Chronic Obstructive Pulmonary Disease

Justin Madders Excerpts

Wednesday 17th November 2021 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is pleasure to see you in the Chair this morning, Ms Nokes. I would like to add my congratulations to those already offered to my neighbour, my hon. Friend the Member for Weaver Vale (Mike Amesbury), for securing this debate on COPD on World COPD Day, when awareness should of course be raised of the condition. Debates and days such as this are important in ensuring that people with COPD have access to the care and information they need to manage their condition well.

My hon. Friend gave an excellent introduction and raised many issues, which many other hon. Members raised in various guises, and which I will return to during my contribution. He wanted to focus on public health issues, to avoid our constituents contracting COPD in the first place; improving diagnosis rates, to ensure that it is caught at an earlier stage; transforming treatment, to help patients manage their condition; and investing more in research, so that we can develop groundbreaking diagnostics and treatments. I think we all agree that those are worthy aims that we ought to cover in the debate.

We also heard from my hon. Friend the Member for Newport West (Ruth Jones). She rightly raised the link between lung conditions and air pollution, and she provided some shocking statistics about the number of maternity units that exceed WHO air quality guidelines, particularly after recently updated guidelines were issued. She also raised a whole series of other statistics that set out the scale of the challenge that we face in improving air quality.

My hon. Friend the Member for Blaydon (Liz Twist) spoke about her region and how the staggering levels of health inequality in this country mean that the north-east has much higher rates of COPD than many other areas. She rightly highlighted the importance of helping people to stop smoking as part of this battle. As Members referred to, a decade of cuts to public health grants has led directly to a reduction in smoking cessation services. She also raised the importance of spirometry testing and how this needs to be conducted in primary care; otherwise, issues related to a failure to diagnose conditions early, which we have talked about, will continue.

It was a pleasure, as always, to hear from my hon. Friend the Member for Halton (Derek Twigg), who talked about the prevalence of COPD in his constituency and the various factors that have led to that. He rightly mentioned how the condition leads to many more unplanned emergency admissions; as we know, pressure on A&E at the moment is immense, and that is before we even get into the depths of winter. He also spoke about the excellent work of the community rapid response teams, which can help reduce that pressure on A&E, which will ultimately deliver better patient outcomes. He was right to highlight the additional demands on GPs and the additional numbers of patients they now see, which of course contributes to the difficulty of getting those early diagnoses that all Members referred to.

COPD is the name for a group of lung conditions, including emphysema and chronic bronchitis, that cause breathing difficulties and a permanent narrowing of the airways. Symptoms include shortness of breath when doing simple, everyday things such as going for a walk or housework; a cough that lasts longer than a week; wheezing, particularly in cold weather; and producing more sputum, or phlegm, than usual. My hon. Friend the Member for Weaver Vale highlighted the case study of Chris, which highlights how we sometimes take good respiratory health for granted; only when we lose it do we realise how critical it is.

As we heard, a significant number of people in the UK—more than 1.3 million—have a COPD diagnosis. As many Members said, at least a similar number are estimated to have the condition but are currently undiagnosed. In 2016, the National Institute for Health and Care Excellence estimated that 3 million people in the UK had COPD, of whom around 2 million remain undiagnosed. As we heard, numbers are higher in the north of England and in areas of deprivation. It is estimated that prevalence in the most deprived 10% of areas is almost double that in the least deprived 10%.

My hon. Friend the Member for Blaydon referred to the British Lung Foundation’s survey of 8,000 people with COPD between December last year and May this year. It found that, before the pandemic, around 70% of people diagnosed with COPD said they faced barriers in getting their diagnosis, 14% experienced an initial misdiagnosis, and others had symptoms mistaken for a chest infection or cough or were sent away by their GP after raising COPD symptoms. Worryingly, the Government’s own figures show that diagnosis rates, which I think we accept were too low to start with, have plummeted—understandably—during covid, and so far show little sign of recovery. This month, the British Lung Foundation reports that diagnostic tests such as spirometry have not yet resumed, which many Members touched on.

My hon. Friend the Member for Halton mentioned that there was a 51% reduction in COPD diagnosis in 2020 compared with the previous year, meaning that around 46,000 people in England alone missed out on a diagnosis. Over two years, that is around 92,000 people missing out on a diagnosis. As we know, receiving a diagnosis late means the disease has progressed, which means there is a greater risk of early mortality, never mind the impact on quality of life. Later diagnosis is also linked to higher levels of COPD exacerbations, which can result in lung damage and longer hospital stays. In fact, COPD is currently the second largest cause of emergency hospital emissions, which have risen three times faster than general admissions, putting enormous strain on our NHS, at an estimated cost of £1.9 billion every year.

As we have heard from other Members today, not only late diagnosis impacts hospital admissions; the BLF survey found that those patients who reported receiving the basic standard care—the five fundamentals of COPD care—had fewer flare-ups and better understood what to do when their symptoms worsened.

It is not acceptable that current levels of care mean that, even when a patient has a confirmed COPD diagnosis, they are likely to struggle to access the care they need, resulting in people needlessly ending up in hospital. When national guidelines are in place, it should not be the case that over three-quarters of those who responded to the BLF survey said they were missing out on some aspect of this care. Those with a recent diagnosis were the most likely to receive the lowest levels of care and there was a clear relationship between the length of time since diagnosis and receiving the five fundamentals of COPD care, so we can see that the situation is deteriorating. The BLF report suggests that this may be because people with COPD have to learn how to navigate the NHS to get the care they need. The report also finds that those who received the basic standards of COPD care had fewer exacerbations, were able to manage their condition, and better understood what to do when their symptoms worsened than those who did not, so it simply is not good enough that that group only received the right care eventually, leaving them vulnerable to a deterioration in their health as a result.

We already know that an estimated 420,000 people in the UK may have had their working lives cut short by COPD, and more than half who responded to the BLF survey said their mental health had worsened since suffering a COPD diagnosis. Clearly, we need to do better than this. As Members have said, it is absolutely vital that the right support and treatment are put in place at the right time.

The NHS long-term plan includes commitments related to respiratory disease, including to detect and diagnose respiratory problems earlier and increase access to pulmonary rehabilitation. Will the Minister update us on what progress has been made towards meeting those commitments? It is important to note that the plan was written before covid-19 struck. As my hon. Friend the Member for Weaver Vale said, this plan is very good for sitting on the shelf, but what happens on the ground and how it is delivered are what really matter.

The Minister will know that services were already severely strained before covid-19. We went into the pandemic with the NHS already on its knees, with 17,000 fewer beds, 100,000 full-time NHS staff vacancies, hospitals crumbling, public health services cut and GP numbers down. Members have picked up on all these things today, so we know that the crisis we are in is not simply the result of covid.

We know that NHS waiting lists are now at a record high, with 5.8 million people waiting for treatment. Hospital leaders have warned in recent days that our services are at breaking point, and we know that the coming winter weeks are going to be some of the most challenging in the history of the NHS.

We need to see a plan to get the NHS through the winter without compromising patient care. We need a realistic plan to tackle the backlog in non-covid care and a dedicated plan to tackle the huge backlog in respiratory care. In a written answer in January this year, the Government said they were working with partners to develop and implement policy on the provision of pulmonary rehabilitation services in England. Almost a year on, I hope the Minister will be able to update us on what progress has been made on that plan.