Chronic Obstructive Pulmonary Disease

Ruth Jones Excerpts

Wednesday 17th November 2021 Westminster Hall

[Ruth Jones (Newport West) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Nokes, and to speak in this important debate today. I am very grateful to my hon. Friend the Member for Weaver Vale (Mike Amesbury) for securing this debate and raising such an important issue. Ms Nokes, you may know that as well as being Member of Parliament for Newport West, I am shadow minister for air quality, so these issues are very important to me.

The link between air pollution and lung disease is obvious to all of us. Before I came to this House, I spent 30 years working as a physiotherapist in the NHS, so I know a little bit about lungs. Thanks to the excellent campaigners at the British Lung Foundation and Asthma UK, we have the data today—the important statistics that we all need. Two in five, or 41%, of babies are born every year into heavily polluted areas of the UK, where levels of particulate matter 2.5 are higher than the 2005 World Health Organisation recommendations. That equates to over a quarter of a million babies every year, or one born every two minutes. Over a third of all maternity units in England exceed the World Health Organisation’s air quality guidance; if we use the new guidelines, which came out a couple of months ago, that figure reaches almost 95%.

We also know that some 85% of people who live in areas with illegal levels of nitrogen dioxide make up the poorest 20% of the UK population. Birmingham, Liverpool and Manchester rank among the top 10 areas with the highest proportion of deprived neighbourhoods in England, and all those cities have main roads that breach legal nitrogen oxide limits. I know from my work with my hon. Friends the Members for Manchester, Withington (Jeff Smith) and for Weaver Vale, as well as the metro Mayors Steve Rotheram and Andy Burnham, how much work is needed to address these issues. Similarly, people in the poorest communities are two and a half times more likely to develop COPD than those in more affluent communities, and we know that disadvantages in early life are linked to the development of COPD. I make no apologies for sharing this data, and I will go on: some 29% of hospitals, 37% of GPs’ surgeries, 31% of schools and 26% of care homes in England are located in communities with levels of PM_2.5 above the levels recommended by the WHO. Of course, those guidelines have been strengthened in recent months, so the pressure on Ministers is even greater now.

The link between toxic air and lung disease is so devastating, and I note that 43% of respondents to the Asthma UK-BLF survey reported that their COPD was adversely affected by air pollution. More broadly, 88% of people with a lung condition have said that air pollution affects their health and wellbeing, so it is not just physical symptoms we are dealing with, but mental health symptoms. Of those who responded to the survey, 63% of people with a lung condition can feel out of breath and 53% have increased coughing due to high levels of air pollution. Some 60% of people with a lung condition affected by air pollution say that they have been discouraged from leaving their home due to air pollution at some point, with 28% feeling this way at least once a month.

This House needs to listen to those affected daily by the impact of toxic air on those living with existing lung disease. In Parliament and out in the community over the past year, I have repeatedly raised the fact that the time to act has well and truly come. Almost 60% of people in England now live in areas where the levels of toxic air pollution exceeded legal limits in 2019 and 2020. We cannot go on as we are: we require real leadership, and we require it now. The Government’s so-called landmark Environment Act 2021 was a missed opportunity to contribute to cross-Government solutions to this problem. I know that much of environment policy is devolved to the nations of the UK, and that health policy is also devolved, but that does not mean there cannot be a co-ordinated approach with the devolved Administrations to addressing this very serious issue. I would be grateful if the Minister outlined the discussions that have taken place, and will take place in the weeks ahead, with the devolved nations.

The covid pandemic saw a big change in people’s behaviour and lifestyle habits, and we saw how that led to cleaner air and a healthier environment, although it was a temporary change. We all know that air pollution is a public health crisis, as my hon. Friend the Member for Weaver Vale has outlined. Last summer, the British Lung Foundation and Asthma UK surveyed about 14,000 people with a lung condition and found that a great many people noticed an improvement in their symptoms, likely due to better air quality during lockdown.

In my more than 30 years working in the NHS as a physio, I saw every day the damage that toxic air can cause to the lungs, health and mobility of people of all ages and from all communities, including those whose lungs are damaged while still in the womb, and those suffering from asthma, COPD and other serious lung conditions. The task of making our air cleaner starts with each of us. It is important that we are all aware of the air pollution levels in the communities we live in, so that we know the local challenges facing us all.

I am so grateful to my hon. Friend the Member for Weaver Vale for calling this debate and providing the opportunity to highlight the very grave link between toxic air and COPD. I hope he will feel better soon. We must act and we must act now.

[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 ---

[The Minister for Care and Mental Health (Gillian Keegan)]

It is a pleasure to serve under your chairmanship, Ms Nokes, for the first time. I add my thanks and congratulations to the hon. Member for Weaver Vale (Mike Amesbury) on securing this debate, particularly on World COPD Day. We very much appreciate his support for the taskforce for improving lung health. It was also a pleasure to hear hon. Members’ contributions to the debate, and I will try my best to answer their questions.

The Government are dedicated to supporting those with chronic obstructive pulmonary disease, or COPD, which is a lot easier to say. In the last 10 years, we have rolled out guidance and initiatives to support and improve this area.

In 2011, a Department of Health outcomes strategy for COPD and asthma set out a proactive approach to early identification, diagnosis, intervention, proactive care and management at all stages of the disease. A wrong diagnosis will result in patients not getting the care they need, as a number of Members mentioned. That is why in 2013 a guide to performing quality-assured diagnostic spirometry was produced by the NHS, with several charities and other stakeholders. The guide was published to support accurate diagnosis of respiratory conditions and tackle the effects of misdiagnosis.

The national asthma and COPD audit programme was launched in March 2018. Led by the Royal College of Physicians, it aims to improve quality of care, services and clinical outcomes for patients with asthma and COPD by collecting and providing data on a range of indicators. As part of the national COPD audit programme, NHS England and NHS Improvement have developed a best practice tariff for COPD. The tariff is applicable to hospital trusts, in order to promote best practice and ensure improvements in care. Best practice will be considered to have been achieved when 60% of patients admitted for an exacerbation of COPD receive specialist input to their care within 24 hours of admission, and where COPD patients receive a discharge bundle before actually being discharged.

The NHS long-term plan sets out the NHS ambition to improve access to treatments for COPD patients. A date was requested by the hon. Member for Strangford (Jim Shannon). As part of the long-term plan, access to pulmonary rehabilitation will be expanded by 2028. Pulmonary rehabilitation, an exercise and education programme, is one of the most effective treatments for COPD, with 90% of patients who complete the programme experiencing improved exercise capacity or increased quality of life. By expanding pulmonary rehabilitation services over 10 years, 500,000 exacerbations can be prevented and 80,000 admissions avoided.

[Ruth Jones]

I take the Minister’s point about pulmonary rehabilitation being so important—an integral part of the management of these long-term chronic conditions—but 10 years is a long time. People need help now, so what is she thinking in terms of immediately putting into place the extra staff and resources required for pulmonary rehab?

[Gillian Keegan]

I will come to that, and I will also come to the questions about recovery and catch-up, which a number of people mentioned.

To increase access to pulmonary rehabilitation, a population management approach will be used in primary care to find eligible patients from existing COPD registers who have not previously been referred to rehabilitation. New models of providing rehabilitation to those with mild COPD, including digital tools, will be offered to give support to a wider group of patients with rehabilitation and self-management support.

The use of COPD discharge bundles, where appropriate, will also help to increase referrals to pulmonary rehabilitation, and the NHS long-term plan will build on a range of existing national initiatives focused on respiratory disease. The quality and outcomes framework, or QOF, ensures that all GP practices establish and maintain a register of patients with a COPD diagnosis, and the QOF for 2021-22 includes the improved respiratory indicator, including the recording of the number of exacerbations and assessments of breathlessness, and an offer of referral to PR.

NICE quality standards have been published, with the aim of raising the standard of care that those with COPD receive. The NHS RightCare Pathway for COPD is being rolled out nationally. This pathway defines the core components of an optimal service for people with COPD, and it includes timely access to PR as part of the optimal treatment pathway. It provides resources to support local health economies, and the pathway also concentrates improvement efforts on addressing variation and population health.

At the beginning of the pandemic, NICE published rapid guidance on COPD, which outlines how to communicate with, treat and care for patients suffering from COPD. It also outlines how healthcare workers should modify their usual care and service delivery during the pandemic.