Respiratory Health

Oliver Heald Excerpts

Tuesday 3rd February 2015 Westminster Hall

[Stephen McPartland (Stevenage) (Con)]

It is a pleasure to serve under your chairmanship, Ms Dorries. I would like to talk about respiratory disease, which affects one in five people in the UK, is responsible for about 1 million hospital admissions and costs the NHS almost £5 billion a year. It is also the third biggest cause of death in the UK. It is the poor relation compared with the investment that goes into tackling the other four big conditions. To put that into context, in 2012, respiratory disease killed 80,000 people—that does not include lung cancer, which killed an additional 35,500 people.

The UK also has the highest mortality rate for respiratory disease among the OECD nations, double that of countries such as Poland and Germany and treble that of countries such as Estonia and Finland. Sadly, the worst thing about those statistics is that many of the deaths would be preventable with the right care. I understand and welcome the announcement by the Secretary of State that he is making it a priority for NHS England to prevent people from dying prematurely from respiratory disease. His ambition is to make us one of the best in Europe for survival rates by improving prevention, diagnosis and treatment. That is a very big statement and a huge aspiration when we are talking about reducing respiratory deaths in this country by almost two thirds.

I want to focus my remarks predominantly on asthma and chronic obstructive pulmonary disease—known as COPD—which together affect almost 6 million people in the UK, including me. I am chairman of the all-party group on respiratory health. With the support of Asthma UK and the British Lung Foundation, we conducted an inquiry into respiratory deaths in an effort to help the Government and the NHS to understand why so many people are dying from these conditions and what can be done to prevent that. I am grateful to the other members of the all-party group for their support, and for the amazing contributions that we receive from patients.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

I pay tribute to my hon. Friend for his work as chairman of the all-party group. What does he make of the NICE evidence that about a third of the people who are receiving treatment should not be, while there is such a lot of undiagnosed asthma? That seems very odd.

[Stephen McPartland]

My hon. and learned Friend makes an incredibly important point, to which I will return later. The information that has come out of NICE is sadly testament to the complacency that we see regarding the effects of respiratory disease, and to how some professionals and patients treat the condition, ultimately resulting in those patients’ deaths.

Contributors to the all-party group’s report include health care professionals, charities, patients, families and professional organisations, as well as a range of other people who contributed both written and verbal evidence. I will read the story of one of those people a little later, but first I want to look at chronic obstructive pulmonary disease, which is an umbrella term for a set of conditions that includes bronchitis and emphysema. Combined, such conditions kill more than 30,000 people a year in the UK—around 5% of all deaths in the UK from all causes. A COPD patient’s journey is often punctuated by multiple exacerbations, which are sudden worsenings of the symptoms, often triggered by external factors such as infection and problems with air quality, that often lead to hospitalisation.

To put it into context, people suffering from COPD exacerbations are the second most common cause of emergency hospital admissions in this country, the biggest being ischaemic heart disease, which is effectively coronary heart disease—heart attacks and strokes. It is estimated that COPD leads to 94,000 admissions a year, with cold weather often a major contributory factor. The direct costs on the NHS are more than £800 million a year, so COPD is causing a huge problem in terms of the costs for the NHS and the impact on individual patients. One of the worst statistics that the all-party group’s inquiry came across was that 50% of people who are admitted to hospital with severe COPD die within four years—once it has reached the stage of their being admitted to hospital, they sadly have a life expectancy of four years.

--- Later in debate ---

[Sir Oliver Heald (North East Hertfordshire) (Con)]

Rightly, my hon. Friend the Member for Stevenage (Stephen McPartland) and other Members who have contributed have talked about the most serious incidents and life-threatening situations. I want to say a few words about mild asthma, of the sort that can affect someone playing sport. If we are talking about campaigning about asthma awareness, there are quite a lot of people who are not going to die because of their asthma but whose lives are spoilt by it.

My own experience is that when I was young I was a keen rugby player. I could play rugby, but after a match I was always wheezy. It never occurred to me that that was because of a medical condition, but I was talking to my doctor one day, when I had been playing rugby for years—I was in my teens at the time—and he said, “Actually, we can help you with that.” He gave me an inhaler and told me to take a puff before I played, and my life was transformed. There was no more wheezing and I improved; I was able to play rugby much better, and was able really to enjoy it for the first time. There must be a lot of people in the country who have not really realised that they have asthma, as it is undiagnosed.

My first point is that in making people aware of respiratory conditions we are talking not just about saving lives but about improving the quality of people’s lives. I am told that there are any number of top sportsmen who have the same condition of mild exercise asthma.

[Caroline Nokes]

My hon. and learned Friend makes an interesting point. This is a problem not just for elite sports players and those who participate in sport regularly, but for those who are not active enough, or not taking part in any physical activity. They tend to look for reasons not to take part in those activities and being a bit wheezy, for some, can be a convenient excuse.

[Sir Oliver Heald]

My hon. Friend makes a good point. It is easy to see this issue as 1 million hospital admissions and the third highest cause of death, without also looking at the huge effect on other sufferers. We know that 5.4 million people are being treated in the UK for asthma, and I rather share the view that the National Institute for Health and Care Excellence, in saying that a third of people have no symptoms at any particular time, may be making a slightly complacent comment. By the time I was in my late 20s I had no symptoms at all and I no longer needed to use an inhaler to do sport. However, when I had a problem one year with flu, they came back. It is a variable condition, and that can be underestimated.

Kay Boycott, the chief executive of Asthma UK, said:

“Asthma has many complex causes, which is one of the reasons why it is sometimes difficult to get a definitive diagnosis. It is also a highly variable condition that can change throughout someone’s life or even week by week, meaning treatment can change over time.”

One of the great lessons to learn is that we need to monitor regularly for asthma. My hon. Friend the Member for Stevenage made a particularly important point about attending the asthma clinic for the test.

The Royal College of Physicians recently made a point about variability and how asthma can suddenly deteriorate. As it said, there are different kinds of asthmatics: brittle asthmatics who can move from having no wheeze to severe problems; others for whom it appears just in the early morning; and others for whom it disappears for a period. We need more research and a campaign on awareness.

[Mark Hunter (Cheadle) (LD)]

I apologise for being late for the start of the debate. Does the hon. and learned Gentleman agree that variability is one of the key problems with asthma? From hon. Members’ contributions, it is clear that each of us who suffer from asthma have different experiences of it. One of the biggest challenges, which has been brought home by the medical advice I have been given by doctors over the years, is never to underestimate asthma. One of the problems is that so many long-time sufferers think that they are in control, and that their medication is on top of it. He talks about the condition being variable for people with mild symptoms, but it can be a killer. A key part of the campaign that all of us want to support is about ensuring that people have regular check-ups and do not ever take asthma for granted.

--- Later in debate ---

[Sir Oliver Heald]

That is exactly the point that I was coming on to make. It would be a mistake to assume that because NICE found that one third of the people it looked at had no symptoms, those people could heave a sigh of relief and forget about asthma for ever. People—as I did—can have periods when they are symptom-free, but they still need regular reviews to ensure that it does not come back or suddenly get worse.

The Royal College of Physicians identified major avoidable factors in two thirds of cases where people died, which were about the constant monitoring and attention to detail that my hon. Friend the Member for Stevenage mentioned. It did not cite all the evidence, but it seems that there are two unstable types of asthma that are often resistant to treatment and that can be a contributory factor. We need more research, awareness and knowledge that it is a variable condition, and that people should therefore not make assumptions or be complacent.

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Dorries. I congratulate the hon. Member for Stevenage (Stephen McPartland) on securing the debate. I commend the work that he and the all-party group on respiratory health do to raise awareness of these important issues in Parliament.

It cannot be denied that care for respiratory health conditions demands far more attention than it currently receives. Asthma, after all, is one of the most widespread and pernicious conditions around, and takes up a huge amount of resources in our health service. I share the hon. Gentleman’s concerns. We need to ensure the proper use of inhalers. My eldest son is asthmatic. He certainly has regular asthma reviews, and my wife and I, like the hon. Gentleman, try to ensure that such reviews are never missed, because they are so important.

The amount of research time that asthma gets is not proportionate to the scale of the problem, and routine asthma care simply is not up to scratch. The hon. Gentleman made that point well; the fact that he has been receiving pretty much the same treatment for the past 15 years speaks volumes. Respiratory disease is the third biggest killer in the UK, but the risk of conditions such as chronic obstructive pulmonary disease and asthma is perennially underestimated. The rate of deaths from respiratory disease in the UK is around three times that in Estonia and Finland.

Like the hon. and learned Member for North East Hertfordshire (Sir Oliver Heald), I get wheezy at sport. That has nothing to do with being asthmatic; it is more to do with my fitness levels. However, he made an important point that awareness of asthma, in the medical community in particular, is crucial. In 2010, I was very ill. My GP diagnosed asthma and prescribed me inhalers, which made me much worse because I was not asthmatic; I had pneumonia. That highlights the real need for the GP community to understand the specific needs of patients and whether asthma is prevalent, because some medication, as I found out to my detriment, can make people much sicker.

We have not touched on smoking to any degree, but we need to reduce its impact on respiratory health. That is a key factor. Patients need to be supported by clearer links being made between smoking and the start of respiratory disease, and there needs to be easier access to effective smoking cessation services and implementation of appropriate tobacco control measures.

There is, of course, a general awareness of the dangers of smoking. Needless to say, many have accepted the associated risks, but many have not. Two thirds of adult smokers took up smoking as children, so alongside measures to help people to quit smoking, we need to support those who have quit so that they do not relapse. We need to reduce exposure to second-hand smoke, and we should focus on protecting children and helping them not to take up smoking in the first place.

Around 10 million adults in Britain—about 20% of the population—smoke. Every year, smoking causes around 100,000 deaths. It is a major driver of health inequalities. Smoking rates are markedly higher among low income groups. I was pleased to see that the APPG report recommended the urgent implementation of standardised packaging for cigarettes, which Labour wholeheartedly agrees with. An independent report by King’s college London found that it was

“highly likely that standardised packaging would serve to reduce the rate of children taking up smoking”.

I commend the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), on her commitment to introducing plain packaging; I hope that the Minister present today will join her in the Lobby and encourage his colleagues in the Cabinet and on the Back Benches to support the measure. Christopher Hope of The Daily Telegraph only last week suggested that as many as 100 Conservative MPs planned to vote against the measure. Will the Minister support the measure and, if so, will he encourage his colleagues to do the same?

There are other measures that the Government could implement to reduce rates of smoking. Tackling the problem of toxic second-hand smoke, for instance, is crucial. It can pose terrible challenges to children’s health because of their smaller lungs and faster breathing, and the risks are increased in the confines of a car, for example. It is staggering that every year, second-hand smoke results in about 300,000 GP visits and nearly 10,000 hospital admissions among children.

That is why I was proud of the sterling efforts of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) in getting a ban on smoking in cars through Parliament. More than 430,000 children every week are exposed to second-hand smoke in the family car, so when the House of Commons voted overwhelmingly for a ban, it was a great moment. However, the onus is now on the Government to act according to the wishes of the House, and to make the measure law at the earliest opportunity. I call on the Minister to commit to taking that step.

I was pleased by the proposals in the all-party group’s report for more joined-up asthma care. As part of Labour’s 10-year plan for the national health service, we have proposed a joined-up approach to long-term care, with patients being given more say in their care plans and more control over their data, so that that they can make more informed choices. That would be particularly pertinent to conditions such as chronic obstructive pulmonary disease, where a bad flare-up can prove life-threatening. Patients with such conditions should have more say in their care pathways. COPD exacerbations are the second most common cause of emergency hospital admissions, so it is clear how important it is to ensure that people can prevent complications where possible.

Clearly, there is some way to go on cutting rates of smoking and giving people support to stop smoking. However, it is also our responsibility to give people the option to influence their own health care. Hospitals provide advanced care, which often cannot be provided anywhere else, but swift developments have meant that lots of care that could previously be provided only in hospital can now be provided in the community. That is a huge leap forward. On the whole, the most deprived are admitted to hospital more often, not because of a higher propensity to fall ill, but because of the inadequacy of community services.

For example, with forms of COPD, most medical professionals firmly believe that good self-care can provide an incalculable benefit to patients. Those who know exactly how to administer their own long-term care tend to live longer and experience less pain, anxiety and depression. They also enjoy a better quality of life because they are more active and independent.

[Sir Oliver Heald]

That bears on a point made by my hon. Friend the Member for Stevenage (Stephen McPartland). Does the hon. Gentleman agree that, in many ways, carers have an important role as well? When someone encourages a person to take their medicine on time, or to go to their annual review, that is important. Carers are often unsung.

[Andrew Gwynne]

I absolutely agree. Carers have an important role in how we integrate health and social care, and we should never underestimate the role they play in providing care for close relatives and friends. The hon. and learned Gentleman is right.

It is only with integrated care that complications can be spotted earlier and hospital admissions potentially avoided. Regular reviews with a patient’s health care team, including information-sharing with other parts of the NHS, can make all the difference. However, there is also a lot to be said for the provision of far more advice and help to those caring for people with COPD.

Labour has said that it will guarantee a single point of contact for people with complex physical and mental health conditions—somebody with the authority to get things done. We will also establish the right to a personalised care plan, developed with the individual and their family, tailored to personal circumstances and not restricted by service boundaries. Patients with conditions such as COPD will also have the right to access peer support and advice from others learning to manage the same condition, which could prove helpful.

I commend the hon. Member for Stevenage on his hard work in advancing the cause of those with respiratory health conditions. Irrespective of the general election outcome, which is largely out of the control of all of us, this issue must be an absolute priority for whomever forms the Government in the next Parliament, and I give the hon. Gentleman a commitment from the Labour party that, if we find ourselves on the Government Benches, it will be.