Editor's blog Tuesday 8 February 2011: Reducing hypertension by correcting SOS Lansley

Health Policy Insight is not produced by people who are clinically expert, to put it mildly.

However, when a reader got in touch to ask for our help in their management of their own hypertension while avoiding drug use, we were naturally glad to help.

The cause of this reader's raised blood pressure was SOS Lansley's recent statement in the second reading of the Health and Social Care Bill in the Commons.

Answering a question from Labour MP Geraint Davies, SOS Lansley claimed the NHS was somewhat tardy in its adoption of primary percutaneous coronary intervention (PCI) compared to other countries.

Mr Lansley concluded this answer by stating "Since then, it has been better implemented in this country, but that started to happen only when the Department of Health gave permission for its adoption".

Not quite how it happened
This reader writes in correction, "I was working at London Ambulance Service during this time and the idea of the DH as some proactive agent of change couldn't be further from the truth.

"A bit of background: the increasing availability of Cath Labs (where PCI is delivered) in the capital had come to the attention of a member of the LAS's Medical Directorate, along  with a growing body of evidence supporting the clinical effectiveness of PCI in treating heart attack patients. He took it upon himself to make them available to LAS's patients.

"At the time the standard against which these patients were assessed was a 60-minute 'call to needle' time for thrombolysis; a much less safe and effective procedure than conveyance to the nearest Cath Lab (potentially bypassing A&E depts on the way) for primary PCI.

"After a huge amount of work (purchasing of equipment; training and significant cultural change (for crews to be happy bypassing A&E depts with what were, after all, very sick patients); etc), the new protocol was rolled out and was a major contributor to an increase in heart attack survival rates across London.

"As the first ambulance trust to introduce PCI in England and Wales, you'd think this would be something to celebrate.

"Unfortunately not, from the perspective of the Healthcare Commission (as they were then called) who, in their annual review (2005/06), branded the LAS's quality of service as 'weak' as we had missed one of their key targets: the 60 minute door-to-needle time for thrombolysis for heart attack patients.

"Much consternation ensued with, I understand, heated exchanges between the CEOs of LAS and the HC. Meanwhile the larger workforce questioned just how all the hard work and benefits to patients were evaluated, if the organisation only found its reputation tarnished as a result.

"Belatedly, in autumn 2009, the DH did issue guidance to ambulance trusts setting out that conveyance to a Cath Lab for PCI should be rolled out across most of England and Wales.

"However, to hear the Department, as sponsor of the Healthcare Commission, held up as a beacon of enablement, especially regarding this specific example, is ludicrous.

"This change happened due to the drive of one individual at LAS, and the buy-in and hard work of people across the NHS in London. It happened despite - not because of - DH policy.

"Two possible explanations for the misconception suggest themselves. The first would be that Mr Lansley might be deluded, which is clearly beyond the realm of the possible.

"The second is that he is simply not particularly well-acquainted with what actually happened".

It's an interesting reflection on the localism that was possible under the system -  the one we're busy dismantling in the name of, erm, greater localism. No?