Respiratory Health

George Freeman Excerpts

Tuesday 3rd February 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is a pleasure to serve under your chairmanship, Ms Dorries.

Let me start by thanking and congratulating my hon. Friend the Member for Stevenage (Stephen McPartland) for securing the debate and highlighting this incredibly important issue. His leadership of the all-party group is to be commended, as is the report it produced under his chairmanship last year. I also acknowledge his successful advocacy of his town of Stevenage as a life science cluster and hub—I can testify to that as the Minister responsible for life sciences.

The all-party group report identified a number of key areas for action, which colleagues have eloquently highlighted this afternoon. They include implementing the outcomes strategy for COPD and asthma; investing in medical research; improving awareness and diagnosis; better case finding; and ensuring that the NHS work force, from top to bottom, have the right skills to treat people with respiratory disease. If time allows, I will attempt to give detailed answers to my hon. Friend’s specific questions. If I am defeated by the clock, perhaps I could write to him. I very much look forward to meeting him in due course to pursue these issues.

Before I turn to those questions, perhaps I could say a few words about the scale of the challenge we face and what the Government are doing to confront it. The seriousness of the challenge posed by respiratory illnesses must not be underestimated, and it will not be shocking news if I say that it is accepted that they have been treated as something of a poor relation in many ways. They affect one in five people in the UK, they are responsible for about 1 million hospital admissions a year and they are the third biggest cause of death in the UK.

As the report from the all-party group’s inquiry into respiratory deaths said, UK death rates from respiratory disease compare poorly with those in other developed countries. In 2010, the UK had a higher rate of respiratory deaths than any other country in the OECD. The Government acknowledge that that situation is simply not acceptable, and we are working hard to improve it. Let me say something about how we are doing that.

The NHS outcomes framework for 2015-16 sets out the Department’s priority areas for the NHS and includes reducing deaths from respiratory disease as a key indicator. It also highlights the need to reduce unplanned hospital admissions due to asthma. In addition, the Government’s mandate to NHS England sets out the requirement for it to improve outcomes in a range of areas. That includes preventing premature deaths from the biggest killers, including respiratory disease, and supporting people with long-term physical and mental health conditions.

We published our “Living Well for Longer” document in April last year. It sets out the health and care system’s ambition to reduce avoidable deaths from the five major causes of death, which include respiratory disease. We set the ambitious target of making England among the best in Europe, to which end there is a lot to be done.

The Department has supported a number of initiatives to help to improve outcomes for people with respiratory disease. In July 2011, we published an outcomes strategy for people with COPD and asthma in England, setting out six high-level objectives to improve outcomes in those areas through high-quality prevention, detection, treatment and care services. The Department also supported the publication of a good practice guide on services for adults with asthma in 2012.

In addition, NICE, for which I have ministerial responsibility, has published quality standards for COPD and asthma, setting out the markers of high-quality, cost-effective care. Their implementation will raise the standard of care that people with such conditions receive.

In the Department of Health, I have responsibility for research. I am proud to say that the National Institute for Health Research has increased funding on these issues by 50% in the last five years, from £16 million in 2009-10 to £24 million in 2013-14. I accept that there is more to be done, but that is a significant start. The NIHR is investing nearly £22 million over five years in three respiratory biomedical research units. The NIHR clinical research network is setting up, and recruiting patients to, nearly 200 trials and studies in respiratory disease. That is some indication of the work that the NIHR and the Government are doing to prioritise this issue.

The Department has collaborated with the national review of asthma deaths, which examined the circumstances surrounding deaths from asthma from 1 February 2012 to 30 January 2013 and reported on its findings in May last year. The lessons learned about the factors that contribute to asthma deaths will inform the NHS about what constitutes good care and encourage the development of appropriate services for people with asthma. NHS England is supporting clinical commissioning groups to improve out-of-hospital treatment for those with asthma by giving doctors more control over the commissioning of asthma services and improving information links between GPs and hospitals.

I am delighted that last week NICE published draft guidelines on the diagnosis and monitoring of asthma. They are out for consultation, and no doubt the all-party group will have comments to make. Roughly 1.2 million adults in the UK may be wrongly receiving treatment for asthma. The guidelines set out the most effective way to diagnose asthma, and how health care professionals can help adults, children and young people control their symptoms better. The draft guidelines stress that to achieve an accurate diagnosis, clinical tests should be used as well as checking for signs and symptoms.

My hon. Friend the Member for Stevenage described how for too long innovation has been lacking in the diagnosis and treatment of the diseases in question. I am delighted about innovations that are coming. The guidelines recommend that health care professionals should ask employed people how their symptoms are affected by work, to check whether they may have occupational asthma. Other guidance is currently in the pipeline, including clinical guidelines on the management of asthma, consultation on which will start in April, and guidance on the diagnosis and management of bronchiolitis in children, which is due to be published in May.

Importantly, NHS Improving Quality, in collaboration with PRIMIS, has developed the GRASP suite of primary care audit tools to help GPs improve the detection and management of COPD, in addition to two other long-term conditions, atrial fibrillation and heart failure. All the GRASP audits, including GRASP-COPD, are funded by NHS IQ, and they run on all clinical systems and are free to use for GP practices in England. Like the other toolkits in the GRASP suite, GRASP-COPD contains a case finder, which helps GPs to identify the number of patients who are at risk of COPD or who have items on their electronic record that suggest possible COPD. It also contains a management tool that compares current management of diagnosed COPD patients with NICE guidelines.

The shadow Minister mentioned smoking, which is an important issue. It is welcome news that the number of smokers is down to its lowest ever level, which means fewer deaths and fewer people living with the disabling consequences of smoking, such as COPD. However, about 8 million people in England still smoke, and it is right that we maintain a commitment to effective tobacco control. Ministers are clear about wanting both to reduce the number of young people who take up smoking and to help those who smoke to quit. That requires action on a range of fronts, nationally and locally, as with so much in the public health arena.

There is no simple, single solution. However, we are taking action. We introduced a package of measures in the Children and Families Act 2014 aimed at protecting young people from tobacco and nicotine addiction and the serious health harms of smoking tobacco. We have also laid regulations to end smoking in private vehicles carrying children, a measure that I am particularly proud of. Subject to parliamentary approval, those regulations will come into force in October. We are changing the law to ban the sale of e-cigarettes to under-18s and have consulted on draft regulations. We will implement the prohibition of proxy purchasing of tobacco by adults on behalf of under-18s, and we will bring forward legislation for the standardised packaging of tobacco products before the end of this Parliament. For the avoidance of doubt, I support that measure, and I shall urge colleagues who care about health to do the same. In 2014-15 Public Health England ran two major campaigns: Stoptober 2014, a nationwide 28-day quit event in October, and the current health harms campaign to prompt attempts at quitting. Public Health England is also running its breathlessness campaign, to raise awareness of the importance of breathlessness and respiratory disease more generally.

My hon. Friend the Member for Stevenage raised several questions, which I want to address. I particularly want to pay tribute to Neil from Norwich, whose story he shared with us, including the extent of his suffering with COPD and asthma. My hon. Friend the Member for South East Cornwall (Sheryll Murray) mentioned the importance of wider allergy risk, and I am delighted to say that I recently visited a centre of excellence at Addenbrooke’s in Cambridge, which is pioneering a new method for detecting and treating allergies. It is an area of immunotherapy in which this country leads. My hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and the hon. Member for Cheadle (Mark Hunter) made important observations about that.

My hon. Friend the Member for Stevenage asked about the importance of a national clinical audit. I could not agree more about the importance of properly measuring and tracking performance. He knows that I am passionate about doing that across the system. NHS England is considering it in this area, among several potential new areas. I will highlight its importance in Parliament, along with the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who is responsible for public health, and I urge the all-party group to do the same, through our offices and independently.

I have provided some answers to the questions that my hon. Friend the Member for Stevenage asked about research funding. We have increased the funding by 50% in this Parliament. However, I urge him to raise the matter directly with the National Institute for Health Research, and to continue campaigning in Parliament.

We support the work of the European Asthma Research and Innovation Partnership, and although it is clearly a matter for the competence of the EU, I assure my hon. Friend that the Public Health Minister and I, and the Department, will do anything we can to support the application. As for the creation of a world-class asthma review, NHS England is currently working to ensure that everyone with a long-term condition has a personalised care plan and that treatment for asthma and COPD improves. The Public Health Minister and I will make clear the levels of parliamentary support for that, following this debate.

Finally, my hon. Friend asked whether we could include lung function in the NHS health check for those over 40. Requests for such additional content will be considered by the NHS health check’s expert scientific and clinical advisory panel. I will happily make representations after the debate. I am sure hon. Members know that the Public Health Minister tenaciously advocates pursuing public health measures such as those on respiratory disease, including in the Tea Room, and she will take the matter seriously.

I will conclude, Ms Dorries, within the time that you mentioned, by paying tribute to my hon. Friend the Member for Stevenage. On this issue, as well as on other life sciences issues, he has brought together the views of Members of different parties. Ministers will take the points that have been made, and we will do all that we can in the short time available in this Parliament to ensure that they are properly addressed by the relevant agencies.