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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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The Minister for Care and Mental Health (Gillian Keegan)
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.
Ruth Jones
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?
Gillian Keegan
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.
Derek Twigg
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.
Gillian Keegan
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.
Jim Shannon
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?
Gillian Keegan
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.
Liz Twist
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.
Gillian Keegan
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.