Respiratory Health
Adam Jogee Excerpts(2 days, 16 hours ago)
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Adam Jogee (Newcastle-under-Lyme) (Lab)
I start by joining the tributes to His Majesty the King on behalf of my constituents in Newcastle-under-Lyme as he marks his birthday today. It is excellent to see my hon. Friend the Minister in her position. I think it is the first time I have had a chance to speak when she has been on the Front Bench. It is very good to see her. I am also pleased to see that the shadow Minister’s brace has gone—evidence of the wonder of our national health service.
I am grateful for the opportunity to speak in this debate. I congratulate the hon. Member for Strangford (Jim Shannon) on leading it and on his opening remarks. He clearly enjoyed the lack of time limit, and probably the typo in the Order Paper that said that the debate would last for three hours. I thank him for his contribution. I should declare an interest: my wife is a deputy sister in an intensive care unit. I remain in full admiration of her and all her colleagues who work in our national health service on a daily basis.
My constituency is in the middle of our country, and air quality is one of the most important issues experienced by my constituents and one of the most frequently raised with me. It was with that in mind that I was delighted to host the Asthma and Lung UK reception in Parliament this Tuesday, where it launched its new report, “A Mission for Lung Health”. I encourage all colleagues present, all Members across the House and all those watching at home to read that report.
Air quality and respiratory health are some of the most important issues experienced by my constituents. The hon. Member for Strangford highlighted the fact that respiratory conditions are the third biggest killer in the United Kingdom, and one in five of us will be diagnosed with a lung condition in our lifetime. Colleagues will have heard me talk about the disgraceful Walleys Quarry landfill site in my constituency. For far too long, the operators have got away with doing whatever they want and leaving our town smothered by the most horrendous levels of hydrogen sulphide emitting from the site.
The levels of hydrogen sulphide have had an undeniable impact on the respiratory health of my constituents. I came down to London on Monday and will be heading back to my constituency shortly. I have had many reports from constituents back home that the levels have been horrendous this week. For us in Newcastle-under-Lyme, the fight for clean air is personal and it is constant. As I have the opportunity of the Floor, I make it clear again and reiterate to the Environment Agency, if it is listening: we need it to issue a closure notice with immediate effect to Walleys Quarry Ltd. We need to cap the site and restore it safely and swiftly.
Chris Bloore
Yes, the west midlands posse is here. I pay tribute to my hon. Friend for his work to draw attention to the disgraceful scenes at Walleys Quarry. We are having a conversation about the health of the nation, in particular air quality and the impact on respiratory health, and there is no doubt in my mind that the years of lack of action on that site have had an impact on people’s health. That cannot be allowed to continue.
Adam Jogee
We are on the way to getting my constituents the justice they deserve. I thank my hon. Friend for his support for our efforts, which have been led by many of my brilliant constituents, Dr Mick Salt, Lee Bernadette Walford, Simmo Burgess, Sheelagh Casey-Hulme and many others, who have been fighting hard. I could list many people. They did not all necessarily vote for me, but they have played an important role in helping to clean our air and save lives.
In recent weeks, there has been a pretty furious rush on behalf of the borough council and an increase in demands placed on the new Government. That is all well and good, but as far as I can see, little representation seems to have been made by the borough council to the previous Government, or indeed to Staffordshire county council. The only theme among all three of those institutions is that they are led by politicians of the same party. My message to my constituents is that change has come, and I am determined to ensure that that change delivers.
I hope that, after the profit-over-people approach of the operators at Walleys Quarry, we do not see that politics over people has prevented the site being closed and the respiratory health of my constituents being protected and enhanced. I will be grateful for an update from the Minister on what cross-departmental work has taken place in Government on such issues.
Access to diagnostic testing for respiratory conditions is in dire need of reform, and the example and experiences of my constituents prove that well. Access to spirometry testing for lung conditions, in particular since the covid-19 pandemic, has been a slow and painful process for too many people across the country. It is estimated that in our United Kingdom, more than 600,000 people live with undiagnosed COPD; the hon. Member for Strangford touched on that.
Even when restrictive respiratory conditions are suspected or diagnosed, people are waiting far too long for care. The latest NHS data shows that in August almost 5,000 people in Staffordshire—4,963, to be exact—were waiting beyond the national target of 18 weeks to be seen by a respiratory doctor. That is a little more than 50% of all patients referred for treatment. Although that is higher than the national average, it is sadly not an uncommon figure. It needs to change.
When patients are diagnosed with a respiratory condition, the quality of care they receive often does not meet the standards set by NICE. Asthma and Lung UK, to which I pay tribute for all its work, has found that 70% of those living with asthma are not receiving all three aspects of basic care, and that the care received by more than 90% of those with COPD does not meet the five fundamentals required by NICE.
People living with undiagnosed and poorly managed lung conditions are more susceptible to environmental factors such as air pollution, wintry weather and poor-quality housing, all of which, sadly, are applicable to the communities and people who live in the areas surrounding Walleys Quarry in Newcastle-under-Lyme. I would be grateful if the Minister took some time today—I am happy to talk at another time, too—to discuss strengthening the powers and scope of the UK Health Security Agency, because although it has an important role to play, most of that role is currently advisory.
As colleagues have highlighted—the hon. Member for Strangford certainly did—lung conditions are more strongly associated with deprivation than any other major health condition. Sadly, the result of these combined factors is clear and, as the hon. Member noted, respiratory conditions are the largest driver of A&E admissions each winter. Thousands of people living with undiagnosed and poorly managed respiratory conditions end up in A&E, adding even more strain to a national health service that is already under strain.
Last year, across the Staffordshire and Stoke-on-Trent integrated care board, 3,765 people were admitted to hospital in an emergency due to a lung condition. Yesterday, my right hon. Friend the Secretary of State for Health and Social Care reiterated this new Labour Government’s ambition to reform our national health service, but it is clear that that will not be achieved without prioritising respiratory health and care. That is entirely in line with the shifting focuses: from treatment to prevention, which has my full support; and from hospital to community care, where most respiratory care happens anyway. The Department should introduce a recovery fund of over £40 million over two years to increase the availability of testing. I know that is a big ask and I understand the financial pressures, but it would result in savings of £80 million for the national health service in reduced exacerbations, as well as a reduction of 85,474 hospital bed days.
Lastly, I want to touch on the link between waste crime and respiratory health. This morning, I received an email from Councillor Robert Bettley-Smith, the chair of Betley parish council in Newcastle-under-Lyme. Although he is in a different party from mine, I appreciate the spirit in which he works with me as we seek to serve the people who elected us. Councillor Bettley-Smith noted the continuing activity on the land at Doddlespool Hall farm in my constituency. I will not go into all the detail, but the link between waste crime and the disposal of waste generally has a huge impact on respiratory health. Councillor Bettley-Smith noted that, apart from the waste issue, there appears to be evidence, based on smoke and smell, that tyres or similar materials are being burned, and have been burned in the last week or so. The failures to regulate the waste sector under the previous Government must be put right by this new one, and I look forward to working with Ministers across Government to do exactly that.
There is a financial issue here, an environmental one and of course a health one too. I urge the excellent Minister to ensure that respiratory health is prioritised in the forthcoming 10-year plan for our beloved national health service and, importantly, in the upcoming review of the long-term workforce plan. I am grateful to the hon. Member for Strangford for introducing this debate, and I look forward to working with him, with the Minister and with colleagues across the House on these issues in the months and years ahead.
Dr Danny Chambers (Winchester) (LD)
I pay tribute to the hon. Member for Strangford (Jim Shannon) for all his work on the APPG for respiratory health. As has been said, it is a hugely important issue, given the sheer number of people affected and killed every year and the huge amount of resources taken from the NHS.
It was good to hear everyone talk about a holistic approach, because this issue is not purely about NHS services. Most people have discussed the importance of air quality and pollution, and the hon. Member for Blaydon and Consett (Liz Twist) acknowledged that people living in poverty are more likely to suffer. I think they are five times more likely to die from COPD and about three times more likely to die from asthma. There are a whole variety of reasons for that, one being air pollution. In the village of Twyford near Winchester, one of our fantastic Lib Dem councillors has been campaigning for years to improve air quality and reduce pollution due to traffic. She is a former doctor, and one of her main motivations is to try to improve outcomes for asthma and children’s respiratory health.
The Minister and I were in this Chamber about a week ago to discuss housing. It was acknowledged that the UK has the oldest housing stock in Europe, with a lot of it have been built before world war two. Again, the link between people living in poverty and living in substandard housing is very strong. I am probably not the only Member who receives correspondence from individuals in private housing association accommodation who struggle to get a response from organisations when they encounter problems such as mould.
Living in substandard housing is bad not only for physical health, but for the environment and carbon dioxide emissions. Last week, we discussed a huge programme to try to improve the housing of people living in poverty, because it is good for the environment and for people’s health. We should remember that the NHS spends about £1.5 billion a year dealing directly with issues, such as damp and cold, that have arisen from people living in poor and substandard housing, so the comorbidities are huge.
I am mindful talking about the clinical treatment of respiratory diseases when the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), is actually a doctor and I am a rudimentary veterinary surgeon, but respiratory disease is a common disease that we treat in horses. By improving the surroundings they are in—by getting rid of dust and improving ventilation—we can get the huge majority of them off medication entirely. It is the same with groups of cattle, which are housed over the winter. Respiratory diseases have a huge impact on farmers’ productivity, but through a combination of improving accommodation, improving ventilation and vaccination, we can get fewer illnesses and better productivity. That would be more cost-effective for the farmer and we would use fewer antibiotics.
It is exactly the same with public health. Treating people who have got sick because they live in substandard conditions is an endless task, but getting to the root cause of the problem will have huge knock-on effects throughout society.
Vaccines in human and veterinary medicine are always the most cost-effective health intervention. They are better for patients and the taxpayer and, importantly, they help us to avoid using antibiotics unnecessarily. The World Health Organisation has noted that antimicrobial resistance is one of the biggest health challenges facing the world right now. Interestingly, vaccine hesitancy is another, so we should monitor levels of vaccination uptake, because the tripledemic, as people call it, of flu, covid and respiratory syncytial virus affects people all year round, but especially in the winter.
Slightly concerningly, it seems that 280,000 fewer NHS staff have been vaccinated this year compared with 2019, even though there are now slightly more frontline staff. Will the Minister explore why that is the case? Is it due to concerns about the vaccination or a lack of access to it? For example, I want to get vaccinated, but I just have not had the time yet this year, and that could be the problem for many people.
Vaccinating pregnant women against RSV is a hugely important intervention that helps to prevent babies under six months old from getting really sick. Most people just get a cold from RSV, but tens of thousands of babies every year are admitted to hospital with it, and it can be hugely damaging in the long run.
I have touched on holistic approaches to respiratory disease, but it is worth looking at other health conditions. The hon. Member for Strangford mentioned the work on smoking cessation, which is hugely important, but it is also worth noting the work on obesity. If a person is obese, any underlying respiratory issues are much more difficult to manage and treat, and the symptoms can often be exacerbated. We need to focus on public health interventions such as improving the quality of our food, including free school meals. I hope that, given the financial constraints the NHS is currently working under, we do not view public health as a cost to be cut, because in the long run we desperately need to invest in it to stop people getting sick and ending up in hospital.
We will not prevent every disease, no matter how hard we try. People will still get sick for a whole variety of reasons, including with COPD, asthma and lung cancer, and they will need long-term management. In our manifesto, we called for people with long-term conditions to be able to see a named GP so that they get continuity of care from someone who is very familiar with their case. Seeing someone different every time causes patients a lot of stress and sometimes results in miscommunication.
We discussed air pollution earlier. During the general election, we called for a new clean air Act, based on World Health Organisation recommendations and ideally enforced by a clean air agency. Will the Minister look seriously at that proposal, and consider other suggestions about working hard on local pollution levels, working to improve vaccination rates and housing standards, and working to ensure that anyone diagnosed with any type of cancer, but particularly lung cancer, sees a consultant within 62 days of being referred?
Adam Jogee
I omitted to put on the record earlier what a pleasure it is to serve under your chairmanship, Mr Rosindell.
Before my election to this House, I spent five years working with my hon. Friend the Member for Newport West and Islwyn (Ruth Jones), who shadowed the Minister responsible for air quality, so I spent a lot of time working on these issues, particularly in respect of the World Health Organisation guidelines. Will the hon. Gentleman find the time for a cup of tea with me, so that we can see what we can do together to make the progress we all want to see?
Dr Chambers
Yes, I will. I live off tea—it is the only way I get through the day—and I have a particular interest in air quality, so it could be a really enjoyable meeting. As this debate is not going on for as long as the hon. Member for Strangford would like, he could come and speak with us as well.
As I was saying, a clean air Act and a named doctor are among our proposals. We are heading into winter, which NHS staff must dread: it is always busier than other periods, and a whole load of respiratory issues add to the winter pressures on the NHS. I thank and pay tribute to all the NHS workers who are heading into this very difficult time. We must do whatever we can to support them, whether that is helping them to get their vaccinations or helping them in any other way.
Dr Luke Evans (Hinckley and Bosworth) (Con)
It is a pleasure to serve under your chairmanship, Mr Rosindell. This is my first day in my new role; it seems appropriate to take over this brief and speak in a debate on respiratory illness, because dealing with respiratory illness was my first ward job as a junior doctor. I worked for four months in accident and emergency department in the west midlands, and then my first ward job was dealing with respiratory conditions in Solihull hospital, so I have seen up front just how important respiratory medicine is.
I put on the record my thanks to the hon. Member for Strangford (Jim Shannon) for securing this debate. He may often get called last in the main Chamber, but he clearly has a trick for successfully securing debates. I look forward to perhaps having a cup of tea with him to learn how he is so successful.
It is both a blessing and a curse to hear the hon. Member for Newcastle-under-Lyme (Adam Jogee) make the same argument that his predecessor made about the quality of air in his constituency. I gather that it is a tip that causes a huge amount of problems there, and I hope he has success in getting the issue sorted. I also hope he takes some comfort from the fact that the previous Government passed the Environment Act 2021 to put in place legal limits to try to improve air quality and, of course, offered air-quality grants.
There is clearly an interest in respiratory conditions in both the east and west midlands, given the contribution from the hon. Member for Redditch (Chris Bloore), who is no longer in his place. Having worked over in the west midlands, I have now transferred to the clearly better east midlands.
Adam Jogee
I gently push back on the narrative that the previous Government made the sort of progress in tackling the issues at Walleys Quarry that the shadow Minister just implied. My constituents continue, on a daily basis, to deal with the worst effects of the hydrogen sulphide levels that the site emits. Hydrogen sulphide is a heavy gas and there are schools around the area. The impact on our children and the respiratory health of young lungs is massively underrated and fails to be part of the conversation. I invite the shadow Minister to come to Walleys Quarry and to Newcastle-under-Lyme to smell the situation for himself.
Adam Jogee
There has been a lot of sobriety in this debate so, rather than having a cup of tea, I will take the shadow Minister to the Waggon and Horses pub in Newcastle-under-Lyme for a slightly colder refreshment.
Dr Evans
I am very grateful to the hon. Gentleman for that offer.
I congratulate the hon. Member for Blaydon and Consett (Liz Twist) on her work in the APPG. She was of course right to highlight smoking as a big problem, and health inequalities are also important. We also know that people experiencing health inequalities generally struggle to access healthcare, let alone healthcare for respiratory conditions—we have not even discussed the equipment and expertise needed to deal with such conditions.
The hon. Member for Sherwood Forest (Michelle Welsh) spoke about pulmonary fibrosis, a really important condition that is not given the precedence it deserves given how debilitating it is for patients who suffer with it. I pay special tribute to her for raising that issue so powerfully and so emotionally. She is a true champion for doing something about a condition that is not thought about nearly enough.
The hon. Member for Winchester (Dr Chambers) is absolutely right about holistic approaches. They are outside the remit of this debate, but housing, environment and smoking are of course all big factors. We have not even talked about comorbidities yet. We know that people over the age of 60 are usually on several medications and may have heart problems or musculoskeletal problems as well. That will have a really big impact.
With regard to the hon. Member being a vet, I think I am right in thinking that he is still allowed to practise on humans, while I certainly am not allowed to practise on pets. That is not something for a debate today, but I think it is noteworthy; if there is a problem you should rush to him too, Mr Rosindell. What he said about antimicrobial resistance is really interwoven into everything, because there is a danger of over-prescriptions for chest infections that turn out to be viruses. That is a really problematic issue that is growing, and it is the next probable pandemic, with no easy solution. He is right to highlight that.
I thank the members of the APPG for all the work they do, led by the hon. Member for Strangford. It is really important to be able to get a debate and raise these issues, and to have the infrastructure behind the members to support the team in dealing with and producing updates.
I myself have a personal history with respiratory medicine, having ended up on the intensive care unit with bilateral pneumonia after an appendicectomy in my late 20s. It has left me, at previous times, at a brittle asthma clinic. There were many attempts to diagnose what was going on, but nothing was ever found. I had to be treated with repeated steroids and felt, full on, what it is like to suddenly not be able to breathe, not be able to exercise and have that ability taken away.
When they are listening to this debate, the key thing for the public to realise is just how important our breathing really is. A breathing condition is so seminal to everything we do. There is a reason why in an emergency it is ABCDE, or airway, breathing, circulation, disability, exposure: because breathing is quite literally life. Many people have experienced having that taken away a little bit by getting covid; that has at least made people aware of just how bad viral illnesses can be.
Turning to some of the other conditions that we have not talked about—I feel like I am back in one of my medical exams in the fifth year—we have heard about asthma and COPD, but we have not talked about pulmonary embolisms, pneumoconiosis or TB. We did hear about cystic fibrosis, but we have not heard about mesothelioma or sarcoidosis. Pneumonia is a really important one to talk about too, as is lung cancer, and there are probably some that I have missed.
Respiratory conditions are really important: they make up the third place for all deaths, so they need that attention. I was therefore pleased to see the last Government come forward with the community diagnostic centres—170 community diagnostic centres going up across the country to get better access to MRI scans, CT scans or blood tests. Those will be really important, and I was lucky to have a £24 million investment for a CDC in Hinckley, which will have MRI and CT scanners, and is being built as we speak. That will be transformative for my community when they are caught between two big centres towards Nuneaton and Leicester. I hope those measures will mean that respiratory conditions play an important part in the hospital rebuild programme and the current review, and that we will ensure we have the apparatus and equipment to support them.
Turning to the nitty-gritty of the debate, I entirely agree with the idea of prevention. The Conservatives brought forward measures to deal with smoking. I hope that as the Government step forward with further ideas of how to tackle smoking and push for a smoke-free generation, we will be looking at that very closely.
The hon. Member for Strangford really hit on a point about data. Health policy must be driven by decent data, and the APPG’s work highlights how respiratory conditions tend to fall behind in that. I have questions for the Minister about what work is being done now only on the simple matter of how we record things, but on how we can join up that dataset. For example, in my constituency we have two boundaries; we are caught between North Warwickshire and Leicestershire when getting answers to tests. An asthmatic does not have an asthma attack directly where they live—they could be on holiday. Sharing information on what has happened with treatment and investigations is really important.
That leads me on to spirometry. Spirometry is key, but where it is and how it is achieved is too sporadic, as is the skillset to deliver it. Then, of course, we have FENO—fractional exhaled nitric oxide—which can help to aid the diagnosis of asthma. That will be key, and the Opposition look forward to seeing what the new BTS guidelines, worked up with NICE, show on dealing with asthma.
I have a couple more questions for the Minister. I appreciate that this is not her brief, so I should be grateful if she passed on any questions she cannot answer for a written response. We have heard that the likes of the RSV vaccine are really important; new vaccines are coming out to tackle this huge problem for the elderly and the young. The vaccine was introduced for those aged between 75 and 80, but it would be interesting to see whether there is scope to grow that and see who else is responsive. I gather from work done by my Opposition colleagues that there is still some debate to be had and evidence to be gathered on what that would look like. I would appreciate it if the Minister took that point away. What steps are the Government taking to increase the uptake of flu and pneumonia vaccinations? Prevention is better than cure.
Finally, it was mentioned that the last Government looked at chronic health strategies. It appears that the new Government have decided to take a different tack with chronic conditions. I appreciate that that is their prerogative, but there is a danger that we could have a lag. The data that has been gathered, the research that has been looked at and the policies that have been structured for the past five years or so could fall by the wayside, even though we have heard how much of an emergency it is to deal with respiratory conditions. Could the Minister clarify whether interested parties will need to resubmit the work they have done, or whether the work will be a continuation within the new structure that the Government are planning? Is there any timescale on what that would look like?
Clearly the Conservative Government were unable to get the long-term health strategies in place in time before the election. Time is ticking on, and we have a winter coming up. It is really important for organisations to understand where they stand. Christmas is coming up, and I well know from my time as a GP—I should declare an interest, as my wife is a GP as well—that Christmas is the busiest time, and respiratory conditions are one of the top reasons for that. If anyone out there is listening, getting vaccinated is imperative. I advise everyone to do so.
We know that the staff of these organisations will go above and beyond when they see someone struggling for breath. They will take their time to get the right history and get medication and treatment in place. We give them our greatest thanks, from the Opposition side of the House, for all the work they have done and will do in the busy Christmas period. I am sure that that sentiment is shared by the Government.
Jim Shannon
I thank everyone for their incredibly helpful contributions. It is no secret that I always look for a consensual debate, because that is more positive. That is what we have had today.
We have had the opportunity to discuss many issues. With your indulgence, Mr Rosindell, I will speak to each. Since coming to this House, the hon. Member for Newcastle-upon-Lyme—
Adam Jogee
On a point of order, Mr Rosindell. My constituency is Newcastle-under-Lyme, not Newcastle-upon-Lyme as several colleagues have called it.
Oral Answers to Questions
Adam Jogee Excerpts(3 months, 3 weeks ago)
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Karin Smyth
My hon. Friend is first out of the blocks on this issue, and has shown his commitment to improving primary care for his constituents. I am sure the local ICB has listened very carefully to his question, because we know that the existing primary care estate is under a great deal of pressure. That is why building a neighbourhood health service remains at the forefront of our mission to rebuild the NHS, and I would be pleased to meet him to discuss that topic.
Adam Jogee (Newcastle-under-Lyme) (Lab)
The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)
I warmly welcome my hon. Friend, the new Member for Newcastle-under-Lyme, and thank him for raising this important issue. The UK Health Security Agency works with the regulator, the Environment Agency, to advise on health risks from landfill sites. In relation to the site in his constituency, the UKHSA undertakes monthly risk assessments using air quality data. A multi-agency group, including Government agencies and local authorities, meets regularly to review the situation and any interventions needed. I will, of course, raise his concerns with my counterparts in the Department for Environment, Food and Rural Affairs.
Adam Jogee
I thank the Minister for his answer, and welcome him to his place. Walleys Quarry landfill in Newcastle-under-Lyme is an environmental crisis and a health one too, and my constituents Sheelagh Casey-Hulme, Jan Middleton, Lee Walford and many others are rightly scared and angry about the impact of toxic levels of hydrogen sulphide on the health and wellbeing of local people. Will the Minister come to Newcastle-under-Lyme to listen, to learn and to smell, and to help us finally stop the stink?
Andrew Gwynne
Public health and prevention are priorities for me and this Labour Government. Obviously, the Environment Agency takes the lead in this specific instance, but I am more than happy to jump off the train at Stoke—if my hon. Friend will pick me up—and visit his constituents to listen to their concerns, and to ensure that the public health considerations are amplified to Environment Agency colleagues.