Jim Shannon (Strangford) (DUP) I beg to move, That this House has
considered asthma outcomes. Thank you very much for calling me to
speak, Mr McCabe. This is an issue that is close to my heart and
close to the hearts of others here. There are few families in the
whole of the United Kingdom for whom asthma has not been a key
issue; it has been an issue for my own, and I want to speak about
that as well. I am grateful to the Backbench Business Committee for
agreeing to...Request free trial
(Strangford) (DUP)
I beg to move,
That this House has considered asthma outcomes.
Thank you very much for calling me to speak, Mr McCabe. This is
an issue that is close to my heart and close to the hearts of
others here. There are few families in the whole of the United
Kingdom for whom asthma has not been a key issue; it has been an
issue for my own, and I want to speak about that as well. I am
grateful to the Backbench Business Committee for agreeing to have
the debate. I am chair of the all-party parliamentary group for
respiratory health, which recently completed an inquiry into this
issue, so I am delighted to be able to raise the issue of
improving asthma outcomes in the UK. I very much look forward to
the response from the Minister. I am also very pleased to see the
shadow Minister, the hon. Member for Enfield North (), in her place, and I wish
her well in her new role.
What does asthma mean to me? My second son, Ian, had asthma. He
was born with very severe psoriasis, which meant that we had to
apply cream to him three times a day when he was a wee boy. The
doctor told us that the psoriasis would eventually go away, but
that it would be replaced by asthma. I am not sure of the medical
connection—I am not medically qualified to understand it—and I
know only what the doctor told me and my wife. Ian has had asthma
all his life now—he is 30 years old—and has used salbutamol, the
wee blue inhaler, which is always there. It is very clear, from
our family’s experience, that those salbutamol inhalers are
really important. They are important for Ian. Asthma did not stop
him participating in sports, but it meant that he always had to
have that inhaler close by, should he at any time feel shortness
of breath or need a wee helper.
In Ian’s class at school, there were many others who had asthma
issues. As an elected representative, whenever I help
constituents with benefit forms, whether for attendance
allowance, personal independence payments or whatever, I always
ask them about their medical circumstances. More often than not,
asthma features among the ailments that they confirm they
have—even for those of a different generation. They have often
had it for many years. Asthma is an incredibly important
issue.
I am pleased to see the Minister in his place. I always like
dealing with him, because I always find his answers helpful. He
has a passion for the health issues that we bring to his
attention, and he always tries to give, and indeed succeeds in
giving, the answers that one wishes to receive. Today, we are
going to ask a number of questions, and we very much look forward
to his responses. I am pleased to see hon. Members in their
places. I had hoped that more Members would be able to attend,
but I understand that last night was a late night for Members and
that there are other pressing matters today.
I have always had a particular interest in respiratory health.
This debate has arisen as a consequence of the APPG’s report,
which we published last year: “Improving asthma outcomes in the
UK”. We looked at the UK mainland, but we also had contributions
from Scotland, Wales and Northern Ireland. Obviously, I bring the
Northern Ireland perspective to any debate, wherever it may be
about, and bring in Strangford too. I am my party’s health
spokesperson in this place, and I work closely with my colleagues
back home in the Northern Ireland Assembly, particularly with Pam
Cameron, my party colleague. She and I work on many things
together, including this topic.
Last year, the APPG produced a report investigating the reasons
behind the UK’s poor asthma outcomes. We were pleased, honoured
and humbled that recognised experts in fields relating to asthma
responded to our invitation to take part. The experts ranged from
clinical experts from primary, secondary and tertiary care to
patient advocacy groups, national asthma champions and
patients.
The inquiry was incredibly helpful and detailed. I thank Hugh
McKinney of the APPG secretariat and his team for bringing
together all the people who wanted to contribute. As a result of
the inquiry and the report, many countries in the world now look
towards us to learn about how we deal with asthma. They want to
learn something from us here in the United Kingdom, and perhaps
do things that wee bit better.
(Rutherglen and Hamilton
West) (Ind)
I congratulate the hon. Member on securing today’s debate. As
with most conditions, research and development is key to
improving outcomes. Does he agree that funding into asthma
research must be provided from a clearly defined central source
and that there must be increased capacity for trials in
hospitals?
I absolutely agree with the hon. Lady. No matter what the sphere
of health, early diagnosis and attention is key. Indeed, my son
is an example of that, as a child born with the ailment. There
was early participation in his treatment by the doctors,
including our own GP and those in the hospital. It is clear to me
that that helped him on the pathway to better health. The hon.
Lady is absolutely right and I thank her.
We received a large number of written submissions, including
evidence from across the numerous asthma disciplines. We were
encouraged that there was such a high level of interest. The APPG
tries to do a catch-up once a month with stakeholders and those
with medical expertise. Each month, we aim to hear from between
16 and 20 people who have an interest in the subject. They bring
all their information to us, which we are pleased to have. We
were incredibly encouraged that there was such a high level of
interest, and I thank every one of them for their help and expert
advice.
Let us consider the impact of asthma on people in the UK. The
number of people affected by asthma in the UK is among the
highest in the world, with some 5.4 million people sufferers. I
had never done an interview with GB News until yesterday morning,
but they were interested in this debate and a former colleague in
this House was the interviewer. It was nice to catch up with
again in her new job, and
it was a platform and an opportunity to raise awareness and the
questions were clear. That figure of 5.4 million people suffering
from asthma came up early on in that interview.
Mr (East Londonderry)
(DUP)
I congratulate my hon. Friend on securing the debate. On raising
awareness, will he join me in congratulating and commending so
many of the voluntary groups, particularly those working with
issues around chronic obstructive pulmonary disease? I can think
of one such group in my constituency, in the Causeway area, that
highlights these matters and draws attention to them in the wider
community, in order that there is greater awareness across
society to try and help people cope with that debilitating
condition.
I thank my hon. Friend and colleague for that point. He is right
that there many charities and volunteers, as well as many people
who have the disease. A great number of people have expertise,
interest and keenness to help and assist them. COPD is one of the
most debilitating diseases that I have ever seen. I never
realised just how many people in my constituency suffer from
COPD, but there seem to be a large number, some of whom are in
the advanced stages of a deterioration in health. I have a very
good friend who is an artist; we have been friends for many
years. He is interested in rural and country sports, as I am,
which is where our friendship came from. Today, he is completely
dependent on oxygen 24/7 and rarely leaves the house. For a man
who was active and fit, COPD has changed his life
dramatically.
Some 65% of people with asthma do not receive a yearly review—I
am keen for the Minister to respond to that—despite
recommendations by the National Institute for Health and Care
Excellence that they should. I respectfully ask the Minister, if
they are not getting a review, why not? Asthma has an impact on
every patient’s quality of life. A recent pilot study for Asthma
UK showed that the impact can be considerable: 68% said asthma
attacks hold them back from work in school; 71% said severe
asthma affects their social life; 54% said it holds them back
from going on holiday; and 66% said severe asthma has made them
or their child anxious. When the child is anxious, the parent is
anxious—we all worry about what happens. The study also found 55%
said having severe asthma has made them or their child depressed.
The issue of depression and mental health has come up during the
difficulties we have had with covid over the past year and a
half.
Asthma deaths in the UK have increased by one third over the last
decade. Three people in the UK die from asthma every day, which
is among the highest in Europe, yet studies show that more than
two out of three asthma deaths could be prevented. Three people
die every day and if we had the right things in place, we could
save two of those three lives every day in the UK. I put that
challenge to the Minister, who I hope will give us the confident
and positive reply that we would like to see.
Air pollution can trigger asthma attacks, and it is believed that
it is linked to the rise in childhood asthma. Does the hon.
Member agree that tackling air pollution could also bring public
health benefits?
I absolutely agree. The hon. Member is making points that we all
agree with. I am glad she has brought that to my attention. I
come to London to work and am aware of the air pollution and the
steps that the Mayor of London and others that are taking to try
to address that, by restricting the number and type of cars
coming in. As the hon. Lady rightly said, people have died in
London from air pollution and we must address that. In large
metropolises and population clusters, where vehicles and the
economy are concentrated, air pollution is important.
I am fortunate to have lived in the countryside all my life. It
means that when I go out of my back door there are green fields
and the neighbours are about half a mile away, so there is a
distance between us as well. However, some 14,000 vehicles a day
pass by us on the road—the A20 from Ards to Portaferry—which, by
its very nature, shows where the problem is.
Asthma exacerbations lead to over 77,000 hospital admissions each
year. It is estimated that asthma leads to a direct cost to the
NHS of £1 billion and an indirect cost to society of £1.2 billion
due to time off work and loss of productivity. This goes back to
the intervention by the hon. Member for Rutherglen and Hamilton
West () when she referred to
early diagnosis which can stop people losing work days and reduce
the cost to the NHS. These factors cannot ignored be when it
comes to addressing the health issues and helping to balance the
books.
This year, the APPG’s intention was to produce a one-year-on
report to highlight and emphasise the tremendous work that has
been carried out by all those working in asthma. We intended to
highlight the progress that has taken place in the past year, the
actions of the Government, and any further areas that needed to
be reconsidered. Our job will be to continue to note the
progress—it may not be the progress we would like to see—and
speak to the Minister to see how we can change that. However,
covid changed everything. It changed our thinking dramatically.
It has had a devastating effect on many lives and has impacted on
asthma care. It affected the scope of our latest report, as well
as concentrating on asthma outcomes one year on. We have also
looked carefully at the impact of covid on respiratory health and
asthma in particular.
I have the greatest admiration and respect for all those working
in the NHS during these difficult times, especially those in
respiratory health, which has been the hardest hit. They are all
heroes—that word is used often, but it is true here—and a credit
to the profession and the NHS. We are grateful and thankful to
them all.
In the past year, covid has had an impact on those with asthma,
COPD and the complex health needs that can sometimes be
exacerbated by covid, leading to further difficulties. The past
year has been difficult for every one of us. We have probably all
lost loved ones to covid. In October last year, we lost my
mother-in-law, who had complex needs. Covid took her, and we
still miss her.
Today, I want to concentrate on the three critical issues
identified by the clinical advisers who addressed our inquiry and
shared their expertise and evidence. The first issue is the
overuse of salbutamol reliever inhalers. We are not saying that
people should not have them. That is not what the inquiry said or
what the APPG is saying. We are looking at the potential overuse
of those inhalers. The second issue is the new unified asthma
guidelines. Thirdly, we need better use of biologics.
Prior to the covid pandemic, responders to our inquiry last year
identified the overuse of salbutamol inhalers—the blue, not
brown, inhalers—and oral corticosteroids as the biggest area of
concern and the most important cause of exacerbation and
unnecessary asthma deaths. In our report, the APPG also cited
numerous studies that have shown that over-reliance on salbutamol
may lead to the reduced use of preventer inhalers and to a
greater risk of preventable attacks. Regular overuse has also
been shown to increase the risk of asthma attacks,
hospitalisations and deaths. The Department of Health and Social
Care needs to look at the overuse of medications and whether that
may do more harm. The evidence in this case seems to show that
this is one of those situations.
A recent study by the SABA use in asthma global programme—the
SABINA programme—found that high use of such inhalers was
frequent among UK patients and
“was associated with a significant increase in exacerbations”
and in reliance on asthma-related healthcare. It stated the need
to align SABA inhaler prescription practices with current
treatment recommendations.
Some 22.5 million of these inhalers are dispensed to asthma
patients each year, an average of five per diagnosed patient. Way
back in 2019, before covid, and during one of the few times in my
life I have had health issues, there was a week when I could not
even come to Westminster, because the doctor told me it would not
be safe to travel. My chest and breathing were at a level where
he advised me not to travel. At that time, I was on the blue
inhalers. I think I had three over that 11 or 12-week period. I
may have had a wee bit too much, although I did not realise that
at the time. That is one of the issues highlighted by the
inquiry.
Patients using excessive numbers of inhalers should be flagged,
identified and immediately seen by an asthma-trained clinician. I
bring it to the Minister’s attention that we think it is time to
rethink asthma treatment and get this right for patients and
constituents across the United Kingdom of Great Britain and
Northern Ireland. There are innovative approaches that
demonstrate SABA-reduction.
A 2018 study in The Lancet suggested a maintenance and reliever
treatment, with a combination steroid and long-acting
beta-agonist, which would allow SABA-free treatment. That could
be an effective way to reduce SABA overuse among patients, where
clinically appropriate. As ever, it must always be done in
consultation with and under the guidance of your doctor and those
with health expertise.
The Sentinel project undertaken in Hull and East Yorkshire
improved outcomes for adult asthma patients by identifying SABA
over-reliance and appropriate implementation of a MART strategy.
There is a pilot scheme, which could be the marker, the guide,
the standard, the level for the rest of the United Kingdom. Data
from that pilot Sentinel study demonstrated that MART can
substantially reduce the SABA prescribing.
To ensure that that happens, it is important to restore the
asthma reviews, which were hit badly by covid. It is time, ever
mindful that covid is our priority, to look at the other issues
in the United Kingdom, and asthma is one of them. Asthma UK’s
latest annual survey showed that 66% of people with asthma are
not receiving basic care for their condition, and that that level
has fallen, for the first time in eight years. Minister, what has
been done to address that fall? How can we do it better?
An annual asthma review is an important component of addressing
that. I should be grateful if the Minister would update us on the
progress that has been made on restoring the annual reviews. When
we are responding to health issues in the United Kingdom we often
need data, so it is important to have that in place.
We also suggested in our APPG report that primary care incentives
might be necessary to drive the reduction of SABA use. We stated
that the QOF—quality and outcomes framework—or the investment and
impact fund have the potential to help with that. The patient
pathway is also an important method to reduce SABA use, which
brings me to my second point—the new unified guidelines.
Last year, in our inquiry, we analysed the challenges faced by
clinicians in treating severe asthma. We found that almost all
the experts identified the existence of multiple asthma
guidelines as confusing, unnecessary and a cause for concern. If
they are confusing to experts, and therefore for our constituents
and patients too, we need to have a singular approach. Again, I
look to the Minister for a response.
The Royal College of Physicians told us in its submission
that
“national audit data collected from England, Scotland and Wales
indicates that the standard of care against national guidelines
(NICE and BTS) and recommendations from NRAD are variable and on
the whole substandard.”
There is a need to get things right and singular. As a
consequence, the APPG strongly welcomed the commitment to and the
ongoing work to produce unified guidelines as a necessary step
forward to improve asthma outcomes. We felt that it was
especially important for our time-stretched clinicians that all
guidelines on asthma should be in one place.
The unified guidelines were delayed due to covid, but are due in
2023. Our main concern, however, is that we understand that the
draft scope for the new unified guidelines does not include
severe asthma. I bring that to the Minister’s attention, because
we feel it should. Perhaps the Minister will give us some
indication of what will be done to address that, because that
appears to me to be a serious omission, and others will
agree.
It is unclear how any guidelines could be described as “unified”
when the most serious type of asthma is not included. I have a
concern, a question mark in mind, about that. It is especially
puzzling when we consider that the existing NICE, British
Thoracic Society/Scottish Intercollegiate Guidelines Network,
Global Initiative for Asthma and NRAD—national review of asthma
deaths—guidelines all give similar criteria for referring a
patient for severe asthma.
If severe asthma is excluded from the scope of the unified
guidelines, the concern is that newer treatment options will not
be addressed properly, which takes us back to the intervention by
the hon. Member for Rutherglen and Hamilton West. This is about
early diagnosis and treatment at an early stage. If we do not get
that right, we will have complications and problems later.
Those newer treatment options include the use of biologic
treatments and the latest best practice in phenotyping, which
were strongly recommended by both clinicians and severe asthma
patients in our inquiry. The long-term plan states:
“We will do more to support those with respiratory disease to
receive and use the right medication”,
but without severe asthma included in the unified guidelines,
that is unlikely to happen. How can we make that happen, rather
than being unlikely? Will the Minister therefore give me, the
House and those in and outside this Chamber the thinking behind
that omission? What is the possibility of adding severe asthma
back into the discussion? If we can retrieve that and bring it
back in, I will be pleased. I also wonder what can be done while
we wait for the new guidelines. Four sets of guidelines are
confusing for clinicians. Surely it would be preferable not to
wait until 2023 for clarity. We need to act today—for the three
people who die every day due to asthma. That is the imperative.
Is there any way that the Minister can reflect on that and give
consideration to updated living guidelines to reflect current
best practice and treatment?
Unified or updated guidelines can materially affect my third
point on biologic therapies. They are life-saving treatments for
people with certain types of severe asthma and asthma that is
difficult to control. They can reduce asthma attacks in severe
asthma, reduce the need for steroids and improve symptoms. At
present, they are only offered to patients through the specialist
asthma clinics. There was strong support in our report last year
for the appropriate use of biologic treatments and we supported
the extension of prescribing to secondary care clinicians for
severe asthma patients. Many clinicians viewed the use of
biologics as a better alternative to traditional oral
corticosteroid treatment for severe asthma and we received
evidence that a large majority of patients who are eligible still
do not have access to them.
Asthma UK suggests that
“82% of difficult and severe asthma patients are often not being
referred at the right time, or sometimes, not at all.”
That is hard to believe. Asthma UK and BLF also told us that the
current NHS asthma care pathway does not take full account of the
availability of the new treatments. So most people with severe
asthma are still reliant on OCS. According to Asthma UK, three in
four people eligible for biologic treatment are still not
accessing it and thousands of patients are having to endure
treatments that are considered inadequate and suffer unnecessary
side effects.
That is linked to the Government’s five highest health gains
programme, which introduced a commitment by the UK to match or
surpass comparative nations in the access to new and innovative
medicines in five clinical areas, one of which is severe asthma
biologics. The scheme committed to the objective of
“reaching the upper quartile of uptake for 5 highest health gain
categories”
during the course of the first half of the scheme, by mid-2021.
We applaud the Government’s initiative and action on that to
date, but the deadline has clearly been missed. New data
commissioned by NHS England has shown that the UK is far from the
upper quartile and confirms that we are currently ninth out of 10
with regard to comparator countries. We must improve that. We
must get better and do that for our patients. We also recommended
extending the Accelerated Access Collaborative’s severe asthma
programme, and increasing resources to increase capacity for
prescribing biologics will be important for achieving that. Will
the Minister give a renewed commitment to achieving upper
quartile access and set a new, clearly defined target for when
and how that will be achieved?
In October 2021 the Government announced 40 new community
diagnostic centres, which are set to open across England in a
range of settings, from local shopping centres to football
stadiums, to offer new and earlier diagnostic tests closer to
patients’ homes. I want to put on record my thanks to the
Government and the Minister for that commitment. It is clearly
there and we thank him for that. However, we cannot make it a
postcode lottery. If it can happen here in London, it should
happen in Cardiff, Newcastle, Liverpool and everywhere else.
Nowhere should be any different, so I would like to see that
happening.
The Government have stated that the new centres will be backed by
a substantial amount of money—a £350 million investment—and will
provide around 2.8 million scans in the first full year of
operation. They are designed to assist with earlier diagnosis
through faster and easier access to diagnostic tests for symptoms
in areas including breathlessness, cancer and ophthalmology. In
the Budget, the Chancellor announced an additional £5.9 billion
to tackle the backlog of general diagnostic tests to deliver more
checks, more scans and more treatment. The intention is to
increase the number of diagnostic centres to at least 100 and I
understand that each one will include a multidisciplinary team of
staff, including nurses and radiographers, and will be open seven
days a week. The Government and the Minister are to be commended
for that, and I warmly welcome it and the funding that will be
allocated. I hope they can help address the covid-imposed
inequalities that we have seen across the country in asthma care
and treatment. Will the centres be fully staffed, will they have
trained staff and will they be in place?
I also welcome the breathlessness diagnostics, which will be
included in the centres. It is essential that they should be
equipped to diagnose any cause of breathlessness, whether
cardiovascular, lung cancer, asthma or chronic obstructive
pulmonary disease, which my hon. Friend the Member for East
Londonderry (Mr Campbell) mentioned. It is also important to
establish an appropriate referral system from the centres, should
further investigation be warranted. Will the Minister confirm
that the FeNO and spirometry tests will be included in all
centres, to allow for fuller asthma assessments?
I look forward to the contributions from other Members, and I
thank those who intervened on my speech. I very much look forward
to the Front-Bench contributions, particularly from the
Minister.
10:00:00
(Loughborough) (Con)
It is a pleasure to serve under your chairmanship, Mr McCabe. I
am delighted to follow the hon. Member for Strangford (), and I congratulate him on securing this excellent
debate. I thank him very much for what he has said. My speech
will be less wide-ranging than his, but I want to deal with two
particular aspects. First, I should declare an interest, in that
my brother works in this industry. Having said that, we never
talk about work, so that is literally as much as I can say about
what he does. However, I have had several meetings with
representatives of Kindeva, a company that deals in the asthma
industry, and visited its site. It is based in my constituency,
so I will refer to the company in some detail. I will first
discuss the change in drug delivery that is proposed by DHSC,
before talking about prescription charges.
Asthma can be an incredibly dangerous condition. As Asthma UK
data show, there are around 75,000 asthma-related emergency
admissions to hospital every year in the UK and, sadly, asthma
causes the death of around 1,200 people every year. Thankfully,
however, although there is no cure, there are simple and,
importantly, accessible treatments that can help keep the
symptoms under control, including inhalers. That being said, the
fact that people are still dying from this condition shows that
more work needs to be done, and I was encouraged by the response
from the Minister for Care and Mental Health to the debate on
access to salbutamol inhalers last week, during which she set out
the steps that the Government and NHS are taking to improve
asthma outcomes. I was particularly encouraged to learn that the
NHS long-term plan includes respiratory disease as a national
clinical priority and sets out a number of respiratory
interventions, including plans for early and accurate diagnosis
of respiratory conditions. I would welcome reassurance from the
Minister that the Government will work with the NHS to achieve
the aims set out in the long-term plan.
I want to take the opportunity to mention an issue that has been
raised with me by Kindeva, a pharmaceutical contract development
and manufacturing organisation, when I visited its
state-of-the-art research, development and manufacturing
facilities at Charnwood Campus in my constituency, which is the
very first life sciences opportunity zone that is based in the
UK. During my visit, I saw the production of pressurised
metred-dose inhalers, or PMDIs, and I heard about Kindeva’s work
to transition to green propellants. I am delighted that as part
of this, Kindeva and Loughborough University formed a knowledge
transfer partnership to proactively address the inhalation drug
delivery industry’s move to develop PMDI propellants with lower
global warming potential, or GWP, than exists currently in
marketed propellants. That is a fantastic example of universities
and businesses working together to turn a cutting-edge idea into
a marketable product, and it reflects the success of Charnwood
Campus.
That being said, I understand that the NHS’s current target to
reduce the carbon impact of inhalers by 50% by 2028—by switching
patients from PMDIs to dry powder inhalers—coupled with the
Government’s review on the use of fluorinated gases, is creating
uncertainty for the industry. Specifically, I have been informed
that the NHS switchover policy is shrinking the size of the UK
PMDI market, and that Department for Environment, Food and Rural
Affairs’ proposals to remove the essential medical use exemption
of F gases in PMDIs would put considerable pressure on the market
before green propellant alternatives are widely available.
Although I fully support the Government’s net zero strategy and
their commitment to build back greener from the pandemic and
level up all areas of the country in the process, if we are to
achieve these aims, we must work with industry to ensure that we
do not unintentionally drive innovation out of the country, along
with opportunities for inward investment and long-term, highly
skilled jobs, particularly in the east midlands and, from my
point of view, most particularly in Loughborough. We have a
fantastic opportunity to be a world leader on green propellants,
and we have the willingness of industry to make the necessary
changes. I therefore ask the Minister and the NHS to work with
the industry and, most importantly, afford it the time needed to
transition to greener propellants, by delivering the current NHS
emissions reduction targets over a longer timeframe, and
maintaining the current medical use exemption for F-gases until
2030.
Consider the situation, imagine the scene, of struggling for
breath. Constituents have that problem across the country every
day. They need consistency of treatment to enable them to trust
the medication and have it delivered quickly and accurately. When
they need the medication, it is very often an emergency. They
need the drug delivery to be accurate and timely. Let us take
that into consideration when looking for net zero outcomes in
medications and treatment.
Asthma UK called for a suspension of prescription charges for
asthma medications and for them to be added to the medical
exemptions list. I think we would all agree, particularly in the
case of the son of the hon. Member for Strangford, who was born
with the condition, that this is not something that can be
avoided. Therefore, why should patients pay for those
prescriptions?
10:06:00
(Blaydon) (Lab)
It is a pleasure to serve under your chairmanship, Mr McCabe. I
congratulate the hon. Member for Strangford () on securing this important debate. It is incredible
that the subject of asthma has not been discussed more often in
the House, given that it affects to so many people.
I would like to start with some key statistics on severe asthma:
5.4 million people in the UK currently receive treatment for
asthma, including 5,282 people in my constituency of Blaydon,
where we have a sad history of respiratory conditions, including
asthma, affecting the lives of too many people.
Around 200,000 people in the UK have severe asthma, which is the
most debilitating and life-threatening form of the condition, and
which does not respond to conventional treatments. Four out of
five people with suspected severe asthma, who should be referred
to a specialist, are not getting the care that they need; 46,000
people are missing out on life-changing biologic treatments.
The north-east region has the highest oral steroid prescribing
rate at 20%, prescribing two or more courses of oral
corticosteroids in the previous 12 months compared with the 14%
average. As we have heard, oral steroids can have very nasty side
effects, including osteoporosis, weight gain and diabetes.
Severe asthma has a devastating impact on every part of someone’s
life. Living with severe asthma is so much more than asthma
attacks and occasional hospital admissions. People may feel
isolated, lonely and scared, left without hope or the right
support. The covid pandemic has clearly shown that for many
people that is a very real concern, leaving many of them in
isolation.
One person with severe asthma reflected on how it impacts on
them:
“It’s really restricted me. I have suffered because there was a
point when I refused to leave the house… So, it really affected
my work, my lifestyle. Meet your friends, just even speaking to
them, I would get really out of breath. I was trying to avoid all
of that.”
Without specialist treatment and support, people with severe
asthma end up in a never-ending cycle of emergency trips to
hospital, relying on toxic oral steroids, which can have very
nasty side effects. It has now been shown that as few as four
courses of oral steroids over a lifetime can be associated with
adverse effects. Another person with asthma, speaking to the
British Lung Foundation and Asthma UK, said:
“Steroids made me able to breathe but they ruined my life. The
insomnia, the racing thoughts, the weight gain. I have lost all
confidence and self-esteem.”
Asthma UK’s recent survey of more than 2,000 people who used oral
steroids in the last year revealed the devastating consequences
on their quality of life, with 73% experiencing at least one side
effect, and one third experiencing side effects relating to their
mental health. Another person in the survey, a woman in her
thirties, said:
“They affect my mental health really badly and the effects last
for weeks or months after I finish the course. I dread taking
them but do it to make my asthma better.”
That is not the kind of life that we want people to have.
However, there are some potential treatments. Life-changing
biologic treatments offer hope, but only if people have access to
them. Treatment in care for severe asthma has transformed over
recent years. There are now five life-changing biologic
treatments available that reduce, or even stop, the need for oral
steroids. A person in another Asthma UK survey said:
“I just wish I had been put on this biologic a lot sooner.
Because the period I was suffering, you can’t explain it in
words. It was really, really hard for me. It was just so
depressing that sometimes you think your life is just not worth
living anymore.”
Access to those biologic treatments is poor. Asthma UK’s report,
“Do No Harm: Safer and Better Treatment Options for People with
Asthma” showed that an estimated 46,000 potentially eligible
people are still missing out. Recent analysis by Logex showed
that England is second from the bottom on biologic uptake in a
comparison with similar European countries. Work is being done to
improve the uptake of biologic therapies through the accelerated
access collaborative, and Asthma UK has also developed a
patient-facing tool, but much more needs to change to bring us in
line with other European countries.
Nicki, from Oxford, has been able to access a biologic treatment
early, in special circumstances, because she was not responding
to other treatments for severe asthma. She says:
“My asthma was so bad that I spent my late twenties and early
thirties being blue-lighted to hospital regularly with
life-threatening asthma attacks, rigged up to machines to help me
breathe and not knowing if I was going to see my 35th birthday. I
couldn't walk anywhere due to breathlessness and had severe
asthma attacks without warning. My plans for starting a family
were put on hold because I was too ill and the only thing that
offered any kind of relief was long-term steroid tablets, but
these caused me to rapidly put on weight and I was still in and
out of hospital continuously. My partner had begun to feel like
my carer and I was losing my independence.
Since I have been on dupilumab, I feel like a new woman. I’ve
taken part in cycling challenges, love walking my dogs, have a
fantastic new job in health research and am able to finally
contemplate starting a family.
It was a difficult process for me to get access to dupilumab but
I know I’m one of the lucky ones—some people wait years for
referrals and this can have a huge impact on their lives. It’s
vital people get referred if they’re ever going to reap the
benefits of this potentially life-changing treatment.”
That is a vivid illustration of the dramatic impact of new
biologic treatments on those for whom they are suitable and
available.
A lack of comprehensive guidelines can result in delays and
missed opportunities for referral. Dedicated specialist services
now offer a comprehensive systematic assessment,
multidisciplinary team input and phenotyping. However, 82% of
people who would benefit from seeing a specialist, according to
British Thoracic Society guidelines, are not getting referred.
Covid-19 will have compounded that; there was an 86% drop in
referrals for respiratory disease during lockdown, and that has
not fully recovered. People are unable to access these specialist
services because there is a lack of awareness that severe asthma
is a distinct condition that needs dedicated services and
biologic therapies to treat it effectively. Furthermore, many
health professionals do not know when to refer someone or
understand the benefits that referral to a specialist could
bring.
Other research from Asthma UK has shown that there is a variation
in when clinicians think they should refer someone. This is
because the current guidelines are confusing and conflicting, as
we have heard. It is incomprehensible that a condition affecting
over 200,000 people in the UK did not have a National Institute
for Health and Care Excellence management guideline until the
covid-19 pandemic, when rapid guidance was produced. That was a
positive step, but a fully evidenced guideline with clear
referral criteria is still urgently needed to address the huge
unmet need and show the benefits of referring someone to
specialist care. It is disappointing to see that severe asthma
has been excluded from the upcoming NICE, British Thoracic
Society and Scottish Intercollegiate Guidelines Network joint
guideline draft scope on asthma. Including severe asthma, with
clear referral criteria, within the NICE guidelines has the
potential to transform care for people with asthma.
There are some clear policy recommendations regarding severe
asthma. Repeated use of oral steroids must be seen as a failure
of asthma management, and prompt urgent action and appropriate
referral should be taken. Primary and secondary care clinicians
need to be proactive in order to recognise and refer those with
suspected severe asthma. NICE should develop a single,
comprehensive severe asthma guideline on identifying, referring
and treating people who may have difficult or severe asthma. We
need to see the brilliant work by the accelerated access
collaborative implemented, and the appropriate funding put in
place, to allow severe asthma specialists to provide the right
care and biologics to all who need them.
Before concluding, rather than concentrating only on severe
asthma, I will touch on some broader issues about asthma. These
are key points that need to be addressed. The SENTINEL study,
which we heard about from the hon. Member for Strangford, is
looking at the use of the blue short-acting beta agonist
inhalers, and proper management for people with asthma that
ensures they are properly reviewed. This is with the aim of
reducing the use of SABA inhalers, and of using other
anti-inflammatory inhalers properly to decrease the number of
exacerbations. That has the potential to bring improvements for
all asthma sufferers, not just those with severe asthma.
As we also heard from the hon. Member for Strangford, annual
reviews are really important for all those with asthma. It is
important that there are properly trained asthma nurses who can
conduct those reviews, and that they feature in the new community
diagnostic hubs that have been announced, so people can get
access to these reviews. Not everyone gets access to reviews—too
few people do at present.
We have talked about how the new asthma guidelines need to
include severe asthma. Having that unified guideline would be
very helpful. We need better access to biologic treatments for
those who would benefit from them. Finally, I want to mention the
impact of covid-19 and the recovery plan. I hope that the
Minister will say something about what is being done to support
people with asthma, and with severe asthma, and to make positive
improvements in the wake of covid-19.
10:19:00
(East Kilbride, Strathaven
and Lesmahagow) (SNP)
It is a pleasure to serve under your chairmanship, Mr McCabe, in
what is an extremely important and timely debate. I thank the
hon. Member for Strangford () for securing it, and I know that the issue is very
close to his heart. He exerts such energy, enthusiasm and
dedication through his work with the all-party parliamentary
group on respiratory health, and the issue also has a very
personal resonance for him, as we heard, given that his son has
been diagnosed with asthma. The hon. Gentleman has first-hand
experience of asthma’s impact on a young person and a family, of
the concerns that it brings to the whole family and of the need
for improved, ongoing care for everybody affected.
The hon. Gentleman set the scene extremely well, and in a
detailed manner. He raised with the Minister the issues that
clearly need to be addressed, and ensured that we are all aware
that we should be speaking more about asthma and its
implications, given its impact on so many people across the
United Kingdom. He gave some startling figures, including that
three people a day die as a result of this treatable disease. We
should be doing far more to ensure that those deaths do not
happen and that the interventions required are delivered in a
timely manner. Those who need additional support must get access
to the trained nurse clinicians and the annual reviews that they
so desperately need.
I also thank the hon. Member for Loughborough (). I do not believe I have had the
pleasure of speaking to her personally in this place yet, because
of our absence during the covid pandemic. I look forward to
speaking with her about her particular interest in health. I say
that as a clinician, as the chair of the all-party parliamentary
health group and as someone with an interest in taking these
issues forward. She raised such important matters, including the
move towards climate change-friendly, net-zero alternatives. She
said that the move must be staged so as not to be too quick for
the people who desperately need the medication to catch up, and
that it must be done in a very pragmatic way so that it does not
impact on those UK organisations that she spoke about, including
in her own constituency. Those organisations are working so hard
to ensure that science is at the forefront and that, while we
achieve net zero, we put patient health at the forefront of all
of the decisions that are made in this context. She spoke
extremely well on that matter.
The hon. Member for Blaydon () always speaks eloquently on
health-related matters, and I very much welcomed her
person-centred approach to the debate. She detailed the impact of
asthma on people’s lives, and contributed that first-hand
information to the debate. Asthma has a devastating impact on
individuals, and people must have access to the biologic
treatments that she described. Where there is innovation and
excellence in our NHS, it must be available to everybody who
needs treatment. That is why, importantly, she told the Minister
that individuals must have access to community hubs for
diagnosis, linked with early prevention and prescribing. There
should be no postcode lottery; no matter where people live in the
United Kingdom, they should have access to the treatment that
they so desperately need.
While I think about hon. Members’ contributions, I will also
briefly mention prescription charges, which the hon. Member for
Loughborough also discussed and are extremely important. The
Scottish Government abolished prescription charges in 2011, but
in England the current charge is £9.35 per item. Since 2011,
those suffering from asthma in Scotland have had access to free
inhalers, meaning that no person is ever left without an inhaler
because of cost. A recent survey conducted by Asthma UK found
that three quarters of people living with asthma in England had
struggled to pay for their prescriptions and that individuals had
often turned to skipping doses of their inhaler to cut
costs—again, the impact of poverty and deprivation causing
detriment to those who have asthma.
I thank the hon. Lady for letting me intervene. I understand her
point about Scotland, but there is available an annual
prescription charge, which is far less. However, my point was
really about the fact that asthma sufferers cannot help it,
essentially. Is there something we could do there?
Dr Cameron
Absolutely, and the hon. Lady makes an excellent point. While the
choice in Scotland has been to abolish prescription charges, I
note that she did not suggest that to the Minister. However, she
did suggest—perhaps because we know that asthma often starts in
childhood and is not something that people have much control
over—that an exemption could be applied. Following that
recommendation from the hon. Lady, I would be interested to hear
the Minister’s thoughts on the matter.
Cost itself should not mean that someone cannot access
healthcare, and in a developed country such as the United
Kingdom, there should be no prohibition owing to charges and
costs, particularly for something for which people often need
daily medication. We have heard from Asthma UK that that is
happening—people are skipping doses and many are struggling to
pay for their prescriptions in England.
In 2021, the Scottish Government published their respiratory care
plan, which is a care plan covering 2021 to 2026. It includes a
workstream specifically on asthma, and I am pleased that that is
being taken forward at that level. We know that asthma attacks
across the UK, including Scotland, have increased by a third over
the last decade, and the number of people affected in the UK is
among the highest in the world, with about 5.4 million receiving
treatment for asthma. That is equivalent to one adult in every
12, and one child in every 11, so we know that asthma is
widespread and that it needs to be a priority for Government
action.
Asthma affects people of all ages, as we have heard, and often
starts in childhood. I must declare that I have been diagnosed
with asthma and have had asthma since childhood. I say to the
Minister that there is absolutely nothing worse than the feeling
of struggling for breath. I have found wearing a mask difficult
at times, but I have continued to do so, and there are exemptions
for people with severe health conditions. However, asthma comes
upon people suddenly and can leave them with a feeling of such a
lack of control, so it is important to have specialist advice
from the nursing staff, which the hon. Member for Strangford
spoke of.
I do not believe that I received such advice when I was younger;
I think I was given an inhaler, told to go off home to practice
and learn to use it myself. I wonder whether the issue that the
hon. Gentleman raised—people overusing their inhaler
medication—is down to there not being enough early intervention
and education on how to use an inhaler properly.
I say to the Minister that although the recommendations have been
raised on the Floor of this debating Chamber, we need meaningful
data. We need to know about overuse, and the rationales and
reasons for that overuse. Do people need more education and
intervention from clinical nursing staff in the community hubs?
Does the cost mean that people in poverty struggle to access
treatment, and is that contributing to the death toll? That data
is crucial.
As has also been widely mentioned, Asthma UK has indicated that
NICE should develop comprehensive guidance on severe asthma. Can
we also make sure that the newer treatment options—the biologic
treatments—are widely available to everyone who needs them?
I thank everyone who has taken part in this debate, which has
been an extremely positive one. I particularly thank the hon.
Member for Strangford, because this issue is so important to so
many people in the United Kingdom, and I look forward to hearing
the Minister’s response.
10:30:00
(Enfield North) (Lab)
It is a pleasure to serve under your chairmanship, Mr McCabe.
I thank the hon. Member for Strangford () for securing this Backbench Business debate on
improving asthma outcomes and for setting out so comprehensively
the issues and challenges faced by the UK’s asthma sufferers. He
said there are not many families in the UK who are not affected
by asthma—his own son is an asthma sufferer—and I absolutely
agree with him. I have a cousin currently in hospital who is a
severe asthma sufferer; his covid was made worse by his severe
asthma. It is a condition that affects many of us.
The hon. Member also set out some sobering statistics about
asthma, which should shame us all. He made three asks and set out
the areas where he believes the Government need to do more, which
was echoed by many other speakers. They relate mainly to the
overuse of blue inhalers, the conflicting guidelines and the need
to improve them, and biologic therapy, which I will touch on.
We also heard from the hon. Member for Rutherglen and Hamilton
West (), who raised the issue of
air quality and air pollution. We know that air pollution
exacerbates asthma. Most Members will know the case of Ella
Kissi-Debrah, the nine-year-old asthma sufferer who died, and the
coroner said air pollution was a factor in her death. We know
that air pollution affects asthma sufferers really badly and more
needs to be done about it.
The hon. Member for Loughborough () set out very well the great work
being done by businesses and the university in her constituency,
and also raised the important issue of prescription charges and
the need to have a medical exemption from them. Others raised
that issue, too, and I absolutely agree.
Finally, my hon. Friend the Member for Blaydon () set out the facts and
statistics—the really terrible statistics—that the UK has on
asthma and the challenges around gaining access to biological
medicines. She also told the stories of some asthma
sufferers.
We have heard today that severe asthma is the most debilitating,
even life-threatening, condition that does not respond to
conventional treatment. As has been said, it is estimated that
about 200,000 people in the UK have severe asthma, and without
specialist treatment and support people with severe asthma end up
in a never-ending cycle of emergency trips to hospitals, relying
on toxic oral steroids that have nasty side effects; we heard
real-life stories about those from my hon. Friend the Member for
Blaydon. She also said that four out of five people with
suspected severe asthma who should be referred to a specialist do
not receive the care they need, and that 46,000 people are
missing out on life-changing biological treatment, an issue that
was raised by almost all hon. Members who spoke today.
Today’s debate is important because currently there is no cure
for asthma; it is only possible to manage the condition so that
symptoms are kept under control. We must ensure that asthma
treatments and outcomes are of the highest quality. The UK has
one of the worst mortality rates for asthma in Europe, with a
death rate almost 50% higher than the average death rate for the
EU. That should embarrass us all. Despite initiatives such as the
2014 national review of asthma, asthma deaths rose by more than
33% in England and Wales between 2008 and 2018. Some 5.4 million
people in the UK are receiving treatment for asthma, leading to
41,000 hospital admissions last year for asthma-related concerns,
and 1,300 deaths.
If those figures are not enough to show that we must improve
asthma outcomes, we should note that two thirds of asthma deaths
are preventable. Three people die from asthma attacks every day.
That number must be lowered.
The disruption caused by the pandemic has had a huge impact on
asthma care and outcomes. Basic asthma care is an annual review,
an inhaler technique check and a written asthma action plan.
Members have discussed how that care is not enough. Last year,
the number of people receiving even that basic level of care
dropped for the first time in eight years, with more than 3.5
million people missing out on potentially life-saving
treatment—that is 3.5 million people with asthma who were put at
risk. However, even before the pandemic, respiratory care was
lagging behind care for other conditions. Basic care levels for
asthma were stalling. Recent research by Asthma UK shows that 75%
of people with chronic obstructive pulmonary disease were also
missing out on fundamental care.
We must understand the challenges of asthma treatment in our
country and look at what we might do differently to save lives
and improve patient outcomes. There are several areas for the
Government to improve. Many excellent suggestions have been made
today. I want to focus on the restoration of the normal delivery
of care, prescription charges and air pollution. The Government’s
work should not be limited to these areas and I urge the Minister
to explore other avenues, such as early diagnosis and promoting
the take-up of covid booster vaccinations for asthma
patients.
In England, the NHS long-term plan included respiratory diseases
as a national clinical priority, with the objective of improving
outcomes for people with respiratory diseases including asthma. I
urge the Government to therefore commit to restoring the normal
delivery of care for people with respiratory diseases, so that
everyone with asthma receives at the very least the most basic
level of care and that 3.5 million people are not denied the
basic care they deserve.
Many Members have referred to the Asthma UK survey that found
that 76% of people with asthma struggle to afford their
prescriptions, 57% skip their medication because of the cost, and
82% say their symptoms worsen as a result. People on lower
incomes are already nearly twice as likely to have had an asthma
attack than those on higher incomes. The inability to afford
prescription charges is highly likely to be a contributing
factor. It is putting lives at risk. People should not be forced
to choose between paying for a prescription or risking their
lives.
Health inequality is one of the major drivers of poor health
outcomes that we see today, and asthma is no exception. We know
that asthma symptoms are exacerbated by breathing polluted air,
as well as from smoking. Air pollution can worsen existing health
inequalities and the people living in the poorest areas are often
the most exposed to polluted air, reinforcing unequal health
outcomes for deprived communities. We need to make sure that air
pollution is reduced across the country and must adopt into law
enforceable targets set out by the World Health Organisation to
bring air pollution down to below harmful levels.
In November 2020, the APPG on respiratory health produced its
report on improving asthma outcomes in the UK, which we have
heard about today, and I look forward to its forthcoming
one-year-on report. I urge the Minister to consider those reports
and reflect closely on the recommendations and issues raised by
the hon. Member for Strangford.
10:40:00
The Minister for Health ()
It is a pleasure to serve under your chairmanship once again, Mr
McCabe, after our many hours in Committee. I thank my hon. Friend
the Member for Strangford () and congratulate him on securing this debate and for
his work on the APPG. As ever, in speaking of his and his
family’s experiences, he was typically open for the benefit of
the House and those watching our proceedings, and I pay tribute
to him for that.
I also welcome the hon. Member for Enfield North () to her role on the
Opposition Front Bench. She has big shoes to fill, but on the
basis of today and what I know of her from her time in this
House, I have no doubt that she will do so with skill and
dedication and with her typical courtesy while holding us to
account as a Government. I wish her all the best in the role.
The Government are dedicated to improving asthma outcomes. In the
past 10 years, we have rolled out guidance and initiatives to
improve in this area. In 2011, the Department for Health, as it
then was, published an outcome strategy for COPD and asthma. It
set out a proactive approach to early identification, diagnosis,
intervention, proactive care and management. All stages of the
disease, as we have heard from hon. Members on both sides of the
House, can affect anyone. When it does, it has a huge impact on
their lives.
I pay tribute to the hon. Member for Blaydon () for bringing to life this issue
and what it means for individuals with the examples she used, and
for talking about her own experience, which is incredibly
powerful. I pay tribute with her, as ever, for being willing to
share that with this House.
A wrong diagnosis will result in patients not getting the care
they need. That is why in 2013 “A Guide to Performing Quality
Assured Diagnostic Spirometry” was produced by the NHS with
several charities and stakeholders. It was published to support
the accurate diagnosis of respiratory conditions to tackle the
effects of misdiagnosis.
In 2014, the national review of asthma deaths—the first UK-wide
investigation—was published. It aimed to identify avoidable
factors, and make recommendations to improve care and patient
self-management. NHS England and NHS Improvement commissioned the
national asthma audit programme in 2018. It provides data on a
range of indicators to show improvements and opportunities in
asthma outcomes. The audit’s data are used by providers to assess
their quality and support improvement.
More recently, as a number of hon. Members have alluded to, the
NHS long-term plan, published in 2019, includes respiratory
disease as a national clinical priority with the objective to
improve outcomes for people with respiratory diseases including
asthma. The respiratory interventions proposed in the NHS
long-term plan include early and accurate diagnosis of
respiratory conditions. Diagnosing conditions earlier may help to
prevent avoidable emergency admissions for asthma.
As part of the long-term planning commitment, pharmacists in
primary care networks will undertake a range of medicine reviews,
including teaching patients the correct use of inhalers and
contributing to multidisciplinary work. I can give my hon. Friend
the Member for Loughborough () and constituency neighbour the
reassurance she sought that we continue to work closely with the
NHS in the delivery of that long-term plan, specifically on these
objectives set out in it.
To deliver on that objective, NHS England has established 13
respiratory networks across the country. They will provide
clinical leadership for respiratory services and are focused on
improving clinical pathways for asthma. Since the long-term plan
was published, a number of initiatives and publications have been
announced.
Before making further progress, I will turn briefly to some of
the comments made by hon. Members—I suspect this is a timely way
of responding to them. My hon. Friend the Member for Loughborough
talked about Kindeva, based on the Charnwood campus in
Loughborough in her constituency. I know it well, as the
neighbouring Member, and know that it is something she and , the leader of Charnwood
Borough Council have championed as a huge asset to our national
economy and national effort in this space. She talked about the
pMDI market, F-gases and the transition. We commit to our net
zero ambitions, but she is right to highlight the need for the
transition to be done in a sensible and measured way, and we
continue to work closely with industry partners and
industry-representative bodies in order to manage that process. I
hope that gives her at least a degree of reassurance on this
important issue.
NHS England’s national patient safety team has prioritised its
work on asthma. This work is part of the adoption and spread
safety improvement programme, which aims to identify and support
effective and safe evidence-based interventions and practice
across England. The asthma ambition is to increase the proportion
of patients in acute hospitals receiving every element of the
British Thoracic Society’s asthma discharge care bundle to 80% by
March 2023.
The quality outcomes framework—QOF—ensures that all GP practices
establish and maintain a register of patients with an asthma
diagnosis. The QOF for 2021-22 includes improved respiratory
indicators. The content of the QOF asthma review was amended to
incorporate key elements of basic asthma care for better patient
outcomes, including an assessment of asthma control, a recording
of the number of exacerbations, an assessment of inhaler
technique, and a written, personalised asthma action plan.
Since April 2021, the academic health science networks and
patient safety collaboratives have been working with provider
organisations to increase take-up of the British Thoracic
Society’s asthma care bundle for patients admitted to hospital in
England. Centres’ compliance with the elements of good care
outlined in the bundle is measured in the national asthma
audit.
I thank the Minister for his responses. He mentioned the 2023
target, to which I referred. Is it possible to shorten that
timescale?
As ever, the hon. Gentleman tempts me to be more ambitious. We
have set 2023 as a realistic and achievable target. If it were
possible to achieve it sooner, that would of course be a
positive. Both in my Department and beyond, everyone will have
been encouraged by the hon. Gentleman’s ambition and
encouragement to go further and faster on that target, if they
can. He makes his point well. I will make a little progress and
then come back to several of the hon. Gentleman’s questions.
We recognise the particular effect of asthma on children and
young people, which is why NHSEI’s children and young people’s
transformation programme is promoting a systemic approach to
asthma management. The first phase of the national bundle of care
for children and young people with asthma has been developed with
clinical and patient experts. A complete version of the bundle of
care will be published in spring next year. The children and
young people asthma dashboard, developed alongside the bundle,
will be able to identify asthma care by race, geography, age and
social deprivation, which goes to a number of points highlighted
by the shadow Minister, among others. That will help ensure that
children and young people with asthma who face the starkest
health inequalities are prioritised.
The national care bundle has an environmental impact section that
sets out three key standards around air pollution, which is an
issue raised by Members on both sides of the House, including the
hon. Member for Rutherglen and Hamilton West (), who is no longer in her
place. We set out the Government’s clean air strategy in 2019,
recognising the impact of air pollution on health and a range of
other factors that affect people’s lives. In this space
specifically, we recognise three key standards. First, all
healthcare professionals working with children and young people
with expected or diagnosed asthma should understand the sources
and dangers of air pollution. Secondly, patients and their
parents or carers should always receive information on how they
can manage asthma with regards to air pollution. Thirdly,
integrated care systems should ensure that they are linked with
schools, where education around asthma should also be
provided.
The NICE guidance, entitled “Air pollution: outdoor air quality
and health”, provides advice for people with chronic respiratory
or cardiovascular conditions on the impacts of air pollution. It
is important that we recognise that there are ways that, in a
health context, we can care for people who face those impacts.
Going back to the 2019 clean air strategy, however, we as a
society have a much broader obligation to tackle the root causes
of those problems and to improve the quality of our air,
particularly in our cities but across our whole country.
Given the pivotal role of respiratory medicine in treating
patients with covid-19, some centres’ ability to commence
patients on biologics may have been impacted at the peak of the
surge. I think all Members will recognise that.
The pandemic obviously revolves around a respiratory illness.
Those who treat respiratory illnesses, including asthma, have
been on the frontline, along with all our health and care staff.
I join the shadow Minister and others in paying tribute to the
amazing work they have done. As we seek to recover elective
services and get more routine services back to normal, we are
ambitious but also recognise, in the face of uncertainties over
winter and the new variant, that respiratory services can be some
of the hardest to recover and bring back to normal operation,
because those are the services affected by the disease and the
nature of its transmission.
Will the Minister be a little more specific about the opportunity
for those with severe asthma to access biologic services? That is
a very specific ask. Without wanting to minimise the impact of
covid-19 and the size of the need for a recovery plan, that is a
specific issue for a group of people.
I always give way to the hon. Lady, occasionally with a little
trepidation, because I know she will ask a measured and difficult
question. That is a very important question. During the pandemic,
specialist respiratory services for severe asthma have continued
to run, but she asked a specific question about biologics, a
subject raised by several colleagues. Prescription and access to
biologics is co-ordinated through severe asthma centre
multidisciplinary teams. They should ensure all treatments,
conditions and options are considered when prescribing. I am
perhaps less clear about that than she might want, because I
would caveat that by saying it would be a clinical judgment.
We do recognise the value of biologics. That goes to what the
hon. Member for Strangford said: all treatments and options
should be considered by clinicians on an individual, case-by-case
basis, rather than what may have happened in the past, which was
a presumption in favour of inhalers as a way of managing the
condition rather than treating it or getting to the root causes.
Although not eliminating the condition, that could deliver the
improvements that make a difference based on an individual’s
condition.
As the Minister has said he is unable to be specific, will he
write to us with a little more information on that issue, and how
we could attempt to put it right? We have heard about the huge
impact for the better on people’s lives.
That is one of the easier things to do, given that this policy
area belongs to the Minister for Care and Mental Health, my hon.
Friend the Member for Chichester (), so I can commit to her
writing to the hon. Lady. I am happy to do that, though I suspect
that response will come back to the point about clinical judgment
and decision making. I will also commit my hon. Friend to writing
to the hon. Member for Strangford on the detailed and specific
point he made about the annual review.
The use of remote consultations and biologic medication that can
be taken at home mean we have been able to support most people
with severe asthma during the pandemic. At the start of the
pandemic, NICE published “COVID-19 rapid guideline: severe
asthma”, which provided guidance on starting or continuing
biological treatment. In writing that guidance, particular
attention was paid to streamlining the process of moving patients
on to biologic therapies, to compensate for any barriers that may
have occurred because of changes to the NHS in response to
covid-19.
The hon. Member for Strangford raised the subject of unified
guidelines. NICE’s updated guidance is produced jointly with the
British Thoracic Society and SIGN, so it will update all three
key areas. They are working with other UK expert bodies to
develop a joint guidance for the diagnosis, monitoring and
management of chronic asthma, which will update and replace
existing guidance.
Community diagnostic centres or CDCs—another theme raised by
several hon. Members—which diagnose a number of conditions, are
to be launched in place of asthma diagnostic hubs. Diagnostics
for respiratory conditions are part of the proposed core services
to be provided by CDCs. I hope that gives reassurance.
A review of diagnostics in the NHS long-term plan highlighted
that patients with respiratory symptoms would benefit from that
facility due to the number of diagnostic tests involved. At the
spending review, we announced an extra £5.9 billion of capital
support for elective recovery, diagnostics and technology over
the next three years, with £2.3 billion of that to increase the
volume of diagnostic activity and to roll out CDCs. The planned
increase will allow the NHS to carry out 4.5 million additional
scans by 2024-25, enhancing capacity, enabling earlier diagnosis
and benefiting asthma patients.
I am conscious that I need to leave the hon. Member for
Strangford at least three or four minutes for his winding-up
speech. One point that has come up among hon. Members this
morning has been about prescription charges: a challenging area.
Currently, we have no plans to review or extend the NHS
prescription charge medical exemption list to include asthma. I
heard the points made by hon. Members, but a number of conditions
are analogous to asthma, in terms not of their effects, but of
their chronic or lifelong impact.
Equally, a balance has to be struck with proportionate charges
and the contribution that makes to the NHS drugs budget to
facilitate the provision of new treatment. Approximately 89% of
prescriptions are dispensed free of charge already, and
arrangements are in place to help those most in need. My hon.
Friend the Member for Loughborough alluded to the fact that to
support those who do not qualify for an exemption, the cost of
prescriptions can be capped by purchasing a prescription
pre-payment certificate, and that can be paid for by instalments.
A holder of a 12-month certificate can get all the prescriptions
they need for just over £2 a week.
When we started the debate, I wondered whether we would use the
full hour and a half. It is testament to the hon. Member for
Strangford, and the contributions of all hon. Members, that we
have, and I should stop here to give him a few minutes to come
back. To conclude, it is right for him to bring this debate to
the House. I am grateful, as other hon. Members are, because
asthma affects many of our constituents, day in, day out, and
while we have made huge progress, it is right for him and other
hon. Members to continue to press for even more ambition and even
more progress. I pay tribute to him for that.
10:57:00
I thank all hon. Members for their immense contributions and
incredibly helpful comments. I think we all spoke with a united
voice, from all parties and all parts of the Chamber. I believe
we got an excellent response from the Minister and a
commitment—even though asthma is not in his direct portfolio.
My hon. Friend the Member for East Londonderry (Mr Campbell)
referred to volunteers and charity groups. The hon. Member for
Rutherglen and Hamilton West () referred to air
pollution, as others did. The hon. Member for Loughborough
()—also a Leicester City supporter,
though we lost on Saturday, but that is by the way—referred to
prescription charges. The firm that she mentioned contacted me as
well, and I am pleased that the Minister was able to respond to
her questions. The hon. Member for Blaydon () brings a vast amount of
knowledge of and interest in this subject. She referred to
quality of life, mental health issues and how biologic therapy is
needed.
The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr
Cameron), a friend and the SNP spokesperson, spoke about her
personal experience of asthma. It is also pleasing to have so
many Members present to support the shadow Minister taking her
place for the Labour party, the hon. Member for Enfield North
(). Certainly; she has had an
exceptional debut as the shadow Minister in Westminster Hall. I
was pleased with her contribution, which encompassed all our
thoughts and ideas, notably the effect of air pollution and how
treatment for severe asthmatics is not in place.
I thank the Minister so much for his response. He gave us the
details and told us about the 2023 target, but we will try to do
better. He referred, too, to consideration of the annual review
and to the unified or joint guidelines to be agreed. There is
much to be encouraged by in his response. With that in mind, I
thank all hon. Members for their contributions. Here is a battle
to be fought; we are about to fight it.
Question put and agreed to.
Resolved,
That this House has considered asthma outcomes.
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