Respiratory Health

Stephen McPartland 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.

[Caroline Nokes (Romsey and Southampton North) (Con)]

I congratulate my hon. Friend on having secured this debate. Does he agree that there is a real problem with undiagnosed COPD, which is contributing to those hospital admissions? People are presenting for treatment only when they are in crisis.

[Stephen McPartland]

My hon. Friend makes an important point. In fact, we believe that more than 2 million people in the UK have COPD but are completely undiagnosed. The British Lung Foundation has done a great deal of work to try to raise the profile of COPD. It has also done a great deal of work on pulmonary rehabilitation with its “Breathe Easy” groups, which help people who are suffering from COPD to access support networks and improve some of the scarring and problems that they have with their lungs. A recent study of more than 39,000 COPD patients showed that more than half had symptoms for six to 10 years before the diagnosis was made—my hon. Friend’s point is powerful—and 42% had has those symptoms for up to 15 years before being diagnosed.

I want to tell the story of Neil, 50 years old and from Norwich. He was continually misdiagnosed by doctors despite being at high risk of lung disease and showing signs of the condition throughout his 30s. By the time he was finally diagnosed, he had lost most of his lung capacity.

Neil was a long-term smoker who worked for many years in cold and dusty conditions. When he was younger, he visited doctors regularly and had breathless attacks that sometimes required emergency treatment in hospital. However, he was never offered a lung function test by his doctor, and he felt that his smoking habit was used as a reason to dismiss his symptoms and not investigate them fully. At the age of 39, he finally managed to see a specialist in the hospital, but his symptoms led doctors to think that he had asthma.

When a doctor told him the extent of the scarring and damage already done to his lungs, Neil decided to quit smoking on that very same day. He also cut back on some work to improve his working conditions. Five years ago, he developed two bouts of pneumonia. His health deteriorated: he felt constantly breathless and could barely walk 50 feet. Even at that stage, Neil was not given a lung function test or information about how to manage his condition; instead, he was told that he could expect to recover soon. He was forced to give up work completely and his wife Wendy had to start caring for him.

Eventually, a doctor told Neil that he had COPD. He had lost 70% of his lung function by the time he was told that he had COPD. He was able to speak to a specialist nurse at his local surgery who took the time to work with him and got him referred to pulmonary rehabilitation, and he became a member of one of the British Lung Foundation’s “Breathe Easy” groups, which are support networks that help people with COPD to come together to improve their conditions and exercise levels, to move forward and to improve themselves all round.

Neil can now talk quite a bit, and he speaks at length about his condition. He has decided that everyone who attends a “Breathe Easy” group becomes an expert on respiratory health and care. Fortunately, his experience was positive in the end, but he had lost 70% of his lung function before he was diagnosed with COPD—that could have been done five or 10 years earlier. Sadly, Neil’s story is a classic example of what is happening right now in GP surgeries and hospitals throughout the country. People have a right to know if they develop such a condition, and they must believe that they will receive the treatment that they want and deserve when they come forward with it.

A big Public Health England awareness campaign is due to take place in the east of England, involving a breathlessness exercise. I did it myself last year in Stevenage—although I would urge Members not to look at the photograph on my website that shows me taking the test because it was a bad hair day and it is an odd photograph—and the nurses were able to tell me that I had asthma, which is very well controlled. Throughout the day, they diagnosed a number of people with COPD, asthma and a range of other respiratory diseases. Had that bus not turned up in Stevenage and those volunteers had not been given those tests, a large number of those people would not know that they had a respiratory disease. Fortunately, the campaign will be rolled out across the whole of the east of England, so I hope that the Minister will visit it and identify whether it is a positive thing that could be rolled out throughout the country.

The NHS health check for those between the ages of 40 and 74 does not include a lung function or respiratory disease test, but 13% of all people over the age of 35 already have COPD. A lung function test should be included because, as my experience on the breathlessness bus in Stevenage showed, such a check would pick up large numbers of people, enabling them to get the care that they need. They will then be able to push on with their lives, instead of having to wait 10 years and only being told, when they are admitted to hospital with the possibility of dying within four years, that they might have COPD.

I am passionate about the need to improve basic care for people with asthma, and I join Asthma UK in highlighting the seriousness of a condition that affects 1.1 million children and 4.3 million adults in the UK. The sort of headlines that we saw last week, which were referred to by my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), are unhelpful when we know that too many people are complacent about asthma. Every 10 seconds, someone in the UK has an asthma attack. Every single day, on average, three people die in the UK from an asthma attack. The national review of asthma deaths, which was led by the Royal College of Physicians, suggests that two out of three of those deaths are preventable.

That review by the Royal College of Physicians was the first such review in this country. It was begun in 2012 and lasted a year, and it was published in May 2014. It found that 57% of people who died from asthma were not recorded as receiving specialist care 12 months before their death; 47% of those who died had a history of hospital admissions; and 21% had attended A and E within the previous 12 months. A written asthma action plan is a step-by-step guide to managing asthma and provides individuals with guidance on what to do if they have an asthma attack, but only 23% of the people who died had an asthma action plan, so more than 75% did not have one.

The Royal College of Physicians found that many asthma deaths could have been avoided had staff received better training. In fact, the expert panel found that 46% of such deaths could have been avoided had the existing asthma guidelines been implemented. The review also found evidence for both over and under-prescription of reliever inhalers, the blue bronchodilators. On average, someone should receive 12 inhalers a year; a number of people are receiving far fewer than 12 and, among a variety of other figures, some are receiving up to 50 inhalers a year. Just from the number of prescriptions, we can identify the target audience of people who will be seriously at risk of dying from an asthma attack.

The statistics and the all-party report both make it clear that too many people are not getting the basic levels of care and that there is great variation in the standards of that care across the country. It is essential that clinical standards are followed consistently. I have asthma myself, so I understand that the condition is complex and variable and should be taken seriously. People with asthma should continue to use their inhalers routinely and ensure that they attend their annual asthma review, at which they may discuss their diagnosis, medications and written asthma action plan.

Last year, more than 1 million people who have asthma did not turn up to their asthma review. I did, because my wife, my mum and my asthma nurse all gang up on me and force me to go every single year. They almost insist on me having my flu jab twice a year. In Parliament, I normally host a session for people with respiratory conditions to have their flu jabs each year. Unless I provide a picture of myself receiving the needle at that session, I am required to have another at my GP’s surgery in Stevenage. So I have to smile at the camera while the lady enjoys stabbing me with a needle—I am sure she takes a little longer than she should. I do that every year.

Let me tell the House about my experience of asthma. I was diagnosed with it when I was eight, and I am now 38 years of age. The Minister will be shocked and disappointed to know that my treatment has not changed in 30 years. The experience at the doctor’s that I had when I was eight is exactly the same as my experience now, except that nowadays I see an asthma nurse, whereas then it was a doctor. The asthma nurse takes the time to go through my peak flow monitor with me, and she weighs and measures me—I think I get shorter every year, and a little heavier—but in effect that is what the doctor was doing when I was eight, although then I was getting slightly taller, if slightly heavier too. The reality is that things have not changed at all.

I was one of those children who was diagnosed with bronchitis from the age of about five until I was eight. The doctors thought, “Oh no, it hasn’t gone in three years, so he must have asthma”, so I was given my inhalers. If I turned up to the doctor’s and said, “I have got this or that”, they would say, “Are you using your inhalers?” I would reply, “Yes, I am using my inhalers.” They would say, “Why don’t you take your blue reliever inhaler”—they call it a Ventolin bronchodilator—“a little more?” That would be my treatment. I have not had antibiotics, but if I were younger, they might have given me a two-week course of them and told me to come back if whatever it was had not cleared up. In effect, that is what I got when I was eight and what I get now when I am 38. That is why we have the highest rate of respiratory deaths among the OECD countries—the treatment for asthma for people at GP surgeries up and down the country has not really changed. It is exactly the same.

There has been some progress. I am delighted to report that after a campaign of three and a half years by myself, other Members of Parliament and Asthma UK, for the first time we can now have asthma inhalers in first aid kits in schools. It took us three and a half years, which is ridiculous, because those inhalers are prescribed medication, which could not simply be given out by a teacher.

[Sheryll Murray (South East Cornwall) (Con)]

My hon. Friend might be aware that before I came to this place, I was a receptionist for a GP. One of the biggest problems that parents find is that they do not have two inhalers prescribed at the same time for their child, so that one can be kept at school and one at home. That is one reason why we need to ensure that all schools have an inhaler for use in an emergency.

[Stephen McPartland]

My hon. Friend makes an important point. I suffer from that myself, so I have an overnight bag in Parliament in case we get stuck here until 4 or 5 in the morning, and it has an inhaler in it. I had to get that inhaler off my dad, because I could not get another one off my own GP. I am a Member of Parliament, but I could not get myself an extra inhaler, so I am not sure what chance a child has of persuading an extra inhaler off the doctor, which his mates will probably just play with. I understand such problems, which is why I said earlier to the Minister that the treatment for asthma has not really changed in the 30 years that I have had it. There has been progress and good news—a number of children will not now die of asthma attacks in school over the next five to 10 years, because those inhalers are in first aid kits. Instead of a mate lending one, it will now be a matter of simply getting it out of the first aid kit, which is good news.

We are seeing great examples of innovation and high-quality asthma care throughout the country, with health care professionals working tirelessly to improve outcomes. They are looking for a cure for asthma. There are centres of excellence, such as the Royal Brompton hospital in London, which provides life-saving specialist care for people with severe asthma—I hope I never have to visit the place. The UK has some of the best asthma researchers, changing the way we think about the causes of asthma. In my constituency thousands of GlaxoSmithKline scientists are working on managing the condition of respiratory diseases on a daily basis; they are leaping forward with the ways in which we can manage such conditions. I thank them all for their brilliant work.

I am sure the Minister is aware that we have some recommendations and questions for him. Shockingly, the NHS does not track its own performance on asthma care. Despite asthma being one of the most common long-term conditions in the UK, no robust data are available. We would like to see a national clinical audit for asthma. Will the Minister commit to supporting such an audit and raise the matter with NHS England? An audit has the potential to stop people needlessly dying from asthma attacks, to improve the quality of life for people with asthma and to reduce costs for the NHS significantly. Such audits are already well established for other long-term conditions such as diabetes.

There should also be greater investment in asthma research. Research into the treatment and care of asthma and other lung conditions is chronically underfunded compared with other conditions such as the other four big killers. The amount of money committed to researching asthma simply does not match the burden it places on the NHS. In spite of that, amazing breakthroughs are taking place and there is potential. Asthma UK is working with the European Asthma Research and Innovation Partnership to establish a new fund to research and develop asthma drugs, with the ultimate aim of finding a cure for asthma. Will the Minister meet me and Asthma UK to explore how the Government can support the European innovation fund?

A variety of asthma research demonstrates that many people have allergies. Of those who have asthma, 50% are more than likely to have some kind of allergy that causes an asthma attack—we call them triggers. We do not have the lung function or capability that those without asthma have, so we have to learn quickly what our triggers are and avoid them. One of my triggers is pets, so although I am 38 I have never had a pet, which is quite sad.

We would also like to see written asthma action plans. The Secretary of State for Health has made a positive commitment to ensuring that every asthmatic has a written asthma action plan, so will the Minister tell us what plans the Government have in place to achieve that commitment? Once someone has an action plan it helps to reduce the seriousness of their attacks, because they learn quickly to manage their own condition. It is a serious condition, and people have to work on improving things such as their peak flow. There are bits and pieces that doctors and asthma nurses do with asthma sufferers—we compete with ourselves to try to improve in our asthma action plan.

We believe that there should be world-class asthma reviews containing key components; that is an item that came up in the national review of asthma deaths. It could result in a nationwide improvement in asthma. A variety of organisations are ready to help to develop the idea and work with the Department of Health and NHS England to make it a reality. The national review found that many asthma reviews did not include key components—only 27% of people had their asthma control assessed, only 42% had an assessment of their medication use and only 71% had an assessment of their inhaler technique. People are using their inhalers in a variety of ways, and could be losing between 40% and 60% of the medication’s effectiveness if they are using them incorrectly, yet almost 30% of people are not being assessed on an annual basis on how they use their inhaler. That could reducing the effectiveness of their medication.

We would like the Minister to support the creation of a world-class asthma review and to encourage NHS England to get on and actually do it. We know that NHS England is working on an improvement programme for children’s asthma, and we would like him to commit to continuing to resource that project into 2015-16. We have already seen significant successes in secondary and tertiary care for children.

It would not be a debate on asthma without a call—I have to declare an interest here—for free prescriptions for those with asthma; all asthma sufferers would like that. People suffering from many other long-term conditions receive free prescriptions for their inhalers, but asthmatics do not. If asthmatics do not take their inhalers they end up in an A and E facility receiving oxygen, normally after an ambulance crew has transported them there, giving them oxygen on the way. That costs a huge amount of money.

My final point is that smoking is a contributory factor in more than a third of all respiratory deaths. The health impact of smoking on asthma sufferers is enormous, so I personally call on the Government to get on and do all they can to push forward standardised packaging for cigarettes as soon as possible.

[Several hon. Members]

rose—