Government strategy to tackle CHD

Government priorities and targets

The goverment's target is to reduce CHD in the under 75s by 40% by 2010.

'Choosing Health'

The Choosing Health (2004) white paper supersedes the government's previous white papers - Smoking Kills (1998) and Our Healthier Nation (1999), stepping up the investment in public health and mainstreaming it in the NHS and schools and local authorities.

Choosing Health prioritises action on childhood obesity. This followed an extensive review by the Health Select Committee on obesity. The National Heart Forum presented written and oral evidence available here.

The government has set out five key Public Service Agreements for public health action by government departments. Which include action on CHD and Obesity.

'Saving Lives: Our Healthier Nation'

The white paper Saving Lives: Our Healthier Nation (1999) set out the government's priorities for improving public health, including reducing deaths from coronary heart disease.

Targets in each priority area were set. National Service Frameworks (NSFs), including one for coronary heart disease, were developed that set out standards of care that should be adopted by all NHS organisations. These contained targets and milestones in areas ranging from disease prevention/health promotion, through care pathways to rehabilitation and secondary prevention.

Recognising that greater funding of the NHS was essential if modernisation was to be achieved, the government asserted that any additional investment must be accompanied by reforms to the system and a radical reorganisation was set in train. In July 2000 The NHS Plan: A plan for investment, a plan for reform was published. This set out national standards and largely superseded the Saving Lives: Our Healthier Nation white paper.

The national standards took three forms:

Standards for key conditions, diseases, or services for particular population groups described in the NSFs;
Clear guidance on the best treatments and interventions from the National Institute for Clinical Excellence;
A limited number of national targets, including shorter waiting times, and the quality of care and facilities for people while they are in hospital.

A streamlined set of 88 national targets was published.

Those that will impact on the incidence of coronary heart disease are:

In primary care, update practice-based-registers so that patients with coronary heart disease and diabetes continue to receive appropriate advice and treatment in line with NSF standards and by March 2006, ensure practice-based registers and systematic treatment regimes, including appropriate advice on diet, physical activity and smoking, also cover the majority of patients at high risk of coronary heart disease, particularly those with hypertension, diabetes and a body mass index greater than 30;
Reduce smoking rates, contributing to the national target of: reducing the rate in manual groups from 32% in 1998 to 26% by 2010; 800,000 smokers from all groups successfully quitting at the four week stage by 2006.

The setting of these targets has resulted in a focus on the use of pharmaceutical interventions to prevent heart disease among patients with existing disease and, to a lesser extent, among those at high risk.