Respiratory Health

Jim Shannon Excerpts

Thursday 14th November 2024 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I beg to move,

That this House has considered respiratory health.

It is a pleasure to serve under your chairship, Mr Rosindell. I look forward to hon. Members’ contributions to this important debate, and I thank the Backbench Business Committee for granting it. I was before the Committee a week ago on Tuesday with three requests, and I was well looked after. This is the first of my three debates; the second is on 28 November in the main Chamber, and I am waiting to hear when the third will be. I hope to get more in after that—I will keep at it.

I declare an interest: I chair the all-party parliamentary group for respiratory health, and it is an issue that has affected my family. I became very aware of respiratory health because of how it affected my son. Did I understand it all? Probably not, but I understood it better from interacting with him. He is now 34 years old and married with two children, but he still has issues with his respiratory health.

I am delighted to be able to raise the issue. I look forward to all the contributions, particularly the response from the Minister for Secondary Care. It is always a pleasure to see her in her place: it makes my day and everybody else’s, I am sure. I know that she has a deep interest in the subject, so I am pretty sure that we will be encouraged by what she tells us. I am also pleased to see the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), in his place. He and I have discussed the matter on a couple of occasions this week: we focused on what we would love to see come out of the debate.

This debate is not about us as Members; it is about our constituents and those who contact us. It will be on behalf of all the people in this great nation of the United Kingdom of Great Britain and Northern Ireland. As chair of the APPG, I will cover issues around asthma, severe asthma, chronic obstructive pulmonary disease and silicosis. The APPG has been conducting an inquiry on silicosis in particular. We have had meetings, usually on Zoom, with at least 20 contributors; the hon. Member for Blaydon and Consett (Liz Twist) and I have attended those meetings regularly.

I will frame my comments around the latest initiatives and the current policy direction, but I first want to say a few thank yous. I am indebted to Sarah Sleet and her wonderful team at Asthma and Lung UK for their outstanding help and ongoing support. They have been enormously helpful to me and the APPG and, I suspect, to other Members present. I welcome their latest report, “A Mission for Lung Health”, which was launched on Tuesday. I was there, as were some Members who are here today and many others who unfortunately cannot be.

I met Dr Jonathan Fuld, the national clinical director for respiratory disease, for the first time to get his expert advice and counsel. I had always seen him on Zoom on a laptop, but on Tuesday I met him in real life: we were able to shake hands and say hello. My thanks also go to Dr Richard Russell of the British Thoracic Society for his insights and opinion, and I pay tribute to the ongoing work of our expert stakeholder groups, which comprise senior clinicians, industry professional bodies and other experts. Whenever we have that vast amount of knowledge, experience and input on a Zoom meeting, we learn quickly: I learned quickly what the issues were.

There have been some very welcome developments in respiratory health recently, including the development of a new guideline for asthma, which is due to be launched soon as a collaboration among the National Institute for Health and Care Excellence, the Scottish Intercollegiate Guidelines Network and the BTS. The seasonal flu and covid vaccination programme appears to have been well planned and is rolling out well this year. Great credit and thanks are due to NHS England for its great work. Back home, where this is a devolved matter, I got two injections in one day: one for covid in the left arm and the ordinary one for flu in the right. It was like a conveyor belt: people were getting it every couple of minutes. It really is wonderful to see how well things can work when things go in the right direction.

The battle with smoking-related respiratory illnesses continues. The Government’s plans on smoking cessation, including through the Tobacco and Vapes Bill, are welcome. I understand that the Bill’s Report stage is coming next week, or certainly the week after. We hope that it will have a big impact in more deprived areas and on outcomes. When we were doing our research, having meetings and doing an inquiry into the matter, it became clear that it was more of an issue in deprived areas and areas of disadvantage. I will say a wee bit more about that later.

I hope that this debate will help to highlight World COPD Day, which falls on 20 November. I am sure that the Minister is well aware of the headline figures on respiratory health in the UK. They are worrying. The reason why this debate is so important is that the evidential base tells us that things are not getting better. That is why I look to the Minister for some succour, support and easement of mind.

Respiratory disease is the third biggest killer in England. In the UK, 7.2 million people have asthma, while 3 million are affected by COPD. These are not just figures; they are people, and their families are affected as well. The UK has a higher death rate due to respiratory illness than the OECD average, and the highest death rate in Europe. My goodness! If that does not scare us, it should. Over the past 10 years, more than 12,000 people have died from asthma. All those deaths were preventable. That is another reason why we are having this debate: because if we can prevent deaths, we should. It is important to put this on the record.

[Chris Bloore (Redditch) (Lab)]

Thank you for your chairmanship, Mr Rosindell. As an asthma sufferer, I know that one of the key elements of ensuring that we get the care we need is an annual survey with a clinician or GP about how our symptoms are either deteriorating or improving. I know many asthma sufferers who are not getting that annual review with their doctor. Some are going years without any sort of review of the deterioration of their symptoms. Given the really concerning number of people who die in this country from asthma attacks, is it not time that we did more to ensure that people get the yearly reviews they really need?

[Jim Shannon]

The hon. Member is absolutely right. If there are deaths of people with asthma that are attributable to not getting regular examinations or appointments with doctors or consultants, that is an issue that must be addressed. I am quite sure that the Minister is taking notes and that her civil servants and her Parliamentary Private Secretary will ensure that information is contributed to the debate.

NHS waiting lists for respiratory care have risen by 263% over the past decade. Poorly controlled respiratory disease results in hospital admissions doubling during the winter period. COPD exacerbations are the second most common cause of emergency hospital admissions. These are worrying figures—as worrying as the issue to which the hon. Member for Redditch (Chris Bloore) refers. New research presented at the European Respiratory Society has shown that the biologics uptake for severe asthma is disastrously poor: the national median for patients in England with severe asthma between 2016 and 2023 is 16%. The uptake varied widely among integrated care boards: it was between 2% and 29% against a target of 50% to 60%. These are worrying figures that indicate an unfortunate trend that should concern us all.

The burden of respiratory disease falls disproportionately on the most deprived. Adults in the poorest 10% of the country are more than two and a half times more likely to have COPD than the most affluent. The 10% most deprived children are four times more likely to require emergency admission to hospital due to asthma than the least deprived. Those figures show a fall-down and a need to focus on those areas.

Lung conditions, especially asthma and COPD, cost the NHS £9.6 billion in direct costs this year and every year. That represents 3.4% of total NHS expenditure. Those conditions result in 12.7 million work days being lost every year. The stats indicate a massive problem that needs to be addressed. The illness and premature death associated with them causes reductions in productivity totalling some £4.2 billion a year, and the conditions have an overall impact of £13.8 billion on the English economy.

All these stats tell us that we have a major problem. I ask the Minister that the NHS prioritise the issue. I understand that it was prioritised by the previous Government, but that that was not acted on because of the election, so I ask respectfully that it be prioritised in our strategy for the time ahead. Improving respiratory outcomes will help to achieve the Government’s ambitions to improve the nation’s health, to halve the disparities in health outcomes, to eliminate waiting lists, to break the winter crisis cycle and to enable everyone to live well for longer.

I have a number of questions for the Minister; I think my staff have sent her a draft of my speech and the questions I will ask. Will she confirm that respiratory health will be a priority for the Government? That is my first big ask. The APPG strongly supports the Secretary of State’s three shifts, which were announced following the Darzi report. I very much welcome that report, and the Secretary of State has done extremely well: it was a difficult portfolio to take on, but he has shown that he has the ideas to take it forward strategically. I hope the Minister can provide an idea of how that will happen for those with respiratory health issues.

The Darzi report proposes a shift from analogue to digital. We certainly have to improve the system that is used for our data and for healthcare more broadly, as the Secretary of State has said in the Chamber; I was very encouraged when I heard him talking about that shift. The other two shifts proposed are from hospital to community and from treatment to prevention. Those three should be front and centre, and they all have an important part to play in improving outcomes. The Government are right to highlight the impact of inequalities and deprivation on health. We strongly support their plans to achieve that through the three shifts, with which they have set a strategic course.

The statistics are clear: we have to improve outcomes for the most vulnerable in society. Our No. 1 duty as elected representatives is to look out for our constituents, particularly those who are vulnerable—that is why we are elected representatives. Our duty is to look after those who are less well-off, those who are physically vulnerable, those who are disabled and those who have other issues in their life.

Mortality rates from respiratory disease are higher among disadvantaged groups and areas of social deprivation, higher exposure to air pollution, higher smoking rates, poor housing conditions and exposure to occupational hazards. That has to be a major focus for us all. The trial of neighbourhood health centres could offer a significant shift from hospital to the community; the Government are considering that, and it is a good step in the right direction. We hope that we will enable a better focus for diagnosis and treatment of respiratory health, which could help to reduce inequalities. As the burden of respiratory disease disproportionately affects the most deprived parts of this great country, winter pressures are higher in those areas, so the centres need to be able to match the local challenges. Will the Minister indicate how that will happen?

Part of the challenge relates to the provision of spirometry testing, which is an essential diagnostic tool for asthma and for COPD. Community diagnostic centres currently offer very few spirometry tests; some offer none at all. I ask the Minister to confirm that spirometry will be widely rolled out, especially in deprived areas where we need its use to be widespread in primary care. It would be extremely helpful if spirometry could receive sustainable funding to be equitably delivered. I welcome the Minister’s thoughts.

As the Minister will be aware, the national screening committee has recommended introducing a targeted lung cancer screening programme across the UK. However, the screening programme only explores the possibility of lung cancer; unfortunately, it does not focus on addressing incidental findings of undiagnosed COPD identified during the screening. Including those findings would enable neighbourhood centres to help deliver better care for COPD.

We are aware of some work being undertaken in Hull to roll incidental findings into potential COPD diagnoses. I ask the Minister and NHS England to look closely at the outcomes of that study, which I believe will give some direction on what needs to be done in the United Kingdom. We are deeply grateful to those in Hull who are working on COPD diagnosis.

The national screening committee’s guidance on COPD has not been reviewed since 2019. I ask the Minister whether there are any plans to revisit that and to bring it up to date. It is five years since it was done, and the figures indicate a worrying trend of more disease. We need to have that in place.

Overprescribing of SABA inhalers—short-acting beta agonists—remains a big problem. Guidelines would be of enormous help. I ask the Minister to ensure full support for the NHS to implement new guidelines.

The APPG has been looking at the impact of inequality for some time. We highlighted that at our COPD event in the House at the end of last year. It was a well-attended event with constructive comments. As we always do in the APPG, off the back of that, we are looking forward more strategically, with a number of asks. We intend to hold regional events to enable local clinicians to inform us what more needs to be done. There is nothing better than asking clinicians the best way forward. They know. They deal with patients daily, and we deal regularly with constituents, and that helps us to focus attention, specifically on prevention.

The number of asthma deaths is far too high. They are worryingly high, as the hon. Member for Redditch mentioned. It has to be a priority for us all to reduce deaths as quickly as possible and for that to be an integral marker in the 10-year plan. The Secretary of State is giving us a 10-year plan. Perhaps the Minister can tell us today where the asthma and respiratory health focus is in that 10-year plan. It needs to have that focus, and I hope we get that response from the Minister today.

We are 10 years on from the national review of asthma deaths report and very little has changed in terms of asthma outcomes. A recent study showed that people on lower incomes reported greater use of oral corticosteroids than people on higher incomes. These findings highlight that there may be an increase in OCS prescriptions for people with asthma and COPD in more deprived areas. The study results are similar to those reported in the 2019 survey by Asthma and Lung UK. I again urge the Minister to keep an eye on that study, to see what lessons we can learn. I know the Minister is committed to making things better and we support her in her quest to do so, but I believe there are many who have helpful contributions on how that can be done.

The APPG also welcomes improvements in inhaler technology, specifically the move to combination inhalers, which will ultimately eliminate the use of twin inhalers. That should benefit both asthma and COPD patients and will contribute to the NHS’s net zero targets. There are lots of things that have to be done. We all subscribe to the net zero targets—they need to be addressed—and this is a way of achieving two goals in one.

We welcome the Government’s commitment to increasing the NHS workforce. That is very good news as well. We will see how that looks in the workforce plan next year. I ask the Minister to ensure that with a significant increase in staffing levels in primary care, we will see an end to untrained staff undertaking annual asthma reviews. I do not want to be too critical—that is not in my nature —but when there is an anomaly we have to address, it has to be said.

The APPG warmly welcomes the promise of the outcomes of the 10-year plan, and we will submit our response to the consultation. To have any real impact on respiratory health, though, we believe the plan has to be disease specific and contain suitable outcome measures for respiratory health. Will the Minister confirm whether the plan will include disease-specific measures for respiratory health? Again, I ask the Minister to benchmark metrics at the start of the plan and to factor in regular outcome updates at three, seven and 10 years. If we do that at those points, we can chart the progress, or perhaps the lack of progress, and make improvements. The metrics could include fewer asthma deaths; reduced hospital admissions for asthma and COPD, especially winter admissions; prescription data; and reduced incidence of asthma and COPD in the most deprived areas. Interim data outcomes will enable us to determine whether the plan is on track to deliver the outcomes we all want to see.

The use of biologics is of particular concern to the APPG and features regularly in our meetings. I am sorry to say that figures on the use of biologics in England are simply dreadful. The national median by patients with severe asthma in England between 2016 and 2023 sat at 16%, and the uptake varied widely among ICBs at between 2% and 29% against an uptake expectation within the clinical community of 50% to 60%. It just does not seem to be working. Biologics treatment has been described by our clinical advisers as life-saving for severe asthma patients. There is both wide regional variation in access, and unacceptable delays to the start of treatment. Many patients who need urgent treatment have to wait years to get access to the services that will prescribe biologics to them. That is an inefficient use of NHS resource and means that the health of patients is deteriorating while they wait for the right treatment. I do not want to see that, hon. Members do not want to see that, and I know the Minister does not want to see that either.

We need more easily accessible severe asthma services. Again, I would be much obliged if the Minister could meet us to look at how we can provide better asthma care for those with the highest burden of disease. I hope that the NHS innovation and adoption strategy will put forward solutions to tackle low and variable uptake and the access to innovative treatments, such as severe asthma biologics. The APPG would like to see a funded transformation with the health innovation networks and clinical leadership on the implementation of NICE guidance on respiratory health at neighbourhood level and on the delivery of biologics.

We are being constructive—the Minister knows that I will always be constructive because I believe we need to move forward together and ask the questions. I note the Secretary of State’s recent remarks on data sharing and the call by Asthma and Lung UK for greater data sharing in its report, which urges the Government to

“Improve data collection and analysis across the care pathway to bring together primary and secondary data, and make high quality, publicly available data which will help ICSs target care where it is needed and ensure accountability”.

We fully support that, and I do not think there is anybody in this room who would not support that, because it is absolutely the way forward.

We are also looking closely at the recent increase in silicosis cases around the country, especially in relation to engineered stone. It is something that maybe not everybody is aware of, although I suspect those in this room are. There is a real threat that the rise in what are entirely preventable cases may add considerably to local health pressures. The Secretary of State has been clear that we need to address the waiting lists and take more action to prevent cases, and that is something I have suggested needs to be done as well. There are a number of recommendations in our silicosis report, and a key recommendation concerns wider data sharing between primary and secondary care.

The APPG will hold a roundtable in the new year to ensure a timely discussion to inform the 10-year plan. I ask the Minister if she would be most kind and put it in her diary and come along. We are not here to give the Minister a hard time, but to take her contribution and help us to move forward together. The Parliamentary Private Secretary, the hon. Member for Aylesbury (Laura Kyrke-Smith), is not nodding because she cannot do that for the Minister, but she is indicating—I will send over the date, if that is okay.

Since 2015, 250 to 300 patients have been diagnosed with CF each year. Despite medical advances in recent years, in 2022 the median age of death for those with CF was just 33. Wow—think about that.

The Cystic Fibrosis Trust has called for greater financial support for people with cystic fibrosis for a number of years. In 2023, a University of Bristol study reported that a typical family with cystic fibrosis loses £6,800 a year due to the extra costs of living with that condition. The CF Trust has multiple requests, including for the Government to explore additional innovative market-incentive options to encourage the industry and others to fund research and trials for new antibiotics because of current antibiotic resistance.

I believe we have seen a good and positive contribution to research and development, but we are probably at a cusp where a bit more investment and help would get us over the line. We need to prioritise diagnostics for antimicrobial-resistant infections to prevent further lung damage. The Trust’s final request is to implement an early warning alert system on pollution for people with respiratory conditions.

I am looking forward to hearing what others have to say. The fact of the matter is that we have an opportunity this time because we have a Government who are spending £22 billion on the NHS. That is a massive amount of money. Every person in this great United Kingdom recognises what that means. It is the time to get it right. The Secretary of State has indicated that he is of that mind, and I know the Minister is also of that mind, so we have an opportunity to make effective change to the lives of people throughout this great United Kingdom of Great Britain and Northern Ireland. Some of the £22 billion will come to us in Northern Ireland through the Barnett consequentials, which is good news as well. It means that everybody gains across this great nation.

I believe now is the time to act. We in the APPG want to do all in our power to inform, support and guide the Minister and her Department in effecting change and improving quality of life for those with respiratory health issues.

--- Later in debate ---

[Liz Twist (Blaydon and Consett) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Rosindell. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate. We spent many years working on these issues together, when I was in opposition.

[Jim Shannon]

I am still here in opposition, but the hon. Lady is now over there on the Government Benches.

[Liz Twist]

We worked together as part of the APPG for respiratory health. I pay tribute to the work of that APPG’s members, as well as to the clinicians and patient organisations involved, including Asthma and Lung UK and Action for Pulmonary Fibrosis.

Respiratory illnesses have a disproportionate impact on the most deprived communities. In my constituency of Blaydon and Consett, the rates of conditions such as COPD are particularly elevated, and I have seen at first hand in my surgeries over the years how debilitating they can be; they can affect every part of a person’s life, from their mobility to their mental health, and tackling them is key to tackling health inequalities. Deprivation is linked not only to heightened rates of respiratory illness, but to faster rates of progression and poorer outcomes. That is true for terminal diagnoses such as pulmonary fibrosis, which has outcomes similar to common cancers, as well as for more common conditions such as asthma, which has seen a 25% increase in deaths over the past 10 years.

We know that the biggest driver of preventable lung disease is smoking, which is responsible for half of the difference in life expectancy between our richest and poorest communities. I am pleased that this Government are taking the decisive action that is needed to protect future generations through legislation, and I am particularly proud of the work that has been done over a number of years by Fresh, which sees public health and ICBs working together to tackle this issue.

Access to timely diagnoses and appropriate clinical pathways is vital for ensuring that people get the best possible treatment, but such access varies between conditions and areas of the UK. Of about 1.7 million people living with COPD in the UK, 600,000 are undiagnosed. Meanwhile, one person in every three has never heard of pulmonary fibrosis, which can lead to people receiving incorrect diagnoses, such as asthma. Incorrect diagnoses of severe asthma are common among children with the genetic condition primary ciliary dyskinesia. It is not a mild condition. In fact, children with PCD—I am not going to try to say it again—have a worse lung function than children with cystic fibrosis. It is vital that we do what we can to raise awareness of these conditions, including the rare condition of PCD, and their impact, whether they are primarily genetic in nature or driven by preventable causes.

We know that our NHS is in a really difficult place, following 14 years of Conservative mismanagement. We lost 14 years in which we could have made progress to improve the lives of people living with these conditions, but instead, they were left extremely vulnerable to the pandemic, following a decade of under-investment and disastrous top-down reorganisation by the previous Government. That is not the fault of our NHS staff, who are working hard to provide services in very difficult situations—I want to be clear about that—but the state of our health service at present was laid bare in the Darzi report just a few weeks ago. Among many other things, the report specifically notes the poor outcomes for respiratory conditions in people with learning disabilities, as well as the link between the rise in these conditions and the growing levels of damp often found in the private rented sector.

We have a long road to travel to fix the problems we have inherited, but I am proud to serve under a Government who are committed to huge investment in our NHS, and who have already made key steps towards a prevention agenda. Better public health and community care will be really important for tackling respiratory conditions and the shocking health inequalities that follow from them. I know that the Government have a sharp focus on preventive measures, such as those mentioned by the hon. Member for Strangford, and will look at how we can best improve our access to diagnostics and treatments, including biologics, for respiratory health.

--- Later in debate ---

[Jim Shannon]

I thank everyone for their incredibly helpful contributions. It is no secret that I always look for a consensual debate, because that is more positive. That is what we have had today.

We have had the opportunity to discuss many issues. With your indulgence, Mr Rosindell, I will speak to each. Since coming to this House, the hon. Member for Newcastle-upon-Lyme—

[Adam Jogee]

On a point of order, Mr Rosindell. My constituency is Newcastle-under-Lyme, not Newcastle-upon-Lyme as several colleagues have called it.

[Andrew Rosindell (in the Chair)]

That will be on the record.

[Jim Shannon]

I will never get it wrong again. I thank the hon. Member for Newcastle-under-Lyme (Adam Jogee) for his contribution. Air quality has been a massive issue for him since he came to this House; he has reiterated that over and over again. I am hopeful that he will have the success for which he hopes. He referred to deprivation and low incomes as factors. Priority for respiratory health is needed, as the Minister confirmed. The hon. Member for Redditch (Chris Bloore) rightly referred to the need for regular asthma check-ups.

It is always a pleasure to work alongside the hon. Member for Blaydon and Consett (Liz Twist). She and I have talked about this issue over the past five or six years. It was a pleasure to hear her contribution, which included first-hand evidence from her surgery. I agree that we need improved access to diagnostics and medical help.

I thank the hon. Member for Sherwood Forest (Michelle Welsh) for her personal contribution; nothing tells a story better than a personal contribution. As the Minister says, we hope that her family members are able to deal with their issues in a positive fashion, and hopefully the medical care will be there as well. The hon. Lady referred to how the disease drastically changes lives, with some people being unable to walk. She also focused on charity work, which is really important.

The hon. Member for Winchester (Dr Chambers) referred to air pollution, as his party has done for many years. He underlined the problems and the impact on children, and he referred to our old housing stock. These are critical issues. We sometimes forget about farmer’s lung, but those who live in the countryside do not, because it is a big issue. He also referred to RSV, the impact on pregnant women and the importance of vaccination.

The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), reminded us that his first job related to this issue. That has allowed him to make an incredible input into the debate: we thank him for everything that he has put forward. It is fair to say that the last Government had a plan, but a more holistic approach is needed. I thank him for his role on the APPG. Prevention is absolutely the way to go, and data is important. He also mentioned spirometry.

The Minister responded in excellent fashion. I wrote down all the things she said. I thank her for committing to a meeting. I am sure that her colleague the hon. Member for Gorton and Denton (Andrew Gwynne) will be watching the debate and will respond. She referred to her former job and vocation, in which she had dealings with COPD directly. I am also grateful for the roundtable commitment. The Government have committed to a smoke-free society, on which a Bill is pending: that will be important in preventing lung cancer, especially for children. She also referred to damp in homes, an incredibly important issue that comes up all the time in the main Chamber.

The Minister responded very positively, if I may say so, to all the issues on which we required answers, including vaccinations, energy efficiency and fuel poverty. The respiratory network across the nation deals with COPD and major contributors to respiratory health issues, and the Government are committed to it. Respiratory health and biologics are priorities for the Government. It is not often that we have a debate with so much input from everyone, and yet we have a Minister who answers all the questions.

Question put and agreed to.

Resolved,

That this House has considered respiratory health.