[Nadine Dorries in the Chair]
It is a pleasure to serve under your chairmanship, Ms Dorries. I would like to talk about respiratory disease, which affects one in five people in the UK, is responsible for about 1 million hospital admissions and costs the NHS almost £5 billion a year. It is also the third biggest cause of death in the UK. It is the poor relation compared with the investment that goes into tackling the other four big conditions. To put that into context, in 2012, respiratory disease killed 80,000 people—that does not include lung cancer, which killed an additional 35,500 people.
The UK also has the highest mortality rate for respiratory disease among the OECD nations, double that of countries such as Poland and Germany and treble that of countries such as Estonia and Finland. Sadly, the worst thing about those statistics is that many of the deaths would be preventable with the right care. I understand and welcome the announcement by the Secretary of State that he is making it a priority for NHS England to prevent people from dying prematurely from respiratory disease. His ambition is to make us one of the best in Europe for survival rates by improving prevention, diagnosis and treatment. That is a very big statement and a huge aspiration when we are talking about reducing respiratory deaths in this country by almost two thirds.
I want to focus my remarks predominantly on asthma and chronic obstructive pulmonary disease—known as COPD—which together affect almost 6 million people in the UK, including me. I am chairman of the all-party group on respiratory health. With the support of Asthma UK and the British Lung Foundation, we conducted an inquiry into respiratory deaths in an effort to help the Government and the NHS to understand why so many people are dying from these conditions and what can be done to prevent that. I am grateful to the other members of the all-party group for their support, and for the amazing contributions that we receive from patients.
I pay tribute to my hon. Friend for his work as chairman of the all-party group. What does he make of the NICE evidence that about a third of the people who are receiving treatment should not be, while there is such a lot of undiagnosed asthma? That seems very odd.
My hon. and learned Friend makes an incredibly important point, to which I will return later. The information that has come out of NICE is sadly testament to the complacency that we see regarding the effects of respiratory disease, and to how some professionals and patients treat the condition, ultimately resulting in those patients’ deaths.
Contributors to the all-party group’s report include health care professionals, charities, patients, families and professional organisations, as well as a range of other people who contributed both written and verbal evidence. I will read the story of one of those people a little later, but first I want to look at chronic obstructive pulmonary disease, which is an umbrella term for a set of conditions that includes bronchitis and emphysema. Combined, such conditions kill more than 30,000 people a year in the UK—around 5% of all deaths in the UK from all causes. A COPD patient’s journey is often punctuated by multiple exacerbations, which are sudden worsenings of the symptoms, often triggered by external factors such as infection and problems with air quality, that often lead to hospitalisation.
To put it into context, people suffering from COPD exacerbations are the second most common cause of emergency hospital admissions in this country, the biggest being ischaemic heart disease, which is effectively coronary heart disease—heart attacks and strokes. It is estimated that COPD leads to 94,000 admissions a year, with cold weather often a major contributory factor. The direct costs on the NHS are more than £800 million a year, so COPD is causing a huge problem in terms of the costs for the NHS and the impact on individual patients. One of the worst statistics that the all-party group’s inquiry came across was that 50% of people who are admitted to hospital with severe COPD die within four years—once it has reached the stage of their being admitted to hospital, they sadly have a life expectancy of four years.
I congratulate my hon. Friend on having secured this debate. Does he agree that there is a real problem with undiagnosed COPD, which is contributing to those hospital admissions? People are presenting for treatment only when they are in crisis.
My hon. Friend makes an important point. In fact, we believe that more than 2 million people in the UK have COPD but are completely undiagnosed. The British Lung Foundation has done a great deal of work to try to raise the profile of COPD. It has also done a great deal of work on pulmonary rehabilitation with its “Breathe Easy” groups, which help people who are suffering from COPD to access support networks and improve some of the scarring and problems that they have with their lungs. A recent study of more than 39,000 COPD patients showed that more than half had symptoms for six to 10 years before the diagnosis was made—my hon. Friend’s point is powerful—and 42% had has those symptoms for up to 15 years before being diagnosed.
I want to tell the story of Neil, 50 years old and from Norwich. He was continually misdiagnosed by doctors despite being at high risk of lung disease and showing signs of the condition throughout his 30s. By the time he was finally diagnosed, he had lost most of his lung capacity.
Neil was a long-term smoker who worked for many years in cold and dusty conditions. When he was younger, he visited doctors regularly and had breathless attacks that sometimes required emergency treatment in hospital. However, he was never offered a lung function test by his doctor, and he felt that his smoking habit was used as a reason to dismiss his symptoms and not investigate them fully. At the age of 39, he finally managed to see a specialist in the hospital, but his symptoms led doctors to think that he had asthma.
When a doctor told him the extent of the scarring and damage already done to his lungs, Neil decided to quit smoking on that very same day. He also cut back on some work to improve his working conditions. Five years ago, he developed two bouts of pneumonia. His health deteriorated: he felt constantly breathless and could barely walk 50 feet. Even at that stage, Neil was not given a lung function test or information about how to manage his condition; instead, he was told that he could expect to recover soon. He was forced to give up work completely and his wife Wendy had to start caring for him.
Eventually, a doctor told Neil that he had COPD. He had lost 70% of his lung function by the time he was told that he had COPD. He was able to speak to a specialist nurse at his local surgery who took the time to work with him and got him referred to pulmonary rehabilitation, and he became a member of one of the British Lung Foundation’s “Breathe Easy” groups, which are support networks that help people with COPD to come together to improve their conditions and exercise levels, to move forward and to improve themselves all round.
Neil can now talk quite a bit, and he speaks at length about his condition. He has decided that everyone who attends a “Breathe Easy” group becomes an expert on respiratory health and care. Fortunately, his experience was positive in the end, but he had lost 70% of his lung function before he was diagnosed with COPD—that could have been done five or 10 years earlier. Sadly, Neil’s story is a classic example of what is happening right now in GP surgeries and hospitals throughout the country. People have a right to know if they develop such a condition, and they must believe that they will receive the treatment that they want and deserve when they come forward with it.
A big Public Health England awareness campaign is due to take place in the east of England, involving a breathlessness exercise. I did it myself last year in Stevenage—although I would urge Members not to look at the photograph on my website that shows me taking the test because it was a bad hair day and it is an odd photograph—and the nurses were able to tell me that I had asthma, which is very well controlled. Throughout the day, they diagnosed a number of people with COPD, asthma and a range of other respiratory diseases. Had that bus not turned up in Stevenage and those volunteers had not been given those tests, a large number of those people would not know that they had a respiratory disease. Fortunately, the campaign will be rolled out across the whole of the east of England, so I hope that the Minister will visit it and identify whether it is a positive thing that could be rolled out throughout the country.
The NHS health check for those between the ages of 40 and 74 does not include a lung function or respiratory disease test, but 13% of all people over the age of 35 already have COPD. A lung function test should be included because, as my experience on the breathlessness bus in Stevenage showed, such a check would pick up large numbers of people, enabling them to get the care that they need. They will then be able to push on with their lives, instead of having to wait 10 years and only being told, when they are admitted to hospital with the possibility of dying within four years, that they might have COPD.
I am passionate about the need to improve basic care for people with asthma, and I join Asthma UK in highlighting the seriousness of a condition that affects 1.1 million children and 4.3 million adults in the UK. The sort of headlines that we saw last week, which were referred to by my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), are unhelpful when we know that too many people are complacent about asthma. Every 10 seconds, someone in the UK has an asthma attack. Every single day, on average, three people die in the UK from an asthma attack. The national review of asthma deaths, which was led by the Royal College of Physicians, suggests that two out of three of those deaths are preventable.
That review by the Royal College of Physicians was the first such review in this country. It was begun in 2012 and lasted a year, and it was published in May 2014. It found that 57% of people who died from asthma were not recorded as receiving specialist care 12 months before their death; 47% of those who died had a history of hospital admissions; and 21% had attended A and E within the previous 12 months. A written asthma action plan is a step-by-step guide to managing asthma and provides individuals with guidance on what to do if they have an asthma attack, but only 23% of the people who died had an asthma action plan, so more than 75% did not have one.
The Royal College of Physicians found that many asthma deaths could have been avoided had staff received better training. In fact, the expert panel found that 46% of such deaths could have been avoided had the existing asthma guidelines been implemented. The review also found evidence for both over and under-prescription of reliever inhalers, the blue bronchodilators. On average, someone should receive 12 inhalers a year; a number of people are receiving far fewer than 12 and, among a variety of other figures, some are receiving up to 50 inhalers a year. Just from the number of prescriptions, we can identify the target audience of people who will be seriously at risk of dying from an asthma attack.
The statistics and the all-party report both make it clear that too many people are not getting the basic levels of care and that there is great variation in the standards of that care across the country. It is essential that clinical standards are followed consistently. I have asthma myself, so I understand that the condition is complex and variable and should be taken seriously. People with asthma should continue to use their inhalers routinely and ensure that they attend their annual asthma review, at which they may discuss their diagnosis, medications and written asthma action plan.
Last year, more than 1 million people who have asthma did not turn up to their asthma review. I did, because my wife, my mum and my asthma nurse all gang up on me and force me to go every single year. They almost insist on me having my flu jab twice a year. In Parliament, I normally host a session for people with respiratory conditions to have their flu jabs each year. Unless I provide a picture of myself receiving the needle at that session, I am required to have another at my GP’s surgery in Stevenage. So I have to smile at the camera while the lady enjoys stabbing me with a needle—I am sure she takes a little longer than she should. I do that every year.
Let me tell the House about my experience of asthma. I was diagnosed with it when I was eight, and I am now 38 years of age. The Minister will be shocked and disappointed to know that my treatment has not changed in 30 years. The experience at the doctor’s that I had when I was eight is exactly the same as my experience now, except that nowadays I see an asthma nurse, whereas then it was a doctor. The asthma nurse takes the time to go through my peak flow monitor with me, and she weighs and measures me—I think I get shorter every year, and a little heavier—but in effect that is what the doctor was doing when I was eight, although then I was getting slightly taller, if slightly heavier too. The reality is that things have not changed at all.
I was one of those children who was diagnosed with bronchitis from the age of about five until I was eight. The doctors thought, “Oh no, it hasn’t gone in three years, so he must have asthma”, so I was given my inhalers. If I turned up to the doctor’s and said, “I have got this or that”, they would say, “Are you using your inhalers?” I would reply, “Yes, I am using my inhalers.” They would say, “Why don’t you take your blue reliever inhaler”—they call it a Ventolin bronchodilator—“a little more?” That would be my treatment. I have not had antibiotics, but if I were younger, they might have given me a two-week course of them and told me to come back if whatever it was had not cleared up. In effect, that is what I got when I was eight and what I get now when I am 38. That is why we have the highest rate of respiratory deaths among the OECD countries—the treatment for asthma for people at GP surgeries up and down the country has not really changed. It is exactly the same.
There has been some progress. I am delighted to report that after a campaign of three and a half years by myself, other Members of Parliament and Asthma UK, for the first time we can now have asthma inhalers in first aid kits in schools. It took us three and a half years, which is ridiculous, because those inhalers are prescribed medication, which could not simply be given out by a teacher.
My hon. Friend might be aware that before I came to this place, I was a receptionist for a GP. One of the biggest problems that parents find is that they do not have two inhalers prescribed at the same time for their child, so that one can be kept at school and one at home. That is one reason why we need to ensure that all schools have an inhaler for use in an emergency.
My hon. Friend makes an important point. I suffer from that myself, so I have an overnight bag in Parliament in case we get stuck here until 4 or 5 in the morning, and it has an inhaler in it. I had to get that inhaler off my dad, because I could not get another one off my own GP. I am a Member of Parliament, but I could not get myself an extra inhaler, so I am not sure what chance a child has of persuading an extra inhaler off the doctor, which his mates will probably just play with. I understand such problems, which is why I said earlier to the Minister that the treatment for asthma has not really changed in the 30 years that I have had it. There has been progress and good news—a number of children will not now die of asthma attacks in school over the next five to 10 years, because those inhalers are in first aid kits. Instead of a mate lending one, it will now be a matter of simply getting it out of the first aid kit, which is good news.
We are seeing great examples of innovation and high-quality asthma care throughout the country, with health care professionals working tirelessly to improve outcomes. They are looking for a cure for asthma. There are centres of excellence, such as the Royal Brompton hospital in London, which provides life-saving specialist care for people with severe asthma—I hope I never have to visit the place. The UK has some of the best asthma researchers, changing the way we think about the causes of asthma. In my constituency thousands of GlaxoSmithKline scientists are working on managing the condition of respiratory diseases on a daily basis; they are leaping forward with the ways in which we can manage such conditions. I thank them all for their brilliant work.
I am sure the Minister is aware that we have some recommendations and questions for him. Shockingly, the NHS does not track its own performance on asthma care. Despite asthma being one of the most common long-term conditions in the UK, no robust data are available. We would like to see a national clinical audit for asthma. Will the Minister commit to supporting such an audit and raise the matter with NHS England? An audit has the potential to stop people needlessly dying from asthma attacks, to improve the quality of life for people with asthma and to reduce costs for the NHS significantly. Such audits are already well established for other long-term conditions such as diabetes.
There should also be greater investment in asthma research. Research into the treatment and care of asthma and other lung conditions is chronically underfunded compared with other conditions such as the other four big killers. The amount of money committed to researching asthma simply does not match the burden it places on the NHS. In spite of that, amazing breakthroughs are taking place and there is potential. Asthma UK is working with the European Asthma Research and Innovation Partnership to establish a new fund to research and develop asthma drugs, with the ultimate aim of finding a cure for asthma. Will the Minister meet me and Asthma UK to explore how the Government can support the European innovation fund?
A variety of asthma research demonstrates that many people have allergies. Of those who have asthma, 50% are more than likely to have some kind of allergy that causes an asthma attack—we call them triggers. We do not have the lung function or capability that those without asthma have, so we have to learn quickly what our triggers are and avoid them. One of my triggers is pets, so although I am 38 I have never had a pet, which is quite sad.
We would also like to see written asthma action plans. The Secretary of State for Health has made a positive commitment to ensuring that every asthmatic has a written asthma action plan, so will the Minister tell us what plans the Government have in place to achieve that commitment? Once someone has an action plan it helps to reduce the seriousness of their attacks, because they learn quickly to manage their own condition. It is a serious condition, and people have to work on improving things such as their peak flow. There are bits and pieces that doctors and asthma nurses do with asthma sufferers—we compete with ourselves to try to improve in our asthma action plan.
We believe that there should be world-class asthma reviews containing key components; that is an item that came up in the national review of asthma deaths. It could result in a nationwide improvement in asthma. A variety of organisations are ready to help to develop the idea and work with the Department of Health and NHS England to make it a reality. The national review found that many asthma reviews did not include key components—only 27% of people had their asthma control assessed, only 42% had an assessment of their medication use and only 71% had an assessment of their inhaler technique. People are using their inhalers in a variety of ways, and could be losing between 40% and 60% of the medication’s effectiveness if they are using them incorrectly, yet almost 30% of people are not being assessed on an annual basis on how they use their inhaler. That could reducing the effectiveness of their medication.
We would like the Minister to support the creation of a world-class asthma review and to encourage NHS England to get on and actually do it. We know that NHS England is working on an improvement programme for children’s asthma, and we would like him to commit to continuing to resource that project into 2015-16. We have already seen significant successes in secondary and tertiary care for children.
It would not be a debate on asthma without a call—I have to declare an interest here—for free prescriptions for those with asthma; all asthma sufferers would like that. People suffering from many other long-term conditions receive free prescriptions for their inhalers, but asthmatics do not. If asthmatics do not take their inhalers they end up in an A and E facility receiving oxygen, normally after an ambulance crew has transported them there, giving them oxygen on the way. That costs a huge amount of money.
My final point is that smoking is a contributory factor in more than a third of all respiratory deaths. The health impact of smoking on asthma sufferers is enormous, so I personally call on the Government to get on and do all they can to push forward standardised packaging for cigarettes as soon as possible.
It is a pleasure to serve under your chairmanship, Ms Dorries. I congratulate my hon. Friend the Member for Stevenage (Stephen McPartland) on securing this debate.
Our respiratory health can be affected by many different things. I want to talk about an aspect that we often do not consider: allergic reactions that affect our breathing and can lead to a fatality. I will tell hon. Members a story about the eating of peanuts. I was unaware of the effects of actions that we take for granted on people who suffer from a peanut allergy until I spoke to my constituent Natalie, and I want to share her story with Members today. In Natalie’s own words:
“The last time I went in to anaphylactic shock it took about 3-5 minutes to make itself known—with each reaction this time will get shorter”;
that is what she has been told.
“I had some warning signs first. I always get a spot on my lip and an itchy tongue, so we went to buy some Piriton and on our way back I went in to anaphylactic shock. First I was just coughing—very weak coughs—and I think that lasted for a few minutes though I am hazy on the whole night. Then what I call ‘phase two’ moved very quickly, it felt like there was a lump in my throat, which it probably was as I was told later that I had hives (Urticaria) on my windpipe and this is what causes anaphylaxis. ‘Phase three’ moved even faster. I had to sit on the pavement as I couldn’t walk any further and I was trying to take control of my breathing. We rang the ambulance somewhere around phase three—I didn’t have an epi-pen because we didn’t know I was anaphylactic—the ambulance arrived very quickly but I was really light-headed by the time they arrived, I couldn’t see anymore and everything was white. My chest was so tight and it was so difficult to get any air in…it feels like being crushed by an elephant and only being able to breathe through a tiny straw. The ambulance men helped me up and gave me the nebuliser like what they give to asthmatics and by the time we got to the hospital I was feeling much better.
If I did have an epi-pen it would have given me around 30 minutes before the ambulance arrived but the reaction can start up again after the adrenalin wears off.”
As a result of that incident, Natalie came to me with a suggestion that I hope the Minister will take on board. She told me that on many occasions she has been in a pub where there are peanuts on the bar or has walked past peanut vendors in the street, and although that does not send her into full anaphylaxis, it makes her chest very tight and she has to remove herself. Some people have suggested to her that she should take antihistamines, but with the amount of allergens around that would not be wise, as if she accidently comes in contact with allergens, any antihistamines she has taken would block the warning signs and give her much less time.
Street stalls vending peanuts and pubs providing peanuts for their customers are things we take for granted and assume are harmless. Many people do not realise that simply being near peanuts can have a devastating effect on someone’s health. Will the Minister join me in calling for wider education and publicity about the harmful effects that being near peanuts can have on some people’s respiratory health?
Rightly, my hon. Friend the Member for Stevenage (Stephen McPartland) and other Members who have contributed have talked about the most serious incidents and life-threatening situations. I want to say a few words about mild asthma, of the sort that can affect someone playing sport. If we are talking about campaigning about asthma awareness, there are quite a lot of people who are not going to die because of their asthma but whose lives are spoilt by it.
My own experience is that when I was young I was a keen rugby player. I could play rugby, but after a match I was always wheezy. It never occurred to me that that was because of a medical condition, but I was talking to my doctor one day, when I had been playing rugby for years—I was in my teens at the time—and he said, “Actually, we can help you with that.” He gave me an inhaler and told me to take a puff before I played, and my life was transformed. There was no more wheezing and I improved; I was able to play rugby much better, and was able really to enjoy it for the first time. There must be a lot of people in the country who have not really realised that they have asthma, as it is undiagnosed.
My first point is that in making people aware of respiratory conditions we are talking not just about saving lives but about improving the quality of people’s lives. I am told that there are any number of top sportsmen who have the same condition of mild exercise asthma.
My hon. and learned Friend makes an interesting point. This is a problem not just for elite sports players and those who participate in sport regularly, but for those who are not active enough, or not taking part in any physical activity. They tend to look for reasons not to take part in those activities and being a bit wheezy, for some, can be a convenient excuse.
My hon. Friend makes a good point. It is easy to see this issue as 1 million hospital admissions and the third highest cause of death, without also looking at the huge effect on other sufferers. We know that 5.4 million people are being treated in the UK for asthma, and I rather share the view that the National Institute for Health and Care Excellence, in saying that a third of people have no symptoms at any particular time, may be making a slightly complacent comment. By the time I was in my late 20s I had no symptoms at all and I no longer needed to use an inhaler to do sport. However, when I had a problem one year with flu, they came back. It is a variable condition, and that can be underestimated.
Kay Boycott, the chief executive of Asthma UK, said:
“Asthma has many complex causes, which is one of the reasons why it is sometimes difficult to get a definitive diagnosis. It is also a highly variable condition that can change throughout someone’s life or even week by week, meaning treatment can change over time.”
One of the great lessons to learn is that we need to monitor regularly for asthma. My hon. Friend the Member for Stevenage made a particularly important point about attending the asthma clinic for the test.
The Royal College of Physicians recently made a point about variability and how asthma can suddenly deteriorate. As it said, there are different kinds of asthmatics: brittle asthmatics who can move from having no wheeze to severe problems; others for whom it appears just in the early morning; and others for whom it disappears for a period. We need more research and a campaign on awareness.
I apologise for being late for the start of the debate. Does the hon. and learned Gentleman agree that variability is one of the key problems with asthma? From hon. Members’ contributions, it is clear that each of us who suffer from asthma have different experiences of it. One of the biggest challenges, which has been brought home by the medical advice I have been given by doctors over the years, is never to underestimate asthma. One of the problems is that so many long-time sufferers think that they are in control, and that their medication is on top of it. He talks about the condition being variable for people with mild symptoms, but it can be a killer. A key part of the campaign that all of us want to support is about ensuring that people have regular check-ups and do not ever take asthma for granted.
That is exactly the point that I was coming on to make. It would be a mistake to assume that because NICE found that one third of the people it looked at had no symptoms, those people could heave a sigh of relief and forget about asthma for ever. People—as I did—can have periods when they are symptom-free, but they still need regular reviews to ensure that it does not come back or suddenly get worse.
The Royal College of Physicians identified major avoidable factors in two thirds of cases where people died, which were about the constant monitoring and attention to detail that my hon. Friend the Member for Stevenage mentioned. It did not cite all the evidence, but it seems that there are two unstable types of asthma that are often resistant to treatment and that can be a contributory factor. We need more research, awareness and knowledge that it is a variable condition, and that people should therefore not make assumptions or be complacent.
It is a pleasure to serve under your chairmanship, Ms Dorries. I congratulate the hon. Member for Stevenage (Stephen McPartland) on securing the debate. I commend the work that he and the all-party group on respiratory health do to raise awareness of these important issues in Parliament.
It cannot be denied that care for respiratory health conditions demands far more attention than it currently receives. Asthma, after all, is one of the most widespread and pernicious conditions around, and takes up a huge amount of resources in our health service. I share the hon. Gentleman’s concerns. We need to ensure the proper use of inhalers. My eldest son is asthmatic. He certainly has regular asthma reviews, and my wife and I, like the hon. Gentleman, try to ensure that such reviews are never missed, because they are so important.
The amount of research time that asthma gets is not proportionate to the scale of the problem, and routine asthma care simply is not up to scratch. The hon. Gentleman made that point well; the fact that he has been receiving pretty much the same treatment for the past 15 years speaks volumes. Respiratory disease is the third biggest killer in the UK, but the risk of conditions such as chronic obstructive pulmonary disease and asthma is perennially underestimated. The rate of deaths from respiratory disease in the UK is around three times that in Estonia and Finland.
Like the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), I get wheezy at sport. That has nothing to do with being asthmatic; it is more to do with my fitness levels. However, he made an important point that awareness of asthma, in the medical community in particular, is crucial. In 2010, I was very ill. My GP diagnosed asthma and prescribed me inhalers, which made me much worse because I was not asthmatic; I had pneumonia. That highlights the real need for the GP community to understand the specific needs of patients and whether asthma is prevalent, because some medication, as I found out to my detriment, can make people much sicker.
We have not touched on smoking to any degree, but we need to reduce its impact on respiratory health. That is a key factor. Patients need to be supported by clearer links being made between smoking and the start of respiratory disease, and there needs to be easier access to effective smoking cessation services and implementation of appropriate tobacco control measures.
There is, of course, a general awareness of the dangers of smoking. Needless to say, many have accepted the associated risks, but many have not. Two thirds of adult smokers took up smoking as children, so alongside measures to help people to quit smoking, we need to support those who have quit so that they do not relapse. We need to reduce exposure to second-hand smoke, and we should focus on protecting children and helping them not to take up smoking in the first place.
Around 10 million adults in Britain—about 20% of the population—smoke. Every year, smoking causes around 100,000 deaths. It is a major driver of health inequalities. Smoking rates are markedly higher among low income groups. I was pleased to see that the APPG report recommended the urgent implementation of standardised packaging for cigarettes, which Labour wholeheartedly agrees with. An independent report by King’s college London found that it was
“highly likely that standardised packaging would serve to reduce the rate of children taking up smoking”.
I commend the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), on her commitment to introducing plain packaging; I hope that the Minister present today will join her in the Lobby and encourage his colleagues in the Cabinet and on the Back Benches to support the measure. Christopher Hope of The Daily Telegraph only last week suggested that as many as 100 Conservative MPs planned to vote against the measure. Will the Minister support the measure and, if so, will he encourage his colleagues to do the same?
There are other measures that the Government could implement to reduce rates of smoking. Tackling the problem of toxic second-hand smoke, for instance, is crucial. It can pose terrible challenges to children’s health because of their smaller lungs and faster breathing, and the risks are increased in the confines of a car, for example. It is staggering that every year, second-hand smoke results in about 300,000 GP visits and nearly 10,000 hospital admissions among children.
That is why I was proud of the sterling efforts of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) in getting a ban on smoking in cars through Parliament. More than 430,000 children every week are exposed to second-hand smoke in the family car, so when the House of Commons voted overwhelmingly for a ban, it was a great moment. However, the onus is now on the Government to act according to the wishes of the House, and to make the measure law at the earliest opportunity. I call on the Minister to commit to taking that step.
I was pleased by the proposals in the all-party group’s report for more joined-up asthma care. As part of Labour’s 10-year plan for the national health service, we have proposed a joined-up approach to long-term care, with patients being given more say in their care plans and more control over their data, so that that they can make more informed choices. That would be particularly pertinent to conditions such as chronic obstructive pulmonary disease, where a bad flare-up can prove life-threatening. Patients with such conditions should have more say in their care pathways. COPD exacerbations are the second most common cause of emergency hospital admissions, so it is clear how important it is to ensure that people can prevent complications where possible.
Clearly, there is some way to go on cutting rates of smoking and giving people support to stop smoking. However, it is also our responsibility to give people the option to influence their own health care. Hospitals provide advanced care, which often cannot be provided anywhere else, but swift developments have meant that lots of care that could previously be provided only in hospital can now be provided in the community. That is a huge leap forward. On the whole, the most deprived are admitted to hospital more often, not because of a higher propensity to fall ill, but because of the inadequacy of community services.
For example, with forms of COPD, most medical professionals firmly believe that good self-care can provide an incalculable benefit to patients. Those who know exactly how to administer their own long-term care tend to live longer and experience less pain, anxiety and depression. They also enjoy a better quality of life because they are more active and independent.
That bears on a point made by my hon. Friend the Member for Stevenage (Stephen McPartland). Does the hon. Gentleman agree that, in many ways, carers have an important role as well? When someone encourages a person to take their medicine on time, or to go to their annual review, that is important. Carers are often unsung.
I absolutely agree. Carers have an important role in how we integrate health and social care, and we should never underestimate the role they play in providing care for close relatives and friends. The hon. and learned Gentleman is right.
It is only with integrated care that complications can be spotted earlier and hospital admissions potentially avoided. Regular reviews with a patient’s health care team, including information-sharing with other parts of the NHS, can make all the difference. However, there is also a lot to be said for the provision of far more advice and help to those caring for people with COPD.
Labour has said that it will guarantee a single point of contact for people with complex physical and mental health conditions—somebody with the authority to get things done. We will also establish the right to a personalised care plan, developed with the individual and their family, tailored to personal circumstances and not restricted by service boundaries. Patients with conditions such as COPD will also have the right to access peer support and advice from others learning to manage the same condition, which could prove helpful.
I commend the hon. Member for Stevenage on his hard work in advancing the cause of those with respiratory health conditions. Irrespective of the general election outcome, which is largely out of the control of all of us, this issue must be an absolute priority for whomever forms the Government in the next Parliament, and I give the hon. Gentleman a commitment from the Labour party that, if we find ourselves on the Government Benches, it will be.
It is a pleasure to serve under your chairmanship, Ms Dorries.
Let me start by thanking and congratulating my hon. Friend the Member for Stevenage (Stephen McPartland) for securing the debate and highlighting this incredibly important issue. His leadership of the all-party group is to be commended, as is the report it produced under his chairmanship last year. I also acknowledge his successful advocacy of his town of Stevenage as a life science cluster and hub—I can testify to that as the Minister responsible for life sciences.
The all-party group report identified a number of key areas for action, which colleagues have eloquently highlighted this afternoon. They include implementing the outcomes strategy for COPD and asthma; investing in medical research; improving awareness and diagnosis; better case finding; and ensuring that the NHS work force, from top to bottom, have the right skills to treat people with respiratory disease. If time allows, I will attempt to give detailed answers to my hon. Friend’s specific questions. If I am defeated by the clock, perhaps I could write to him. I very much look forward to meeting him in due course to pursue these issues.
Before I turn to those questions, perhaps I could say a few words about the scale of the challenge we face and what the Government are doing to confront it. The seriousness of the challenge posed by respiratory illnesses must not be underestimated, and it will not be shocking news if I say that it is accepted that they have been treated as something of a poor relation in many ways. They affect one in five people in the UK, they are responsible for about 1 million hospital admissions a year and they are the third biggest cause of death in the UK.
As the report from the all-party group’s inquiry into respiratory deaths said, UK death rates from respiratory disease compare poorly with those in other developed countries. In 2010, the UK had a higher rate of respiratory deaths than any other country in the OECD. The Government acknowledge that that situation is simply not acceptable, and we are working hard to improve it. Let me say something about how we are doing that.
The NHS outcomes framework for 2015-16 sets out the Department’s priority areas for the NHS and includes reducing deaths from respiratory disease as a key indicator. It also highlights the need to reduce unplanned hospital admissions due to asthma. In addition, the Government’s mandate to NHS England sets out the requirement for it to improve outcomes in a range of areas. That includes preventing premature deaths from the biggest killers, including respiratory disease, and supporting people with long-term physical and mental health conditions.
We published our “Living Well for Longer” document in April last year. It sets out the health and care system’s ambition to reduce avoidable deaths from the five major causes of death, which include respiratory disease. We set the ambitious target of making England among the best in Europe, to which end there is a lot to be done.
The Department has supported a number of initiatives to help to improve outcomes for people with respiratory disease. In July 2011, we published an outcomes strategy for people with COPD and asthma in England, setting out six high-level objectives to improve outcomes in those areas through high-quality prevention, detection, treatment and care services. The Department also supported the publication of a good practice guide on services for adults with asthma in 2012.
In addition, NICE, for which I have ministerial responsibility, has published quality standards for COPD and asthma, setting out the markers of high-quality, cost-effective care. Their implementation will raise the standard of care that people with such conditions receive.
In the Department of Health, I have responsibility for research. I am proud to say that the National Institute for Health Research has increased funding on these issues by 50% in the last five years, from £16 million in 2009-10 to £24 million in 2013-14. I accept that there is more to be done, but that is a significant start. The NIHR is investing nearly £22 million over five years in three respiratory biomedical research units. The NIHR clinical research network is setting up, and recruiting patients to, nearly 200 trials and studies in respiratory disease. That is some indication of the work that the NIHR and the Government are doing to prioritise this issue.
The Department has collaborated with the national review of asthma deaths, which examined the circumstances surrounding deaths from asthma from 1 February 2012 to 30 January 2013 and reported on its findings in May last year. The lessons learned about the factors that contribute to asthma deaths will inform the NHS about what constitutes good care and encourage the development of appropriate services for people with asthma. NHS England is supporting clinical commissioning groups to improve out-of-hospital treatment for those with asthma by giving doctors more control over the commissioning of asthma services and improving information links between GPs and hospitals.
I am delighted that last week NICE published draft guidelines on the diagnosis and monitoring of asthma. They are out for consultation, and no doubt the all-party group will have comments to make. Roughly 1.2 million adults in the UK may be wrongly receiving treatment for asthma. The guidelines set out the most effective way to diagnose asthma, and how health care professionals can help adults, children and young people control their symptoms better. The draft guidelines stress that to achieve an accurate diagnosis, clinical tests should be used as well as checking for signs and symptoms.
My hon. Friend the Member for Stevenage described how for too long innovation has been lacking in the diagnosis and treatment of the diseases in question. I am delighted about innovations that are coming. The guidelines recommend that health care professionals should ask employed people how their symptoms are affected by work, to check whether they may have occupational asthma. Other guidance is currently in the pipeline, including clinical guidelines on the management of asthma, consultation on which will start in April, and guidance on the diagnosis and management of bronchiolitis in children, which is due to be published in May.
Importantly, NHS Improving Quality, in collaboration with PRIMIS, has developed the GRASP suite of primary care audit tools to help GPs improve the detection and management of COPD, in addition to two other long-term conditions, atrial fibrillation and heart failure. All the GRASP audits, including GRASP-COPD, are funded by NHS IQ, and they run on all clinical systems and are free to use for GP practices in England. Like the other toolkits in the GRASP suite, GRASP-COPD contains a case finder, which helps GPs to identify the number of patients who are at risk of COPD or who have items on their electronic record that suggest possible COPD. It also contains a management tool that compares current management of diagnosed COPD patients with NICE guidelines.
The shadow Minister mentioned smoking, which is an important issue. It is welcome news that the number of smokers is down to its lowest ever level, which means fewer deaths and fewer people living with the disabling consequences of smoking, such as COPD. However, about 8 million people in England still smoke, and it is right that we maintain a commitment to effective tobacco control. Ministers are clear about wanting both to reduce the number of young people who take up smoking and to help those who smoke to quit. That requires action on a range of fronts, nationally and locally, as with so much in the public health arena.
There is no simple, single solution. However, we are taking action. We introduced a package of measures in the Children and Families Act 2014 aimed at protecting young people from tobacco and nicotine addiction and the serious health harms of smoking tobacco. We have also laid regulations to end smoking in private vehicles carrying children, a measure that I am particularly proud of. Subject to parliamentary approval, those regulations will come into force in October. We are changing the law to ban the sale of e-cigarettes to under-18s and have consulted on draft regulations. We will implement the prohibition of proxy purchasing of tobacco by adults on behalf of under-18s, and we will bring forward legislation for the standardised packaging of tobacco products before the end of this Parliament. For the avoidance of doubt, I support that measure, and I shall urge colleagues who care about health to do the same. In 2014-15 Public Health England ran two major campaigns: Stoptober 2014, a nationwide 28-day quit event in October, and the current health harms campaign to prompt attempts at quitting. Public Health England is also running its breathlessness campaign, to raise awareness of the importance of breathlessness and respiratory disease more generally.
My hon. Friend the Member for Stevenage raised several questions, which I want to address. I particularly want to pay tribute to Neil from Norwich, whose story he shared with us, including the extent of his suffering with COPD and asthma. My hon. Friend the Member for South East Cornwall (Sheryll Murray) mentioned the importance of wider allergy risk, and I am delighted to say that I recently visited a centre of excellence at Addenbrooke’s in Cambridge, which is pioneering a new method for detecting and treating allergies. It is an area of immunotherapy in which this country leads. My hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and the hon. Member for Cheadle (Mark Hunter) made important observations about that.
My hon. Friend the Member for Stevenage asked about the importance of a national clinical audit. I could not agree more about the importance of properly measuring and tracking performance. He knows that I am passionate about doing that across the system. NHS England is considering it in this area, among several potential new areas. I will highlight its importance in Parliament, along with the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who is responsible for public health, and I urge the all-party group to do the same, through our offices and independently.
I have provided some answers to the questions that my hon. Friend the Member for Stevenage asked about research funding. We have increased the funding by 50% in this Parliament. However, I urge him to raise the matter directly with the National Institute for Health Research, and to continue campaigning in Parliament.
We support the work of the European Asthma Research and Innovation Partnership, and although it is clearly a matter for the competence of the EU, I assure my hon. Friend that the Public Health Minister and I, and the Department, will do anything we can to support the application. As for the creation of a world-class asthma review, NHS England is currently working to ensure that everyone with a long-term condition has a personalised care plan and that treatment for asthma and COPD improves. The Public Health Minister and I will make clear the levels of parliamentary support for that, following this debate.
Finally, my hon. Friend asked whether we could include lung function in the NHS health check for those over 40. Requests for such additional content will be considered by the NHS health check’s expert scientific and clinical advisory panel. I will happily make representations after the debate. I am sure hon. Members know that the Public Health Minister tenaciously advocates pursuing public health measures such as those on respiratory disease, including in the Tea Room, and she will take the matter seriously.
I will conclude, Ms Dorries, within the time that you mentioned, by paying tribute to my hon. Friend the Member for Stevenage. On this issue, as well as on other life sciences issues, he has brought together the views of Members of different parties. Ministers will take the points that have been made, and we will do all that we can in the short time available in this Parliament to ensure that they are properly addressed by the relevant agencies.