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Chronic Obstructive Pulmonary Disease

Volume 703: debated on Wednesday 17 November 2021

Before we begin, I remind Members that they are expected to wear face coverings when not speaking in the debate, in line with current Government and House of Commons Commission guidance. I remind Members that they are asked by the House to have a covid lateral flow test twice a week if coming on to the estate, which can be done either at the testing centre or at home. Please also give each other room when you leave the Chamber.

I beg to move,

That this House has considered support for people with chronic obstructive pulmonary disease.

It is a pleasure to serve under your chairmanship, Ms Nokes. I am grateful for the opportunity to lead the debate—and on World COPD Day itself, no less. Chronic obstructive pulmonary disease impacts many of our constituents, but it is simply not given the clinical priority in our health systems that it should have. I hope today, with the other parliamentarians present, to push the Government a step further and improve our fight against COPD on a few fronts: to push public health action to avoid our constituents contracting it; to improve diagnosis rates, so that it is caught at an earlier stage; to transform treatment to help patients manage their condition; and to invest in more research, so that we can develop groundbreaking diagnostics and treatments.

I am thankful for the hard work of the British Lung Foundation, which has campaigned tirelessly for better recognition and treatment of lung disease and which, ahead of World COPD Day, has highlighted the experiences of those living with COPD in their report “Failing on the fundamentals”, which I know some hon. Members in the room will have seen. I am also grateful to the all-party parliamentary group for respiratory health and those involved with the COPD national action plan for their work. I know that some Members present are involved in that APPG; I thank them sincerely. Many thanks also go to my constituent Sarah Jones, who has worked with the taskforce for lung health and pushed me to raise the fight against lung disease in Parliament after the sad loss of her father, John Jones, from idiopathic pulmonary fibrosis.

Chronic obstructive pulmonary disease is a group of lung conditions that cause breathing difficulties, including emphysema, which is a breakdown of lung tissue, and chronic bronchitis, the chronic inflammation of central airways. It is a disease chiefly caused by smoking, which causes nine out of 10 cases of COPD. Air pollution, childhood poverty and exposure to dust in workplaces are also contributing factors. I know that other Members in the Chamber will be very familiar with COPD and its constituent conditions. Many champion the cause of their constituents while others have direct experience.

In a case study provided by the British Lung Foundation, Chris highlights his desperation to breathe—something that many of us take for granted—the panic, the fear, the wheezing and in some cases the crushing sensation that he feels in depleted lungs. Those are just some of the facets of the debilitating disease known as COPD. Early signs are shortness of breath, a wheezing chest, tightness, chronic cough, lack of energy and weight loss. I encourage people with these signs to get an appointment with their GP.

According to the National Institute for Health and Care Excellence, 3 million people in the UK suffer from COPD. Shockingly, 2 million of are undiagnosed. As Sarah Woolnough, the chief executive of the British Lung Foundation stated:

“It is hard to imagine, for example, this proportion of cancer cases going undiagnosed”.

But that is the reality and it has to change. It is nothing short of a silent scandal.

To the Government’s credit, in response to campaigners and clinicians campaigning for respiratory disease, COPD is given priority in the NHS long-term plan. Yet, like all plans, the devil is in the detail and delivery on the ground is essential. It is vital to ensure that people with the disease are diagnosed early. Too often, diagnosis occurs only when the disease has considerably progressed, leading to greater risk of damaging flare-ups of COPD symptoms and greater risk of being one of the 30,000 people killed by the disease every year, making it Britain’s fifth biggest killer.

Of course, we encourage people to see GPs, but 9.8% of people in the north-west, for example, are struggling to get appointments. I am sure the Minister will refer to that in her reply. An important survey conducted by the British Lung Foundation—its largest ever of those suffering with COPD—found that 75% of those surveyed were missing out on the basic care recommended for the disease.

The theme of this year’s World COPD Day is “Healthy Lungs—Never More Important”. It aims to highlight the risk COPD poses against the backdrop of the pandemic, which has represented a higher risk for those suffering from lung disease and resulted in the additional demand on services created by the impact of covid-19. Even before the pandemic, it is clear that those with COPD experienced unacceptable delays in receiving a diagnosis—delays that can prove fatal.

Diagnosis rates, already far too low, plummeted further during the pandemic by 51%, meaning that nearly 50,000 of our constituents in England alone missed out on a diagnosis. Although the impact of covid-19 was widespread across our health service, this drop was more substantial than for comparable non-respiratory diseases, such as diabetes. Some GPs were advised during the pandemic to stop diagnosis breathing tests and they have yet to restart.

Does the Minister think that we should put in place a delivery plan with funding to get lung health strategies back on track and tackle the respiratory backlog so that another 50,000 people do not miss out on the diagnosis in the coming year? COPD already costs the health economy £1.9 billion. This could be an effective saving, not only of lives, but of essential financial resources.

Can the Minister confirm whether the new diagnostic hubs announced as part of the Budget will cover the tests needed to diagnose COPD and other pulmonary diseases? It would be useful to hear more detail on the part these hubs will play in the diagnosis of lung disease, and on an effective staffing and recruitment strategy.

The British Lung Foundation’s recent report on the experience of people with COPD also highlights shortcomings after diagnosis. It found that three quarters of people across the UK did not receive the five fundamentals of COPD care, as set out in the NICE guidelines. The problem is particularly severe in the north of England and in the devolved nations. Tackling this and ensuring that everyone is offered the five fundamentals of COPD care needs to be at the centre of the strategy. Those five fundamentals are a written management plan, access to pulmonary rehabilitation, help to stop smoking, management of co-existing medical conditions, and access to flu and pneumonia vaccinations.

As with many diseases, prevalence of COPD is linked with deprivation. Between 2019 and 2020 the life expectancy gap between the least and most deprived areas in England grew from 9.3 years to 10.3 years for men and 7.7 years to 8.3 years for women. Respiratory conditions are major contributors to widening health inequalities in the UK, with those living in the most socioeconomically deprived areas in England seven times more likely to die from respiratory disease compared with the least deprived areas.

In my constituency of Weaver Vale, 2.6% of residents are estimated to suffer from COPD, compared with 1.9% of people in England as a whole. Looking at the map of the prevalence in my constituency, we can clearly see that the most deprived areas have twice the proportion of COPD cases than the least deprived areas, and I know other hon. Members here will have the same experience. Eighteen of the 20 clinical commissioning groups in the worst areas for respiratory diseases and emergency responses are in the in the north of England.

If the Government are serious about tackling health inequalities and levelling up life chances, more work needs to be done to ensure that COPD is not overlooked as one of the major respiratory conditions driving health inequality in the UK. If this Government are really serious about levelling up, that should be a focus. Those living with COPD, as well as those living with other diseases, should have equal access to fast diagnosis, care and treatment, no matter who they are and where they live. I hope to hear from the Minister about how her Department plans to ensure that disparities in COPD prevalence, diagnosis and care are a major part of the national health inequalities strategy.

In most cases COPD is caused by smoking, so I would like the Minister to give an update on the new tobacco control plan, how it will focus on tackling health disparities and how she intends to plan and fund an effective, high-quality stop smoking service throughout the country. Over the past 11 years, many of those services have been cut, so I would be fascinated by her response.

Finally, I would like to raise the problem of awareness of COPD, lung disease more widely and the importance of lung health. Today’s debate has primarily focused on the lack of funding, the lack of real clinical and Government priority and the lack of awareness that extends beyond that. I would like the Minister to outline how, as part of getting lung disease the delivery prioritisation it desperately needs, her Department can promote greater public awareness of lung disease. Our shared interest must be to transform COPD care in the UK, while driving down the numbers who develop this condition in the first place. I look forward to this debate, and I certainly look forward to the Minister’s response.

It is a pleasure to serve under your chairmanship, Ms Nokes, and to speak in this important debate today. I am very grateful to my hon. Friend the Member for Weaver Vale (Mike Amesbury) for securing this debate and raising such an important issue. Ms Nokes, you may know that as well as being Member of Parliament for Newport West, I am shadow minister for air quality, so these issues are very important to me.

The link between air pollution and lung disease is obvious to all of us. Before I came to this House, I spent 30 years working as a physiotherapist in the NHS, so I know a little bit about lungs. Thanks to the excellent campaigners at the British Lung Foundation and Asthma UK, we have the data today—the important statistics that we all need. Two in five, or 41%, of babies are born every year into heavily polluted areas of the UK, where levels of particulate matter 2.5 are higher than the 2005 World Health Organisation recommendations. That equates to over a quarter of a million babies every year, or one born every two minutes. Over a third of all maternity units in England exceed the World Health Organisation’s air quality guidance; if we use the new guidelines, which came out a couple of months ago, that figure reaches almost 95%.

We also know that some 85% of people who live in areas with illegal levels of nitrogen dioxide make up the poorest 20% of the UK population. Birmingham, Liverpool and Manchester rank among the top 10 areas with the highest proportion of deprived neighbourhoods in England, and all those cities have main roads that breach legal nitrogen oxide limits. I know from my work with my hon. Friends the Members for Manchester, Withington (Jeff Smith) and for Weaver Vale, as well as the metro Mayors Steve Rotheram and Andy Burnham, how much work is needed to address these issues. Similarly, people in the poorest communities are two and a half times more likely to develop COPD than those in more affluent communities, and we know that disadvantages in early life are linked to the development of COPD. I make no apologies for sharing this data, and I will go on: some 29% of hospitals, 37% of GPs’ surgeries, 31% of schools and 26% of care homes in England are located in communities with levels of PM2.5 above the levels recommended by the WHO. Of course, those guidelines have been strengthened in recent months, so the pressure on Ministers is even greater now.

The link between toxic air and lung disease is so devastating, and I note that 43% of respondents to the Asthma UK-BLF survey reported that their COPD was adversely affected by air pollution. More broadly, 88% of people with a lung condition have said that air pollution affects their health and wellbeing, so it is not just physical symptoms we are dealing with, but mental health symptoms. Of those who responded to the survey, 63% of people with a lung condition can feel out of breath and 53% have increased coughing due to high levels of air pollution. Some 60% of people with a lung condition affected by air pollution say that they have been discouraged from leaving their home due to air pollution at some point, with 28% feeling this way at least once a month.

This House needs to listen to those affected daily by the impact of toxic air on those living with existing lung disease. In Parliament and out in the community over the past year, I have repeatedly raised the fact that the time to act has well and truly come. Almost 60% of people in England now live in areas where the levels of toxic air pollution exceeded legal limits in 2019 and 2020. We cannot go on as we are: we require real leadership, and we require it now. The Government’s so-called landmark Environment Act 2021 was a missed opportunity to contribute to cross-Government solutions to this problem. I know that much of environment policy is devolved to the nations of the UK, and that health policy is also devolved, but that does not mean there cannot be a co-ordinated approach with the devolved Administrations to addressing this very serious issue. I would be grateful if the Minister outlined the discussions that have taken place, and will take place in the weeks ahead, with the devolved nations.

The covid pandemic saw a big change in people’s behaviour and lifestyle habits, and we saw how that led to cleaner air and a healthier environment, although it was a temporary change. We all know that air pollution is a public health crisis, as my hon. Friend the Member for Weaver Vale has outlined. Last summer, the British Lung Foundation and Asthma UK surveyed about 14,000 people with a lung condition and found that a great many people noticed an improvement in their symptoms, likely due to better air quality during lockdown.

In my more than 30 years working in the NHS as a physio, I saw every day the damage that toxic air can cause to the lungs, health and mobility of people of all ages and from all communities, including those whose lungs are damaged while still in the womb, and those suffering from asthma, COPD and other serious lung conditions. The task of making our air cleaner starts with each of us. It is important that we are all aware of the air pollution levels in the communities we live in, so that we know the local challenges facing us all.

I am so grateful to my hon. Friend the Member for Weaver Vale for calling this debate and providing the opportunity to highlight the very grave link between toxic air and COPD. I hope he will feel better soon. We must act and we must act now.

It is a pleasure to serve under you as chair, Ms Nokes. I congratulate my hon. Friend the Member for Weaver Vale (Mike Amesbury) on securing this debate on an important subject.

In my constituency of Blaydon, in the north-east of England, the figures for those diagnosed with COPD are sadly above the UK average. We know that 1.3 million across the UK have a diagnosis of COPD, but it is estimated that a similar number have undiagnosed COPD. In Blaydon, 2.9% of people have a COPD diagnosis, well above the England-wide figure of 1.9%. It is sadly in the top 10% of constituencies with the highest prevalence. The north-east is the region with the highest prevalence of COPD, at 3%. Remember, that figure is for diagnosed COPD. As I have said, it is estimated that double that number have COPD but do not have a diagnosis.

The British Lung Foundation has today—World COPD day—launched its report “Failing on the fundamentals”, based on the largest survey of those with COPD. It finds unacceptable levels of diagnosis and care for those with the condition. In the north-east, 78.1% of survey respondents reported that they had not received the five fundamentals of COPD care, as set out in NICE guidelines, and as referred to by my hon. Friend. That is 4 percentage points higher than the England-wide average of 74.1%.

Some 29.1% reported facing stigma and discrimination, which is similar to the England-wide average. A higher proportion in the north-east cited as barriers to diagnosis not wanting to know if they had COPD and not knowing the signs of potential COPD. In addition, 53% of respondents in the north-east who smoke said that they had been offered support to quit smoking in the past year, slightly lower than the 55.9% across England. As we know, stopping smoking is a key part of the treatment of COPD.

That matters because behind each of those statistics lies a real struggling person. In my constituency office, we see too many people hugely affected by COPD. As the condition develops, they face increasing disability and exacerbations or flare-ups of their condition, affecting their mobility and day-to-day life, evidenced by their need to claim disability benefits. It affects every part of their life, including their mental health. We need to get better at diagnosing and treating COPD, to stop its progression and reduce that impact on daily life. I want to speak in particular about diagnosis and what needs to be done, first, in the recovery from covid and then more generally.

As we have heard, the diagnosis of COPD is appallingly low, and the British Lung Foundation cite several reasons. More than 1.3 million people have a diagnosis of COPD and a similar number have the condition, as yet undiagnosed. The British Lung Foundation’s first annual COPD survey, which was just published, as I said earlier, shows that even before the pandemic, almost three quarters—70%—of people who have been diagnosed with COPD said that they faced barriers in getting a diagnosis. Recent Government figures demonstrate that diagnosis rates, which were already far too low, plummeted further during covid-19. In 2020, there was a 51% reduction in COPD diagnosis compared with 2019, which means that about 46,000 people in England alone missed out on a diagnosis. As we heard, that is a much higher drop than for comparable conditions.

The BLF says that diagnostic tests have still not properly resumed, so it is likely that as many as 92,000 people in England have gone undiagnosed in the past two years. While rates of cancer diagnosis are already up to, and in some areas better than, pre-pandemic levels—thank goodness for that, I hasten to add—there is no dedicated plan to address the huge backlog in respiratory care.

Spirometry is the main diagnostic test for COPD, but it was paused at the height of the pandemic because it was believed to be an aerosol-generating procedure. It has been now confirmed that that is not the case. Guidance has been published on how to conduct spirometry in a covid-safe manner, but it appears to have made little difference. By and large, spirometry testing has still not resumed in primary care, which is where most people with COPD are diagnosed.

My hon. Friend is making a powerful point. Spirometry is key, because COPD cannot be diagnosed by video link or telephone. Does she agree that it is crucial for people to be seen face to face to ensure that we fully diagnose them in future?

I certainly agree. The British Lung Foundation says that there is a clear need for NHS England to intervene and work with local health services to prioritise the urgent restart of spirometry testing in primary care for the diagnosis of COPD and other respiratory conditions. The same would also be true in the other nations of the UK.

Two of the major barriers to restarting spirometry testing in primary care are a lack of capacity and, ironically, the creation of community diagnostic centres. If rolled out to the recommended scale, community diagnostic centres should help to improve diagnosis of COPD and other conditions, but people with COPD cannot afford to wait until CDCs are established for a formal diagnosis while their symptoms and wellbeing deteriorate. Unless spirometry and other diagnostic tests are restarted in general practice, the diagnostic backlog risks overwhelming CDCs as soon as they are established.

The Government and NHS England need to provide sufficient funding for enough capacity to conduct spirometry testing in primary care. Delays in diagnosis mean that too many people with COPD are seeing their condition worsen, which has the real impact on their day-to-day lives that I talked about, so the problem must be tackled urgently for the sake of my constituents with COPD, particularly those not yet diagnosed.

The Government need to properly fund our public health services. We have to make sure that stop smoking services can be easily accessed by those already diagnosed with COPD and those who may develop it, as the link between smoking and COPD is clear. The proposed updated tobacco control plan, which we are expecting, will play a key part in preventing COPD. It needs to look at the polluter pays principle, which calls on tobacco producers to pay for the damage that they cause, as recommended by the all-party parliamentary group on smoking and health.

Will the Minister agree today to implement the steps proposed by the British Lung Foundation and others to improve diagnosis of COPD as a matter of urgency? Will she commit to improve funding for public health services, in particular smoking cessation services? Will she ensure that the tobacco control plan addresses the issues raised by the APPG on smoking and health?

It is a pleasure to serve under your chairmanship, Ms Nokes, and I congratulate my neighbour, my hon. Friend the Member for Weaver Vale (Mike Amesbury), on securing this important debate.

I welcome the British Lung Foundation report, “Insights from those living with chronic obstructive pulmonary disease (COPD) around the UK”. I completely support its call for Governments and health services across the nations of the UK to rapidly commit to funding for national health services to get lung health strategies back on track, and to tackle the respiratory backlog. I note the finding that while respiratory conditions are supposedly a clinical priority, that does not seem to be the case in practice, and we need to see ambitious targets for improving COPD prevention, diagnosis and care.

It is truly frightening and disturbing to watch someone suffering with COPD, or chronic chest disease, fighting for their breath; especially when they are stuck on a trolly in a long queue outside A&E or left all day waiting for a hospital bed to become available. Watching them struggle for every breath with very low oxygen levels is distressing for both the individual and the families. My constituency has historically high rates of lung disease, including lung cancer, for a mix of reasons such as its industrial legacy and, of course, high rates of smoking and deprivation. As we have heard, COPD is the fifth most common cause of death in the UK, resulting in 30,000 deaths per year.

There are 3,878 patients on Halton GP registers for COPD—a prevalence of 2.9% of GP registered patients. That is higher than the England average of 1.9%, and slightly higher than the Cheshire and Merseyside average of 2.6%. There is variation between different GPs in Halton, with prevalence’s ranging from 1.3% to 4.1%. The Halton prevalence has not changed since the last publication in 2018-19. Over the past five years it has increased very slightly from 2.6% in 2015-16. The latest published data from 2017 to 2019 shows that Halton’s mortality rate for COPD was higher than England and the north-west’s. Halton’s rate was 70.5 per 100,000 of the population, whereas England’s was 50.4, and the north-west’s was 63.3.

Death rates from COPD are higher for males than females in Halton; this is also the case both nationally and regionally. As I referred to earlier, it has been estimated that there are many more patients nationally with COPD who have not been diagnosed; the most recent 2015 estimate suggested a COPD prevalence of 3.3% in Halton. This would mean that there are potentially around 550 people in Halton who are not diagnosed at this point in time.

I must refer to hospital admissions, because we know the pressures that our hospitals are under. Most people with COPD are managed in primary care, but for some the condition will deteriorate or be undiagnosed, which can result in emergency unplanned admissions to hospital. The latest published data for 2019-20 shows that Halton had a higher rate of emergency hospital admissions for COPD than England. Halton’s rate was 502 per 100,000 of the population, whereas England’s was 415 per 100,000 people. The female rate of emergency hospital admissions is also contributing to the overall high rate.

Several worrying findings came out of the British Lung Foundation report, and given the limited time I can only highlight just a few of those—some of them have previously been referred to by hon. Friends. As we have heard, thousands of people are missing out on diagnosis. The British Lung Foundation conducted a survey of over 8,000 people with COPD between December 2020 and May 2021. Even before the pandemic, it is clear from the responses that many people with COPD had experienced unacceptable delays before a diagnosis was made.

Recent Government figures found that diagnosis rates, which were already far too low, plummeted even further. In 2020 there was a 51% reduction in COPD diagnosis when compared with 2019, meaning that around 46,000 people in England alone missed out on a diagnosis. Again, the latest figures available in Halton suggest that 550 people have missed out on a diagnosis.

I know from the figures I obtained from the local health commission support unit that GP referrals to respiratory medicine in Halton are still not at pre-pandemic levels. As of November 2021, diagnostic tests for spirometry have not yet properly resumed. It is particularly worrying that the British Lung Foundation found that, across the UK, over three quarters of those with COPD did not receive what NICE clinical guidance defines as the five fundamentals of COPD care, but I will not go into them because my hon. Friend the Member for Weaver Vale referred to them earlier.

The British Lung Foundation believes that the national health service should amend guidance for GPs across the UK to ensure proactive case finding among high-risk groups to identify COPD and other lung conditions such as idiopathic pulmonary fibrosis and lung cancer in a timely way. Questions on respiratory health should be made a mandatory part of the NHS health check to help identify many undiagnosed cases of COPD. Smoking cessation schemes, which we have heard about today, must continue to be a priority, with more effort and drive put into them and, importantly, with better data on success rates.

I would like to make a specific plea for more resources to be put into community rapid response teams who, when they work well and get to patients and treat them at an early stage before they deteriorate, can and do in many cases prevent hospitalisation, easing the pressures on hospitals. They are a really important part of the health service and we need to concentrate more on them. Once people get to hospital, some of them people are very ill, so the more we can do to prevent it in the first place, the better.

The covid pandemic is, without doubt, a major contributing factor to the challenges facing primary and secondary care. The Government’s failure to properly address staffing shortages and better diagnostic facilities over the past 11 years, and prior to the start of the pandemic, is a significant reason why the current pressures on the NHS are so acute. A shortage of GPs is not helping quick diagnosis and rapid treatment. As I referred to during the Budget debates, the number of patients per GP practice is 22% higher than in 2015, but the GP workforce has not expanded with this rise in patient need. Nor has it helped that there are over 90,000 staff vacancies in the NHS.

The fact is that the Government have allowed this situation to occur since they first came into power in 2010. The Government need to get their act together and ensure that they have a workable, funded plan in place to transform the quality of life of people living with COPD, to prevent more people from developing it in future and to stop unnecessary suffering.

It is always a pleasure to speak on these issues, Ms Nokes. I commend the hon. Member for Weaver Vale (Mike Amesbury) for bringing the debate to the House.

I am my party’s health spokesperson, but it is not just a duty for me to be here—I also have a particular interest in this issue. As has been said, we all know people who have COPD, and I can think of a number in my constituency. One gentleman, Kenny Legge, has been a friend of mine for umpteen years. He has COPD and is on a 24/7 oxygen tank, which he takes everywhere with him. That means that if he goes to the shops or to the doctors he takes it with him. It is possible to carry it because it is a small tank, but he lives with it 24/7—his whole life.

My other introduction to COPD—I suspect the same is true of others in the Chamber—was filling in benefit forms. When filling in forms, we always ask the constituent what the issues are, and they explain them to us. Although we might need to know more about the COPD, the issue becomes clear when we are talking face to face with our constituent and he or she is gasping for breath. We are able to be agile and athletic. People tell me they go for runs, and others tell me they go for walks, but I am one of those who goes for a dander, which is the third category. But people suffering from COPD cannot even do that. That is the issue.

Throughout the pandemic we often forget about other health conditions that must be awarded awareness. Covid has taken over our lives; everywhere we look there is something related to covid. That is not a criticism; it is a fact—an observation. There must be sustainable support for those who, sadly, suffer from other respiratory diseases, such as bronchitis and emphysema.

The British Lung Foundation is the leading charity in the UK highlighting the impacts of chronic obstructive pulmonary disease. Statistics show that an estimated 1.2 million people in the UK—wow, that’s a big figure—live with diagnosed COPD, with thousands more not yet diagnosed. I wonder sometimes whether we are just scraping at the figure, which may or may not be there. That figure equates to 4.5% of all adults over 40.

Intense research by the British Lung Foundation shows that prevalence is growing. I hope the Minister will give us the answers we seek, and I know she will endeavour to produce them. One thing I always ask about is prevention, and it is important that we address it, because it prevents costs further down the line. Perhaps she can tell us what has been done on that. The research also shows that COPD diagnosis has increased by 27% in the last decade, so additional resources and funding are needed to improve research into it.

I always make the comment—although that does not make this any less of an issue—that research and development is so important in, hopefully, addressing some of the issues for those with COPD. Last Friday I had a lady in my office with severe COPD who has an issue with housing She is in a flat, and when she moved there I suppose the issue was not apparent, but she is now a prisoner in her flat and cannot get out unless someone takes her. She is overwhelmed by exhaustion whenever she goes anywhere, and I am trying my best to help get her relocated to a property at ground level that is nearer the centre of the town, where perhaps her quality of life can improve.

The Regulation and Quality Improvement Authority for Northern Ireland has stated that 37,000 people have been diagnosed as having COPD. Half as many as the number already on the COPD registers are thought to be living with COPD without the disease being diagnosed —a point I made earlier—bringing the total to approximately 55,500. Those figures are just for Northern Ireland, where 37,000 people have it, but 55,500 might have it—one third more. If that is replicated in the rest of the United Kingdom, the figures will be almost 2 million. I am not the greatest mathematician in the world, but I think those figures are fairly approximate.

The Northern Ireland Chest, Heart and Stroke charity, which does incredible work, has nicknamed COPD the “creeping killer”, as it is the fifth biggest killer in the UK, but very often people are completely unaware of its severity. When we see constituents in the advanced stages of COPD or living on 24/7 oxygen, we very quickly understand the severity of it.

The all-party parliamentary group for respiratory health, which I chair, has recently gained mass support from respondents for a lung cancer action plan to draw together all the different strands of respiratory policy and make them into one strategy. The British Lung Foundation has strongly supported that plan. The Primary Care Respiratory Society also supported the need for a national NHS action plan, claiming it would help to improve rates of earlier diagnosis and reduce the rates of death from lung cancer. If we adopt, pursue and fund those twin goals, we can try to address the issue, reduce the numbers and give people a better quality of life. It was also felt that any action plan should consider a pathway for people who are found to have non-cancer respiratory symptoms that need investigating.

We often find that constituents do not have just one issue; they have a complex number of issues, and central to that for those with COPD is the COPD. People with COPD who have been active for most of their days suddenly have issues with mobility, anxiety and depression and cannot be active any more. Some of the most prominent ways to help slow the progression of the condition are often the simplest.

The summarised treatment options from the NHS include encouraging people to stop smoking. We had a debate in this Chamber yesterday morning on the tobacco control plan and it was clear—certainly to me as a Northern Ireland MP—that the figures for those stopping smoking have not reached the targets we hoped they would. The consensus among parties on both sides of the Chamber yesterday was clear.

Treatment options also include taking up the use of inhalers and tablets, lung rehabilitation and transplants. The NHS long-term plan addresses the need for early diagnosis and more suitable treatment. Given the figures stated earlier, the long-term plan must be implemented as soon as possible. I ask the Minister—I usually try to ask a couple of questions in my contribution—when will the long-term plan be implemented? We need to see a timescale for that so that we know whether the right strategy has been adopted. I am not criticising anybody—I want to make that quite clear—but if we are committed to the long-term plan, can we have the timescale, please?

Much of our time and funding has been dedicated to covid, and there is no doubt that it falls under the umbrella term of respiratory disease. Our lungs are one of our most vital organs—needed to keep us alive—and there must be better awareness of the symptoms of COPD. The main ones include increasing breathlessness and a persistent phlegmy cough—we get that with colds or flu, but those with COPD have it every day of their lives, and every hour of every day. Those are not normal symptoms to have for a prolonged period.

I want to conclude by thanking the charities that do significant work in providing support for those who suffer from COPD, such as the British Lung Foundation, the National Association for the Relief of Apnoea—the breathing charity—and the COPD Foundation. I call on the Minister and the Government to study the figures and strongly consider allocating additional funding. We must help those constituents and patients with COPD. That, if we can do that, is the most essential way of preventing serious illness or even death. Our lung health is something that we should all make a priority.

Like so many speakers before me, I will begin by paying tribute to the hon. Member for Weaver Vale (Mike Amesbury) for bringing forward this important debate on chronic obstructive pulmonary disease, and on World COPD Day. World COPD Day is intended to raise awareness of the fact that this condition is chronic, because it is long term and does not go away; it is obstructive, because the airways are narrowed, making breathing difficult; and it is pulmonary—it affects the lungs.

The theme of World COPD Day is

“Healthy Lungs—Never More Important”.

This year’s aim is to highlight that the challenge of COPD remains, despite the ongoing global covid pandemic. Even as we continue to battle covid, COPD remains a leading cause of death worldwide. It is a terrible condition affecting millions, and the pandemic and long covid have highlighted this condition, which includes emphysema and chronic bronchitis.

The condition cannot be cured or reversed but, with treatment, it can be managed so that it does not severely limit daily activities. However, we also know that despite treatment, COPD can deteriorate, eventually having a significant and debilitating effect on quality of life and leading to life-threatening challenges.

As we have heard today from almost every speaker, while the main cause of COPD is smoking, some cases are caused by long-term exposure to harmful dust or fumes. Worryingly, the National Institute for Health and Care Excellence found in 2016 that an estimated 3 million people have COPD in the UK, of whom 2 million are undiagnosed. There are an estimated 140,000 cases in Scotland, with another estimated 200,000 people undiagnosed.

The Scottish Government are taking action through the development of their respiratory care action plan, which sets out priorities to support the prevention, diagnosis and treatment of respiratory conditions. It is vital that those with these conditions can access safe, effective and person-centred care, treatment and support. To that end, the Scottish Government’s respiratory care action plan for Scotland, published in March, outlines the strategy for improving prevention, diagnosis, care and treatment for those living with respiratory conditions such as COPD.

The Scottish Government are working with partners across health and social care and the third sector, as well as with people with lived experience, to develop an implementation programme, which will make clear the funding commitments that will be brought forward to promote the plan. Important work is also going on to learn more about COPD, such as work with the EU—which provided €7.7 million of funding for the project last year—to discover why, strangely, Stranraer in Scotland has higher than average rates of the condition, despite average smoking rates.

The Scottish Government will move forward with the implementation of the respiratory care action plan for Scotland over the course of this Parliament and continue to tackle smoking in Scotland. I pay tribute to the Scottish Parliament’s cross-party group on lung health, established and so ably chaired by Emma Harper MSP. Lobbying by the cross-party group was instrumental in the publication of the respiratory care action plan.

We all understand the correlation between COPD and smoking, but despite the UK having one of the lowest smoking rates in Europe, smoking leads to a significant number of deaths across the UK every year, including through COPD. However, we have come far in the fight against smoking. For example, around 15% of UK adults are smokers, which is one of the lowest rates in Europe. The figure is slightly higher in Scotland, at 19%, so we have a wee bit more work to do.

We must bear in mind that there is a higher concentration of smokers in socially disadvantaged communities. Of course, we know that there is a clear link between poverty and health outcomes. That helps us to understand why 35% of adults in the most deprived areas are smokers, compared with 10% in the least deprived areas. Smoking accounted for 16% of all deaths in Scotland in 2018—around 10,000 deaths a year—and the figures in England are much the same. Scotland’s target is to be smoke-free by 2034, with smoke-free defined as 5% or less of the adult population being smokers. To that end, a new tobacco strategy will be published in the next parliamentary Session in Scotland.

We continue to make progress with smoking rates, which have fallen 9% since 2003, but of course we are all want the pace of that decline to continue to increase. Scotland was the first part of the United Kingdom to prohibit smoking in enclosed public spaces, in 2006. That measure was introduced in the Scottish Parliament by a certain MSP called Kenneth Gibson. The rest of the UK followed in 2007. Although the measure was controversial at the time, the banning of smoking in enclosed public spaces is now accepted and is the undisputed norm. Such measures can help us as we strive to help people live healthier lives and give up smoking.

I wish to end by paying tribute to the British Heart Foundation, which does so much valuable work to promote the importance of clean air and healthy lungs. It is appropriate to do that on World COPD Day. All year round, the British Heart Foundation works to raise awareness of this condition, to ensure that everyone with COPD has access to the care and information that they need to manage their condition well and to ensure that those of us who do not have the misfortune to suffer from it are more aware of it in our communities.

It is pleasure to see you in the Chair this morning, Ms Nokes. I would like to add my congratulations to those already offered to my neighbour, my hon. Friend the Member for Weaver Vale (Mike Amesbury), for securing this debate on COPD on World COPD Day, when awareness should of course be raised of the condition. Debates and days such as this are important in ensuring that people with COPD have access to the care and information they need to manage their condition well.

My hon. Friend gave an excellent introduction and raised many issues, which many other hon. Members raised in various guises, and which I will return to during my contribution. He wanted to focus on public health issues, to avoid our constituents contracting COPD in the first place; improving diagnosis rates, to ensure that it is caught at an earlier stage; transforming treatment, to help patients manage their condition; and investing more in research, so that we can develop groundbreaking diagnostics and treatments. I think we all agree that those are worthy aims that we ought to cover in the debate.

We also heard from my hon. Friend the Member for Newport West (Ruth Jones). She rightly raised the link between lung conditions and air pollution, and she provided some shocking statistics about the number of maternity units that exceed WHO air quality guidelines, particularly after recently updated guidelines were issued. She also raised a whole series of other statistics that set out the scale of the challenge that we face in improving air quality.

My hon. Friend the Member for Blaydon (Liz Twist) spoke about her region and how the staggering levels of health inequality in this country mean that the north-east has much higher rates of COPD than many other areas. She rightly highlighted the importance of helping people to stop smoking as part of this battle. As Members referred to, a decade of cuts to public health grants has led directly to a reduction in smoking cessation services. She also raised the importance of spirometry testing and how this needs to be conducted in primary care; otherwise, issues related to a failure to diagnose conditions early, which we have talked about, will continue.

It was a pleasure, as always, to hear from my hon. Friend the Member for Halton (Derek Twigg), who talked about the prevalence of COPD in his constituency and the various factors that have led to that. He rightly mentioned how the condition leads to many more unplanned emergency admissions; as we know, pressure on A&E at the moment is immense, and that is before we even get into the depths of winter. He also spoke about the excellent work of the community rapid response teams, which can help reduce that pressure on A&E, which will ultimately deliver better patient outcomes. He was right to highlight the additional demands on GPs and the additional numbers of patients they now see, which of course contributes to the difficulty of getting those early diagnoses that all Members referred to.

COPD is the name for a group of lung conditions, including emphysema and chronic bronchitis, that cause breathing difficulties and a permanent narrowing of the airways. Symptoms include shortness of breath when doing simple, everyday things such as going for a walk or housework; a cough that lasts longer than a week; wheezing, particularly in cold weather; and producing more sputum, or phlegm, than usual. My hon. Friend the Member for Weaver Vale highlighted the case study of Chris, which highlights how we sometimes take good respiratory health for granted; only when we lose it do we realise how critical it is.

As we heard, a significant number of people in the UK—more than 1.3 million—have a COPD diagnosis. As many Members said, at least a similar number are estimated to have the condition but are currently undiagnosed. In 2016, the National Institute for Health and Care Excellence estimated that 3 million people in the UK had COPD, of whom around 2 million remain undiagnosed. As we heard, numbers are higher in the north of England and in areas of deprivation. It is estimated that prevalence in the most deprived 10% of areas is almost double that in the least deprived 10%.

My hon. Friend the Member for Blaydon referred to the British Lung Foundation’s survey of 8,000 people with COPD between December last year and May this year. It found that, before the pandemic, around 70% of people diagnosed with COPD said they faced barriers in getting their diagnosis, 14% experienced an initial misdiagnosis, and others had symptoms mistaken for a chest infection or cough or were sent away by their GP after raising COPD symptoms. Worryingly, the Government’s own figures show that diagnosis rates, which I think we accept were too low to start with, have plummeted—understandably—during covid, and so far show little sign of recovery. This month, the British Lung Foundation reports that diagnostic tests such as spirometry have not yet resumed, which many Members touched on.

My hon. Friend the Member for Halton mentioned that there was a 51% reduction in COPD diagnosis in 2020 compared with the previous year, meaning that around 46,000 people in England alone missed out on a diagnosis. Over two years, that is around 92,000 people missing out on a diagnosis. As we know, receiving a diagnosis late means the disease has progressed, which means there is a greater risk of early mortality, never mind the impact on quality of life. Later diagnosis is also linked to higher levels of COPD exacerbations, which can result in lung damage and longer hospital stays. In fact, COPD is currently the second largest cause of emergency hospital emissions, which have risen three times faster than general admissions, putting enormous strain on our NHS, at an estimated cost of £1.9 billion every year.

As we have heard from other Members today, not only late diagnosis impacts hospital admissions; the BLF survey found that those patients who reported receiving the basic standard care—the five fundamentals of COPD care—had fewer flare-ups and better understood what to do when their symptoms worsened.

It is not acceptable that current levels of care mean that, even when a patient has a confirmed COPD diagnosis, they are likely to struggle to access the care they need, resulting in people needlessly ending up in hospital. When national guidelines are in place, it should not be the case that over three-quarters of those who responded to the BLF survey said they were missing out on some aspect of this care. Those with a recent diagnosis were the most likely to receive the lowest levels of care and there was a clear relationship between the length of time since diagnosis and receiving the five fundamentals of COPD care, so we can see that the situation is deteriorating. The BLF report suggests that this may be because people with COPD have to learn how to navigate the NHS to get the care they need. The report also finds that those who received the basic standards of COPD care had fewer exacerbations, were able to manage their condition, and better understood what to do when their symptoms worsened than those who did not, so it simply is not good enough that that group only received the right care eventually, leaving them vulnerable to a deterioration in their health as a result.

We already know that an estimated 420,000 people in the UK may have had their working lives cut short by COPD, and more than half who responded to the BLF survey said their mental health had worsened since suffering a COPD diagnosis. Clearly, we need to do better than this. As Members have said, it is absolutely vital that the right support and treatment are put in place at the right time.

The NHS long-term plan includes commitments related to respiratory disease, including to detect and diagnose respiratory problems earlier and increase access to pulmonary rehabilitation. Will the Minister update us on what progress has been made towards meeting those commitments? It is important to note that the plan was written before covid-19 struck. As my hon. Friend the Member for Weaver Vale said, this plan is very good for sitting on the shelf, but what happens on the ground and how it is delivered are what really matter.

The Minister will know that services were already severely strained before covid-19. We went into the pandemic with the NHS already on its knees, with 17,000 fewer beds, 100,000 full-time NHS staff vacancies, hospitals crumbling, public health services cut and GP numbers down. Members have picked up on all these things today, so we know that the crisis we are in is not simply the result of covid.

We know that NHS waiting lists are now at a record high, with 5.8 million people waiting for treatment. Hospital leaders have warned in recent days that our services are at breaking point, and we know that the coming winter weeks are going to be some of the most challenging in the history of the NHS.

We need to see a plan to get the NHS through the winter without compromising patient care. We need a realistic plan to tackle the backlog in non-covid care and a dedicated plan to tackle the huge backlog in respiratory care. In a written answer in January this year, the Government said they were working with partners to develop and implement policy on the provision of pulmonary rehabilitation services in England. Almost a year on, I hope the Minister will be able to update us on what progress has been made on that plan.

It is a pleasure to serve under your chairmanship, Ms Nokes, for the first time. I add my thanks and congratulations to the hon. Member for Weaver Vale (Mike Amesbury) on securing this debate, particularly on World COPD Day. We very much appreciate his support for the taskforce for improving lung health. It was also a pleasure to hear hon. Members’ contributions to the debate, and I will try my best to answer their questions.

The Government are dedicated to supporting those with chronic obstructive pulmonary disease, or COPD, which is a lot easier to say. In the last 10 years, we have rolled out guidance and initiatives to support and improve this area.

In 2011, a Department of Health outcomes strategy for COPD and asthma set out a proactive approach to early identification, diagnosis, intervention, proactive care and management at all stages of the disease. A wrong diagnosis will result in patients not getting the care they need, as a number of Members mentioned. That is why in 2013 a guide to performing quality-assured diagnostic spirometry was produced by the NHS, with several charities and other stakeholders. The guide was published to support accurate diagnosis of respiratory conditions and tackle the effects of misdiagnosis.

The national asthma and COPD audit programme was launched in March 2018. Led by the Royal College of Physicians, it aims to improve quality of care, services and clinical outcomes for patients with asthma and COPD by collecting and providing data on a range of indicators. As part of the national COPD audit programme, NHS England and NHS Improvement have developed a best practice tariff for COPD. The tariff is applicable to hospital trusts, in order to promote best practice and ensure improvements in care. Best practice will be considered to have been achieved when 60% of patients admitted for an exacerbation of COPD receive specialist input to their care within 24 hours of admission, and where COPD patients receive a discharge bundle before actually being discharged.

The NHS long-term plan sets out the NHS ambition to improve access to treatments for COPD patients. A date was requested by the hon. Member for Strangford (Jim Shannon). As part of the long-term plan, access to pulmonary rehabilitation will be expanded by 2028. Pulmonary rehabilitation, an exercise and education programme, is one of the most effective treatments for COPD, with 90% of patients who complete the programme experiencing improved exercise capacity or increased quality of life. By expanding pulmonary rehabilitation services over 10 years, 500,000 exacerbations can be prevented and 80,000 admissions avoided.

I take the Minister’s point about pulmonary rehabilitation being so important—an integral part of the management of these long-term chronic conditions—but 10 years is a long time. People need help now, so what is she thinking in terms of immediately putting into place the extra staff and resources required for pulmonary rehab?

I will come to that, and I will also come to the questions about recovery and catch-up, which a number of people mentioned.

To increase access to pulmonary rehabilitation, a population management approach will be used in primary care to find eligible patients from existing COPD registers who have not previously been referred to rehabilitation. New models of providing rehabilitation to those with mild COPD, including digital tools, will be offered to give support to a wider group of patients with rehabilitation and self-management support.

The use of COPD discharge bundles, where appropriate, will also help to increase referrals to pulmonary rehabilitation, and the NHS long-term plan will build on a range of existing national initiatives focused on respiratory disease. The quality and outcomes framework, or QOF, ensures that all GP practices establish and maintain a register of patients with a COPD diagnosis, and the QOF for 2021-22 includes the improved respiratory indicator, including the recording of the number of exacerbations and assessments of breathlessness, and an offer of referral to PR.

NICE quality standards have been published, with the aim of raising the standard of care that those with COPD receive. The NHS RightCare Pathway for COPD is being rolled out nationally. This pathway defines the core components of an optimal service for people with COPD, and it includes timely access to PR as part of the optimal treatment pathway. It provides resources to support local health economies, and the pathway also concentrates improvement efforts on addressing variation and population health.

At the beginning of the pandemic, NICE published rapid guidance on COPD, which outlines how to communicate with, treat and care for patients suffering from COPD. It also outlines how healthcare workers should modify their usual care and service delivery during the pandemic.

I am listening carefully to what the Minister is saying, but one of the problems that I referred to briefly in my speech is that of being able to see a GP—not necessarily just for diagnosis, but when someone becomes ill. I wonder how she can square that circle in terms of what has been put in place, if people cannot get to see a GP in person in the first place.

Of course, access to GPs’ services is a concern that all Members will have heard a number of their constituents raise. That is why we put in place £250 million to increase access to face-to-face GP appointments as part of the recovery plans, which are quite extensive for the NHS.

The guidelines I was talking about aim to highlight ways to support people with COPD, such as signposting charities and support groups for better health and wellbeing. They recommend using technology to reduce some in-person appointments, while making sure not to provide a service that would increase health inequalities through a lack of digital access—it is additional, not instead of—as well as offering advice on how to modify care during the pandemic.

A number of questions were raised about the recovery plan, and how to restore services for patients and restore the diagnostics to pre-pandemic levels, or above them. The 2021-22 priorities and operational planning guidance set the priorities for NHS England and NHS Improvement, and includes tackling the backlog for non-urgent treatment such as services for lung disease patients. That plan aims to stabilise total waiting lists, and eliminate waiting times of two years or more and the increase in waiting times of more than one year. We have made £1.5 billion available to assist local teams to increase their capacity and invest in other measures to achieve those priorities, and the 2021 spending review announced £2.3 billion to increase the volume of diagnostic activity and open community diagnostic centres to provide more clinical tests, including for patients with lung disease.

Targeted lung health checks are running in the parts of the country with the highest rates of mortality from lung cancer. However, those projects will not just identify more cancers, but pick up a range of other health conditions, including COPD. People aged between 55 and 74 who have ever smoked are now offered a free lung health check closer to where they live. They may then have a lung cancer screen scan if that check shows that they need one. A review undertaken by Professor Sir Mike Richards highlighted that patients with respiratory symptoms would benefit from community diagnostic centres, due to the number of diagnostic tests that will be made available. As well as supporting patients with COPD, the Government are committed to strategies that will help to prevent that condition, as a number of Members have mentioned.

Just for clarification, following on from the question that the hon. Member for Halton (Derek Twigg) has asked, does the Department of Health proactively—perhaps even aggressively—contact smokers to follow through, rather than those smokers contacting the health service? I am not sure whether that would always happen. What is the Government’s policy on that?

Obviously, there would be a relationship between the GP and the smoker, but that can go either way. Anybody who is in those age groups needs to be made aware that they are entitled to this free lung health check, and it is the responsibility of us all to make sure those checks are available. I am sure we will all ensure that that is understood.

In 2019, 85% of deaths due to COPD were attributable to smoking, and in 2019-20, 84% of hospital admissions with COPD were attributable to smoking. The proportion and the number have remained quite similar over the past five years, and as has been mentioned by a number of hon. Members, smoking is a key factor in many cases of COPD. This Government are committed to reducing the harms caused by tobacco, and have made good long-term progress in reducing smoking rates, which are currently 13.9%, the lowest on record. However, with 6.1 million smokers in England, tobacco is still the single largest cause of preventable mortality, and a radical new approach is needed to address the stark health disparities associated with tobacco use. As such, we have set out the bold ambition for England to be smoke free by 2030. To support that ambition, we have announced the publication of a new tobacco control plan, which will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda.

The NHS long-term plan commits to delivering NHS-funded tobacco treatment services to all inpatients, pregnant women and people accessing long-term mental health and learning disability services by 2024. COPD is responsible for around 33% of annual deaths from respiratory diseases and is the single largest cause of occupational lung disease. There are an estimated 17,000 annual new cases of self-reported, work-related breathing or lung problems, which is why our colleagues in the Department for Work and Pensions are also helping to tackle the causes of COPD in the workplace.

I thank the Minister for recognising that a proportion of COPD cases are caused by work-related issues, which will of course affect the north and the north-east most of all because of their industrial heritage. I assume she will tell us what steps the Department will be taking to pursue that.

Yes, indeed. In fact, one of my own family members—my uncle—has COPD and has never smoked. As we are from the north-west, it is likely to be due to his workplace conditions.

Tackling occupational respiratory disease remains one of the Health and Safety Executive’s health priorities, and the aim is to reduce the number of new cases of occupational-related lung disease. To help achieve that, HSE focuses its inspection and enforcement activity where it can have the most effect. It continues to work with a broad range of partners to extend its reach and raise awareness of the need to prevent exposure. HSE’s WorkRight campaign, which includes occupational lung disease, uses communication and social media channels to promote the benefits of good health and safety, and a range of initiatives are being undertaken to support reducing mortality rates among patients with lung disease—for example, HSE undertook interventions in 2019-20 to address the carcinogenic risks from welding fume exposure.

I hope that what I have set out answers the many questions that right hon. and hon. Members had, but clearly it is work in progress. We are working hard to ensure that COPD care improves for all, as outlined in the NHS long-term plan, and that people have access to the very best care available.

I thank the Minister for her detailed response and for taking a number of interventions—she was generous with her time. I also thank right hon. and hon. Members of different parties for championing the cause and for highlighting cases in their constituencies across the UK.

Some of the key asks on World COPD Day were for a dedicated, detailed and resourced plan. Everybody spoke about the need for early diagnosis and access to GPs. We all have examples in our constituencies, and it was interesting that the Minister talked about resources going forward in her response, but we know that COPD is a real issue here and now in our constituencies. The British Lung Foundation said that over 70% of those diagnosed with COPD were struggling to access services, particularly the NICE-recommended COPD five-point plan.

Regional disparities are a big issue. The Government talk about levelling up, and here is a real opportunity to level up the life chances and health chances of people right across the UK. COPD is particularly prevalent in the north, Scotland and Northern Ireland.

We mentioned other factors such as workplace, and the Minister spoke about some personal family experience in the industrialised north-west. We also spoke about the link with poverty.

The Government have to address these issues effectively, and we will continue to hold their feet to the fire. They have been in power for 11 years. It is right to say that this is a journey, and we are not where we need to be for the millions of constituents who face this awful, debilitating disease.

Question put and agreed to.


That this House has considered support for people with chronic obstructive pulmonary disease.

Sitting suspended.