Chronic Obstructive Pulmonary Disease

Caroline Nokes Excerpts

Wednesday 17th November 2021 Westminster Hall

[Caroline Nokes (in the Chair)]

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

[Mike Amesbury (Weaver Vale) (Lab)]

I beg to move,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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