NHS: Respiratory Syncytial Virus Infections

Baroness Brinton Excerpts

Thursday 9th June 2022 Grand Committee

[Baroness Brinton (LD) [V]]

My Lords, I congratulate the noble Baroness, Lady Ritchie, on securing this important, and for me very personal, debate. As she outlined, RSV is a common respiratory virus that affects large numbers, mainly of children younger than five, but also some elderly and immunocompromised people. The burden of RSV includes not only ill health for children but the emotional and practical burdens of the affected families and carers and the impact that that has on productivity in the economy, alongside the costs of providing healthcare.

I found the key findings from a very interesting report by RAND published earlier this year, which did a desktop review of recent literature and published data on RSV in the UK. It approximated the annual healthcare costs of having RSV at £80 million. That equates to a mean cost of £97 to the NHS per child under five with RSV. Just over £40 million of that is due to productivity loses, £1.5 million is due

“to out-of-pocket costs incurred by parents/carers, and the remaining nearly £65 million to healthcare costs.”

Estimates suggest that each year 33 children under five die from RSV. While most cases of RSV have very short-term impacts, some children may face long-term respiratory issues later in their life.

Children born prematurely account for nearly 20% of the total cost burden of RSV in the under-fives. My twin granddaughters were born very early. The smaller of the two, Amelia, was 700 grams when she was born and at that point 30% of her lung tissue was dead. She was very unwell for the first few weeks of her life; we were lucky that she survived. Once she was home, within two or three days she picked up an infection, which transpired later to be bronchiolitis. It presented with all the traditional things you hear from Public Health England. Two parents were at home with premature twins and one was suddenly finding breathing very difficult. All the signs you are told to look for were already evident in her and 999 was used.

The Evelina Hospital was absolutely brilliant. My granddaughter remained in and out of hospital for the next year of her life; she was about three months old when this happened. The intensity to which the disease took over was extraordinary, on top of her underlying prematurity problems. She was in PICU—the premature intensive care unit—for some time and then did a step down to the next tier of ward. She then spent months on the lovely Snow Leopard ward—in the old days we would have called it a community hospital, but it is inside the Evelina—where the focus is very much on helping the families to understand the consequences of their child’s problems.

That was where I learned as a grandmother how to put on her ventilator every night, which she needed until she was three. I learned how to put on her heart monitor, because she also had heart problems, and to spot the signs of any infection, including future infections of influenza or anything else. Her skin was very pale and blue a lot of the time. I do not believe she was immunised with the monoclonal antibody, but she certainly had a substantial amount of medication as well. The most useful thing my son and daughter-in-law saw was how it was managed and how they could manage it and help her and themselves in the future.

Now, this bouncy six-year-old girl still has lung damage; you cannot revive dead lung tissue. She still cannot run around the way her twin sister does, but without the care of that extended paediatric team she probably would not be with us today. She is a shark expert, a budding oceanographer and absolutely determined to live her life to the full. The cost of her bronchiolitis was certainly in the upper economic numbers provided by the RAND desktop survey. But the benefit to the family is absolutely inestimable—in the support of the hospital and a large range of healthcare professionals who made it possible for her to go home. There were considerable difficulties, but she did.

She has a baby brother, born a year before Covid. His experience of RSV earlier this year, aged two, was very different. He has absolutely no problems. His experience was a very heavy cold with some croup and minor bronchiolitis. He saw the GP, but no more. His parents were very relaxed, while all their friends whose children were having RSV like that were getting very worried—but that is life when you have had a child who has had quite a severe illness.

RSV is with us and will be with us. As the noble Baroness, Lady Ritchie, said, as Covid starts to lift, we must expect to see more of it as small children mix with each other, as it is extremely infectious. She is right to be concerned about the overprescription of antibiotics. For some it is necessary but it needs to be checked. What is really clear from Public Health England’s guidance is that families can help themselves; they can recognise the symptoms of RSV and do what I did as a mother with my eldest child, who had quite severe croup, which is to make sure that there is lots of humidity in the atmosphere—with the kettle boiling away to make sure that there is steam in the room to help the bronchioles open and ensure that your child is protected.

However, it is not just about parents. Unfortunately, far too many GPs, community nurses and childcare staff do not recognise RSV either. I hope that one of the things we can ask of the Minister is to hear that that will change, and that this illness will be part and parcel of normal paediatric training. For some children, RSV is extremely serious, and the cost to the NHS and the families of those children—let alone to their long-term future—can be severe.