UK is falling behind in terms of diagnosis and treatment for heart valve disease. Can she give an assurance that the new framework will take full account of these guidelines and pay particular attention to the diagnosis and treatment of older people?

I am most grateful to my noble friend for his work in promoting the improvement of services for those with heart valve disease. I can say—it might be helpful—that we are driving down cardiology waiting lists. The number of people waiting over 52 weeks from referral to treatment was down 9% between the end of December 2025 and the end of January 2026. Yes, the modern service framework will accelerate this progress to reduce premature mortality and will set standards for the best evidence-based interventions.

I am most grateful to my noble friend for his work in promoting the improvement of services for those with heart valve disease. I can say—it might be helpful—that we are driving down cardiology waiting lists. The number of people waiting over 52 weeks from referral to treatment was down 9% between the end of December 2025 and the end of January 2026. Yes, the modern service framework will accelerate this progress to reduce premature mortality and will set standards for the best evidence-based interventions.

My Lords, management of people with heart valve disease is truly a low-hanging fruit in reducing deaths due to cardiovascular disease. Some 400 people a year die on waiting lists for transcatheter aortic valve implantation. It is simple for people who have breathlessness or suffer from decreased exercise tolerance or chest pain. Even I, within five minutes, could diagnose whether they were at risk of heart valve disease or not—line them up and I will tell you.

My Lords, management of people with heart valve disease is truly a low-hanging fruit in reducing deaths due to cardiovascular disease. Some 400 people a year die on waiting lists for transcatheter aortic valve implantation. It is simple for people who have breathlessness or suffer from decreased exercise tolerance or chest pain. Even I, within five minutes, could diagnose whether they were at risk of heart valve disease or not—line them up and I will tell you.

I am reassured that the noble Lord can assist within five minutes—we might consider engaging him. The serious point is that early diagnosis is important, and the modern service framework will build on the work that has already been done. I know that the noble Lord is aware of this, but just the use of a stethoscope is the way to make an early and initial diagnosis. We are upping our game here by bringing in AI-assisted stethoscopes, which will be a massive assistance for diagnosis.

I am reassured that the noble Lord can assist within five minutes—we might consider engaging him. The serious point is that early diagnosis is important, and the modern service framework will build on the work that has already been done. I know that the noble Lord is aware of this, but just the use of a stethoscope is the way to make an early and initial diagnosis. We are upping our game here by bringing in AI-assisted stethoscopes, which will be a massive assistance for diagnosis.

I am sorry to hear the experience that the noble Baroness describes. We are indeed seeking to have a whole-team approach to the whole patient. I absolutely agree with her that it should indeed consider where somebody is in their life stage.

I am sorry to hear the experience that the noble Baroness describes. We are indeed seeking to have a whole-team approach to the whole patient. I absolutely agree with her that it should indeed consider where somebody is in their life stage.

The noble Lord, Lord McCabe, referenced older people in particular in his Question—he did not say where he drew the line at old, but perhaps I will declare an interest. What happens, for example, when really older people need heart surgery but are considered to be an anaesthetic risk? With new

developments in heart surgery, I wonder whether the Minister can tell us what progress there has been in carrying out procedures without necessarily needing to have invasive surgery.

The noble Lord, Lord McCabe, referenced older people in particular in his Question—he did not say where he drew the line at old, but perhaps I will declare an interest. What happens, for example, when really older people need heart surgery but are considered to be an anaesthetic risk? With new

developments in heart surgery, I wonder whether the Minister can tell us what progress there has been in carrying out procedures without necessarily needing to have invasive surgery.

I can privately share with the noble Baroness that I suspect that “older people” covers both of us: it is over 65. The point that she makes is important. The option of what is called a TAVI intervention is far less invasive than a surgical intervention, as she referred to. That activity has grown significantly year on year, with something like a 16% increase on 2024-25. That is a very welcome step forward as we move towards minimally invasive procedures.

I can privately share with the noble Baroness that I suspect that “older people” covers both of us: it is over 65. The point that she makes is important. The option of what is called a TAVI intervention is far less invasive than a surgical intervention, as she referred to. That activity has grown significantly year on year, with something like a 16% increase on 2024-25. That is a very welcome step forward as we move towards minimally invasive procedures.

My Lords, it is obvious that early testing for heart valve disease is an exemplary form of preventive medicine, which is where we all need to get to. The House owes my noble friend gratitude for organising heart valve testing through the Heart Valve Voice, which was extremely successful. Does my noble friend agree with me that, because of the absence of routine testing, we should look for opportunities to link heart valve testing with the other sorts of routine testing where there is a captive audience? These could include, for example, occasions when people go for cholesterol testing or possibly even flu vaccination, which are becoming more routine? If we could get that in operation at an early stage, it could make a significant difference.

My Lords, it is obvious that early testing for heart valve disease is an exemplary form of preventive medicine, which is where we all need to get to. The House owes my noble friend gratitude for organising heart valve testing through the Heart Valve Voice, which was extremely successful. Does my noble friend agree with me that, because of the absence of routine testing, we should look for opportunities to link heart valve testing with the other sorts of routine testing where there is a captive audience? These could include, for example, occasions when people go for cholesterol testing or possibly even flu vaccination, which are becoming more routine? If we could get that in operation at an early stage, it could make a significant difference.

My noble friend is right and, certainly, as we move through our 10-year health plan, the opportunity to make every contact count is very important. I refer my noble friend to the advances that we have made in services available in community pharmacies, because measuring blood pressure is hugely important. Our pharmacies, I am glad to say, have delivered nearly 4.2 million blood pressure monitoring checks since October 2021. We have more than 7,500 pharmacies now available in our high streets delivering this service. That is the kind of thing that my noble friend is looking for.

My noble friend is right and, certainly, as we move through our 10-year health plan, the opportunity to make every contact count is very important. I refer my noble friend to the advances that we have made in services available in community pharmacies, because measuring blood pressure is hugely important. Our pharmacies, I am glad to say, have delivered nearly 4.2 million blood pressure monitoring checks since October 2021. We have more than 7,500 pharmacies now available in our high streets delivering this service. That is the kind of thing that my noble friend is looking for.

My Lords, I declare my interest as chairman of King’s Health Partners. The Minister made reference to AI stethoscopes aiding in the diagnosis of patients with heart conditions. The evidence for this was established in a very large trial—the TRICORDER trial—involving some 1.5 million patients and more than 200 general practices in our country. What it demonstrated was, compared to the use of the ordinary standard of care, a doubling of the rate of diagnosis for heart failure and a tripling of the rate of diagnosis for heart arrhythmias. The problem was that, subsequent to the trial, the diagnostic rate did not increase, suggesting that it is necessary to invest in training and the establishment of new working pathways to ensure that innovation can be properly established in routine clinical practice. Is His Majesty’s Government funding such activity?

My Lords, I declare my interest as chairman of King’s Health Partners. The Minister made reference to AI stethoscopes aiding in the diagnosis of patients with heart conditions. The evidence for this was established in a very large trial—the TRICORDER trial—involving some 1.5 million patients and more than 200 general practices in our country. What it demonstrated was, compared to the use of the ordinary standard of care, a doubling of the rate of diagnosis for heart failure and a tripling of the rate of diagnosis for heart arrhythmias. The problem was that, subsequent to the trial, the diagnostic rate did not increase, suggesting that it is necessary to invest in training and the establishment of new working pathways to ensure that innovation can be properly established in routine clinical practice. Is His Majesty’s Government funding such activity?

The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters.

However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.

The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters.

However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.

My Lords, I am grateful to the Minister for giving me time for this question. She will be aware that studies analysed in around 155,000 diagnoses of aortic stenosis in England have found that women were significantly less likely to be referred to specialists and far less likely to receive valve replacement. This also applies to patients from deprived areas and in some ethnic minority groups. What assessment have the Government made of these disparities and what action are the noble Baroness’s department and NHS England taking to ensure that patients have access to heart valve treatment regardless of their gender, ethnicity or where they live?

My Lords, I am grateful to the Minister for giving me time for this question. She will be aware that studies analysed in around 155,000 diagnoses of aortic stenosis in England have found that women were significantly less likely to be referred to specialists and far less likely to receive valve replacement. This also applies to patients from deprived areas and in some ethnic minority groups. What assessment have the Government made of these disparities and what action are the noble Baroness’s department and NHS England taking to ensure that patients have access to heart valve treatment regardless of their gender, ethnicity or where they live?

The noble Lord is quite right: women are underdiagnosed, they are undertreated and some ethnic minority groups face poorer access. That is why I very much welcome the fact that, in the framework to which I referred, dealing with inequalities will be absolutely key. Research, in which we are partnering with the British Heart Foundation, will focus on tackling inequalities in higher-risk groups as well as unequal cardiovascular disease outcomes. Inequalities and tackling them will be at the heart of all our acceleration of progress as well as our research.

The noble Lord is quite right: women are underdiagnosed, they are undertreated and some ethnic minority groups face poorer access. That is why I very much welcome the fact that, in the framework to which I referred, dealing with inequalities will be absolutely key. Research, in which we are partnering with the British Heart Foundation, will focus on tackling inequalities in higher-risk groups as well as unequal cardiovascular disease outcomes. Inequalities and tackling them will be at the heart of all our acceleration of progress as well as our research.

My Lords, the Resuscitation Council UK, the British Cardiovascular Society and the National Council for Palliative Care have excellent and sensitive joint guidance on the use of cardiovascular implants towards the end of life. My family’s experience in different parts of the country shows that not all cardiac surgeons take account of end-of-life care in patients. In one case, a patient was told that she would not be allowed to leave the hospital until she had a pacemaker, despite the fact that, at 88 years old, she did not want one and, two years on, bitterly regrets finally agreeing. Can the Minister say whether the review that she just mentioned will ensure that surgeons follow the guidance and work not only with patients but with their other clinicians?

My Lords, the Resuscitation Council UK, the British Cardiovascular Society and the National Council for Palliative Care have excellent and sensitive joint guidance on the use of cardiovascular implants towards the end of life. My family’s experience in different parts of the country shows that not all cardiac surgeons take account of end-of-life care in patients. In one case, a patient was told that she would not be allowed to leave the hospital until she had a pacemaker, despite the fact that, at 88 years old, she did not want one and, two years on, bitterly regrets finally agreeing. Can the Minister say whether the review that she just mentioned will ensure that surgeons follow the guidance and work not only with patients but with their other clinicians?

To ask His Majesty’s Government what assessment they have made of whether NHS services for heart valve disease support healthy ageing and ensure older adults receive equitable access to timely treatment.

To ask His Majesty’s Government what assessment they have made of whether NHS services for heart valve disease support healthy ageing and ensure older adults receive equitable access to timely treatment.

To ask the Secretary of State for Health and Social Care, how much funding the Government has spent on research into improving palliative care in the last five years.

To ask the Secretary of State for Health and Social Care, how much funding the Government has spent on research into improving palliative care in the last five years.

To ask the Secretary of State for Health and Social Care, what steps he is taking to support research into palliative care (a) standards and (b) techniques.

To ask the Secretary of State for Health and Social Care, what steps he is taking to support research into palliative care (a) standards and (b) techniques.

Ways and means resolution. Agreed to on question. Programme motion (No. 3) on consideration of Lords amendments and subsequent stages. Agreed to on question. Consideration of Lords amendments. Amendment (a) to Lords amendment 91 agreed to. Lords amendment 91, as amended, agreed to. Lords amendment 85 disagreed to on division (275 to 183). Lords amendments 86 to 88 disagreed to. Lords amendment 92 disagreed to and amendment (a) in lieu agreed to on division (215 to 188). Lords amendment 95 disagreed to and amendment (a) in lieu agreed to. Lords amendments 52 to 54, 66 to 79, 82, 84, 93, 94, 96 to 101 and 109 to 129 agreed to, with Commons financial privileges waived in respect of Lords amendments 52 to 54, 84, 93, 94, 96, 97 and 129. Lords amendment 29 disagreed to on division (249 to 167). Lords amendment 30 disagreed to on division (265 to 156). Lords amendment 48 disagreed to and amendment (a) in lieu agreed to. Lords amendment 57 disagreed to. Lords amendment 89 disagreed to and amendment (a) in lieu agreed to. Lords amendment 108 disagreed to. Lords amendments 42 to 47, 55, 56 and 58 to 64 agreed to. Lords amendment 11 disagreed to and amendment (a) in lieu agreed to. Lords amendment 51 disagreed to and amendment (a) in lieu agreed to. Lords amendment 80 disagreed to on division (247 to 150) and amendments (a) to (n) in lieu agreed to. Lords amendment 81 disagreed to. Lords amendment 90 disagreed to on division (259 to 147) and amendment (a) in lieu agreed to. Lords amendment 105 disagreed to and amendment (a) in lieu agreed to. Lords amendments 1 to 10, 12 to 28, 31 to 41, 49, 50, 65, 83, 102 to 104, 106 and 107 agreed to, with Commons financial privileges waived in respect of Lords amendments 34 to 37. Motion that a Committee be appointed to draw up Reasons to be assigned to the Lords for disagreeing to their amendments. Agreed to on question. Reasons to be reported and communicated to the Lords.

Ways and means resolution. Agreed to on question. Programme motion (No. 3) on consideration of Lords amendments and subsequent stages. Agreed to on question. Consideration of Lords amendments. Amendment (a) to Lords amendment 91 agreed to. Lords amendment 91, as amended, agreed to. Lords amendment 85 disagreed to on division...

I beg to move Government amendment (a) to Lords amendment 91.

I beg to move Government amendment (a) to Lords amendment 91.