Respiratory Health

Karin Smyth Excerpts

Thursday 14th November 2024 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Rosindell, for the first time in my new role. I thank the hon. Member for Strangford (Jim Shannon) for securing this debate on an important issue, and I thank other Members for their contributions.

As the hon. Member for Hinckley and Bosworth (Dr Evans) said, I am covering for my hon. Friend the Member for Gorton and Denton (Andrew Gwynne). I am pleased to do so. We had an outing this morning, and I was able to talk to the hon. Member for Hinckley and Bosworth earlier, whose first ward area was in this area as a medic. I must say that he is getting his money’s worth out of the NHS at the moment—I hope he does not have to do that again.

One of my jobs as a manager some 15 years ago was with the British Thoracic Society and primary care leading physicians on COPD. It was a project about living and dying with COPD and helping people to understand the disease and navigate it. I learned an awful lot about respiratory disease at that time and how people live and die with it. I commend that work.

I am shocked at some of what we have heard this afternoon and what I found in preparing for this debate about quite how poor things are, and that some basic preventive measures we were talking about 15, 16 or 17 years ago are still not in place. I am really happy to be responding this afternoon. I am not sure I will be able to satisfy everyone’s requests, but I can say on behalf of the Minister for Public Health and Prevention, my hon. Friend the Member for Gorton and Denton, that he will be happy to accept the invitation to the roundtable that the hon. Member for Strangford talks about, and his expertise will be better there than mine. We are keen to pursue that conversation with the hon. Gentleman and the all-party parliamentary group.

As we have heard, one in five of us will be affected by a chronic respiratory disease at some point in our life. These conditions are, sadly, the third biggest contributor to years of life lost in England. Many people out and about using public transport will know the symptoms of poor respiratory health. They might associate a wheezing or raking cough with being indicative of a smoker, but not all ill health is about personal choice. In fact, this common symptom belies a huge range of conditions, only some of them related to smoking and each requiring different interventions. On all those conditions, we are taking forward a combination of immediate bold actions and long-term reforms.

The Government are taking radical action to create the first smoke-free generation. We are clamping down on kids getting hooked on vapes and protecting children and vulnerable people from second-hand smoke. Tobacco is a uniquely harmful product and smoking is the No. 1 preventable cause of death, disability and ill health. The statistics are stark: smoking claims the lives of about 80,000 people a year in the UK and kills up to two thirds of its long-term users. Second-hand or passive smoke is extremely harmful to health. There is no safe level of exposure to smoke: if we can smell cigarette smoke, we are inhaling it. Smoke is harmful, particularly to children, pregnant women or people with pre-existing health conditions such as asthma or heart disease, which may not be visible to the smoker.

Our Tobacco and Vapes Bill, which we introduced last week, will be the single biggest public health intervention since the last Labour Government banned smoking in indoor public spaces. The Bill’s primary aim is to create a smoke-free generation by gradually ending the sale of tobacco products throughout the country and breaking the cycle of addiction and disadvantage, so that someone born after 2009 will never be able to legally buy tobacco. This landmark legislation will also enable the Government to strengthen the existing ban on smoking in public places and to reduce the harms of passive smoking in certain outdoor settings. It will ban vapes and nicotine products from being promoted and advertised, to prevent the next generation from being hooked on nicotine.

We will hear all sorts of arguments against these sorts of policies, with people saying it is the nanny state or that they are anti-growth. However, most smokers—myself included—always wish they had never started. They have had their choice taken away by addiction induced at a young age by the tobacco industry. I remind Members present that smoking costs the economy and wider society some £21.8 billion a year through lost productivity, smoking-related lost earnings, unemployment and early death, as well as the cost to the NHS and social care of over £3 billion. Our action will save thousands of lives and protect the NHS. I pay tribute to charities such as Action on Smoking and Health and Asthma and Lung UK, which have supported our work. Through our changes we will create a healthier society and, in doing so, boost the economy.

As we have heard this afternoon, smoking is only one example of how our respiratory health is influenced by our environment. Even though it has been almost 70 years since the first Clean Air Act was passed, what we breathe remains one of the greatest risks to public health in the UK. As the chief medical officer’s 2022 annual report on air pollution sets out, there is clear evidence that outdoor air pollution contributes to the initiation and development of respiratory diseases such as lung cancer. That is why the Government are committed to a preventive approach in this policy area. I assure people that we are taking a mission-led approach, working across Departments to improve air quality. We want to address the inequalities in the quality of the air that people breathe simply because of where they live.

The Department of Health and Social Care will support the Department for Environment, Food and Rural Affairs to deliver a comprehensive and ambitious clean air strategy. This will include a series of interventions to reduce emissions so that everyone’s exposure to air pollution is reduced. The UK Health Security Agency, which has been talked about this afternoon, is working closely with DEFRA to review how we communicate air-quality information to ensure that members of the public, and vulnerable groups in particular, have what they need to protect themselves.

I commend my hon. Friend the Member for Newcastle-under-Lyme (Adam Jogee) for his work in support of his constituents with regard to Walleys Quarry. The Minister for Public Health and Prevention visited Newcastle-under-Lyme recently and will pursue those discussions with the Environment Agency.

The Government are also taking steps to reduce risks to respiratory health in people’s homes—a point addressed well by the Liberal Democrat spokesperson, the hon. Member for Winchester (Dr Chambers). Living in a home with damp and mould increases the risk of respiratory illness and conditions such as asthma and COPD. It also affects symptom severity and the risk of death for individuals with existing respiratory conditions. We are therefore putting forward an initial £3.4 billion towards heat decarbonisation and household energy efficiency over the next three years, and £1.8 billion to support fuel poverty schemes. That means that over 225,000 households will receive help to reduce their energy bills by more than £200.

The hon. Members for Winchester, for Strangford and for Hinckley and Bosworth made excellent points about vaccinations. We want to encourage everyone, including ourselves—I look around the room, even at myself; I am slightly behind on my flu vaccine—to do all we can ourselves and to encourage others to take up vaccines and prevent some of the related problems.

We recognise, however, that not all ill health can be prevented, so we need to act to help those who need treatment. I assure the hon. Member for Strangford and other contributors that respiratory disease remains a clinical priority.

The NHS long-term plan under the last Government set a series of objectives for improving outcomes for people with respiratory disease through early diagnosis and increased access to treatments. As we have heard, and as I have said, it is quite shocking that that basic objective is not being achieved everywhere. Access to checks and basic preventive care needs to be much better spread across the country. That is why we say that we want to take the best of the NHS to the rest of the NHS. NHS England has 13 respiratory clinical networks across the country, which are vital in providing clinical leadership across primary and secondary care for respiratory services and supporting services in primary care, where of course most patient contact is.

I commend my hon. Friend the Member for Sherwood Forest (Michelle Welsh) for highlighting pulmonary fibrosis. I wish her father and her family well. She is absolutely right that early and accurate diagnosis is a priority for NHS England. Work to make improvements is under way, and that should have an impact on reducing delayed diagnoses of pulmonary fibrosis. As I understand it, access to these treatments has recently been expanded to patients with non-idiopathic pulmonary fibrosis, following the publication of the NICE technology appraisal for treating progressive fibrosing lung diseases. I hope that that goes some way towards reassuring my hon. Friend, who spoke so eloquently today.

As the hon. Member for Strangford and my hon. Friends the Members for Newcastle-under-Lyme, for Blaydon and Consett (Liz Twist) and for Sherwood Forest highlighted, COPD is a major contributor to inequalities in life expectancy and in healthy life expectancy. People living in the most deprived parts of the country are five times more likely to die from COPD than those in the least deprived. I have seen that both in my previous work with those working in the NHS and since becoming the Member of Parliament for Bristol South in 2015. My constituency was home to the Wills tobacco company, a huge employer in the area over many decades. Its legacy can be seen in many different ways, but particularly in the very high rates of smoking in my constituency—up to 32% in some parts. The reduced lives lived in good health, and those shocking early deaths, are things that I see every day. The impact is still very apparent in the shocking statistics on health inequality across my home city of Bristol.

Let me assure hon. Members that this issue remains a priority for all of us in this Government. Reducing health inequalities is a key part of our mission. That requires us to work across Government, and it runs across all parts of Government. In NHS England, Core20PLUS5 is a national approach to inform action to reduce healthcare inequalities at both national and local system level. The approach provides a vehicle for targeted interventions to detect and treat the diseases that are major contributors to life expectancy as well as pressures on the NHS.

We know that there is a particular risk of condition exacerbation around the winter, leading to emergency treatment in hospital and in-patient care. That is why the focus of the Core20PLUS5 action on respiratory health this year has been to increase vaccination uptake, including covid-19, flu and pneumovax, which can protect against serious illnesses such as pneumonia and meningitis.

NHS England is leading on the development of an approach for COPD management. This will support proactive identification and management of risk in patients in winter, to reduce demand on primary and secondary care. My hon. Friend the Member for Blaydon and Consett was absolutely right to highlight the low levels of diagnosis, the number of people living with COPD and other respiratory diseases, and the impact on children that we might not even know about. The plan is to test and evaluate this approach in four sites this winter to help inform decisions on winter planning in the future.

On severe asthma and access to biologic treatment, significant work has been undertaken through the NHS England severe asthma collaborative to develop the capacity of the severe asthma centres. That important work includes streamlining patient pathways to biologic therapy and reducing variation in prescribing and patient management. Patient outcomes are now submitted to the UK severe asthma registry. That has led to improved identification of patients with potential severe asthma in primary and secondary care, resulting in referral to severe asthma centres for consideration of eligibility for biologic therapy.

Action to address avoidable deaths from asthma has not gone far enough. That is why we are working to ensure that asthma care has a higher prioritisation within systems, for example through the national bundle of care for children and young people with asthma workstream, which is intended to improve outcomes for children and young people with asthma.

Looking further forward, a central mission of the Government is to build healthcare that is fit for the future. As hon. Members have noted, our 10-year health plan will focus on the three shifts needed to deliver a modern NHS: from hospital to community, from analogue to digital and from sickness to prevention. That is a long-term challenge and those shifts will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and bring waiting lists down, as well as the longer-term changes needed to make the health service fit for the future.

I thank the hon. Member for Strangford for his commitment to respond to our engagement exercise. I encourage all organisations and individuals to contribute to the 10-year plan at change.nhs.uk. We are keen to work with the public, patients and our partners in all the organisations that support this work. We will listen and co-design the plan with them.

Disease-specific and more general long-term conditions that affect people’s health are a very live issue. Given the level of comorbidities with which people currently live, it is important to look at the person as well as the diseases. We will continue to look at that as part of the development of the 10-year plan; I know that all hon. Members will take an active part in that process. The hon. Gentleman will tell me if there is anything to which I have not responded.

The hon. Member for Hinckley and Bosworth asked for an update on the RSV vaccine. As part of my portfolio working on urgent and emergency care, we are looking closely at a vaccine update, as well as at the presentation of very young children with respiratory disease in the emergency care system; I am sure that he is aware of that issue. If there is anything else that he would like to know, I will ensure that he is written to. On spirometry and fractional exhaled nitric oxide tests, a look at the NICE guidelines is long overdue, so I hope that we see some more progress on that. If I have missed something, Members may write to the Minister for Public Health and Prevention and he will respond very promptly.

I thank the hon. Member for Strangford and the APPG for raising the issue. I am genuinely very pleased to see it being raised. As a contributor to admissions and inequalities, it is a very serious disease and we need to highlight it. I thank him for the invitation to take part in a discussion with healthcare professionals on the way ahead for respiratory health. My ministerial colleagues look forward to discussing that further.