Chronic Obstructive Pulmonary Disease

Derek Twigg Excerpts

Wednesday 17th November 2021 Westminster Hall

[Derek Twigg (Halton) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Nokes, and I congratulate my neighbour, my hon. Friend the Member for Weaver Vale (Mike Amesbury), on securing this important debate.

I welcome the British Lung Foundation report, “Insights from those living with chronic obstructive pulmonary disease (COPD) around the UK”. I completely support its call for Governments and health services across the nations of the UK to rapidly commit to funding for national health services to get lung health strategies back on track, and to tackle the respiratory backlog. I note the finding that while respiratory conditions are supposedly a clinical priority, that does not seem to be the case in practice, and we need to see ambitious targets for improving COPD prevention, diagnosis and care.

It is truly frightening and disturbing to watch someone suffering with COPD, or chronic chest disease, fighting for their breath; especially when they are stuck on a trolly in a long queue outside A&E or left all day waiting for a hospital bed to become available. Watching them struggle for every breath with very low oxygen levels is distressing for both the individual and the families. My constituency has historically high rates of lung disease, including lung cancer, for a mix of reasons such as its industrial legacy and, of course, high rates of smoking and deprivation. As we have heard, COPD is the fifth most common cause of death in the UK, resulting in 30,000 deaths per year.

There are 3,878 patients on Halton GP registers for COPD—a prevalence of 2.9% of GP registered patients. That is higher than the England average of 1.9%, and slightly higher than the Cheshire and Merseyside average of 2.6%. There is variation between different GPs in Halton, with prevalence’s ranging from 1.3% to 4.1%. The Halton prevalence has not changed since the last publication in 2018-19. Over the past five years it has increased very slightly from 2.6% in 2015-16. The latest published data from 2017 to 2019 shows that Halton’s mortality rate for COPD was higher than England and the north-west’s. Halton’s rate was 70.5 per 100,000 of the population, whereas England’s was 50.4, and the north-west’s was 63.3.

Death rates from COPD are higher for males than females in Halton; this is also the case both nationally and regionally. As I referred to earlier, it has been estimated that there are many more patients nationally with COPD who have not been diagnosed; the most recent 2015 estimate suggested a COPD prevalence of 3.3% in Halton. This would mean that there are potentially around 550 people in Halton who are not diagnosed at this point in time.

I must refer to hospital admissions, because we know the pressures that our hospitals are under. Most people with COPD are managed in primary care, but for some the condition will deteriorate or be undiagnosed, which can result in emergency unplanned admissions to hospital. The latest published data for 2019-20 shows that Halton had a higher rate of emergency hospital admissions for COPD than England. Halton’s rate was 502 per 100,000 of the population, whereas England’s was 415 per 100,000 people. The female rate of emergency hospital admissions is also contributing to the overall high rate.

Several worrying findings came out of the British Lung Foundation report, and given the limited time I can only highlight just a few of those—some of them have previously been referred to by hon. Friends. As we have heard, thousands of people are missing out on diagnosis. The British Lung Foundation conducted a survey of over 8,000 people with COPD between December 2020 and May 2021. Even before the pandemic, it is clear from the responses that many people with COPD had experienced unacceptable delays before a diagnosis was made.

Recent Government figures found that diagnosis rates, which were already far too low, plummeted even further. In 2020 there was a 51% reduction in COPD diagnosis when compared with 2019, meaning that around 46,000 people in England alone missed out on a diagnosis. Again, the latest figures available in Halton suggest that 550 people have missed out on a diagnosis.

I know from the figures I obtained from the local health commission support unit that GP referrals to respiratory medicine in Halton are still not at pre-pandemic levels. As of November 2021, diagnostic tests for spirometry have not yet properly resumed. It is particularly worrying that the British Lung Foundation found that, across the UK, over three quarters of those with COPD did not receive what NICE clinical guidance defines as the five fundamentals of COPD care, but I will not go into them because my hon. Friend the Member for Weaver Vale referred to them earlier.

The British Lung Foundation believes that the national health service should amend guidance for GPs across the UK to ensure proactive case finding among high-risk groups to identify COPD and other lung conditions such as idiopathic pulmonary fibrosis and lung cancer in a timely way. Questions on respiratory health should be made a mandatory part of the NHS health check to help identify many undiagnosed cases of COPD. Smoking cessation schemes, which we have heard about today, must continue to be a priority, with more effort and drive put into them and, importantly, with better data on success rates.

I would like to make a specific plea for more resources to be put into community rapid response teams who, when they work well and get to patients and treat them at an early stage before they deteriorate, can and do in many cases prevent hospitalisation, easing the pressures on hospitals. They are a really important part of the health service and we need to concentrate more on them. Once people get to hospital, some of them people are very ill, so the more we can do to prevent it in the first place, the better.

The covid pandemic is, without doubt, a major contributing factor to the challenges facing primary and secondary care. The Government’s failure to properly address staffing shortages and better diagnostic facilities over the past 11 years, and prior to the start of the pandemic, is a significant reason why the current pressures on the NHS are so acute. A shortage of GPs is not helping quick diagnosis and rapid treatment. As I referred to during the Budget debates, the number of patients per GP practice is 22% higher than in 2015, but the GP workforce has not expanded with this rise in patient need. Nor has it helped that there are over 90,000 staff vacancies in the NHS.

The fact is that the Government have allowed this situation to occur since they first came into power in 2010. The Government need to get their act together and ensure that they have a workable, funded plan in place to transform the quality of life of people living with COPD, to prevent more people from developing it in future and to stop unnecessary suffering.

--- Later in debate ---

[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.