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Asthma

– in Westminster Hall at 12:00 am on 12th May 2004.

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Photo of Bob Laxton Bob Laxton Labour, Derby North 12:00 am, 12th May 2004

There are several good reasons—one of them is certainly a good reason—why I am pleased that I have secured this debate. First, when I entered the House, I became a member of the all-party asthma group because, along with many other hon. Members, I happen to be an asthmatic, and have been all my life. The second reason was the document published by Asthma UK the other week entitled "Living on a Knife Edge", which presents some useful statistical information about the impact that asthma has on society and the life and well-being of asthma sufferers.

Some of the statistics in the report are pretty dramatic. In this country, about 5.1 million people have asthma and 2.6 million of those suffer from the severe symptoms of asthma. That figure comprises about 2 million adults and about half a million children. The report shows the increase that took place between the 1980s and 1990s in the prevalence of asthma. It increased by 114 per cent. among males and no less than 165 per cent. among females.

In the report, Asthma UK makes the point that one in six of the individuals who suffer from asthma have weekly attacks so bad that they are unable to speak. Fortunately, my asthma is under control. As a Member of Parliament, one can hardly imagine anything worse than suddenly finding one could not speak—although some would argue that too much speaking takes place here, and I am as guilty of that as anyone.

What impact does severe asthma have on individuals? Many people's lives are—I was going to use the word "inconvenienced", but that is inadequate: it is far more severe than that. Despite taking large doses of medication, many people live disjointed and distressed lives as a result of asthma. Many people have it so badly that they are constantly being hospitalised. They are put on ventilators, they suffer from breathlessness, and so on.

Of course, there is no cure for asthma. When I was 18, the original treatment I received from a military doctor was a choice between benzedrine and ephedrine. These were heart stimulants: quite dangerous and powerful drugs that increase one's heart rate and take the pressure off one's chest. They are not nice medications and have some pretty unpleasant side effects. When, at the age of 30, my asthma suddenly became worse, I was very fortunate that in my constituency in Derby lived an individual by the name of Dr. Harry Morrow-Brown. I became very friendly with Harry. He was a consultant at the chest clinic and was—and still is—one of the world's foremost experts on the connection between allergy and asthma.

Harry, who is about 85 now, is still involved in running a charity in Derby: the Midlands Asthma and Allergy Research Association. It carries out pollen counts, so that people know about the effects of pollen and how it can trigger allergies, which can trigger asthma. He undertook a series of tests on me. He established—which was a bit traumatic at that stage of my life—that I was allergic to hops, malt and brewers' yeast. Some of those listening to the debate will know that those are—with the exception of water—all the ingredients in beer. Coming from Derby, just down the road from the brewing centre of the world, Burton-on-Trent, and as a moderate consumer of the finest Bass and Marston's Pedigree, which I still drink on occasion, it was dramatic for me, because I had to knock off drinking beer for two or three years.

Later, my asthma became more under control. Harry was keen on pushing the use of the preventers—steroid-based inhalers—that the medical profession at the time said would not work and were useless drugs. However, he put me on one and it has made my asthma eminently more tolerable. My asthma is under control. I think that such medication has made a huge change to asthmatics. However, while one can use preventers or relievers, there is no cure.

Let us consider the public perception of asthma. What do people who are not asthmatic think about it? Well, they think that it is a bit of coughing and wheezing, hacking and barking, and that the sufferer will get over it. Many people think that it is associated with childhood. "You have it as a child," they might say, "but don't worry, when you're 18 or 19, you'll grow out of it." The "Living on a Knife Edge" report illustrates the fact that, in some cases, people with severe asthma are embarrassed by it, because some people think that their breathlessness is something to do with obesity—that could not, of course, apply in my case—lack of exercise and being unfit.

The economic and human costs are immense. Each year, 18 million working days are lost. On average, it takes a week to recover from a severe asthma attack. There are 71,000 more hospital admissions for asthma each year. Asthma costs the NHS about £680 million a year. Emergency hospital admissions for asthma cost the NHS about £46 million every year, and 80 per cent. of that expenditure is spent on the 20 per cent. whose asthma is most severe.

Asthma affects people's relationships and family life. The "Living on a Knife Edge" report—I would recommend that anyone who is interested in the subject reads it—graphically illustrates cases of individuals whose family life has been disrupted, including teachers and people in all sorts of professions. Of those severe asthma sufferers that the report details, 44 per cent. feel that their social life is restricted; in particular, they feel unable to go out to pubs and bars because of the smoky atmosphere. A very graphic statistic is that more than 1,400 people die from asthma each year.

Photo of Andrew George Andrew George Shadow Minister (Environment, Food and Rural Affairs), Shadow Minister (Environment, Food and Rural Affairs)

I am very grateful to the hon. Gentleman for the excellent case that he is making, drawing on his own experience. I am also grateful to the Minister for attending the launch of the Asthma UK report last week on world asthma day. That was much appreciated.

Does the hon. Gentleman agree that, in supporting early-day motion 1082—which draws attention to the fact that 90 per cent. of asthma deaths are preventable—we need to concentrate not on the failure of the individual but on the need to ensure that asthma is properly managed and understood in both the medical profession and the community, to ensure that fewer preventable deaths from asthma occur?

Photo of Bob Laxton Bob Laxton Labour, Derby North

I could not agree more. I was making the point that the public perception of asthma is that it is to do with unfitness or obesity and that sufferers should go out and get some exercise. The hon. Gentleman is spot on; the public perception is distorted. People do not really understand the effects of asthma unless there is someone with asthma in their household.

Equally, many people, including me, have well-managed asthma. My GP, who looks after me extremely well, runs very effective asthma surgeries and clinics, which I regularly attend. However, many people struggle without knowing what medication is available. They do not get regular checks and are not registered with GP practices that undertake surgeries and clinics specifically to deal with asthmatics. The EDM highlights that. I will be interested to hear what my hon. Friend the Minister has to say about the issue.

Photo of David Drew David Drew Labour/Co-operative, Stroud

My hon. Friend makes a cogent case. Like him, I am an asthmatic. What he is saying is crucial as we move to a new generation of medicines. Does he agree that the issue is not just which medicines are available but how people use them? The Government must be attuned to the need for services for people who move on to new medicines, to ensure that they get the full benefit of them.

Photo of Bob Laxton Bob Laxton Labour, Derby North

Again, I could not agree more. There are new medicines and new delivery systems for them. Such systems are crucial, particularly for children and elderly people who sometimes find it difficult to get the correct dosage from some devices. There are mechanisms and pieces of kit that enable the correct dosage to be delivered. That is why it is important that some GP practices raise their game to ensure that their patients are aware of what is available to and appropriate for them and that they have regular check-ups.

What have the Government done and what is their position? A report on allergies has been produced by the Department of Health. It states that they are on the rise, that allergy services need improvement and that the record investment in the NHS should help. A great deal of work has been done by the Food Standards Agency to tackle allergies: better labelling, funding of research to investigate the causes of food allergies, and so on. However, I ask whether that is really enough to tackle asthma.

What do the all-party group on asthma and I think the Government should be doing? Respiratory disease is not included in the Government's national strategy for health. The British Lung Foundation has said that it finds that astounding. It believes that because diseases targeted in the national service framework are better funded, respiratory illness is "doubly disadvantaged".

I would like the Government to invest more in asthma care. Most asthma care is provided through primary care, often in dedicated clinics. However, uptake of such services is poor, at around 3 per cent., and few people have a personal asthma plan, which is important in controlling the affliction they live with. It makes a real difference if people with severe asthma see their specialist or GP at least once a year, even though it costs three times as much to treat a patient with stable asthma as opposed to one whose asthma is more difficult to control.

We should invest more in asthma research. The Government spend some £3 million a year, which only equals the amount spent by the charitable organisation Asthma UK. We must compare the amount that goes into research with the nearly £50 million spent on emergency hospital admissions for asthma. An even starker comparison would be with the £680 million the NHS spends each year to treat asthmatics. We need to understand what causes asthma so that we can develop better strategies to prevent its onset and provide better treatment for those who continue to suffer from it.

Comprehensive services for asthma care do not exist. They must be developed. There are evidence-based guidelines for the care of asthma, but they remain voluntary. The Government must ensure that they give official support to future guidelines.

Finally, there is one thorny issue about which we, as a nation, must make up our minds. The Government and others, including me, are studying New York's experiment with banning smoking to see what the social, economic and financial fallout will be. Closer to home, some of us are looking closely at what is happening in southern Ireland. So, my final point—there is a big question mark after it, and I shall be more than interested to hear what the Minister has to say about it—is whether we should be somewhat more positive about banning smoking in public places.

Photo of Stephen Ladyman Stephen Ladyman Parliamentary Under-Secretary, Department of Health

I congratulate my hon. Friend Mr. Laxton on securing the debate and, more important, on taking time to work on asthma and on the all-party group. I also congratulate my hon. Friend Mr. Drew and Andrew George on their work on asthma. Unfortunately, the hon. Member for St. Ives, who is the chairman of the all-party group, missed the reception that I attended last week because his train was held up. I guess that that explains why he was here during the previous debate to make clear to Ministers his views about the train service from his constituency.

When people first become Members of Parliament, they are assailed by invitations to join all-party groups. Like my hon. Friend the Member for Derby, North, I decided to concentrate on groups that I thought were worthy. Some time later, I discovered that all my friends were jetting around the world because they had joined the all-party Hawaii group or the all-party Philippines group instead. However, he and I will get our reward in heaven, and his constituents will reward him for his work on behalf of the all-party group on asthma and asthmatics throughout the country.

The Government are making good progress in improving treatment and care for people with asthma, and I welcome the opportunity to put our position. I also warmly endorse my hon. Friend's praise for the work of Asthma UK and its recently published report, "Living on a Knife Edge". I am glad that Asthma UK recognises in that report that Health Ministers do, indeed, take asthma seriously.

I should emphasise that the Government recognise how distressing and debilitating asthma can be for individuals, their carers and their families. It is the most common chronic disease in the UK and affects all age groups. I assure hon. Members that we share my hon. Friend's concerns about improving the lives of people living with this condition, and we are taking action in five broad areas.

First, the new general medical services contract includes a specific quality indicator for the treatment and care of people with asthma. It builds on the chronic disease management programme in the existing contract. GP practices must keep records and effectively manage and review patients with asthma to qualify for additional quality payments.

Secondly, new guidance on the appointment of GPs with a special interest in respiratory medicine, including asthma, was published in April 2003. It was written in conjunction with a range of experts, including Asthma UK and the British Thoracic Society. GPs with a special interest have a pivotal role as clinical leads within primary care. They provide clinical expertise and leadership in developing integrated local services that best meet patients' needs. GPs with a special interest in asthma and respiratory disease will carry out consultations with patients who are referred by other practitioners for advice on clinical management. That will help patients by reducing the need to wait for referral to a hospital specialist, and it may help avoid the need for admission to hospital.

Thirdly, a national service framework for children is being developed to set standards for the care of children and young people and ensure that they have access to good-quality care. Those new standards will help to ensure better access to care and a smoother progression in the provision of services for children—from the initial contact with the national health service at a GP's surgery or NHS hospital, through to social services support. Our aim is to enable children to have access to modern health and social care services that are designed to meet their needs and that involve them and their carers in choices about their care. Furthermore, we have agreed that asthma, as one of the most common childhood conditions, will be used as a key exemplar illustrating how the standards should be applied to ensure that services are effective and that they meet children's needs.

Fourthly, the national primary care development team is working to improve primary care for patients with respiratory disease, including asthma, as part of the largest health improvement programme in the world. The team supports front-line primary care clinicians and primary care trust managers in developing skills and techniques to bring about significant improvements in the management of chronic disease for their patients.

Already, the highly successful work of the practices involved in the programme has cut waiting times to see a GP by more than 70 per cent. The programme, which initially involved 20 primary care trusts and 100 practices, is currently being rolled out through the 11 NPDT centres to every primary care trust in the country.

Fifthly, my right hon. Friend the Secretary of State for Health announced in March his vision for a new deal for people suffering from long-term chronic diseases such as asthma. Under those plans, specialist teams across the country will provide advice, care and treatment for chronic disease. We will launch case management demonstration sites within each strategic health authority.

Central to good chronic disease management is an effective partnership between the patient and the care providers, with the aim of maximising self-care—something that is particularly important for people with asthma. The latter will benefit from the expert patients programme that is currently being piloted in primary care trusts around the country. That provides NHS-based training in self-management skills for people with long-term chronic illnesses.

I think that the five key initiatives that I have outlined will help people with asthma, but in his excellent speech my hon. Friend raised a number of points on which he hoped for additional Government action. For example, he was concerned that respiratory disease does not feature in the Government's national strategy for health. As I have already said, the children's national service framework is using asthma as a key exemplar condition. I assure him that although we are not yet committed to a new wave of national service frameworks, we will, if there are to be more of them, consider the case for asthma.

As my hon. Friend rightly said, the cost of treating asthma absorbs substantial NHS resources. He asked for more investment in services for people with the condition. Although we have not made any extra funding available specifically for asthma services—because we are now shifting the balance of power, and we expect primary care trusts to make local decisions about local priorities—the considerable extra resources that we are investing in the NHS will improve services for all patients, including those with asthma and other respiratory diseases.

My hon. Friend also asked for greater investment in research into the condition. As has already been noted, total Government spending on research into asthma was approximately £3.2 million for 2002–03. However, that is not the full picture. In the previous year—I am sorry that I do not have more recent figures—£12.2 million was spent on research into respiratory disorders overall. The Department of Health is running a £1 million research programme on air pollution and health. The Medical Research Council, which prioritises research on the Government's behalf, is always happy to consider good-quality research projects that are suggested to it.

In addition, the Department manages the national health service research and development programme to deliver improvements in medicine and health, which is undertaken in hospitals, general practice and other health care settings. The Department works closely with Asthma UK on the NHS research and development programme on asthma management, which provides funding to individual projects in hospitals and universities across the country and will receive a grant of £5 million over six years.

My hon. Friend also referred to evidence-based guidelines for the care of those with asthma. Primary care trusts are responsible for commissioning comprehensive services to meet the health needs of the populations that they serve. We expect them to commission services in line with evidence-based good practice guidelines. The health care standards, which will be published by the Secretary of State for Health in the summer, will require health care organisations to have systems in place to ensure that treatment and care are based on agreed best practice. Services should be based on what appropriately assessed research evidence has shown provides an effective outcome for patients' needs.

My hon. Friend also added his voice to that of Asthma UK in highlighting smoking as a serious public health issue. He did not call for a ban on smoking in public places, but he asked whether I was prepared to go that far. I am not, at present, because we are having a consultation, and it is not right for Ministers to prejudge consultations, but his views and those of Asthma UK will certainly be taken into account. Smoking is a known trigger for asthma. Around 80 per cent. of people with asthma say that other people's tobacco smoke makes their symptoms worse, so we are working to educate parents about the effects of smoking not only on their health but on that of their children, and to help them give up through our successful smoking cessation programmes. "Smoking Kills", the Government's White Paper on tobacco, includes support for the licensed hospitality industry's charter to improve facilities for non-smokers in pubs, bars and restaurants, as well as consultation on an approved code of practice on smoking in the workplace.

The Government have consistently said that smoke-free enclosed workplaces and public places are the ideal, and have encouraged employers and managers of public places to introduce smoke-free policies. Progress is being made, but we want to see more. We are particularly keen to see more progress from the hospitality sector and look forward to the proposals that they will make later this month when representatives will meet Ministers.

I hope that my hon. Friends and other hon. Members, and our constituents, especially those with asthma, will be reassured that the Government are committed to improving the treatment and prevention of asthma in the NHS. I recognise that there is still some way to go, but we are making good progress. My hon. Friend has set out an eloquent and important case for why we must concentrate on the issue—not least because I should not like to keep him from his beer for very long. The more we can do, the more we shall try to do: we can do more and we shall do more.

Progress is being made across the board. I am committed to driving that progress, and I look forward to working with my hon. Friend and other hon. Members, the all-party group and Asthma UK to achieve that goal. It is an important subject, and the Government are determined to put effort and drive into ensuring that there are improvements.

Sitting suspended until Two o'clock.