Chronic Obstructive Pulmonary Disease

Liz Twist Excerpts

Wednesday 17th November 2021 Westminster Hall

[Liz Twist (Blaydon) (Lab)]

It is a pleasure to serve under you as chair, Ms Nokes. I congratulate my hon. Friend the Member for Weaver Vale (Mike Amesbury) on securing this debate on an important subject.

In my constituency of Blaydon, in the north-east of England, the figures for those diagnosed with COPD are sadly above the UK average. We know that 1.3 million across the UK have a diagnosis of COPD, but it is estimated that a similar number have undiagnosed COPD. In Blaydon, 2.9% of people have a COPD diagnosis, well above the England-wide figure of 1.9%. It is sadly in the top 10% of constituencies with the highest prevalence. The north-east is the region with the highest prevalence of COPD, at 3%. Remember, that figure is for diagnosed COPD. As I have said, it is estimated that double that number have COPD but do not have a diagnosis.

The British Lung Foundation has today—World COPD day—launched its report “Failing on the fundamentals”, based on the largest survey of those with COPD. It finds unacceptable levels of diagnosis and care for those with the condition. In the north-east, 78.1% of survey respondents reported that they had not received the five fundamentals of COPD care, as set out in NICE guidelines, and as referred to by my hon. Friend. That is 4 percentage points higher than the England-wide average of 74.1%.

Some 29.1% reported facing stigma and discrimination, which is similar to the England-wide average. A higher proportion in the north-east cited as barriers to diagnosis not wanting to know if they had COPD and not knowing the signs of potential COPD. In addition, 53% of respondents in the north-east who smoke said that they had been offered support to quit smoking in the past year, slightly lower than the 55.9% across England. As we know, stopping smoking is a key part of the treatment of COPD.

That matters because behind each of those statistics lies a real struggling person. In my constituency office, we see too many people hugely affected by COPD. As the condition develops, they face increasing disability and exacerbations or flare-ups of their condition, affecting their mobility and day-to-day life, evidenced by their need to claim disability benefits. It affects every part of their life, including their mental health. We need to get better at diagnosing and treating COPD, to stop its progression and reduce that impact on daily life. I want to speak in particular about diagnosis and what needs to be done, first, in the recovery from covid and then more generally.

As we have heard, the diagnosis of COPD is appallingly low, and the British Lung Foundation cite several reasons. More than 1.3 million people have a diagnosis of COPD and a similar number have the condition, as yet undiagnosed. The British Lung Foundation’s first annual COPD survey, which was just published, as I said earlier, shows that even before the pandemic, almost three quarters—70%—of people who have been diagnosed with COPD said that they faced barriers in getting a diagnosis. Recent Government figures demonstrate that diagnosis rates, which were already far too low, plummeted further during covid-19. In 2020, there was a 51% reduction in COPD diagnosis compared with 2019, which means that about 46,000 people in England alone missed out on a diagnosis. As we heard, that is a much higher drop than for comparable conditions.

The BLF says that diagnostic tests have still not properly resumed, so it is likely that as many as 92,000 people in England have gone undiagnosed in the past two years. While rates of cancer diagnosis are already up to, and in some areas better than, pre-pandemic levels—thank goodness for that, I hasten to add—there is no dedicated plan to address the huge backlog in respiratory care.

Spirometry is the main diagnostic test for COPD, but it was paused at the height of the pandemic because it was believed to be an aerosol-generating procedure. It has been now confirmed that that is not the case. Guidance has been published on how to conduct spirometry in a covid-safe manner, but it appears to have made little difference. By and large, spirometry testing has still not resumed in primary care, which is where most people with COPD are diagnosed.

[Ruth Jones]

My hon. Friend is making a powerful point. Spirometry is key, because COPD cannot be diagnosed by video link or telephone. Does she agree that it is crucial for people to be seen face to face to ensure that we fully diagnose them in future?

[Liz Twist]

I certainly agree. The British Lung Foundation says that there is a clear need for NHS England to intervene and work with local health services to prioritise the urgent restart of spirometry testing in primary care for the diagnosis of COPD and other respiratory conditions. The same would also be true in the other nations of the UK.

Two of the major barriers to restarting spirometry testing in primary care are a lack of capacity and, ironically, the creation of community diagnostic centres. If rolled out to the recommended scale, community diagnostic centres should help to improve diagnosis of COPD and other conditions, but people with COPD cannot afford to wait until CDCs are established for a formal diagnosis while their symptoms and wellbeing deteriorate. Unless spirometry and other diagnostic tests are restarted in general practice, the diagnostic backlog risks overwhelming CDCs as soon as they are established.

The Government and NHS England need to provide sufficient funding for enough capacity to conduct spirometry testing in primary care. Delays in diagnosis mean that too many people with COPD are seeing their condition worsen, which has the real impact on their day-to-day lives that I talked about, so the problem must be tackled urgently for the sake of my constituents with COPD, particularly those not yet diagnosed.

The Government need to properly fund our public health services. We have to make sure that stop smoking services can be easily accessed by those already diagnosed with COPD and those who may develop it, as the link between smoking and COPD is clear. The proposed updated tobacco control plan, which we are expecting, will play a key part in preventing COPD. It needs to look at the polluter pays principle, which calls on tobacco producers to pay for the damage that they cause, as recommended by the all-party parliamentary group on smoking and health.

Will the Minister agree today to implement the steps proposed by the British Lung Foundation and others to improve diagnosis of COPD as a matter of urgency? Will she commit to improve funding for public health services, in particular smoking cessation services? Will she ensure that the tobacco control plan addresses the issues raised by the APPG on smoking and health?

--- Later in debate ---

[Gillian Keegan]

Obviously, there would be a relationship between the GP and the smoker, but that can go either way. Anybody who is in those age groups needs to be made aware that they are entitled to this free lung health check, and it is the responsibility of us all to make sure those checks are available. I am sure we will all ensure that that is understood.

In 2019, 85% of deaths due to COPD were attributable to smoking, and in 2019-20, 84% of hospital admissions with COPD were attributable to smoking. The proportion and the number have remained quite similar over the past five years, and as has been mentioned by a number of hon. Members, smoking is a key factor in many cases of COPD. This Government are committed to reducing the harms caused by tobacco, and have made good long-term progress in reducing smoking rates, which are currently 13.9%, the lowest on record. However, with 6.1 million smokers in England, tobacco is still the single largest cause of preventable mortality, and a radical new approach is needed to address the stark health disparities associated with tobacco use. As such, we have set out the bold ambition for England to be smoke free by 2030. To support that ambition, we have announced the publication of a new tobacco control plan, which will include an even sharper focus on tackling health disparities and will support the Government’s levelling-up agenda.

The NHS long-term plan commits to delivering NHS-funded tobacco treatment services to all inpatients, pregnant women and people accessing long-term mental health and learning disability services by 2024. COPD is responsible for around 33% of annual deaths from respiratory diseases and is the single largest cause of occupational lung disease. There are an estimated 17,000 annual new cases of self-reported, work-related breathing or lung problems, which is why our colleagues in the Department for Work and Pensions are also helping to tackle the causes of COPD in the workplace.

[Liz Twist]

I thank the Minister for recognising that a proportion of COPD cases are caused by work-related issues, which will of course affect the north and the north-east most of all because of their industrial heritage. I assume she will tell us what steps the Department will be taking to pursue that.