Asthma

Question

Asked by

To ask Her Majesty's Government what support they are giving to people suffering from asthma, including on access to medicines.

My Lords, respiratory disease, including asthma, is a clinical priority in the NHS Long Term Plan, which aims to improve outcomes for patients through earlier diagnosis and increased access to treatments. Pharmacists in primary care networks will undertake medicine reviews for asthma patients. This will include education on inhaler use and uptake of dry powder and smart inhalers where clinically appropriate. Finally, the NHS will build on the RightCare programme to implement respiratory initiatives in 2019-20.

My Lords, Asthma UK finds that, of the 2.3 million people with asthma in England who pay for their prescriptions, more than three-quarters struggle to afford them, let alone follow an essential treatment plan. Does the Minister agree that prescription charging sends out entirely the wrong signals to the whole community about the seriousness of the condition which causes the deaths of many young people? The great tragedy is that most of those deaths are avoidable. Should we not as a priority look again at the exemptions list?

I thank the noble Lord for his question. I have met with Asthma UK on this issue. As an asthmatic myself, I understand the challenges of keeping up with medication, especially when in the middle of an exacerbation. At the moment, we do not intend to review the prescription charges list. However, there are some exemptions in the prescription list, and we have committed to work with Asthma UK to ensure that those who are eligible for low-income exemptions and for the pre-payment charge are accessing them and to look at any other ways in which we can help those who need life-saving medication.

My Lords, I am sure that the Minister will know about the recent shocking report from the BMA describing the UK health system as complacent about the risks of asthma. It comments on and documents some of the tragic deaths of young children who would still be alive if their chronic asthma had been properly cared for. It shows a sorry litany of absence of a proper asthma plan across primary and secondary care and failure to refer children suffering repeated attacks to a specialist respiratory team or to optimise medical management of the condition. Some clinicians and staff are unaware of national treatment guidelines, prescribing advice or recommendations from the national review of asthma deaths. What is the Government’s response to this? Why has only one of the NRAD recommendations been implemented since 2014? Why are the remaining 18 still to be acted on to try to stop these unnecessary and untimely deaths?

The noble Baroness will have heard in my opening remarks that we have put treating asthma and respiratory diseases as a key priority within the NHS Long Term Plan precisely because we recognise that we need to improve our performance on respiratory diseases. Working with Asthma UK, we have identified that one of the key challenges in improving performance has been the identification of those with severe asthma and providing them with an appropriate care plan. That is exactly why we are pleased that a new NICE quality standard, QOF and the RightCare programme are in place; these should help to improve referrals and outcomes for patients as is desperately needed.

My Lords, as the Government roll out the early diagnosis centres, including for lung-health checks, across the country, will they be looking to implement recommendation 1e of the lung task force as part of their strategy, so that air pollution is monitored and the NHS can provide advice when pollution levels are high?

I thank my noble friend. She is right that we need to improve our response to those at high risk of respiratory illness. That is partly why we are improving our offer on mobile lung-health screening, specifically as part of the national targeted lung health checks programme. It is also why we are offering smoking cessation advice and treatment as part of that service. We offer the general population and vulnerable groups advice via the daily air quality index, but she is right: we need to improve our monitoring of air pollution if we are to make progress on this issue. It is something that I will take up with the department.

In view of the gravely damaging effect of asthma on children, does the Minister agree that the abolition by the former Mayor of London of the west London zone for congestion charging has increased the amount of air pollution in London over recent years? Many children have died and many people have suffered as a consequence. Will she ask the candidates for the Tory leadership whether they are prepared to reintroduce such a zone in London?

The noble Lord is asking me to step in and comment on matters that are slightly outside my brief. However, I am pleased that we have brought in the clean air strategy, which is a significant step forward. He is also asking me to commit the Mayor of London rather than leadership candidates to a policy area. We do need to move further and faster on air pollution; that is what I expect to see in the prevention Green Paper which will be published shortly.

My Lords, given the recent report of an upsurge in acute asthma attacks among schoolchildren at the start of each school year, and given that—as we have already heard—there are three deaths per day from asthma in the UK, many of them preventable, what plans do Her Majesty’s Government have for encouraging better health education regarding the seriousness of this disease?

As ever, the right reverend Prelate is insightful on this matter. Children going into school with identified respiratory illnesses should have care plans to assist the school in caring for them. Asthma UK has indicated that many children are slipping through the net and remaining on long-term oral steroids in primary care. This results in repeated trips to A&E with no referral to specialist centres. We are working with NHS Improvement and others to ensure that we support them with training in the use of medication and improving the use of smart inhalers, which can track the management of their care and reduce referrals to secondary care.

My Lords, I am grateful to the NHS for the fact that as a diabetic I do not pay prescription charges, but other people in England with long-term conditions have to pay such charges. In Scotland, Northern Ireland and Wales, all prescription charges have now been scrapped. Is this not somewhat anomalous? Is it not unfair that the 2.3 million adults with asthma have to pay these charges?

The noble Lord will already have heard me answer his question in reply to the opening Question. I have already met Asthma UK on this issue and discussed its concerns about the balance of prescription charges. We are not in a position at the moment to review prescription charges as a whole, but I will be working with that organisation to make sure that the system works as effectively as possible for asthma patients and that they get access to the exemptions that are in place.