World Asthma Day

15:10:00

I beg to move, That this House has considered World Asthma Day. It is a real pleasure to serve under your chairship, Dr Huq. We had a very productive parliamentary visit to Egypt to promote freedom of religious belief. I commend you for that publicly today in the Chamber. I am grateful to the Backbench Business Committee for accepting this debate. I am pleased, as always, to see the Minister in her place. I will come to my request to her later. My speech has been given to her staff and, I understand, to the shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), and to the Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller). I am pleased and privileged to be the chair of the all-party parliamentary group for respiratory health. I have a deep interest in respiratory health. It is probably because my second son was born with asthma. From a very early age, he was on medication. He had some psoriasis as well; there is an association between the two. He seems by and large to have grown out of it, but even now, at the age of 34, he depends upon the inhaler. Therefore, I have a personal interest in the issue, as most people do when they talk about asthma. I am delighted to sponsor the debate for this year’s World Asthma Day, which was on 6 May. This year’s theme, set by the Global Initiative for Asthma, is “Make inhaled treatments accessible for all”. GINA emphasises the need to ensure that everyone, regardless of their global location or socioeconomic status, has access to the inhaled medications that they need to control the underlying disease and to treat asthma attacks. I will be looking at that and other aspects of asthma care and treatment today. It is a pleasure to do so, and to see other Members who have been able to turn up to participate in the debate. This may be my first occasion where the Minister has responded specifically to my debate. I wish her well in her role, I wish her well personally—she knows that—and I wish her well in the debate. I am indebted to Asthma + Lung UK for its outstanding help and ongoing support. It has been enormously helpful to me and to the APPG. I welcome the work it does to serve the needs of people living with respiratory ill health. I also put on record my special thanks to Jonathan Fuld, the national clinical director for respiratory disease in England, for his expert advice, counsel and wisdom. I pay tribute to our expert stakeholder groups, which comprise senior clinicians, industry, professional bodies and other experts, for their ongoing work. The APPG has regular Zoom meetings, and Jonathan Fuld is always there to guide us and help us through the process. The APPG has welcomed the improvements in inhaler technology, specifically the move to combination inhalers, which will ultimately eliminate the use of twin inhalers. That is a significant step and one that we should welcome. As highlighted in the National Institute for Health and Care Excellence asthma guideline and by the Medicines and Healthcare products Regulatory Agency in its safety warning, SABAs—short-acting beta 2 agonists—should not be used by people with a diagnosis of asthma. Therefore, there are and will always be treatments that we need to be careful with for safety reasons. Combination inhalers combine two kinds of medicine in one device, helping to keep inflammation in the lungs at bay while giving relief from symptoms such as breathlessness and tight chest. I will come on to some figures later on, as we need to be reminded in this debate that, with asthma, it is not just that the inhaler saves someone and they are okay. There have been a number of deaths, which I will refer to later on. The availability of inhalers in the UK ensures that people with asthma get the most clinically effective treatment and also allows the NHS to take a step towards its net zero targets, given that they are low carbon. It is therefore right to acknowledge that the first inhaled respiratory medicine using next-generation propellant with near-zero global warming potential was approved this week. That is a step in the right direction. Although it is for chronic obstructive pulmonary disease, the technology offers great promise for other inhalers in the future. It is wonderful to look back at all the advances made over the years in cancer treatments, or on diabetes or cardiovascular disease. They are trying to find a cure for dementia and for Alzheimer’s, and there are some ideas for how that could be progressed, so there have been advances. I am sure we have all seen the latest statistics on respiratory conditions and asthma—I will touch on them briefly. Lung conditions are the third biggest killer in the UK. Hospitalisations have doubled in the last 20 years and there has been little improvement over that time. I mentioned some of the improvements with inhalers, but there is still a long way to go. Some 7.2 million people in the UK live with asthma; 2 million children live with asthma. That represents one in nine adults and one in eight children. The UK has a higher death rate due to respiratory illnesses than the OECD average, and we have the highest death rate in Europe. Asthma kills four people in the UK every day and someone has a potentially life-threatening asthma attack every 10 seconds. These are the stats, but they are not just stats—they are families and individuals, and people who deal with this every day. The children and the parents worry, the adults worry and the families worry. Over the past 10 years, more than 12,000 people have died from asthma. Almost all of those deaths were preventable. The National Review of Asthma Deaths report, “Why asthma still kills”, published by the Royal College of Physicians in 2014, found that two thirds of asthma deaths were preventable. If they are preventable, why can we not do more and make that happen? That is one of my requests to the Minister. Some 66% of people are not getting an appointment with a GP or an asthma nurse within the recommended 48 hours after an emergency admission. Between 2012 and 2020, deaths from asthma have increased by 26%. The number of people who have died due to asthma attacks is very cruel. The costs to the country associated with asthma are substantial. Asthma and COPD cost the NHS some £9.6 billion in direct costs each year, representing 3.4% of total NHS expenditure, and they cause wider reductions in productivity due to illness and premature deaths, totalling £4.2 billion a year, with an overall impact of £13.8 billion on the economy. In my country, my region of Northern Ireland, asthma costs £178 million a year alone. These costs cannot be ignored. I will put forward some ideas that the Government and the Minister can hopefully take on board to reduce the expenditure and the death toll. Adding up the cost to the NHS and direct costs from the loss of productivity and the monetary value of people suffering lung conditions, the cost to the UK economy is some £188 billion a year. The annual estimated cost of asthma and COPD to the NHS is £4.9 billion, with an estimated 12.7 million lost workdays per year. There is a financial cost, a loss of workdays and a cost to the productivity of our nation. The impact of asthma on the NHS is considerable. Respiratory conditions are a major cause of avoidable hospital admissions. If we can avoid hospital admissions, that is a strategy and a way forward. There were some 56,853 admissions due to asthma in 2022-23. Waiting lists for respiratory care have risen by 263% over the past 10 years. Those are worrying figures. There is a need to have this debate, and today is the opportunity to do that and to look forward. Lung conditions, including COPD, asthma and respiratory infections, place a huge burden on the NHS, especially in the winter months, when it is always worse: respiratory admissions increase by some 80%. Breathing issues are the leading cause of all emergency admissions in England, and in common with other respiratory illnesses, asthma is hit hard by inequalities and deprivation. There is a link between poverty and asthma, so I hope that the Minister can give some encouragement in relation to that. The burden of respiratory disease disproportionately affects the most deprived. Those from the poorest communities are three times more likely to die from asthma, compared with those in the richest—that is another worrying trend. Children living in the most deprived 10% of areas are four times more likely to require emergency admission to hospital due to asthma than those living in the least deprived areas. Again, there is a clear statistical difference between those who live in deprived areas and those who do not. The findings of the national child mortality database report on child deaths expose the inextricable link between poor lung health and deprivation, with more than half—56%—of the children who died in the period that the report covers coming from the poorest communities. I know that when the NHS was set up, this would not have been the policy of the Government, but if there are more deaths among children who just happen to live in deprived areas, we really need to address that. I welcome and support the Government’s commitment to reducing inequalities and deprivation—in particular, inequitable asthma outcomes. We hope to run local meetings in the most deprived areas of the country to try to determine some of the causes of the variation in asthma outcomes. I would like to offer the Minister our support in any way that we can help. We are pleased to have here today representatives who carry out the admin for the APPG on respiratory health. We thank both of them, and others, for their contributions. There have been some welcome developments in respiratory health recently, including the introduction of a new integrated guideline for asthma, which was a joint collaboration by NICE, the Scottish Intercollegiate Guidelines Network and the British Thoracic Society. It is being rolled out across the country. They are good steps in the right direction to try to do even better, but I urge the Minister to make sure that there is no implementation hesitancy across the integrated care boards, with uneven take-up. I also ask what steps she will take to ensure that it is rolled out equally across the country. That is one of our requests. The APPG also welcomes and supports the three shifts announced by the Secretary of State: analogue to digital, hospital to community, and treatment to prevention. I suggest that respiratory health outcomes could benefit significantly from all three of those commitments from him. I also welcome the upcoming neighbourhood health services, in principle. Although we do not know all the details yet, there is an agreement in principle for that work to happen. I ask the Minister what future she sees for the community diagnostic centres, following the transition to the abolition of NHS England? The APPG has already sent a submission for the 10-year plan, which we hope will deliver what we all wish to see. I welcome the Government’s commitment to investing £26 billion of extra money for health. I welcome the positive stance that the Secretary of State and the Minister have taken in relation to that. However, we feel that respiratory health should be key and in the centre of the 10-year plan. I understand that that plan is likely to have cancer and cardiovascular disease plans associated with it, and I hope that respiratory health conditions will be prioritised in the same way. Could the Minister ensure that respiratory health will be prioritised in national strategies and NHS guidance, including in the 10-year plan and the life sciences sector plan, which are in development, and in future winter resilience guidance? One major issue that we see every year in the NHS is winter pressure. We cannot deny it, and it is not anybody’s fault; it is a fact of life. Vaccines for flu and other respiratory infections are enormously helpful, of course, but ensuring that patients are on the right treatment can also contribute to reducing these pressures. The transitions from hospital to community and sickness to prevention are essential to making this happen. The question is, how best can it happen? Again, I hope that the Minister can give us some thoughts on that. The APPG will hold a roundtable in the next few weeks to discuss how good respiratory health measures can help to ease winter pressures. It might be helpful to consider those at this time of the year, long before we get to that stage in the latter part of the year. The APPG will report its findings to the Minister directly. A previous Minister agreed to a meeting with us, and I am quite sure that the Minister today will do the same, so I ask whether we could have that in the diary. Severe asthma affects up to 5% of people with asthma, and is associated with frequent exacerbations, hospital attendances and steroid use. Biologics have been described by leading clinicians as lifesaving for severe asthma patients, yet an Asthma + Lung UK report suggested that in June 2020 only 23% of eligible patients were receiving a biologic for their severe asthma. Those figures worry me. I understand that that was five years ago, but again I seek some positivity in relation to it. A recent poster at the European Respiratory Society congress showed that the uptake of biologics for severe asthma is low and variable in the UK. That has to be addressed, and I seek the Minister’s thoughts on it. The national median uptake of biologics by patients with severe asthma in England between 2016 and 2023 was 16%. ICBs are not maximising the uptake, which varies widely between 2% and 29%, against a target of 50% to 60%. That does not cut the cake. Based on current regional use of biologics in England, modelling forecasts that it will take 37 years for only 50% of eligible patients to be on biologic therapy. That cannot be satisfactory. We must do better. At present, with the existing severe asthma service specification, patients can wait years for access to these treatments. There is limited awareness of severe asthma and insufficient capacity in the system, and unnecessarily complicated multidisciplinary teams hinder timely access. This must not be ignored. We must not have a postcode lottery, with some parts of the United Kingdom providing the correct standard of asthma care and other parts falling behind. We await the publication of the new service specification, which I hope will minimise delays for patients who really need the biologics. In other areas, such as dermatology or rheumatology, secondary care clinicians can prescribe biologic medicines to patients who fit the relevant criteria without the patient requiring assessment at tertiary level, so can secondary care prescribing be introduced for severe asthma? I have had a lot of asks of the Minister, but they are positive, constructive asks that seek to move us forward, save lives and help those with asthma. Time is going far too fast, but the facts are clear: too many people living with lung conditions are missing out on the treatments that they desperately need to live and stay well at home. Current access is limited, patchy and being held back by workforce shortages. Severe asthma accounts for only around 4% of the total asthma population, but this is still almost 5,000 people, and they are probably the ones who will contribute the most to asthma deaths in a year. Such is the severity of their symptoms that this group is estimated to account for at least half of all expenditure on asthma—some £38 million a year. I want to give an example of what we are doing in Northern Ireland and show what it would mean here on the mainland. I know that this is not the Minister’s responsibility, but thousands of people across Northern Ireland are missing out on key diagnostic tests because of disagreements between primary and secondary care about who should deliver the services. If, for example, fractional exhaled nitric oxide were made available to all GPs across Northern Ireland, its use could save £4 million by optimising asthma treatment. An uptake in spirometry testing in primary care to just 40% of eligible patients would result in £1.7 million in direct health service cost savings in reduced COPD exacerbations —a reduction of 1,778 hospital bed days, of which 605 would be winter bed days. I used an example from Northern Ireland because I have access to those figures, but were we to replicate that for each healthcare trust or board in the United Kingdom of Great Britain and Northern Ireland, the improvement to health and freedom from financial weight would be massive. It is not just about the money saved, or the lives saved; it is about the care of those with asthma. If we can make it better in any way through today’s debate, it will have been worth while. I look forward to everyone’s contributions. I believe that changes can and must be made. I look to the Minister to begin that process today.

15:31:00

It is a privilege to speak under your chairship, Dr Huq. I am deeply grateful to the hon. Member for Strangford (Jim Shannon) for securing this debate, which is crucial—not only for my constituents of Birmingham Perry Barr and the city of Birmingham, but nationally and internationally. Last week, we marked World Asthma Day—a moment of reflection that should fill us with not only resolve but deep discomfort. Asthma is one of the most common health conditions in the UK, as the hon. Member for Strangford mentioned, affecting over 7 million people, yet all too often it is also one of the most fatally overlooked. Every eight hours, someone in this country dies from an asthma attack. In 90% of those cases, their death means a life cut short, a family devastated and a future lost due to what should have been a manageable condition. Such people are dying not because we lack treatments but because our holistic healthcare system is failing them. This crisis is particularly felt by my constituents in Birmingham Perry Barr. Ours is a proud industrial city, but that legacy comes at a cost. Poor air quality continues to fuel respiratory illnesses, and too many of my constituents are left battling the consequences. I received a deeply moving letter from a constituent who has lived with asthma for years. Despite managing her condition to the best of her ability, she suffers asthma attacks constantly, leaving her in constant agony. Unfortunately, her words echo the experiences of many up and down the country. Let us be clear: asthma may be common, but it is no less deadly for that, and no less deserving of urgent, focused attention. I commend the tireless work of people such as Kim Douglas, who is a constituent of mine, after the tragic loss of her three-year-old son George to undiagnosed and untreated asthma. She founded the George Coller Memorial Fund in his memory. That foundation is now calling for two vital reforms that could save lives and ease the burden on our health system. First, it is calling for inhalers to be made free of charge for all patients; 57% of those who end up in emergency care for asthma have skipped their medication because they could not afford the prescription, and almost half missed appointments out of fear that they would not be able to pay for the medication afterwards. In one of the richest countries in the world, that is simply indefensible. A child’s ability to breathe should never depend on their parents’ ability to pay. Secondly, the foundation is calling for all emergency inhalers to be fitted with a dose counter. Inhalers are often relied on in moments of life or death—in emergencies—yet nearly three quarters of patients cannot tell when their inhaler is empty. They go on using them, trusting them, only to find when it matters most that they offer no relief. For too many families, that avoidable failure has had devastating consequences. Those two simple changes could prevent thousands of hospital admissions every year and, importantly, they could save lives. I ask the Minister whether she will meet with me and the George Coller Memorial Fund organisers to discuss these vital recommendations? Will she commit to a 10-year respiratory health plan that finally treats this crisis with the urgency it demands?

15:35:00

It is a pleasure to serve under your chairship, Dr Huq. I congratulate the hon. Member for Strangford (Jim Shannon) for bringing forward this debate to mark World Asthma Day. There are two reasons why I wanted to speak in this debate. The first is personal: I developed asthma as a child, almost certainly as a result of the pollution of the Milan of the early 1990s, and living down the road from the Alfa Romeo factory. While the condition improved for me, unfortunately my younger sister suffered severely with it and continues to suffer today. The second reason reflects the changes that my constituency has faced. Bournemouth was founded as a wellness resort, and back in the day visitors would come to take the air. In fact, one of our most famous residents, Sir Merton Russell-Cotes, who went on to become mayor and own the Royal Bath hotel, was sent to the south coast of England because he had chronic respiratory conditions, and ended up living in Bournemouth. It is still a place where people move to improve their quality of life and to live a healthier life—but Bournemouth was recently ranked as the 14th worst location in the UK for air quality. A staggering 83% of residents with lung conditions in my constituency say that poor air quality has made their conditions worse. The hon. Member for Strangford has already pointed out that respiratory deaths are strongly linked to deprivation, more so than any other condition, and people living in the poorest areas of the UK are three times more likely to die from asthma than those in the wealthiest. That national injustice is reflected starkly in my constituency, where areas in the less affluent north, such as Alderney, West Howe, Kinson and Branksome, have asthma rates significantly higher than the national and regional averages. If we are serious about improving outcomes for people with asthma, we must take a cross-departmental and holistic approach—one that addresses not just healthcare, but pollution, housing, transport and lifestyle. That is why I welcome the Environment Secretary’s commitment to improve air quality across the country, including in Bournemouth West; cleaner air saves lives and it must remain a top priority. I welcome the Government’s broader efforts to tackle the root causes of respiratory illness: cutting emissions and improving public access to air quality information; the Tobacco and Vapes Bill and the Government’s ambition to create a smoke-free generation; and key legislation such as the Renters Rights’ Bill—specifically the inclusion of Awaab’s law, which is vital for my constituents. I am regularly contacted by residents, who are living in substandard conditions, plagued by mould and damp. These environmental hazards are not just unsightly, but dangerous. Mould is a known trigger for asthma and other respiratory conditions. With a clear link between asthma and deprivation, improving housing standards is a matter of not just fairness, but health. Our national health service is in need of fundamental reform. We must move away from a system that reacts to ill health towards one that prevents it. I support the Government’s vision to shift more care into the community and tackle the backlog in treatment. In Bournemouth West, the challenges are particularly acute: 32% of respiratory patients are not seen within the 18-week NHS target and, worryingly, 60% of people diagnosed with asthma are not receiving even the most basic asthma care. Those outcomes place us among the worst-performing areas in the south-west. Meanwhile, over 90% of COPD patients in Dorset are not receiving the standard of care—the worst figure in the south of England. We must end the postcode lottery in NHS services. Access to care should not depend on where someone lives. Is the Department aware of the issues facing my constituents in Bournemouth and people across Dorset? What can be done to improve access to healthcare for people with respiratory conditions in my area? As the Health Secretary develops the NHS 10-year plan, I also urge the Minister to seriously consider the proposals set out by Asthma and Lung UK, which include: establishing national targets to reduce preventable asthma deaths, improving access to biologic medicines, supporting the use of digital monitoring tools and reviewing funding for asthma research. In the spirit of World Asthma Day, let us recommit to ensuring that no one dies from preventable asthma attacks and ensure that every person, regardless of postcode or background, can access the care, medicine and environment they need to breathe freely.

15:39:00

It is a pleasure to serve under your chairmanship, Dr Huq, and always a pleasure to see the Minister in her place. I thank the hon. Member for Strangford (Jim Shannon) for securing this important and timely debate to mark World Asthma Day, which took place last week. As the chair of the all-party parliamentary group for respiratory health, he is a tireless advocate for the millions of people across the UK living with lung conditions—and, indeed, multiple other conditions. As my party’s health spokesperson, I have been in this Chamber many times for debates that he has secured. He is certainly a credit to the less-spoken-about health conditions. His commitment to raising awareness and driving change in health is deeply appreciated, and I commend him for his leadership. To mark World Asthma Day 2025, the Global Initiative for Asthma has chosen the theme “Make Inhaled Treatments Accessible for ALL”. It is pertinent that this debate follows one on international development and global health—a powerful reminder of the need to ensure people with asthma have access to the treatments they need, not just to manage their day-to-day symptoms, but to prevent life-threatening attacks. Asthma remains one of the most common chronic health conditions worldwide, yet, as the hon. Gentleman clearly set out, progress over the past two decades have been slow. Lung conditions are now the third biggest killer in the UK. Hospitalisations due to respiratory illness have doubled in the past 20 years, and the UK has seen little improvement in outcomes over that time. Those are not just statistics—they are people, and they reflect a systematic failure to treat respiratory health with the seriousness it demands. There are 7.2 million people living with diagnosed asthma in the UK today, including 2 million children—one in nine adults and one in eight children. The UK’s asthma death rate is higher than the OECD average, and the highest in Europe. Every day, four people in this country die from asthma attacks. Every 10 seconds, someone experiences an asthma attack that could be life-threatening. That should be a wake-up call. In my constituency of Chichester, 7.5% of GP patients aged six and over have been prescribed some form of asthma-related medication in the past year. That statistic is higher than the national average, and it represents hundreds of families trying to manage a condition that, with the right support, should not prevent anyone from living a full and active life. Yet time and again those are the families let down in other areas, by poor housing, air pollution—as the hon. Member for Bournemouth West (Jessica Toale) mentioned—inconsistent care and a public health system that has been hollowed out over the past decade. The UK should be a world leader in public health. We have a long history of innovation, grassroots sports, high-quality food production and leading medical research, but, thanks to the previous Government, we now lag behind our international peers. It is profoundly troubling that our children experience some of the worst asthma outcomes across Europe and other high-income countries. The Liberal Democrats are calling on the Government to take urgent action. First and foremost, we must reverse the Conservative cuts to public health funding, but we must not stop there. We need a comprehensive approach that tackles the root causes of poor lung health, from poverty and cold, damp housing to polluted air and hazardous working environments. We want an increase to the public health grant delivered by local authorities, with part of that funding set out for communities facing the greatest health inequalities. Those communities must be supported by co-designed solutions, including better smoking cessation services, stronger action on air quality and improvements to housing and occupational health. Prevention must be at the heart of our approach. That means investing in primary care, supporting individuals to improve their own health and giving local areas the tools they need to build healthier environments. It is one of the most effective ways that we can reduce pressure on NHS services and deliver better value for money to taxpayers. The Liberal Democrats would also take decisive action on air pollution by passing a clean air Act based on World Health Organisation guidelines and establishing a new air quality agency to enforce those standards. We must do more to ensure access to consistent, high-quality care for those already living with long-term respiratory conditions such as asthma. That includes guaranteeing that people with severe asthma have access to a named GP so that they do not have to constantly retell their story to new clinicians, and increasing the capacity of the Medicines and Healthcare products Regulatory Agency so that new treatments can reach patients more quickly. I was on a Delegated Legislation Committee earlier this week, with the Minister, where the funding for the MHRA was increased. However, it was not clear whether that would speed up the process of getting new medicines to patients. As the hon. Member for Strangford rightly pointed out, the scale of this issue demands urgency. Four asthma deaths every day and a life-threatening attack every 10 seconds are tragedies could be prevented, if only we prioritised respiratory health as we ought to. Will the Minister, therefore, commit to setting aside part of the public health grant to support those communities facing the largest health inequalities? Will the Government propose a new clean air Act based on World Health Organisation guidelines, to ensure those with severe, long-term respiratory conditions are not breathing in harmful pollutants? Finally, when can we expect the publication of the 10-year health plan, and will respiratory health be included? Asthma is not just a clinical issue; it is a question of justice and of whether we are willing to tackle the social and environmental factors that make people ill in the first place. I hope the Minister will reflect seriously on what has been said today.

15:45:00

It is a pleasure to serve under your chairmanship, Dr Huq. I would also like to place on record my thanks again to the hon. Member for Strangford (Jim Shannon). Those unkind might say he chases the spotlight of Westminster Hall, but they would be grossly mistaken: he chases purpose, which is why we find him everywhere, with boundless energy, trying to make a difference, and nowhere more so than in health. This must be the sixth debate I have had with him, if not more, so I take my hat off to him—he really is a champion in this space—and I thank him for what he does. Asthma teaches us never to take a single breath for granted. When simply breathing becomes a conscious effort, we realise just how much strength it takes just to stay alive. I have seen that as a clinician working in A&E and as a GP; one of the scariest moments is when a child comes in having an asthma attack, or worse still, has one in the GP surgery, and having to manage the inhalers, the puffs they take and what to do when they deteriorate. I have a personal story too—if we are declaring interests—to share with the hon. Member for Bournemouth West (Jessica Toale). I suffered from mild asthma growing up as a child and into my teens, but I ended up in an intensive care unit after having my appendix taken out. I ended up with bilateral pneumonia. That is highly unusual in the first place, but even more so when it is a doctor involved—we seem to be the most complicated to treat. It meant that afterwards I was left with significant breathing problems and symptoms that behaved like asthma—so much so that I would need steroids to solve them. I was also under the brittle asthma clinic in Oxford when I lived there. I know at first hand what it is like to suffer when it is impossible to breathe, when someone’s ability to run is taken away or, worse still, they up in the middle of the night in a panic. This is a very timely and important debate that the hon. Member for Strangford has brought forward, and he has my sympathies and gratitude for doing so. On that line, I also thank Asthma + Lung UK for all the work it does to highlight this issue. As we have heard, with 7 million people suffering, this is the bread and butter of the NHS: from primary care to secondary care, day in, day out, people are being diagnosed with and treated for asthma. As we await the 10-year plan for the NHS next month, this debate provides the chance for us to ask where we have got to with the Government. The last Government had come forward with the major conditions strategy but, alas, the new Government decided to take a different direction. Of course, that is their prerogative—no Government are bound by their predecessors. However, it does raise the question: what next? The Government will need to set out what they will do as an alternative to tackle asthma and other respiratory conditions. It would be helpful to hear from the Minister today what assurances she can give about the inclusion she may have made of these conditions in the plan. Can she also set out what engagement her Department has had with patient groups such as Asthma + Lung UK, who put a lot of time into previous submissions to ensure the last Government understood what was needed? It would be sad to see that replication being needed, but at least the work would not be lost. Part of dealing with asthma and respiratory conditions is vaccines and prevention. Work is clearly needed to increase uptake of the respiratory syncytial virus vaccine. I welcome findings that there was nearly a 30% reduction in hospital admissions among those aged 75 to 79, thanks to this vaccine, but the UK Health Security Agency has warned that many more older adults remain unprotected from RSV. To illustrate that point, up to the end of March, only half of eligible older adults had been vaccinated and more than 1 million people were yet to receive their vaccine. I think we all share concerns about the significant increase in the number of bed spaces occupied by people with flu in the 2024-25 winter. That was partly due to vaccination rates among eligible groups being below what we would hope for. This winter, three times as many people as in the previous year were hospitalised because of the flu, which contributed significantly to waiting times in A&E departments. Without a clear increase in vaccination, the NHS will continue to face difficulties in urgent and emergency care. What steps will the Minister take over the next few months to increase the uptake of RSV, flu and pneumonia vaccines, particularly by those who suffer with asthma and COPD? As a clinician, I remember over the years having to deal with different sets of guidelines. The hon. Member for Strangford hit the nail on the head. It was great to see the BTS, NICE and SIGN guidelines all coming together in November 2024, but there is a challenge in having guidelines, rolling them out and making sure clinicians are educated on the changes. What steps have the Government taken to ensure that ICBs and royal colleges are aware of the guidelines and that they are percolating down to everyone who might need to see them? Access to fractional exhaled nitric oxide—FeNO—testing is an important step in diagnosis. There is also spirometry. Given the success of community diagnostic centres, have the Government given any thought to how such apparatus could be rolled out to communities so that more people might get access to it? One thing that is really important with respiratory diseases, especially asthma, is smoking cessation. The Tobacco and Vapes Bill is going through Parliament, but is there any targeted approach for those who suffer with asthma to help them to reduce smoking? Much of asthma care is delegated to nurses, not doctors. How does that fit into the forthcoming workforce plan? Will special consideration be given to respiratory nurses in both primary and secondary care? After all, they have become the experts in exactly what to prescribe and when. Finally and most importantly, what steps are being taken to reduce asthma deaths, especially preventable ones? The word “preventable” is the biggest key here. I am keen to hear from the Minister how the Government intend to tackle this problem. Breathing: it is the first and last thing we do, but we rarely notice it until it has gone—or, in the case of asthma, until it is threatened. I know the Minister understands that, and I know the people out there watching understand it. I hope that understanding transforms into policy.

15:53:00

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for bringing this timely debate forward as we mark last week’s World Asthma Day. It shows real leadership from the chair of the APPG for respiratory health. In that spirit, I would be delighted to take him up on his offer of a meeting. We will arrange that as soon as we possibly can—I am keen to do it. I thank hon. Members for their contributions. I am more than happy to meet the hon. Member for Birmingham Perry Barr (Ayoub Khan) to discuss the issues that he raised, including prescription charges. There are currently no plans to review the list of medical conditions that entitle someone to apply for a medical exemption certificate. However, approximately 89% of prescription items are dispensed free of charge in the community in England and a wide range of exemptions are already in place. Eligibility depends on factors such as the patient’s age and whether they are in qualifying full-time education, are pregnant, have recently given birth or are in receipt of certain benefits. People on low incomes can apply for help with their health costs through the NHS low income scheme. Children are of course entitled to free prescriptions. NHS England’s children and young people’s transformation team have been working closely with the MHRA on dose counters being added to inhalers. The “British National Formulary for Children” has been updated with guidance and supportive resources for patients and clinicians, which have been widely shared. We are awaiting an update on progress on making dose counter inhalers dominant in the supply chain from the pharmaceutical industry. I will be more than happy to update the House when we have it. I thank my hon. Friend the Member for Bournemouth West (Jessica Toale), who focused on air quality, which is a priority for the Government and part of our prevention strategy, and the technology to help to manage asthma. There are a range of technologies available to help people to manage their asthma, and NHS England and NICE are exploring the potential for the platforms for digital self-management of asthma to be evaluated, but that depends on the technology readiness level. Guidelines developed jointly by NICE, the Scottish Intercollegiate Guidelines Network and the British Thoracic Society to harmonise recommendations across the organisations were published in November 2024, and I hope they are useful. Before I respond to the Front-Bench contributions—if there is anything I do not cover, please let us know and we will endeavour to write with the relevant details—I want to pay tribute to charities and campaigners: people who are doing the hard yards of helping to equip our hospitals and supporting people to manage their conditions in their day-to-day lives. I thank Asthma + Lung UK, Beat Asthma and the Asthma Relief Charity, to name just a few. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), asked about the contributions by charities to the major conditions strategy. I reassure him that engagement with such stakeholders has been central to the development of the 10-year plan. All submissions made to the major conditions strategy have been taken into account—nothing was wasted. As the hon. Member for Strangford outlined, asthma is the most common lung condition, affecting nearly 5.5 million people in the UK. Just under one in 10 kids live with asthma, and more than 12,000 people have died from asthma attacks in the last 10 years. World Asthma Day is not just about treating a condition; it is about shining a spotlight on inequalities. I strongly agree with the hon. Gentleman that everyone, regardless of where they live or how much they have in their bank account, has the right to access the inhaled medications they need to control their condition and treat attacks. Nevertheless, statistics published by Asthma + Lung UK just this month show that Asian people with asthma from the most deprived quintile in England are almost three times more likely to have an emergency admission to hospital than their white counterparts. Black people with asthma from that group are also more than twice as likely to be admitted to hospital. This is a burning injustice. As if that were not enough, the annual economic burden of asthma in the UK is around £3 billion a year. Lung conditions collectively cost the NHS £11 billion annually. That is why we must act. I will update Members on NHS England’s activities in this space before moving on to wider Government efforts. NHS England is taking steps to support integrated care systems to improve outcomes for people with asthma through its national respiratory programme by providing targeted funding, clarifying what systems should be doing to ensure that people with asthma receive a high-quality and timely diagnosis, and working with key partners, industry representatives, patient groups and clinicians to support improved respiratory disease management. That will include shared decision making on inhaler choice and making better use of inhalers to reduce the overuse of reliever inhalers and encourage the use of preventer inhalers. The hon. Member for Strangford raised the issue of access to and roll-out of treatments. Healthcare Quality Improvement Partnership, on behalf of NHS England, commissioned a national audit across respiratory care, which includes asthma, and all data from the audit is published for open access. NICE is working with BTS, SIGN, NHS England and others to review the resources available to support implementation of the guidelines, and plans to publish a respiratory toolkit. To support implementation of NICE guidance, NHS England has been engaging with health system partners across the country to co-ordinate resources and implementation efforts to make sure that patients are on the appropriate treatment regime. NHS England is also protecting our children and young people through the national bundle of care. It is putting asthma care at the top of the agenda by giving asthma a higher priority within systems, providing funding for regional leadership, and strengthening governance and accountability to improve outcomes. It has also played a crucial role in making training easier and more readily available for staff by bringing together existing guidance and resources with a structured training scheme. Since its publication there has been a noticeable reduction in hospital admissions. The hon. Member for Strangford and the shadow Minister both raised spirometry, a diagnostic test for asthma as well as other respiratory diseases. NHS England is working with a range of partners, including Asthma + Lung UK, the British Thoracic Society, the Association for Respiratory Technology and Physiology and clinical leads to make sure that systems have everything they need to increase the number of people receiving early and accurate diagnosis for respiratory disease. In the past year the Government have made extra funding available to make sure that staff have the proper training and accreditation to use spirometry effectively. On inequalities, NHS England is taking steps to uplift the most deprived quintile through Core20PLUS5. That initiative focuses on five areas of improvement, of which chronic respiratory disease is a key part. There are targeted interventions to detect and treat asthma. The PLUS population groups include ethnic minority communities, people with a learning disability, autistic people, coastal communities, people with multimorbidity and protected characteristic groups. Core20PLUS5 also has a dedicated workstream for children and young people. The primary focus is to address over-reliance on reliever medications while decreasing the number of asthma attacks. That has made some progress, with clear reductions in the over-prescribing of reliever inhalers over the past few years. Between April 2022 and February 2025 the proportion of patients with asthma who received six or more reliever inhaler prescriptions fell from just under 20% to under 16%. The Government are supporting systems to take innovative approaches to expanding access to their diagnostic services, with a particular focus on addressing health inequalities. Finally, the NHS rightly offers the flu vaccine free of charge to people with severe asthma as seasonal illnesses pose more of a threat to them than others. NHS England has been working with the severe asthma collaborative to develop the capacity of severe asthma centres to improve patient access to biologic treatments and to reduce variation in prescribing and patient management. That work has shown improved identification of patients with potential severe asthma in primary and secondary care, resulting in referral to severe asthma centres for consideration of their eligibility for biologic therapy. For four in 10 asthma patients with severe asthma those treatments can significantly improve their quality of life. However, it is vital that biologics are prescribed only following specialist assessment. Currently, the NHS is deploying six biological treatments approved to treat severe asthma. The shadow Minister raised the issue of vaccines. I reassure him that a strategy and action are being delivered to increase vaccination uptake, including RSV and flu, because that is a priority for the Government. Returning to biologics, significant work was undertaken to drive uptake and access to them through the NHS England severe asthma collaborative, and patient outcomes are submitted to the UK severe asthma registry. That has improved the identification of patients with potential severe asthma, and has resulted in those people being referred to the relevant care pathways. Every member of the Government is committed to raising the healthiest generation of children in our history. We are taking steps to protect our kids from obesity and smoking, which are major risk factors; each one is responsible for roughly a third of asthma deaths. We are taking action through the Tobacco and Vapes Bill, which I am pleased to say has just passed Second Reading in the other place. In her autumn Budget, my right hon. Friend the Chancellor took steps to ensure that the soft drinks industry levy remains effective. We have not just uprated the levy to bring it in line with inflation; we also published a consultation just last month on two proposed changes—reducing the lowest sugar tax threshold from 5 grams to 4 grams of total sugar per 100 ml, and removing the exemption for milk-based and milk substitute drinks. Finally, my right hon. Friend the Secretary of State for Energy Security and Net Zero is cleaning up our air with Great British Energy and a raft of other measures. My Department will shortly be publishing its 10-year plan for health to make our NHS fit for the future. We will shift the focus of our NHS from sickness to prevention, hospital to community, and analogue to digital. Until then, we are already taking steps on prevention by helping people to lose weight and quit smoking or vaping, and by helping to clean up our air. We are helping people to get diagnosed closer to home by requiring community diagnostic centres to provide spirometry tests. The Government remain committed to ensuring that existing CDCs, where they are not already, are rolled out at full operational capacity at their permanent site.

The Minister mentioned spirometry. Could she comment on FeNO, and if not, could she write to us? The guidelines are built around that, but access is going to be an issue.

Yes, I confirm that I will write to the shadow Minister on FeNO at a later date. NHS England is also piloting a digital annual asthma check. I am sorry, Dr Huq, this is highly irregular, but I am feeling extremely unwell; I need to go and make myself okay. [Interruption.] Thank you for your forbearance, Dr Huq. Crohn’s is not something that we have debated in this Chamber; if we did, no doubt I would be the responding Minister, and I can assure you that I would be able to speak from personal expertise.

I used to have close contact with a guy called Simon Hamilton, who was an MLA for the constituency that I represent. He had Crohn’s disease—my knowledge of it came through him—and he was caught short many a time, if that is the way to put it. May I ask the Minister a wee question? I asked about CDCs once NHS England is abolished—[Interruption.] I can see that she is coming to that. That is grand.

Yes, I will come to many of those issues. As I was saying, NHS England is piloting a digital annual asthma check, which, if successful, will mean that fewer people miss that valuable check and will keep the monitoring of their asthma up to date. The Lib Dem spokesperson, the hon. Member for Chichester (Jess Brown-Fuller), asked about the public health grant. The grant has been increased and local directors of public health are best placed to identify where to target resources in their communities. As I have said, the 10-year health plan will be published next month. It will cover all conditions and will consider lung health. I have talked about the stakeholder engagement that was really important in that, and I can guarantee that, with the 10-year strategic plan for the NHS, we will look right across the board at how we can make sure that all conditions get due consideration. During our short interruption, I was able to get a little more information for the shadow Minister on FeNO. Wessex Academic Health Science Network has created a FeNO rapid uptake product delivery toolkit, which is providing downloadable tools and resources to support NHS organisations with the adoption and implementation of FeNO testing to improve outcomes. Anyone can access that toolkit, which contains case studies of best practice identified through the programme. I hope that is helpful. On the changes to NHS England, we are abolishing NHS England in itself, but none of its functions is disappearing. We are working really closely across the Department and NHS England, as well as with our ICB colleagues, to ensure that all services are transferred in an appropriate way. The purpose of the changes is to make things as efficient and targeted as possible and to ensure that they get to the people who need them the most. Ensuring that community diagnostic centres are supported is really important to the Government, as it is very much part of one of our three shifts: from hospital to community. Those shifts—the other two are from sickness to prevention and from analogue to digital—are at the very heart of the 10-year plan. I thank the hon. Member for Strangford for bringing forward the debate. I am sure that he would agree that World Asthma Day is not just for raising awareness; it should also be a celebration of the great things that people with asthma have accomplished. I did not know this until I saw the research for this debate, but past asthmatics have included Dickens, Disraeli and Beethoven. If those examples seem archaic, I can also point to Harry Styles, Jessica Alba and David Beckham, as well as to many prominent Olympic medallists. People with asthma achieve great things. It is our job in this place to help them to reach their full potential, with a particular focus on addressing how respiratory conditions affect people in deprived communities.

16:14:00

I thank all hon. Members for participating in the debate. The hon. Member for Birmingham Perry Barr (Ayoub Khan) referred to the fact that someone dies every six hours—four people in a day—from asthma. He also talked about young George Coller, and the Minister kindly agreed to meet the hon. Gentleman and the family. That is very positive; I would not expect anything other than positivity of the Minister, but I thank her for that. Such meetings help us to represent our constituents in a positive fashion. The hon. Member for Bournemouth West (Jessica Toale), who is an asthma sufferer—I know about asthma only through my son, but the hon. Lady has lived experience—talked about how asthma affects her life, and I understand that her sister also suffers from it. She also referred to the Tobacco and Vapes Bill and the Renters’ Rights Bill, which are relevant to issues that contribute to asthma. Asthma goes way outside the remit of Health Ministers alone; Ministers in other Departments have to be part of addressing it. The hon. Member for Chichester (Jess Brown-Fuller) always brings her knowledge to the subject matter. She referred to air pollution and the Lib Dems’ commitment to addressing that issue. She mentioned poor housing and healthier homes, and said that the increase in children’s asthma needs to be addressed. Again, lung conditions are the third biggest killer in the UK, as others have mentioned. I have lost count of the number of debates that my friend, the hon. Member for Hinckley and Bosworth (Dr Evans), and I have been in together—it is like a tag team here on a Thursday afternoon—and I thank him for his personal story about asthma. He referred to the work of charities and to primary and secondary care, which the Minister referred to positively in her contribution. He mentioned smoking cessation, the passage of the Tobacco and Vapes Bill, and preventable deaths. I thank him for bringing his knowledge as a doctor to add to the debate. I thank the Minister; I think that we are all impressed by her replies. She did her utmost to answer all our questions in a positive fashion. I thank her for agreeing to the meeting, which we will look forward to. It will give the APPG a chance to talk more insightfully, if that is the way to put it, about the issues. The commitment to asthma shines out across the nation. The Minister referred to the Government’s commitment to improving air quality, which we are all pleased about, and she referred to the national bundle of care—I hope I got that right—as well as regional funding. She also referred to spirometry diagnostic tests, which is an issue that the hon. Member for Hinckley and Bosworth and I were trying to pursue. The Minister also mentioned action for those with severe asthma—biologics—and the training of staff; her positive replies to our questions were an example of how other Ministers should reply. She mentioned the moves from sickness to prevention and from analogue to digital. She discussed ensuring, first of all, that we prevent the deaths, but also that we help those who have asthma. It has been a positive debate. It may be a few weeks after World Asthma Day, but none the less it has been World Asthma Day for this hour or so. I thank everyone for their contributions and look forward to meeting the Minister. Question put and agreed to. Resolved, That this House has considered World Asthma Day.

16:19:00