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Asthma

Volume 404: debated on Tuesday 6 May 2003

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Motion made, and Question proposed, That this House do now adjourn.— [Charlotte Atkins.]

12.9 am

I am grateful to you, Mr. Speaker, for my being able to introduce this short debate on asthma. It is an extremely timely debate, as Tuesday 6 May is world asthma day. In parliamentary terms, it remains Tuesday 6 May, although in real time, of course, that was yesterday.

I want to pay tribute to the work of the National Asthma Campaign, the independent charity dedicated to conquering asthma, which launched its new asthma charter today. If implemented, the charter could literally be a breath of fresh air, as it describes the quality of care that the 5.1 million people with asthma in the United Kingdom should receive from the national health service. The charter aims to ensure that everyone who works in the national health service and in government gives asthma the priority it deserves.

In view of the debate in the House tomorrow—perhaps I should say "today"—on the Health and Social Care (Community Health and Standards) Bill, one of the issues that deeply concerns many people is the balance between the role of primary care and the role of secondary care. Asthma—not the most glamorous end of health care policy—provides a timely example of how, if we invest more in primary care, we can ultimately save more in the costs of secondary care.

Let us be under no illusion that asthma can and does kill: in the United Kingdom, 1,500 people die from asthma each year. That equates to four people a day and one person every six hours. We all know someone who has asthma. Currently, 5.1 million people in the United Kingdom are receiving treatment for asthma. For many people, asthma means daily anxiety about how to avoid an attack. For some, it is a matter of life and death. Currently, there is no cure for asthma. It is a real problem, but, fortunately, we can do more about it. With better care and treatment from the point of diagnosis, an estimated 90 per cent. of deaths could be prevented and 75 per cent. of hospital admissions could be avoided.

Asthma is a condition that affects the airways—the small tubes that carry air in and out of the lungs. People with asthma have airways that are almost always red and sensitive because they are inflamed. Their airways can react badly when they have a cold or other viral infection or when they come into contact with an asthma trigger—something that sets off their symptoms. When that happens, the muscles around the walls of the airways tighten and become narrower. The lining of the airways swells and often produces a sticky mucus. As the airways narrow, the air must squeeze in and out, and that is what causes the person with asthma to find it difficult to breathe. Asthma symptoms can include coughing, wheezing, shortness of breath or a tight feeling in the chest. One of my constituents recently described an asthma attack to me, saying that it felt like an elephant sitting on their chest. It is a frightening experience, and it is important to emphasise that asthma is far more serious than an occasional shortage of breath.

One in 13 of my constituents in Bury, North suffers from asthma. A vast number of them have been in touch with me with regard to a variety of issues ranging from the impact of smoking in the workplace and other public places, asthma policies for schools, the impact of air pollution and the effect of prescription charges for asthma sufferers.

Of course, asthma is more than a health issue. For most sufferers, it is a quality of life issue, and in the absence of a cure I want people with asthma to be able to live a symptom-free life.

I declare an interest as an asthma sufferer. Does my hon. Friend agree that one of the best changes in terms of preventive care is the way in which people's use of the drugs can be managed through advice in doctors' surgeries, often involving practice nurses? Does he also agree that as new generations of those drugs are developed, there is a need to manage carefully people's access to them? Too often, people do not know how to use the drugs in the appropriate way, and more work must be done in that area. Does my hon. Friend agree that that is a way to take the matter forward?

My hon. Friend speaks with personal experience as an asthma sufferer and I pay tribute to the work that he has done to raise the profile of the condition. What he says about the need to increase people's awareness of the disease and to increase their ability to manage the drugs is right and will be a theme of my remarks.

The impact of new technology in alleviating the suffering of asthma sufferers also needs to be taken more seriously. I was recently made aware of the use of mobile phone technology by one of the major mobile phone networks to enable more direct communication at the crisis point between asthma sufferers and their GPs. Again, as time goes by, with the correct level of investment and with greater understanding and awareness of the problem by both GPs and asthma sufferers, that will lead to a severe reduction in the number of deaths from asthma.

The data and statistics presented by the National Asthma Campaign demonstrate how enormous a burden asthma can be. I was shocked to discover that almost 4 million people with asthma needlessly experience symptoms. As a nation, we do not meet our international targets for asthma care. That is through no fault of the patients or the health care professionals; it is entirely because the nation and the Government do not give asthma sufficient priority. If we do not make it a priority, how can asthma sufferers and their carers be expected to meet those critical standards? The sheer number of emergency admissions—74,000 per annum—is surely evidence enough that people with asthma are not getting the support or care from the health service that would prevent so many of those admissions.

People with asthma often have low expectations of how well they can be and do not realise that their health and quality of life could be better. Almost half of all people with asthma in the United Kingdom experience significant symptoms that disrupt their daily lives, such as difficulty in walking upstairs and interrupted sleep. The majority of people with asthma do not need to tolerate asthma symptoms. They can and should be able to go through life virtually symptom free.

The sheer scale of asthma as a condition makes it an expensive business at all levels of the health service and to society as a whole. Approximately 18,000 first or new episodes are presented to GPs each week in the United Kingdom. Respiratory disease is now the most common illness responsible for emergency admissions to hospital. Asthma costs the NHS an average of £850 million a year. At the local level, the annual cost of managing asthma for an average size primary care trust is approximately £4 million. In total, asthma costs the UK economy and the NHS more than £2 billion a year. As a consequence of symptoms and inadequate care, more than 18 million working days are lost as a result of asthma each year. That could be changed by better health care.

People with asthma are frequently forced to visit hospital because their asthma is poorly managed. Much of the suffering and unnecessary journeys to hospitals that are sometimes many miles away could be avoided because most patients would prefer to visit their local GP. Today's modern medicines mean that people with asthma should lead symptom-free lives, but the asthma care system leaves a great deal to be desired. With good support from health care professionals, backed up by written information, the National Asthma Campaign believes that people can take the lead in managing their asthma and relieve the impact of the condition on their lives—exactly the point made by my hon. Friend the Member for Stroud (Mr. Drew). That in turn will help to cut the costs of emergency admissions and reduce the number of unnecessary deaths.

Our current system leaves a lot to be desired in terms both of cost-efficiency and cost-effectiveness. However, it is clear that changes should be made, many of which may have little cost implication. People with asthma are not asking the earth; they want only common-sense things such as a quick and accurate diagnosis, to meet their respiratory consultant and asthma nurses on a regular basis, to be shown how to use the inhaler device correctly, to agree a personal action plan with a doctor or nurse and to expect any person who works in the NHS to be aware of the serious risks that the person with asthma faces if their condition deteriorates. However, it is also clear that prescription charges are a major problem for most people with asthma in the UK. In a recent survey, 71 per cent. of people with asthma said that free prescriptions would be the most useful thing in improving their quality of life. Some people with asthma are quite unable to pay for all their prescribed medication, and are forced to choose which treatment to go without.

Limiting asthma treatment because of financial difficulty puts the health of people with asthma at risk. Under-treatment can lead to irreversible lung damage, lower quality of life, an increase in the frequency of asthma attacks and the ultimate burden on the NHS, which is why the National Asthma Campaign wants asthma to be added to the list of clinical exemptions from prescription charges. As with many current clinical exemptions, asthma is a long-term medical condition with variable expression that requires consistent treatment to avoid worsening symptoms. There is no

clinical reason why asthma should not be added to the list. Free prescriptions for people with asthma will save NHS resources by reducing emergency hospital admissions and will improve their quality of life. In essence, better use of prescription medicines leads to less emergency health care use, less secondary care use, fewer asthma attacks and fewer days lost from work.

I would welcome a wider role for pharmacists in asthma care, as they often have immense knowledge of asthma and have a little more time to deal with patients than GPs. They could, for example, check a patient's inhaler technique—something that is vital, yet can make such a huge difference. Incorrect inhaler use means that the medication does not work effectively to control inflammation in the airways or open them when symptoms occur. I would like the inhaler check to be a standard procedure when people pick up an asthma prescription. People with asthma often underestimate the seriousness of the disease. Many put up with poor, substandard care because they have low expectations of the health care that they receive and the quality of life that they can enjoy. I urge people with asthma to take the asthma charter to their doctor to ensure that they get the best treatment and advice.

Only 3 per cent. of people with asthma in the United Kingdom have a personal asthma plan. Those plans are the single most effective non-drug-based way of controlling the condition, and can make the difference between a good quality of life and repeated admissions to hospital and all the associated health care costs. Making self-management plans a reality depends on the training of staff in asthma, which is neglected at present. There is an immense amount of good will among our nurses and health care professionals, but we need to harness that good will and provide structured plans so that training can come into force. Personal asthma plans lead to fewer asthma symptoms, improved lung function, fewer acute attacks because of the prompt response to a worsening condition, less need for reliever treatment, less need for steroids, less inappropriate use of antibiotics, improved compliance and a better quality of life.

Many people with asthma do not have the chance to speak to a trained asthma nurse or respiratory specialist before they are discharged from accident and emergency. That is a key factor in avoiding repeat admission. A thorough assessment of their asthma should be made, including, perhaps most importantly, the reason for the admission, so that we can find out what precipitated the attack and how the situation could be better managed in future. Perhaps we should look at Australia as a benchmark of good practice elsewhere. It has made asthma a national priority and has more than halved asthma deaths in 11 years. It managed to lower asthma deaths by implementing better asthma care across the board.

As a nation, we lag behind not only Australia but other European countries. In 1996, for example, mortality rates from asthma in the UK were 105 per 100,000 people, compared with 44 in France and 43 in Germany, which is why the National Asthma Campaign has long called for confidential inquiries into all asthma deaths. I want to reiterate that call so that we can know the reasons behind the 1,500 asthma deaths every year. If, as many people suspect, the reasons boil down to inadequate routine care, delay in obtaining help during the final, fatal attack or poor adherence to medication, the Government and the NHS need to act quickly and cut the number of deaths with the easy and common-sense points on implementation to which I referred earlier.

With one in every five households being affected by asthma, it is clear that we as parliamentarians need to do more to represent the views and needs of asthma sufferers. Regrettably, there remain many people, including politicians, doctors and nurses, who are not convinced that asthma is a problem. They do not seem to realise that their actions can make the difference between someone's asthma being under control and that person's being a regular visitor at the local accident and emergency department. I believe that the House can make a difference and I call on the Government to make asthma a national priority.

We need more asthma clinics run by asthma-trained health professionals offering a patient-centred approach to increase patient expectations, coupled with health care trusts ensuring that asthma is a local priority. In addition, health care professionals should adhere to the latest British guidelines on asthma management. I pay tribute to the work of the National Asthma Campaign, the voice of people with asthma, for its ceaseless campaigning to improve patient care and public awareness of asthma. We in Parliament need to take heed of that, as we know that good management can lead most people with asthma to have full and active lives, and a better quality of life overall. Admittedly, the onus does not lie solely with Westminster, but it is a good opportunity for parliamentarians of all parties to use their power and influence to unite to make asthma a national priority.

It is evident that much more work remains to be done within the NHS on behalf of the majority of people with asthma who should be experiencing a life free from symptoms. That is a problem connected with the health service, not with the health care professionals working within it. The Government should make asthma a national priority so that we can have a seamless co-ordinated system of care across primary care, accident and emergency, ambulance and in-patient and outpatient services. That m turn would cut the burden and costs incurred by the NHS and the pressure on the UK economy.

12.26 am

I congratulate my hon. Friend the Member for Bury, North (Mr. Chaytor) on initiating the debate. It is opportune that we are discussing asthma on world asthma day. I, too, have seen the National Asthma Campaign's 10-point charter, "A Breath of Fresh Air", which was published today. I share my hon. Friend's high regard for that campaign, with its proud record of supporting research and raising the issue of asthma, as has my hon. Friend today.

We are making progress in improving treatment and care for people with asthma, and I welcome the opportunity to outline what has been done and what more we can do. I start by recognising, as my hon. Friend explained, how distressing and debilitating the condition can be for individuals, their carers and their families. As he rightly said, asthma is the commonest chronic disease in the UK and it affects all age groups. Its cause, despite much research worldwide, is still not known.

Before I deal with some of the detailed points and outline some of the action that has been and will be taken, I want to give some good news. Asthma treatments have improved and the number of deaths has fallen. Since 1988, the number of deaths in England and Wales has fallen by about 25 per cent. I recognise my hon. Friend's concern about people being admitted to hospital when earlier preventive treatment could have avoided that, but admissions to hospital have fallen significantly since 1997, when they stood at 71,434 a year, to 60,134 in 2001–02. Like him, I believe that the advances in treatment are due to the commitment, dedication and expertise of the NHS and researchers.

As my hon. Friend pointed out, asthma is mainly managed in primary care. The chronic disease management programme, which was introduced in July 1993, provides arrangements for health promotion under the GP contract. Participating GPs, who currently account for about 93 per cent. of the total number, receive a fixed annual payment for running organised programmes of care for patients with asthma.

The asthma charter published today by the National Asthma Campaign sets out 10 rights that a person with asthma might expect from the NHS. GPs who participate in the chronic disease management programme are providing services that help to meet many of the charter rights. For example, the charter calls for access to nurses and doctors with specific asthma training. To participate in the chronic disease management programme, health professionals must be adequately trained in the management of asthma. Other requirements include ensuring that all newly diagnosed patients with asthma receive appropriate education and advice. My hon. Friend the Member for Stroud (Mr. Drew) was right to say that that is an important element whereby we can improve management of asthma. GPs are expected to ensure that all patients receive continuing education, including supervision of inhaler technique if necessary, and to prepare an individual management plan with the patient and ensure regular reviews.

All those requirements put participating practices in a strong position to meet many of the important charter rights. Of course, we need to build on that. Hon. Members will be aware that a new general medical services contract was launched in February. If that new GP contract is accepted by the profession, it will lead to unprecedented investment in general practice to deliver a wide range of high-quality services with better clinical outcomes for all patients, including those with asthma.

The proposed contract includes a specific quality indicator for treatment and care of people with asthma that builds on the chronic disease management programme and will expect GP practices to keep records and effectively manage and review patients with asthma in order to qualify for additional quality payments. In particular, it highlights and promotes the offering and development of smoking cessation advice for patients with asthma who smoke. It promotes an increase in the number of patients who have asthma reviews and the number who have flu immunisation. If the profession accepts the new contract, the quality indicators will help to drive up standards of treatment and care in that important area of primary care.

It is also crucial that the work force are in place and that we have the numbers and quality of staff needed to provide the standards of care that my hon. Friend outlined. Since September 1997, there has been a growth in the number of consultants across all specialties and a 63 per cent. increase in the number specialising in respiratory medicine. Clearly, it is important that we further increase the numbers of trained specialists available to take posts in that specialty. In addition, the Department of Health and the Royal College of General Practitioners have produced a framework for implementing a scheme for general practitioners with special interests and clinical guidelines for them.

My hon. Friend pointed out the importance of GPs and I very strongly share his view. The new guidance for the appointment of GPs with a special interest in respiratory medicine was published last month. Guidelines were written in conjunction with a range of experts, including the National Asthma Campaign and the British Thoracic Society. GPs with a special interest in respiratory medicine will be able to develop in their own services and along with their colleagues in primary care some of the improvements in treatment that we all want. They will be able to act as a clinical lead in the primary care organisation and carry out consultations with patients who may have been referred by other practitioners for advice on clinical management of problems such as asthma. That might well help to avoid the need to wait for referral to a hospital specialist or to be admitted to hospital at all.

GPs with a special interest might also be expected to help develop the competence and confidence of their professional colleagues in providing an optimal service for people with asthma, acting as a training resource, a development and a clinical leader in the local primary care area, and helping to improve treatment for those with asthma. That scheme is an example of how we are putting into place plans to improve care for people with asthma.

We recognise that not only GPs but specialist nurses have a very important role to play in the management of respiratory conditions such as asthma. Last month, the Department published "Liberating the Talents", a guide to inform the development of nurses with a special interest in primary care. Like GPs with a special interest, they could work across a number of practices, providing secondary care services to patients across the community. Alternatively, they might work out of a hospital trust on an outreach basis, perhaps supporting patients with asthma at home or in a local health centre.

We need to ensure that we have more and better-quality professionals. but there is also an important role for developing the approach of patients with asthma to managing their own condition. People with asthma will benefit from the emerging expert patients programme, which, from 2004 to 2007, will provide mainstream NHS training in self-management skills for people with long-term chronic conditions. The programme is piloting courses in selected primary care trust sites. We expect that it will develop to give individuals the skills to manage some of the generic issues around chronic conditions, including the need to deal with acute attacks, to make effective use of medicines and treatments, and to cope with other people's responses. We then intend to introduce specific training modules, including one for asthma, into those pilot programme processes. Experience to date suggests that expert patients can reduce the severity of their symptoms and increase their quality of life—an area where there may be some important benefits.

Asthma has a major impact on children. Alongside the work that we have done with the Department for Education and Skills on spelling out what we expect from schools in terms of helping children to manage their asthma and to play a full part in the life of the school, my right hon. Friend the Secretary of State for Education and Skills recently met representatives of the National Asthma Campaign to discuss what more we need to do to ensure that children have that opportunity. We are developing the national service framework for children to set standards for the care of children and young people so that all children and young people have access to good-quality care. We are developing, with input from the National Asthma Campaign, an exemplar that uses—because of its prevalence—asthma to demonstrate how services from primary care to acute care, including ambulance trusts, must work together to ensure that the services that we provide for children with asthma are the most appropriate.

That applies not only to children, but to adults. We recently welcomed guidance from the National Institute for Clinical Excellence on inhalers. Last year, it advised on inhalers for children aged between five and 15 and, in September 2000, for children under the age of five. We strongly support that guidance, which emphasises the importance of ensuring that the device suits the individual needs of the child. That fits with my hon. Friend's comments on making sure that we prepare patients and educate them properly about the use of drugs, and more broadly.

On smoking, the Government's ban on tobacco advertising, work to educate parents about the effects of smoking, and support for the licensed hospitality industry's charter to improve facilities for non-smokers in pubs, bars and restaurants will be important contributions to helping to tackle asthma.

I pay tribute to the role of the National Asthma Campaign as one of the largest funders of asthma research.

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-one minutes to One o'clock.