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Mr. David Amess (Southend, West): I begin by registering an interest. In common with many thousands of people, I suffer from hayfever. In my case, by the end of the hayfever season it will have turned into asthma. My first challenge to the Minister is to come up with a cure for hayfever, which would delight me and many others.
When I developed hayfever as a child, I was told that I would grow out of it, but I am nowhere near having done so. I have tried every medication available. I applaud pharmaceutical companies, which seem to produce a different nasal spray or tablet every year. I have had injections. I have been to a major hospital to be tested for allergies. On discovering that I was allergic to practically everything, I decided to forget it. Eventually, my wife, annoyed by my constant fits of sneezing, told me to go to the doctor to get it sorted out with the latest product on the market, with which I was injected using a huge needle. It made no difference whatsoever. I have even been to a Chinese herbalist. I faithfully followed the instructions for boiling up the leaves, but it tasted revolting and had no effect.
If the Minister is unable to come up with a cure today, she will do me a great favour if she can reassure me that she recognises that it is a real problem that causes misery to many people. Although I may appear to be perfectly fine at the moment, it can start up again at any time. The problem affects the quality of people's lives--for example, children taking examinations--and seems, for whatever reason, to be getting worse. People are developing it at all ages.
I want to concentrate on a call for national standards of health care for people with asthma. I pay tribute to the National Asthma Campaign, which I am sure all hon. Members regard highly and which is, as much as any organisation can be, above politics. It would like me, with another hon. Member, to highlight the issue with the aim of trying to find a solution.
We all have constituents who are affected by the problem. Regardless of their postcode or their medical condition, they should have the best possible treatment available. As Members of Parliament, we have a responsibility to ensure that constituents who live with long-term medical conditions receive proper care. I accept that that has cost implications, but I would like to suggest to the Minister an idea that might not cost too much.
No one pretends that achieving consistent standards of care across the country is easy--it is difficult, but it is something for which we should strive. Unfortunately, many patients are bypassed as a result of where they live or because their illness is not on the Government's target list of health priorities. I understand why the Government target coronary heart disease and cancer. I tried to get stroke included on the list. Important as those conditions are, I hope that they will consider widening the terms of reference to include people with chronic long-term medical conditions, including asthma.
The Government and the Minister should take the opportunity to give greater direction from the centre, ensure that local health care professionals recognise asthma as a long-term problem, which they do not always do, and provide the means for people with asthma to receive the quality care that enables them to take charge of their own condition instead of simply struggling on valiantly, as many do.
We welcome the asthma clinics that many surgeries now operate, although they tend to be for newly recognised symptoms. Does the hon. Gentleman agree that one of the biggest problems is that people who have had asthma for a long time think that they are using their inhalers properly but often need educating in better ways of treating themselves?
Mr. Amess : The hon. Gentleman makes an excellent point. Although such clinics do a superb job, like accident and emergency units, long-term sufferers, as he eloquently said, badly need this extra help. I hope that the Minister will acknowledge that. If the clinics are to make an impact, national direction must be backed up by local initiatives.
The National Asthma Campaign, the independent United Kingdom charity, works as hard as it can, with others, on research to combat this problem, which is suffered by 3.4 million people. That is a huge number, which would fill 7,000 jumbo jets or sell out Wembley stadium more than 40 times. In my constituency 2,600 people suffer from asthma, which is one in 25 adults. More disturbing--I know that the Minister has a child herself--is the fact that in Southend, West one in seven children suffers from asthma, and in the rest of the country on average four or five children in every classroom will have asthma.
Apart from hay fever, the symptoms are difficulty in breathing, tightness of the chest, wheezing, coughing and sleepless nights. One feels absolutely miserable because one does not get a good night's sleep and wakes up feeling like death warmed up. Inflammation and constriction of the airways can be triggered by different things including tobacco smoke--something that I am not particularly enamoured with--house dust mites, pollen or even a sharp change in temperature. As many as 20 per cent. of people with asthma experience it so severely that they have to make frequent trips to hospital. As the national health service is under such pressure, it would be wonderful if we could make it unnecessary for people who have an attack to go to hospital.
More children miss lessons because of asthma than because of truancy. A National Asthma Campaign survey found that nearly a third of children with asthma miss more than a week of school because of their illness. According to Devon's health and safety adviser, 100,000 school days are lost in that county every year because of asthma, 10 times more than are lost through truancy. Large numbers of children are losing out on their education as a result of the failure of all of us, not just the Government, to help people with asthma.
Asthma does not simply affect children. As I said, I have not grown out of it yet. People from all walks of life and in all areas, rural and urban, suffer from asthma, and I am sure that every hon. Member has constituents who suffer from it. It is extraordinary that at the beginning of the new century asthma is on the increase, and no one seems to know why. We all have theories about it, but no one has come up with a convincing, well-tested explanation.
The number of children aged between five and 11 who reported an asthma attack during the past 12 months was three times higher than the figure for 10 years ago. A comparison of the health survey results for England for 1991 and those for 1996 shows that the percentage of people who reported attacks of wheezing or whistling in the chest increased last year from 16 per cent. to 21 per cent.
The Minister knows only too well that, unfortunately, asthma is not going to go away. The National Asthma Campaign tells me that, sadly, we are a long way from establishing the cause of the increase. The problem impacts on many people's lives. In broad terms, the cost of hospital admissions due to asthma is more than £50 million a year. We could use that money to train extra nurses.
More than 1,500 people die from asthma each year. A young man and close family friend who lived in my previous constituency died in tragic circumstances--no one could get to him when he was at the peak of an asthma attack.
Excellent initiatives are being carried out in some parts of the country. I am advised that Leicestershire--I believe that no hon. Member who is present has a constituency interest in this--has an effective local health improvement management plan. In Birmingham, the Small Heath primary care group, which is close to the constituency of one of the health Ministers, is working to improve local care of children with asthma by producing new standardised documentation that will be held in the child's medical notes. My own South Essex health authority has, according to a survey conducted by the National Asthma Campaign, recognised the importance of asthma in its HIMP. Such efforts are commendable, but the situation throughout the country is patchy. In some parts of the UK, health professionals pay only scant regard to the problem. The primary care groups offer us an opportunity to do much better.
We understand that there will be local variations, but such diversity should be reflected in the methods that are used to tackle the disease, not in the level and quality of care that is available to people with asthma. Treatment is currently a bit of a lottery, and we need national standards so that health professionals and people with asthma know what is expected of them.
I return to a point that I made eight or nine minutes ago: a small investment by the Government could solve the problem and promote a sea change in the way in which people with asthma are cared for and manage their illness. I welcome the fact that the Government identified the need for national standards in health care, but the delivery of those standards is currently inadequate. National standards would benefit our constituents by giving them access to better care and a benchmark against which to measure their experience.
People with asthma have the right to expect equal access to the best possible asthma care, which should be delivered by experienced and committed health professionals according to nationally agreed guidelines. What progress is being made in that regard? Specially trained health professionals should review the management of a person's asthma at least once a year. When a GP and a practice nurse share asthma care, the nurse should expect to have access to the best available asthma training and to regular updates--which is probably what the hon. Member for Stroud (Mr. Drew) had in mind. He also made the point that, when the severity of a person's asthma warrants it, prompt referral to a specialist should be provided as a matter of course. Young children, young people in transfer to adult care and elderly people with asthma should receive special consideration. I hate the expression "joined-up government", but the Minister will know what I mean with regard to the need for that kind of provision.
Scientific research has proved the safety and effectiveness of complementary therapies. I condemned Chinese medicine at the outset of my speech, but I am sure that all other aspects of such therapies are marvellous. Perhaps the Minister would like to comment on that. If appropriate standards were implemented nationwide, every person with asthma would be able to make informed choices about their own care.
Does the Minister agree that people with asthma have the right to expect care from the NHS on a broader basis? What are the Government doing to encourage health authorities to include asthma in their HIMPs? What instructions are being given to primary care groups? National standards are useless without effective mechanisms to ensure that they are implemented and monitored locally. It would be more than possible for the Government to establish national guidelines for asthma care relatively quickly. Some guidelines already exist, but they are somewhat out of date.
I draw the Minister's attention to early-day motion 676, supported by 91 hon. Members, which calls on the National Institute for Clinical Excellence--of which I have also been critical, but, none the less, we have it--to update the British guidelines on asthma management as soon as is practicable. Will she also give us an idea of the timetable for revising and issuing new guidelines?
I congratulate those asthma sufferers who are able to control their condition, but that is not always easy. It is no wonder that people panic when they suffer a serious attack. Asthma currently costs the NHS about £670 million a year, including GP consultations and accident and emergency visits. That is an even larger figure than the £500 million that I mentioned earlier.
Finally, I shall leave the Minister with these thoughts. Any hon. Members who visit schools will be shown the headmaster's secretary's room. Nine times out of 10, the secretary will open the medicine cupboard, out of which will fall a variety of ventilators. Young people are our future. This is a real problem and I should be grateful if the Minister would take on board the points that I and the hon. Member for Stroud have made, and give us some hope for the future.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper ): I congratulate the hon. Member for Southend, West (Mr. Amess) on raising the subject of asthma. I only wish that I could come up with a cure for hayfever. As a fellow sufferer, I have a personal interest in that, and would certainly derive a great deal of relief from such a discovery. I find that sea air helps, so perhaps additional constituency duties will help the hon. Gentleman with his condition during the worst time of year.
I shall respond to many of the points that the hon. Gentleman has made about asthma, which is a most important issue. It is the most common of all chronic diseases, affecting thousands of families every year. I welcome many of the points that he has made, and his support for Government action to introduce national standards and to tackle the problem of the postcode lottery in care. The Government feel strongly about that issue, and have set out a programme of action to tackle many of the variations in care across the country.
The hon. Gentleman is right to say that the prevalence of asthma has increased in recent years. In the mid-1950s, when the population was about 44 million, the first national survey of morbidity in general practice estimated that 380,000 people had consulted a doctor about asthma at least once. According to figures published in the document "Key Health Statistics for General Practice 1996", the prevalence of asthma in England and Wales was 6.7 per cent. for men and 6.9 per cent. for women. That amounts to as many as 3.5 million sufferers.
It is difficult to be precise about the trend, given variations in measurement, improvements in diagnosis and wide variations in the way in which figures are recorded, but it is clear that the number of cases of asthma has increased in the past few decades. As a result of improvements in diagnosis, drug development and changing diagnostic thresholds, more people are prepared to consult general practitioners to get prescriptions for asthma. Nevertheless, however one looks at the matter, the figures are going up, and that is a cause for serious concern.
For general practitioners and nurses, the increase is also very real. My hon. Friend the Member for Stroud (Mr. Drew) talked about services provided in primary care, and average general practice staff will see a tenfold increase in the number of asthma patients, compared with figures when the NHS was formed. Treatment options are now clearer. Beta 2 stimulants are used to prevent the potentially lethal symptoms of asthma in young children. As a result of such improvements, and
The number of asthma-related deaths in England and Wales fell from 1,700 in 1993 to 1,366 in 1998, and the number of hospital admissions also declined. The number of children who were admitted in that period fell by almost a third--from 47,700 to 32,000. Despite those changes and improvements, I share the hon. Gentleman's concern that too many people are suffering. In particular, I share his concern about asthma among children. I join him in paying tribute to doctors, nurses and other health professionals who have done so much to make the improvements a reality, and to those patients who have taken responsibility for managing their own care. I, too, would like to mention the National Asthma Campaign, which has played a vital role in providing information and support to patients and their families for many years. It has been at the leading edge of asthma-related research, and it worked with the British Thoracic Society to establish important guidelines on asthma care.
Progress has been made, but there is still much more to do. The hon. Gentleman is right to say that asthma imposes substantial costs on the NHS. The NHS spends almost £500 million a year on GP-prescribed drugs for asthma, and the Government spend almost £4 million a year on research into asthma. The National Asthma Campaign estimates that a substantial number of working days--and, as the hon. Gentleman rightly said, school days--are lost every year through asthma. I am particularly concerned about the impact of inequalities in this regard. Often, it is the children of parents on low incomes who are most likely to die from asthma attacks.
The hon. Gentleman referred to making improvements by establishing national standards. The Government recognise the importance of national standards and the need to tackle the postcode lottery, and we have put in place measures to that effect. He also mentioned the national service frameworks for coronary heart disease and mental health, which have been published, and for older people and diabetics, which are still in progress. They are not simply about acute conditions, but include long-term chronic care issues and require considerable time and investment from the NHS and from experts and patient groups. In addition, we are working with the National Institute for Clinical Excellence to improve the clinical effectiveness of health services.
The role of NICE is to ensure that, by identifying best practice, every patient in England and Wales has fair access to quality treatment. NICE will promote the uptake of successful innovations and will appraise treatments, both new and old, to ensure that there is good evidence to support their effectiveness. On asthma, NICE is carrying out an appraisal of inhaler systems, and its guidance is expected in the late summer. In addition, two major reports from our health technology assessment programme on inhaled steroids are expected
The Department of Health is assessing a number of topics for possible referral to NICE in the next year. Clearly, NICE has a finite capacity and cannot look at every technology or intervention with evidence of variations in practice in the first year. No service anywhere in the world, no matter how it was funded, could do so. The selection criteria will include the potential impact on patient care, on Government priorities and policies and on NHS resources. The Department will also consider whether NICE is likely to add value. We are considering the programme of work for NICE for next year, and announcements will be made about that programme later this year. Unfortunately, I cannot pre-empt those announcements.
While NICE and the NSFs are vital steps forward, they are not the only way to spread best practice, provide high-quality care and tackle the postcode lottery across the NHS. Systems must be put in place across the board, not simply in priority areas or for asthma but in every area, to promote the rapid take-up of new technologies, to promote improvements and best practice and to ensure that that best practice is spread across the country. Those issues are being addressed as part of the development of the national plan. Experts and patient groups across the field are being drawn together to study the key priorities and ensure that the systems are in place to implement best practice, as the hon. Member for Southend, West described, and not simply to set national standards.
The national plan will set out the way in which we intend to use the record extra resources available to the NHS not simply to expand services but to reform them fundamentally. A key aim is to ensure that patients are at the centre of the process. The hon. Gentleman referred to the need for patients to take responsibility and manage their own care. Last year, in the "Saving Lives" White Paper, we signalled our intention to introduce an expert patients programme to help those with chronic illnesses better to manage their health. The expert patients task force, which has been set up by the chief medical officer, will promote self-help and self-management for asthma patients and others and will ensure greater awareness among asthmatics of their condition. That is being done through a series of joined-up initiatives--that wonderful phrase that the hon. Gentleman used. That includes working not only with patients but also, as he said, with various aspects of the NHS, linking in-patients, out-patients, emergency care and primary care.
The health improvement programme is one way to do that. Its main role is to develop the programme to improve the health of the local population. We have highlighted key national priorities for heart disease, cancer and mental health, but local areas must look at their own strengths and weaknesses and at their needs and set their own priorities. We expect areas that have problems with asthma care to address them as part of the health improvement programmes. Many already recognise the needs of people with asthma.
The hon. Gentleman mentioned other examples. I know that primary care groups in Croydon and west Kent have identified asthma as a key local priority, and a scheme in Cornwall involves giving grants to councils to fund central heating and insulation improvements for homes occupied by families with children suffering from asthma.
To make a long-term difference, we must tackle prevention as well as treatment, which means taking action on smoking. That is why we have done so much to reduce smoking and have taken action in schools as