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Asthma Services

Volume 447: debated on Wednesday 7 June 2006

Motion made, and Question proposed, That this House do now adjourn.—[Huw Irranca-Davies.]

I would first like to thank Mr. Speaker for selecting asthma services as the subject for this Adjournment debate. It is a subject close to my heart and I gather, although not from the number of Members present, that it is also a subject in which hundreds of thousands of people throughout the country are interested.

I should like to introduce the background to the debate. World asthma day was on 2 May, and like many other hon. Members I attended a reception given by Asthma UK in this House. The Secretary of State for Health also attended the event and made encouraging noises about the need to improve health care provision for people with long-term conditions.

I am grateful to the Minister of State, Department of Health, the hon. Member for Doncaster, Central (Ms Winterton), for coming here today to expand on the Secretary of State’s comments, and I will be sure to leave her ample time to deal with the detail of the Government’s thinking.

My hope and intention is that today’s debate can be a constructive one in which as many Members as possible are able to feed to the Minister some of their thoughts and concerns about asthma services in the UK. There is much to be commended in the work that the Government have done for people with asthma. If that is not clear later on in my speech, it is only because time is tight and I am keen to flag up gaps in provision and procedures that could be improved. In particular I wish to pass on what people with asthma have said to me, because there is no doubt that they are among the best judges of what does and does not work, and what could be improved.

I have lived with asthma all my life. My sister, Caroline, had undiagnosed asthma for many years, and her quality of life suffered as a consequence—at one point, she ended up in hospital with pneumonia. Through my sister’s experience, my shovel-like cough was identified as a symptom of asthma, which was diagnosed at the age of two. My elder son, Alexander, has had two extended visits to hospital in years two and three of his life. My other son, Stephen, who is just two, is showing all the signs of asthma, but he is yet to be diagnosed.

In my previous life, I worked with Asthma UK—at the time, it was known as the National Asthma Campaign—on a number of campaigns, including a campaign on smoking in public places. I am delighted to see that a similar ban to that in Scotland will be introduced in the rest of the country, which will make a big improvement to the quality of life of people with asthma. Other important issues include the administration of medicines in schools and the redesign of asthma services.

I have found ways to manage my asthma and, like many others with the condition, enjoy a number of sports and activities in which I would be unable to participate without proper medication. At this point, I challenge other hon. Members to join me in the Scottish coal-carrying championship, which takes place at the end of June. Competitors are required to carry a 1 cwt bag of coal for 1,000 m along the undulating main street in Kelty, my home village. Given the marathon sittings that hon. Members endure in this House, I imagine that they would find that a stroll in the park.

I consider myself lucky that my asthma is relatively mild and controllable and that I have the wherewithal to pay for repeat prescriptions. I believe that the person should control the asthma rather than the asthma controlling the person. When GPs, nurses and pharmacists ask people with asthma whether their condition is under control, the people often say, “Yes.”, but if they are asked whether they can climb stairs without wheezing, whether they can sleep for a whole night without wheezing and whether they can run for the bus, they often say, “No.” People accept far too much of their condition, and awareness needs to be raised among people with asthma about the quality of life that they could live.

I have personal experience of the benefits of modern medicines and the value of asthma clinics. When I was in my 20s, I did not control my asthma well, and when I went to the asthma clinic, the nurse told me that I would die if I continued not to control it. That information was dramatic, and it shook me up. The nurse explained that if I did not manage my asthma, the blue inhaler would not work and my lungs would collapse during my next asthma attack. I took that information to heart and have controlled my asthma much better—the modern medicines are fantastic. Nurses and pharmacists play as an important part as GPs, and they are skilled health professionals who should be encouraged to do even more. They are in the front line and face people with asthma all the time, and we should encourage them to do more to provoke people to reassess whether their condition is acceptable.

Asthma is a disease of the lungs in which the airways are unusually sensitive to a wide range of triggers, including house dust mites, cold air, viral infections—in my case, it is usually colds—or cut grass. Common triggers also include tobacco smoke and animal fur—interestingly, people who live with a cat or dog in their early years tend not to suffer from animal sensitisation in later years, so not all animals are bad for people with asthma. The airways react to those triggers and become inflamed, resulting in symptoms of tightness and wheeziness in the chest. People suffering severe attacks find it nearly impossible to breathe and require rapid medication. Approximately 1,400 people die every year from asthma, and 90 per cent. of those deaths are preventable, which is a huge percentage that needs to be tackled.

There are about 5.2 million people with asthma in the UK, which is one of the highest rates in the world. It affects one in eight children and one in 13 adults. An estimated 8 million people in the UK have been diagnosed with asthma at some stage in their lives—an average of one in seven of the population. There are now three to four times more adult people with asthma in the UK and six times more children with the condition than 25 years ago. There is a big debate as to why that is the case. Asthma is a serious problem encountered by a large proportion of the population. There is currently no cure for it. Some people say that the problem largely disappears when they enter adulthood; many, however, live with it for life. It is a condition that they manage through their medication and lifestyle adaptations.

At the end of January this year, the Government published their White Paper on health care outside hospitals, entitled, “Our health, our care, our say”, which came out of the consultation exercise, “Your health, your care, your say”. There is much to applaud in that White Paper and much for which people with asthma have been calling for many years. In particular, I welcome the recognition that better community-based care can reduce hospital admissions and thus costs. I will, however, press the Minister to take that logic further in relation to prescription charges.

Several specific proposals will have come as welcome news for people with asthma. First, there are the plans to develop so-called information prescriptions and personal care plans for those with long-term conditions. They constitute an important recognition that people can be the best judges of their own needs. I hope that the Minister can confirm that information prescriptions will be just one part of a larger drive towards self-management of long-term medical conditions. I am sure that she will know that my colleagues have long espoused the value of self-management for the estimated 17.5 million people in Britain living with chronic conditions.

The potential benefits of such an approach are considerable. For example, a person aware of the nature of their condition and empowered to control it should be less likely to require regular emergency treatment, thereby reducing the burden on stretched NHS resources. Asthma UK estimates that for every £1.60 spent on personal asthma action plans, £7 is saved on NHS care. Many people with asthma resent the feeling of powerlessness that comes with the uncertainty about when attacks might occur. A successful self-management programme should improve a person’s mental health and self-esteem as well as promoting their long-term physical well-being. Self-management programmes could be integrated with greater use of voluntary sector organisations such as Asthma UK. There is no doubt that people with asthma looking to develop self-management programmes would benefit from the expert advice that voluntary sector organisations can offer and from the chance to talk to other people with asthma within that context.

Will the Minister expand on how the Government see self-management programmes developing? In particular, may I encourage her to make a commitment to place a clear duty on local health commissioners to commission self-management packages for people with asthma involving patient groups in the design, delivery and evaluation? I hope that she will consult her colleagues in the Scottish Executive, who are funding a pilot project for personal health plans using asthma as the test condition. I am sure that lessons can be learned from each other’s experience. The White Paper recognises that health professionals have not always been given sufficient incentives to manage long-term conditions. I have heard many GPs and consultants say that asthma is sorted, but when one hears people with asthma tell stories about what they have to put up with, it is clear that that is certainly not so.

As I said, about 1,400 people die from asthma each year and about 90 per cent. of those deaths are preventable. It is worth taking a minute to consider how those deaths could have been avoided.

First, it is important that people who are admitted to hospital with severe asthma attacks are seen by respiratory specialists. One in five people with asthma say that they do not get to see an asthma specialist when their asthma becomes hard to control. There must be adequate provision of asthma specialists across the board, from GPs and nurses with specific asthma training to respiratory specialists for emergency admissions and long-term support.

Secondly, the Government must be willing to fund properly research into the causes, treatment, cure and prevention of asthma. Asthma UK already puts more funding into asthma research than the Government. A recent report by the UK clinical research collaborative found that respiratory diseases received disproportionately low funding, considering the number of people affected. Indeed, respiratory disease is now the most common illness responsible for emergency admissions to hospitals and kills more people than coronary heart disease.

Above all, the Government must be committed to keeping people with asthma out of hospital by improving their day-to-day support. Nearly 200 people are admitted to hospital every day with emergency asthma attacks at a cost of nearly £80 million. As many as 75 per cent. of hospital admissions are probably preventable with proper long-term care and support.

On 20 March, the Secretary of State called for a 30 per cent. reduction in hospital admissions. She estimated that that would save the NHS more than £400 million a year. The Government’s health White Paper commits them to refocusing the quality and outcomes framework of the GP contract and changing the payment by result system to encourage greater concentration on managing long-term conditions. I welcome that and I hope that the Minister can expand on what it might mean for people with asthma who too often feel deprived of specialist advice on the day-to-day management of their condition.

The role of the voluntary sector is vital. I hope hon. Members will not object if I focus on the services provided by Asthma UK as it is the example with which I am most familiar. That is not intended as a slight on the many other charities and support groups that provide excellent services for people with asthma, but I wish to highlight the role of Asthma UK because it has been developing the concept of self-management for some time. The Government could learn much from its example and establish a useful partnership with Asthma UK on the issue.

Asthma UK provides an advice line, which is staffed by specialist nurses, who can offer advice on medication and effective self-management. It has also helped thousands of people develop personal asthma action plans or care plans, which already deliver genuine benefits in reducing symptoms and improving quality of life. However, research by Asthma UK suggests that only 24 per cent. of people with asthma have care plans. I know that the Minister will want to explain how the Government intend to extend such plans so that people with asthma have access to them.

The Minister may be interested to hear about Asthma UK’s control test—a 60-second, five-point questionnaire that helps people to understand how their asthma is controlled, with a simple score out of 25. I tried it today and I am pleased to say that I scored 23 out of 25, which is not too bad. I encourage hon. Members to take part in the census because it is a good way in which to assess how well one’s asthma is being controlled.

I hope that the Minister will join me in applauding a joint collaboration between Asthma UK, the British Heart Foundation and Diabetes UK, which have worked with primary care trusts, the Department of Health, the Healthcare Commission and the National Institute for Health and Clinical Excellence to develop a so-called “commissioners’ toolkit”. It is intended to outline examples of good practice in the treatment of long-term conditions such as asthma, heart conditions and diabetes and is to be made available to all commissioners of health care.

The final issue that I would like to raise is, I believe, one of the most important, which ties in closely with the theme that I have sought to develop, namely reducing hospital admissions through encouraging self-management of asthma. It is prescription charges. The current system of exemptions from prescription charges dates from 1968 and makes little sense now, if it ever did. The Minister will remember the 2002 report by Mr. Wanless, entitled, “Securing our Future Health: Taking a Long-Term View”. In it, Mr. Wanless stated:

“The present structure of exemptions from prescription charges is not logical, nor rooted in the principles of the NHS. If related issues are being considered in future, it is recommended that the opportunity should be taken to think about the rationale for the exemption policy.”

Members will be familiar with the general arguments for extending exemptions to a greater range of long-term conditions, but I hope that they will forgive me if I reiterate some of the key points. The present system fails the test of fairness. People with diabetes and certain forms of epilepsy are exempt from prescription charges, but people with arthritis, asthma, mental illness and multiple sclerosis are not. Those with an underactive thyroid are exempt, but those with an overactive thyroid are not.

The present system hits the poorest hardest. The Government’s 2000 NHS plan states:

“New charges increase the proportion of funding from the unhealthy, old and poor compared with the healthy, young and wealthy. In particular, high charges risk worsening access to healthcare by the poor.”

People with incomes barely above the income support level have to meet the full cost of prescriptions, providing them with two disincentives: a disincentive to work and a disincentive to pay for necessary prescriptions. The knock-on effects of this problem are precisely those that we all wish to avoid. Prescription charges discourage people with asthma from taking medication to control their condition, and encourage them to think of treatment as something only to be taken in an emergency. This increases emergency hospital admissions, thus increasing costs to the NHS. It may also lead to a number of preventable deaths every year.

I am pleased to report that the Scottish Executive are undertaking a review of prescription charges. They have recognised the innate unfairness in the system, and the extensive review will include a full literature review, consultation and debate. I hope that the Government will read the review documentation and have discussions with the Scottish Executive about their emerging conclusions.

I do not expect the Minister to make new policy in this Chamber at this time. I would, however, welcome her personal view on how the system of exemptions for prescription charges might develop in the future. As she knows, my party committed itself at the last election to an independent review to suggest reforms to the system of exemptions. I would be grateful if she could tell me whether she sees merit in this suggestion. I would also be grateful to hear the views of others on this matter. It is my view that free prescriptions for people with asthma would do much to help them to control their condition and live normal lives, and I would welcome a range of views on the issue.

I would now like to give the Minister a chance to give a full response, and I hope that she will make specific reference to the important issues that I have raised about people with asthma.

I congratulate the hon. Member for Dunfermline and West Fife (Willie Rennie) on securing this important debate today. I saw by the way in which he set out his personal experiences how strongly he feels about this issue. I would also like to join him in paying tribute to the outstanding contribution of bodies such as Asthma UK, and I shall say more about their work later.

As the hon. Gentleman graphically described, there are approximately 5 million people whose lives are blighted by asthma to a greater or lesser degree. The big challenge is to find ways for people to manage their condition through medication and lifestyle adaptation. Again, the hon. Gentleman described his personal experience in that regard. Our aim for patients is certainly to move away from care that is reactive, unplanned and episodic, and to put in place an approach that is centred on early detection, disease management and promoting independence. That will involve offering a personalised care plan and improving care in primary and community-based services, particularly for the most vulnerable people. Such an approach will not only improve personal health outcomes for people with long-term conditions; it will also reduce avoidable hospital visits. The hon. Gentleman touched on that issue as well, and I hope that he will welcome our commitment to trying to reduce emergency bed days by 5 per cent. by 2008.

This whole programme of work, which is called “Supporting People with Long-term Conditions”, was launched in 2005. It set out a new NHS and social care model specifically designed to help local NHS and social care organisations to improve care for people with long-term conditions.

From the outset, self-care has been a vital component of that model. We want to help NHS organisations to develop a local self-care strategy, which means working with local agencies, the community, the voluntary sector and—as the hon. Gentleman said—the people themselves and their carers. As the hon. Gentleman also said, part of that involves information prescription. I am happy to reassure him that information prescription is an important part of our approach to self-management.

I am glad that the hon. Gentleman welcomes the White Paper. The theme of community-based services and supported self-care for people with long-term conditions and their families, especially those with asthma, emerged strongly in our consultation. Here again joined-up thinking and working is vital, and not just between health and social care partners. As we said in the White Paper, local strategic partnerships will be responsible for the delivery of services and for ensuring that they are genuinely integrated and, crucially, focused on the needs of individuals.

The hon. Gentleman mentioned the work of the Scottish Executive. We shall, of course, want to hear and learn from our colleagues in Scotland, and elsewhere for that matter, but I am sure that the hon. Gentleman will be interested to know that the PRODIGY system that is used in GP surgeries in England generates personalised asthma action plans based on guidelines produced by the British Thoracic Society and the Scottish Intercollegiate Guidelines Network.

I will give way, but because the hon. Gentleman has not left me much time, I may not be able to deal with all the points that he raised if I do.

As I think the Minister will admit, self-care is not about simply letting people loose or letting them free. It probably requires harder work to arrange for them to be included in self-management plans. Self-management plans are not simply about printed forms; they are about agreements and partnerships.

That is absolutely true. The expert patient programme, for instance, has proved to be a very good way of helping people to manage their conditions and learn about them. I realise that it is not always easy, but the benefits are enormous.

It has been the policy of successive Governments that those who can afford to make a small contribution to the costs of medicines should do so. I assure the hon. Gentleman that the existing list of medical conditions that give exemption from prescription charges has been reviewed on a number of occasions, but no clear-cut case for extending it has emerged. There is no consensus on additional conditions that might be included, or on how distinctions could be drawn between one condition and another or between a mild form of a condition and a severe one. It is a difficult issue, and it has been considered, but I am sorry to tell the hon. Gentleman that we currently have no plans to extend that particular list. What we have been doing is giving priority to helping those who have difficulty in paying charges. Nearly 90 per cent. of prescriptions are already issued free of charge because of the extensive exemption and charge remission arrangements.

The hon. Gentleman described the vital role of the voluntary sector, and I entirely agree with what he said. He spoke of the work done by Asthma UK in raising awareness of the condition, and mentioned the reception attended by the Secretary of State on world asthma day. That constituted a vital contribution to the development of national policy.

The hon. Gentleman referred to the commissioners’ toolkit that Asthma UK has been working on with my Department. It will be extremely useful in ensuring that there are good services at a local level for people with asthma. The Minister of State, Department of Health, my hon. Friend the Member for Don Valley (Caroline Flint), who is responsible for public health, has discussed smoking policies with Asthma UK, and I know that she found that very useful.

Asthma UK has done a lot of work at a local level. There is a project in West Sussex that provides swimming lessons for children with asthma, and a project in Hackney is training 80 people in self-management and in how to live healthy lifestyles. Those are exactly the kind of approaches that the hon. Gentleman set out.

Last July, my hon. Friend the Minister for Immigration, Citizenship and Nationality, in his former role as Minister with responsibility for care services, announced the Third Sector Commissioning Task Force. Its programme is to identify barriers to achieving that strong relationship between the voluntary and public sectors. We want to promote that relationship, but we must ensure that we look out for barriers and see what we can do to assist in removing them.

In terms of asthma specialists, we have more doctors, nurses and other health care professionals than ever before within the NHS. It is from that expanded work force that specialists of all kinds will be drawn.

The hon. Gentleman also asked about research. The agency through which we carry out research is the Medical Research Council. We consider the ways in which we can contribute to increasing research in all areas.

I hope that I have given an indication of how the Government have put the concerns of those living with long-term conditions at the heart of our reform agenda. Diseases such as asthma present a massive challenge to the health and social care system. It is a challenge that will need to be met by services that benefit not only from the increased funding in the system, but from the reforms to service delivery. By focusing on the needs of patients, we empower them to take control of their own health and care.

Question put and agreed to.

Adjourned accordingly at twenty-eight minutes to Eight o’clock.