Asthma Outcomes

Jim Shannon Excerpts

Tuesday 7th December 2021 Westminster Hall

[Steve McCabe (in the Chair)]

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

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered asthma outcomes.

Thank you very much for calling me to speak, Mr McCabe. This is an issue that is close to my heart and close to the hearts of others here. There are few families in the whole of the United Kingdom for whom asthma has not been a key issue; it has been an issue for my own, and I want to speak about that as well. I am grateful to the Backbench Business Committee for agreeing to have the debate. I am chair of the all-party parliamentary group for respiratory health, which recently completed an inquiry into this issue, so I am delighted to be able to raise the issue of improving asthma outcomes in the UK. I very much look forward to the response from the Minister. I am also very pleased to see the shadow Minister, the hon. Member for Enfield North (Feryal Clark), in her place, and I wish her well in her new role.

What does asthma mean to me? My second son, Ian, had asthma. He was born with very severe psoriasis, which meant that we had to apply cream to him three times a day when he was a wee boy. The doctor told us that the psoriasis would eventually go away, but that it would be replaced by asthma. I am not sure of the medical connection—I am not medically qualified to understand it—and I know only what the doctor told me and my wife. Ian has had asthma all his life now—he is 30 years old—and has used salbutamol, the wee blue inhaler, which is always there. It is very clear, from our family’s experience, that those salbutamol inhalers are really important. They are important for Ian. Asthma did not stop him participating in sports, but it meant that he always had to have that inhaler close by, should he at any time feel shortness of breath or need a wee helper.

In Ian’s class at school, there were many others who had asthma issues. As an elected representative, whenever I help constituents with benefit forms, whether for attendance allowance, personal independence payments or whatever, I always ask them about their medical circumstances. More often than not, asthma features among the ailments that they confirm they have—even for those of a different generation. They have often had it for many years. Asthma is an incredibly important issue.

I am pleased to see the Minister in his place. I always like dealing with him, because I always find his answers helpful. He has a passion for the health issues that we bring to his attention, and he always tries to give, and indeed succeeds in giving, the answers that one wishes to receive. Today, we are going to ask a number of questions, and we very much look forward to his responses. I am pleased to see hon. Members in their places. I had hoped that more Members would be able to attend, but I understand that last night was a late night for Members and that there are other pressing matters today.

I have always had a particular interest in respiratory health. This debate has arisen as a consequence of the APPG’s report, which we published last year: “Improving asthma outcomes in the UK”. We looked at the UK mainland, but we also had contributions from Scotland, Wales and Northern Ireland. Obviously, I bring the Northern Ireland perspective to any debate, wherever it may be about, and bring in Strangford too. I am my party’s health spokesperson in this place, and I work closely with my colleagues back home in the Northern Ireland Assembly, particularly with Pam Cameron, my party colleague. She and I work on many things together, including this topic.

Last year, the APPG produced a report investigating the reasons behind the UK’s poor asthma outcomes. We were pleased, honoured and humbled that recognised experts in fields relating to asthma responded to our invitation to take part. The experts ranged from clinical experts from primary, secondary and tertiary care to patient advocacy groups, national asthma champions and patients.

The inquiry was incredibly helpful and detailed. I thank Hugh McKinney of the APPG secretariat and his team for bringing together all the people who wanted to contribute. As a result of the inquiry and the report, many countries in the world now look towards us to learn about how we deal with asthma. They want to learn something from us here in the United Kingdom, and perhaps do things that wee bit better.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

I congratulate the hon. Member on securing today’s debate. As with most conditions, research and development is key to improving outcomes. Does he agree that funding into asthma research must be provided from a clearly defined central source and that there must be increased capacity for trials in hospitals?

[Jim Shannon]

I absolutely agree with the hon. Lady. No matter what the sphere of health, early diagnosis and attention is key. Indeed, my son is an example of that, as a child born with the ailment. There was early participation in his treatment by the doctors, including our own GP and those in the hospital. It is clear to me that that helped him on the pathway to better health. The hon. Lady is absolutely right and I thank her.

We received a large number of written submissions, including evidence from across the numerous asthma disciplines. We were encouraged that there was such a high level of interest. The APPG tries to do a catch-up once a month with stakeholders and those with medical expertise. Each month, we aim to hear from between 16 and 20 people who have an interest in the subject. They bring all their information to us, which we are pleased to have. We were incredibly encouraged that there was such a high level of interest, and I thank every one of them for their help and expert advice.

Let us consider the impact of asthma on people in the UK. The number of people affected by asthma in the UK is among the highest in the world, with some 5.4 million people sufferers. I had never done an interview with GB News until yesterday morning, but they were interested in this debate and a former colleague in this House was the interviewer. It was nice to catch up with Gloria de Piero again in her new job, and it was a platform and an opportunity to raise awareness and the questions were clear. That figure of 5.4 million people suffering from asthma came up early on in that interview.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I congratulate my hon. Friend on securing the debate. On raising awareness, will he join me in congratulating and commending so many of the voluntary groups, particularly those working with issues around chronic obstructive pulmonary disease? I can think of one such group in my constituency, in the Causeway area, that highlights these matters and draws attention to them in the wider community, in order that there is greater awareness across society to try and help people cope with that debilitating condition.

[Jim Shannon]

I thank my hon. Friend and colleague for that point. He is right that there many charities and volunteers, as well as many people who have the disease. A great number of people have expertise, interest and keenness to help and assist them. COPD is one of the most debilitating diseases that I have ever seen. I never realised just how many people in my constituency suffer from COPD, but there seem to be a large number, some of whom are in the advanced stages of a deterioration in health. I have a very good friend who is an artist; we have been friends for many years. He is interested in rural and country sports, as I am, which is where our friendship came from. Today, he is completely dependent on oxygen 24/7 and rarely leaves the house. For a man who was active and fit, COPD has changed his life dramatically.

Some 65% of people with asthma do not receive a yearly review—I am keen for the Minister to respond to that—despite recommendations by the National Institute for Health and Care Excellence that they should. I respectfully ask the Minister, if they are not getting a review, why not? Asthma has an impact on every patient’s quality of life. A recent pilot study for Asthma UK showed that the impact can be considerable: 68% said asthma attacks hold them back from work in school; 71% said severe asthma affects their social life; 54% said it holds them back from going on holiday; and 66% said severe asthma has made them or their child anxious. When the child is anxious, the parent is anxious—we all worry about what happens. The study also found 55% said having severe asthma has made them or their child depressed. The issue of depression and mental health has come up during the difficulties we have had with covid over the past year and a half.

Asthma deaths in the UK have increased by one third over the last decade. Three people in the UK die from asthma every day, which is among the highest in Europe, yet studies show that more than two out of three asthma deaths could be prevented. Three people die every day and if we had the right things in place, we could save two of those three lives every day in the UK. I put that challenge to the Minister, who I hope will give us the confident and positive reply that we would like to see.

[Margaret Ferrier]

Air pollution can trigger asthma attacks, and it is believed that it is linked to the rise in childhood asthma. Does the hon. Member agree that tackling air pollution could also bring public health benefits?

[Jim Shannon]

I absolutely agree. The hon. Member is making points that we all agree with. I am glad she has brought that to my attention. I come to London to work and am aware of the air pollution and the steps that the Mayor of London and others that are taking to try to address that, by restricting the number and type of cars coming in. As the hon. Lady rightly said, people have died in London from air pollution and we must address that. In large metropolises and population clusters, where vehicles and the economy are concentrated, air pollution is important.

I am fortunate to have lived in the countryside all my life. It means that when I go out of my back door there are green fields and the neighbours are about half a mile away, so there is a distance between us as well. However, some 14,000 vehicles a day pass by us on the road—the A20 from Ards to Portaferry—which, by its very nature, shows where the problem is.

Asthma exacerbations lead to over 77,000 hospital admissions each year. It is estimated that asthma leads to a direct cost to the NHS of £1 billion and an indirect cost to society of £1.2 billion due to time off work and loss of productivity. This goes back to the intervention by the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) when she referred to early diagnosis which can stop people losing work days and reduce the cost to the NHS. These factors cannot ignored be when it comes to addressing the health issues and helping to balance the books.

This year, the APPG’s intention was to produce a one-year-on report to highlight and emphasise the tremendous work that has been carried out by all those working in asthma. We intended to highlight the progress that has taken place in the past year, the actions of the Government, and any further areas that needed to be reconsidered. Our job will be to continue to note the progress—it may not be the progress we would like to see—and speak to the Minister to see how we can change that. However, covid changed everything. It changed our thinking dramatically. It has had a devastating effect on many lives and has impacted on asthma care. It affected the scope of our latest report, as well as concentrating on asthma outcomes one year on. We have also looked carefully at the impact of covid on respiratory health and asthma in particular.

I have the greatest admiration and respect for all those working in the NHS during these difficult times, especially those in respiratory health, which has been the hardest hit. They are all heroes—that word is used often, but it is true here—and a credit to the profession and the NHS. We are grateful and thankful to them all.

In the past year, covid has had an impact on those with asthma, COPD and the complex health needs that can sometimes be exacerbated by covid, leading to further difficulties. The past year has been difficult for every one of us. We have probably all lost loved ones to covid. In October last year, we lost my mother-in-law, who had complex needs. Covid took her, and we still miss her.

Today, I want to concentrate on the three critical issues identified by the clinical advisers who addressed our inquiry and shared their expertise and evidence. The first issue is the overuse of salbutamol reliever inhalers. We are not saying that people should not have them. That is not what the inquiry said or what the APPG is saying. We are looking at the potential overuse of those inhalers. The second issue is the new unified asthma guidelines. Thirdly, we need better use of biologics.

Prior to the covid pandemic, responders to our inquiry last year identified the overuse of salbutamol inhalers—the blue, not brown, inhalers—and oral corticosteroids as the biggest area of concern and the most important cause of exacerbation and unnecessary asthma deaths. In our report, the APPG also cited numerous studies that have shown that over-reliance on salbutamol may lead to the reduced use of preventer inhalers and to a greater risk of preventable attacks. Regular overuse has also been shown to increase the risk of asthma attacks, hospitalisations and deaths. The Department of Health and Social Care needs to look at the overuse of medications and whether that may do more harm. The evidence in this case seems to show that this is one of those situations.

A recent study by the SABA use in asthma global programme—the SABINA programme—found that high use of such inhalers was frequent among UK patients and

“was associated with a significant increase in exacerbations”

and in reliance on asthma-related healthcare. It stated the need to align SABA inhaler prescription practices with current treatment recommendations.

Some 22.5 million of these inhalers are dispensed to asthma patients each year, an average of five per diagnosed patient. Way back in 2019, before covid, and during one of the few times in my life I have had health issues, there was a week when I could not even come to Westminster, because the doctor told me it would not be safe to travel. My chest and breathing were at a level where he advised me not to travel. At that time, I was on the blue inhalers. I think I had three over that 11 or 12-week period. I may have had a wee bit too much, although I did not realise that at the time. That is one of the issues highlighted by the inquiry.

Patients using excessive numbers of inhalers should be flagged, identified and immediately seen by an asthma-trained clinician. I bring it to the Minister’s attention that we think it is time to rethink asthma treatment and get this right for patients and constituents across the United Kingdom of Great Britain and Northern Ireland. There are innovative approaches that demonstrate SABA-reduction.

A 2018 study in The Lancet suggested a maintenance and reliever treatment, with a combination steroid and long-acting beta-agonist, which would allow SABA-free treatment. That could be an effective way to reduce SABA overuse among patients, where clinically appropriate. As ever, it must always be done in consultation with and under the guidance of your doctor and those with health expertise.

The Sentinel project undertaken in Hull and East Yorkshire improved outcomes for adult asthma patients by identifying SABA over-reliance and appropriate implementation of a MART strategy. There is a pilot scheme, which could be the marker, the guide, the standard, the level for the rest of the United Kingdom. Data from that pilot Sentinel study demonstrated that MART can substantially reduce the SABA prescribing.

To ensure that that happens, it is important to restore the asthma reviews, which were hit badly by covid. It is time, ever mindful that covid is our priority, to look at the other issues in the United Kingdom, and asthma is one of them. Asthma UK’s latest annual survey showed that 66% of people with asthma are not receiving basic care for their condition, and that that level has fallen, for the first time in eight years. Minister, what has been done to address that fall? How can we do it better?

An annual asthma review is an important component of addressing that. I should be grateful if the Minister would update us on the progress that has been made on restoring the annual reviews. When we are responding to health issues in the United Kingdom we often need data, so it is important to have that in place.

We also suggested in our APPG report that primary care incentives might be necessary to drive the reduction of SABA use. We stated that the QOF—quality and outcomes framework—or the investment and impact fund have the potential to help with that. The patient pathway is also an important method to reduce SABA use, which brings me to my second point—the new unified guidelines.

Last year, in our inquiry, we analysed the challenges faced by clinicians in treating severe asthma. We found that almost all the experts identified the existence of multiple asthma guidelines as confusing, unnecessary and a cause for concern. If they are confusing to experts, and therefore for our constituents and patients too, we need to have a singular approach. Again, I look to the Minister for a response.

The Royal College of Physicians told us in its submission that

“national audit data collected from England, Scotland and Wales indicates that the standard of care against national guidelines (NICE and BTS) and recommendations from NRAD are variable and on the whole substandard.”

There is a need to get things right and singular. As a consequence, the APPG strongly welcomed the commitment to and the ongoing work to produce unified guidelines as a necessary step forward to improve asthma outcomes. We felt that it was especially important for our time-stretched clinicians that all guidelines on asthma should be in one place.

The unified guidelines were delayed due to covid, but are due in 2023. Our main concern, however, is that we understand that the draft scope for the new unified guidelines does not include severe asthma. I bring that to the Minister’s attention, because we feel it should. Perhaps the Minister will give us some indication of what will be done to address that, because that appears to me to be a serious omission, and others will agree.

It is unclear how any guidelines could be described as “unified” when the most serious type of asthma is not included. I have a concern, a question mark in mind, about that. It is especially puzzling when we consider that the existing NICE, British Thoracic Society/Scottish Intercollegiate Guidelines Network, Global Initiative for Asthma and NRAD—national review of asthma deaths—guidelines all give similar criteria for referring a patient for severe asthma.

If severe asthma is excluded from the scope of the unified guidelines, the concern is that newer treatment options will not be addressed properly, which takes us back to the intervention by the hon. Member for Rutherglen and Hamilton West. This is about early diagnosis and treatment at an early stage. If we do not get that right, we will have complications and problems later.

Those newer treatment options include the use of biologic treatments and the latest best practice in phenotyping, which were strongly recommended by both clinicians and severe asthma patients in our inquiry. The long-term plan states:

“We will do more to support those with respiratory disease to receive and use the right medication”,

but without severe asthma included in the unified guidelines, that is unlikely to happen. How can we make that happen, rather than being unlikely? Will the Minister therefore give me, the House and those in and outside this Chamber the thinking behind that omission? What is the possibility of adding severe asthma back into the discussion? If we can retrieve that and bring it back in, I will be pleased. I also wonder what can be done while we wait for the new guidelines. Four sets of guidelines are confusing for clinicians. Surely it would be preferable not to wait until 2023 for clarity. We need to act today—for the three people who die every day due to asthma. That is the imperative. Is there any way that the Minister can reflect on that and give consideration to updated living guidelines to reflect current best practice and treatment?

Unified or updated guidelines can materially affect my third point on biologic therapies. They are life-saving treatments for people with certain types of severe asthma and asthma that is difficult to control. They can reduce asthma attacks in severe asthma, reduce the need for steroids and improve symptoms. At present, they are only offered to patients through the specialist asthma clinics. There was strong support in our report last year for the appropriate use of biologic treatments and we supported the extension of prescribing to secondary care clinicians for severe asthma patients. Many clinicians viewed the use of biologics as a better alternative to traditional oral corticosteroid treatment for severe asthma and we received evidence that a large majority of patients who are eligible still do not have access to them.

Asthma UK suggests that

“82% of difficult and severe asthma patients are often not being referred at the right time, or sometimes, not at all.”

That is hard to believe. Asthma UK and BLF also told us that the current NHS asthma care pathway does not take full account of the availability of the new treatments. So most people with severe asthma are still reliant on OCS. According to Asthma UK, three in four people eligible for biologic treatment are still not accessing it and thousands of patients are having to endure treatments that are considered inadequate and suffer unnecessary side effects.

That is linked to the Government’s five highest health gains programme, which introduced a commitment by the UK to match or surpass comparative nations in the access to new and innovative medicines in five clinical areas, one of which is severe asthma biologics. The scheme committed to the objective of

“reaching the upper quartile of uptake for 5 highest health gain categories”

during the course of the first half of the scheme, by mid-2021. We applaud the Government’s initiative and action on that to date, but the deadline has clearly been missed. New data commissioned by NHS England has shown that the UK is far from the upper quartile and confirms that we are currently ninth out of 10 with regard to comparator countries. We must improve that. We must get better and do that for our patients. We also recommended extending the Accelerated Access Collaborative’s severe asthma programme, and increasing resources to increase capacity for prescribing biologics will be important for achieving that. Will the Minister give a renewed commitment to achieving upper quartile access and set a new, clearly defined target for when and how that will be achieved?

In October 2021 the Government announced 40 new community diagnostic centres, which are set to open across England in a range of settings, from local shopping centres to football stadiums, to offer new and earlier diagnostic tests closer to patients’ homes. I want to put on record my thanks to the Government and the Minister for that commitment. It is clearly there and we thank him for that. However, we cannot make it a postcode lottery. If it can happen here in London, it should happen in Cardiff, Newcastle, Liverpool and everywhere else. Nowhere should be any different, so I would like to see that happening.

The Government have stated that the new centres will be backed by a substantial amount of money—a £350 million investment—and will provide around 2.8 million scans in the first full year of operation. They are designed to assist with earlier diagnosis through faster and easier access to diagnostic tests for symptoms in areas including breathlessness, cancer and ophthalmology. In the Budget, the Chancellor announced an additional £5.9 billion to tackle the backlog of general diagnostic tests to deliver more checks, more scans and more treatment. The intention is to increase the number of diagnostic centres to at least 100 and I understand that each one will include a multidisciplinary team of staff, including nurses and radiographers, and will be open seven days a week. The Government and the Minister are to be commended for that, and I warmly welcome it and the funding that will be allocated. I hope they can help address the covid-imposed inequalities that we have seen across the country in asthma care and treatment. Will the centres be fully staffed, will they have trained staff and will they be in place?

I also welcome the breathlessness diagnostics, which will be included in the centres. It is essential that they should be equipped to diagnose any cause of breathlessness, whether cardiovascular, lung cancer, asthma or chronic obstructive pulmonary disease, which my hon. Friend the Member for East Londonderry (Mr Campbell) mentioned. It is also important to establish an appropriate referral system from the centres, should further investigation be warranted. Will the Minister confirm that the FeNO and spirometry tests will be included in all centres, to allow for fuller asthma assessments?

I look forward to the contributions from other Members, and I thank those who intervened on my speech. I very much look forward to the Front-Bench contributions, particularly from the Minister.

--- Later in debate ---

[The Minister for Health (Edward Argar)]

It is a pleasure to serve under your chairmanship once again, Mr McCabe, after our many hours in Committee. I thank my hon. Friend the Member for Strangford (Jim Shannon) and congratulate him on securing this debate and for his work on the APPG. As ever, in speaking of his and his family’s experiences, he was typically open for the benefit of the House and those watching our proceedings, and I pay tribute to him for that.

I also welcome the hon. Member for Enfield North (Feryal Clark) to her role on the Opposition Front Bench. She has big shoes to fill, but on the basis of today and what I know of her from her time in this House, I have no doubt that she will do so with skill and dedication and with her typical courtesy while holding us to account as a Government. I wish her all the best in the role.

The Government are dedicated to improving asthma outcomes. In the past 10 years, we have rolled out guidance and initiatives to improve in this area. In 2011, the Department for Health, as it then was, published an outcome strategy for COPD and asthma. It set out a proactive approach to early identification, diagnosis, intervention, proactive care and management. All stages of the disease, as we have heard from hon. Members on both sides of the House, can affect anyone. When it does, it has a huge impact on their lives.

I pay tribute to the hon. Member for Blaydon (Liz Twist) for bringing to life this issue and what it means for individuals with the examples she used, and for talking about her own experience, which is incredibly powerful. I pay tribute with her, as ever, for being willing to share that with this House.

A wrong diagnosis will result in patients not getting the care they need. That is why in 2013 “A Guide to Performing Quality Assured Diagnostic Spirometry” was produced by the NHS with several charities and stakeholders. It was published to support the accurate diagnosis of respiratory conditions to tackle the effects of misdiagnosis.

In 2014, the national review of asthma deaths—the first UK-wide investigation—was published. It aimed to identify avoidable factors, and make recommendations to improve care and patient self-management. NHS England and NHS Improvement commissioned the national asthma audit programme in 2018. It provides data on a range of indicators to show improvements and opportunities in asthma outcomes. The audit’s data are used by providers to assess their quality and support improvement.

More recently, as a number of hon. Members have alluded to, the NHS long-term plan, published in 2019, includes respiratory disease as a national clinical priority with the objective to improve outcomes for people with respiratory diseases including asthma. The respiratory interventions proposed in the NHS long-term plan include early and accurate diagnosis of respiratory conditions. Diagnosing conditions earlier may help to prevent avoidable emergency admissions for asthma.

As part of the long-term planning commitment, pharmacists in primary care networks will undertake a range of medicine reviews, including teaching patients the correct use of inhalers and contributing to multidisciplinary work. I can give my hon. Friend the Member for Loughborough (Jane Hunt) and constituency neighbour the reassurance she sought that we continue to work closely with the NHS in the delivery of that long-term plan, specifically on these objectives set out in it.

To deliver on that objective, NHS England has established 13 respiratory networks across the country. They will provide clinical leadership for respiratory services and are focused on improving clinical pathways for asthma. Since the long-term plan was published, a number of initiatives and publications have been announced.

Before making further progress, I will turn briefly to some of the comments made by hon. Members—I suspect this is a timely way of responding to them. My hon. Friend the Member for Loughborough talked about Kindeva, based on the Charnwood campus in Loughborough in her constituency. I know it well, as the neighbouring Member, and know that it is something she and Jonathan Morgan, the leader of Charnwood Borough Council have championed as a huge asset to our national economy and national effort in this space. She talked about the pMDI market, F-gases and the transition. We commit to our net zero ambitions, but she is right to highlight the need for the transition to be done in a sensible and measured way, and we continue to work closely with industry partners and industry-representative bodies in order to manage that process. I hope that gives her at least a degree of reassurance on this important issue.

NHS England’s national patient safety team has prioritised its work on asthma. This work is part of the adoption and spread safety improvement programme, which aims to identify and support effective and safe evidence-based interventions and practice across England. The asthma ambition is to increase the proportion of patients in acute hospitals receiving every element of the British Thoracic Society’s asthma discharge care bundle to 80% by March 2023.

The quality outcomes framework—QOF—ensures that all GP practices establish and maintain a register of patients with an asthma diagnosis. The QOF for 2021-22 includes improved respiratory indicators. The content of the QOF asthma review was amended to incorporate key elements of basic asthma care for better patient outcomes, including an assessment of asthma control, a recording of the number of exacerbations, an assessment of inhaler technique, and a written, personalised asthma action plan.

Since April 2021, the academic health science networks and patient safety collaboratives have been working with provider organisations to increase take-up of the British Thoracic Society’s asthma care bundle for patients admitted to hospital in England. Centres’ compliance with the elements of good care outlined in the bundle is measured in the national asthma audit.

[Jim Shannon]

I thank the Minister for his responses. He mentioned the 2023 target, to which I referred. Is it possible to shorten that timescale?

[Edward Argar]

As ever, the hon. Gentleman tempts me to be more ambitious. We have set 2023 as a realistic and achievable target. If it were possible to achieve it sooner, that would of course be a positive. Both in my Department and beyond, everyone will have been encouraged by the hon. Gentleman’s ambition and encouragement to go further and faster on that target, if they can. He makes his point well. I will make a little progress and then come back to several of the hon. Gentleman’s questions.

We recognise the particular effect of asthma on children and young people, which is why NHSEI’s children and young people’s transformation programme is promoting a systemic approach to asthma management. The first phase of the national bundle of care for children and young people with asthma has been developed with clinical and patient experts. A complete version of the bundle of care will be published in spring next year. The children and young people asthma dashboard, developed alongside the bundle, will be able to identify asthma care by race, geography, age and social deprivation, which goes to a number of points highlighted by the shadow Minister, among others. That will help ensure that children and young people with asthma who face the starkest health inequalities are prioritised.

The national care bundle has an environmental impact section that sets out three key standards around air pollution, which is an issue raised by Members on both sides of the House, including the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), who is no longer in her place. We set out the Government’s clean air strategy in 2019, recognising the impact of air pollution on health and a range of other factors that affect people’s lives. In this space specifically, we recognise three key standards. First, all healthcare professionals working with children and young people with expected or diagnosed asthma should understand the sources and dangers of air pollution. Secondly, patients and their parents or carers should always receive information on how they can manage asthma with regards to air pollution. Thirdly, integrated care systems should ensure that they are linked with schools, where education around asthma should also be provided.

The NICE guidance, entitled “Air pollution: outdoor air quality and health”, provides advice for people with chronic respiratory or cardiovascular conditions on the impacts of air pollution. It is important that we recognise that there are ways that, in a health context, we can care for people who face those impacts. Going back to the 2019 clean air strategy, however, we as a society have a much broader obligation to tackle the root causes of those problems and to improve the quality of our air, particularly in our cities but across our whole country.

Given the pivotal role of respiratory medicine in treating patients with covid-19, some centres’ ability to commence patients on biologics may have been impacted at the peak of the surge. I think all Members will recognise that.

The pandemic obviously revolves around a respiratory illness. Those who treat respiratory illnesses, including asthma, have been on the frontline, along with all our health and care staff. I join the shadow Minister and others in paying tribute to the amazing work they have done. As we seek to recover elective services and get more routine services back to normal, we are ambitious but also recognise, in the face of uncertainties over winter and the new variant, that respiratory services can be some of the hardest to recover and bring back to normal operation, because those are the services affected by the disease and the nature of its transmission.

--- Later in debate ---

[Jim Shannon]

I thank all hon. Members for their immense contributions and incredibly helpful comments. I think we all spoke with a united voice, from all parties and all parts of the Chamber. I believe we got an excellent response from the Minister and a commitment—even though asthma is not in his direct portfolio.

My hon. Friend the Member for East Londonderry (Mr Campbell) referred to volunteers and charity groups. The hon. Member for Rutherglen and Hamilton West (Margaret Ferrier) referred to air pollution, as others did. The hon. Member for Loughborough (Jane Hunt)—also a Leicester City supporter, though we lost on Saturday, but that is by the way—referred to prescription charges. The firm that she mentioned contacted me as well, and I am pleased that the Minister was able to respond to her questions. The hon. Member for Blaydon (Liz Twist) brings a vast amount of knowledge of and interest in this subject. She referred to quality of life, mental health issues and how biologic therapy is needed.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), a friend and the SNP spokesperson, spoke about her personal experience of asthma. It is also pleasing to have so many Members present to support the shadow Minister taking her place for the Labour party, the hon. Member for Enfield North (Feryal Clark). Certainly; she has had an exceptional debut as the shadow Minister in Westminster Hall. I was pleased with her contribution, which encompassed all our thoughts and ideas, notably the effect of air pollution and how treatment for severe asthmatics is not in place.

I thank the Minister so much for his response. He gave us the details and told us about the 2023 target, but we will try to do better. He referred, too, to consideration of the annual review and to the unified or joint guidelines to be agreed. There is much to be encouraged by in his response. With that in mind, I thank all hon. Members for their contributions. Here is a battle to be fought; we are about to fight it.

Question put and agreed to.

Resolved,

That this House has considered asthma outcomes.