National director for heart disease Appointed: March 2000

My achievements

The NHS in the 1990s was an organisation that had lost its way. Bristol, Shipman, and a range of other clinical disasters meant that morale among our doctors, nurses, and other health professionals was low.

Against this background, it was with some trepidation that in March 2000 I took on the role of national director for heart disease, responsible of implementing the national service framework for coronary heart disease.

It was vital that clinicians bought into the process or the framework would become yet another policy document destined to gather dust on many an official shelf.

I need not have worried. Long before I had finished a series of visits across the country with members of my team, it became clear that the those working in the field of coronary heart disease were actually champing at the bit. Not only did they wish to implement what the national service framework required, they wanted to do more—a lot more and right away.

Now, three and half years on, thanks to the experience, expertise, and hard work of thousands of dedicated NHS staff, important progress has been made. Cigarette advertising has been banned; over 300 000 smokers have been helped to quit. The national school fruit scheme is providing nearly one million children with a free piece of fruit each schoolday. In primary care, the number of prescriptions for statins has risen by 30% each year, and the annual spend is now in excess of £0.5bn ($0.9bn; €0.7bn). In emergency care, we have seen steady improvement in ambulance response times and improvement in delivery of thrombolysis. The targets to reduce waiting times for heart surgery have long been eclipsed. Not long ago some patients were waiting up to two years for coronary bypass surgery; now the NHS is on target to reach a maximum wait of three months by March 2005 at the latest. And we are building for the future: 15 major cardiac developments, in areas where need is greatest, have been announced, at a cost of over £580m.

Nevertheless there is still much to do—for example, increasing angioplasty activity and developing services for heart failure. But there is huge consensus in the clinical community that we are on the right tracks.

What others say

Professor Roger Hall, division of cardiology, Hammersmith Hospital, London, and editor of Heart: I believe that Roger Boyle has been a success—the interface between government and the profession is always a very difficult place to be, and there are inevitable tensions. In that position, strong pressure may well simply result in the sack, and the close association with the political side drags people in!

It is hard to say in a concrete way what would have happened had he not been there, as cardiology has always been quite well organised and has a powerful case to put because heart disease kills so many in this country.

The real benefit is that there is an established route [to government] and someone at the table who is respected by both the profession and the government. Roger Boyle fits this bill and understands many if not all of the tensions that there are. I think it is difficult for one person to represent the whole speciality. Roger is a cardiologist at a district general hospital, and, although well versed in theory about tertiary centres, he does not work in one— although I know he would insist that makes no difference.

Overall he is what we needed, and before he was appointed I thought he was one of the few people who could do the job.

Professor Sir Charles George, medical director at the British Heart Foundation: The British Heart Foundation welcomed the introduction of national clinical directors, in particular the national service framework.

The framework sowed the seeds of change for patients with heart disease, promising better diagnosis and quicker access to treatment. Now, we are reaping the benefits and can already see the difference that this programme has made to the quality of life of thousands of patients in England.

Inequalities in access to health care for coronary heart disease around England and between different population groups are well documented and were, at the time, in urgent need of tackling. The national service framework sets clear parameters for resolving many of these problems and for improving overall prevention and treatment of coronary heart disease in the NHS.

This framework made a very significant impact on the unacceptably high levels of death and disability caused by heart disease in England.

The British Heart Foundation also welcomes the recognition that additional staff and equipment—including defibrillators and diagnostic equipment—are needed.

Sir Magdi Yacoub, cardiothoracic surgeon, Harefield Research Foundation: One of the greatest attributes of the NHS is the capacity to deliver an egalitarian, efficient service. To be able to develop and monitor that in a dynamic fashion responding to developments in each specialty requires the help of tsars in each specialty. The work of Dr Boyle in the field of treatment of coronary heart disease exemplifies this. Application of the same process to the treatment of other conditions such as aneurysms (especially acute dissection) and mitral valve repair is urgently needed to achieve the desired goals. Dr Boyle's appointment has been a success story that needs to be extended.