Asked by: Baroness Masham of Ilton (Crossbench - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the report by Asthma UK Living in limbo, the scale of unmet need in difficult and severe asthma, published in 2019, which found that four out of five severe asthma patients are not referred to specialists for treatment.
Answered by Lord Bethell
The UK Severe Asthma Registry (UKSAR) has gone from having less than 2000 patients registered to over 8000 patients as a result of work on the asthma pathway. Severe asthma services will continue to participate in the NHS England and Improvement Accelerated Access Collaborative programme to deliver the best healthcare to severe asthma patients. The UKSAR is the world’s largest national severe asthma registry and provides novel insights across a range of research areas as well as enabling annual reporting on performance outcomes for severe asthma services.
Asked by: Lord Hunt of Kings Heath (Labour - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have, if any, to develop a national comprehensive severe asthma guideline to ensure that people with severe asthma are identified and treated correctly.
Answered by Lord Bethell
NHS England and NHS Improvement have recently updated their specialised commissioning service specification for managing difficult and severe asthma. A copy of the service specification is attached.
Asked by: Earl of Dundee (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what plans they have to reduce the incidence of asthma in the UK.
Answered by Lord Bethell
The NHS Long Term Plan set out the commitments and objectives for the National Health Service for the next 10 years. The plan includes respiratory disease as a national clinical priority, with the overarching objective of improving outcomes for people with respiratory disease, including asthma. This includes early and accurate diagnosis of respiratory conditions like asthma to provide the opportunity for better management which can help prevent exacerbations and avoidable emergency admissions.
NHS England and NHS Improvement have established 13 respiratory clinical networks across the country, to provide clinical leadership of respiratory services. One of their objectives focuses on improving clinical pathways for asthma. The Quality Outcomes Framework (QOF) ensures all general practitioner (GP) practices establish and maintain a register of patients with an asthma diagnosis in accordance with the National Institute for Health and Clinical Excellence’s guidance. An update to the GP Contract for 2020/21-2023/24 to be implemented in 2021 includes an improved QOF asthma domain. The content of the asthma review has been amended to incorporate aspects of care positively associated with better patient outcomes and self-management, including a review of inhaler technique and record of exacerbations.
Asked by: Earl of Dundee (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what assessment they have made of the impact of asthma on the lives of (1) those with the disease, and (2) their families.
Answered by Lord Bethell
The NHS Long Term Plan set out the commitments and objectives for the National Health Service for the next 10 years. The plan includes respiratory disease as a national clinical priority, with the overarching objective of improving outcomes for people with respiratory disease, including asthma. This includes early and accurate diagnosis of respiratory conditions like asthma to provide the opportunity for better management which can help prevent exacerbations and avoidable emergency admissions.
NHS England and NHS Improvement have established 13 respiratory clinical networks across the country, to provide clinical leadership of respiratory services. One of their objectives focuses on improving clinical pathways for asthma. The Quality Outcomes Framework (QOF) ensures all general practitioner (GP) practices establish and maintain a register of patients with an asthma diagnosis in accordance with the National Institute for Health and Clinical Excellence’s guidance. An update to the GP Contract for 2020/21-2023/24 to be implemented in 2021 includes an improved QOF asthma domain. The content of the asthma review has been amended to incorporate aspects of care positively associated with better patient outcomes and self-management, including a review of inhaler technique and record of exacerbations.
Asked by: Earl of Dundee (Conservative - Excepted Hereditary)
Question to the Department of Health and Social Care:
To ask Her Majesty's Government what steps they are taking to improve asthma outcomes.
Answered by Lord Bethell
The NHS Long Term Plan set out the commitments and objectives for the National Health Service for the next 10 years. The plan includes respiratory disease as a national clinical priority, with the overarching objective of improving outcomes for people with respiratory disease, including asthma. This includes early and accurate diagnosis of respiratory conditions like asthma to provide the opportunity for better management which can help prevent exacerbations and avoidable emergency admissions.
NHS England and NHS Improvement have established 13 respiratory clinical networks across the country, to provide clinical leadership of respiratory services. One of their objectives focuses on improving clinical pathways for asthma. The Quality Outcomes Framework (QOF) ensures all general practitioner (GP) practices establish and maintain a register of patients with an asthma diagnosis in accordance with the National Institute for Health and Clinical Excellence’s guidance. An update to the GP Contract for 2020/21-2023/24 to be implemented in 2021 includes an improved QOF asthma domain. The content of the asthma review has been amended to incorporate aspects of care positively associated with better patient outcomes and self-management, including a review of inhaler technique and record of exacerbations.
Asked by: Jonathan Ashworth (Labour (Co-op) - Leicester South)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, whether he plans to develop a national comprehensive severe asthma guideline to ensure that people with severe asthma are identified and put on the right treatments.
Answered by Edward Argar - Minister of State (Ministry of Justice)
Through NHS England and NHS Improvement specialised commissioning, a comprehensive specification for managing difficult and severe asthma is available. This has been refreshed recently and is available at the following link:
Those with severe asthma require systematic assessment and specialist care in tertiary respiratory centres, as there is no standard diagnostic test for severe asthma.
Asked by: Henry Smith (Conservative - Crawley)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, pursuant to the Answer of 22 June 2020 to Question 60724, what steps his Department is taking to ensure at-home treatment of severe asthma patients is available and offered to all patients; and what assessment has been made of the clinical capacity released within respiratory units as a result of such home management.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
Specialist respiratory services for severe asthma, along with urgent and emergency treatment for other serious complaints, have continued throughout the COVID-19 outbreak. In most cases people with severe asthma have been able to receive their medication at home instead of having to attend hospital through increasing home care support and via access to remote outpatient consultations for new patients.
Although clinical capacity was re-directed to support care of patients with COVID-19 and this need has reduced, trusts are also required to prepare for potential future waves of COVID-19 and this will affect the clinical capacity required particularly in respiratory units. Regions have oversight of the local plans developed by each trust.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, with reference to the Answer of 22 June 2020 to Question 58769, what assessment he has made of the reduction in severe asthma patients beginning biologic therapies from January to March 2020; and what steps he is taking to increase uptake of those therapies to pre-covid-19 levels.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
NHS England and NHS Improvement’s Chief Executive wrote to the National Health Service in July 2020 setting clear expectations about the need to accelerate the return to near-normal levels of non-COVID-19 health services, with target dates for both outpatient and inpatient services. Prior to this, all regions were tasked with restoring services which included developing COVID-19 safe pathways for all patients. Regions have access to local data and national data to assist in this process. Patients with severe asthma disease have been considered within these plans.
Further to this, NHS England’s specialised services commissioners identified restoration of respiratory services as a priority within its portfolio of responsibilities and considered mitigations in the event of a further waves of the pandemic. NHS England and The Getting It Right First Time (GIRFT) programme have produced guidance to support commissioners and hospitals in restoring specialist respiratory services following the first wave of the pandemic. The development of this guidance was led by specialists, and involved NHS England’s clinical reference group, and the GIRFT clinical lead.
Further work is being undertaken to share best practice on providing care to people with severe asthma to ensure ongoing provision of high-quality care and to accelerate the initiation of biologics where required. A severe asthma toolkit has been developed and will be circulated to teams shortly.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, pursuant to the Answers of 22 June 2020 to Questions 58768 and 58769, what assessment he has made of the effect of waiting times on patients awaiting (a) assessment and (b) treatment for severe asthma in order to understand potential regional variation; and what plans he has to reduce waiting lists for those patients.
Answered by Helen Whately - Minister of State (Department of Health and Social Care)
NHS England and NHS Improvement’s Chief Executive wrote to the National Health Service in July 2020 setting clear expectations about the need to accelerate the return to near-normal levels of non-COVID-19 health services, with target dates for both outpatient and inpatient services. Prior to this, all regions were tasked with restoring services which included developing COVID-19 safe pathways for all patients. Regions have access to local data and national data to assist in this process. Patients with severe asthma disease have been considered within these plans.
Further to this, NHS England’s specialised services commissioners identified restoration of respiratory services as a priority within its portfolio of responsibilities and considered mitigations in the event of a further waves of the pandemic. NHS England and The Getting It Right First Time (GIRFT) programme have produced guidance to support commissioners and hospitals in restoring specialist respiratory services following the first wave of the pandemic. The development of this guidance was led by specialists, and involved NHS England’s clinical reference group, and the GIRFT clinical lead.
Further work is being undertaken to share best practice on providing care to people with severe asthma to ensure ongoing provision of high-quality care and to accelerate the initiation of biologics where required. A severe asthma toolkit has been developed and will be circulated to teams shortly.
Asked by: Rachael Maskell (Labour (Co-op) - York Central)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what assessment he made of the implications of reliever inhalers for the carbon footprint of propellant inhalers when establishing the metric in the Primary Care Network Contract to tackle that footprint; and for what reason reliever inhalers were excluded from that metric.
Answered by Jo Churchill - Minister of State (Department for Work and Pensions)
We are informed by NHS England and NHS Improvement that carbon impact of reliever inhalers was reviewed when establishing the proposed indicator as part of the Investment and Impact Fund in the Network Contract Direct Enhanced Services (DES). The final version of the Network Contract DES did not include the Investment and Impact Fund proposals for the first six months of the 2020/21, to ensure Primary Care Networks were able to focus on the COVID-19 pandemic.
The original proposal provided an opportunity to encourage a move towards lower carbon inhalers, where clinically appropriate and as part of regular medicines review, within the evidenced range of existing local prescribing practice. Reliever (SABA) inhalers were not included in the proposals at this stage, given the clinical evidence that an MDI inhaler may remain more appropriate where used for exacerbations (such as asthma attacks). However, NHS England and NHS Improvement are simultaneously pursuing a variety of strategies to also support a shift away from high-carbon SABA options where this can be done in a safe and clinically appropriate way.