---

Health: Asthma

As someone who has severe brittle asthma, and who can have a serious attack within a few seconds following the inhalation of certain triggers, I am pleased to have secured this Question for Short Debate on asthma. Four and a half million—that is, one in 11—people in England are currently receiving treatment for asthma, making it one of the commonest long-term conditions. An estimated 10 per cent of people with asthma—that is, 450,000 in England, including me—have difficulty controlling asthma, which impacts significantly on their health, life chances and quality of life. This Government have delivered some real improvements for people with asthma. In particular, the smoking ban allows us to work and socialise in smoke-free environments and will help to reduce the impact of asthma in the future. But we must not be complacent. Asthma UK has estimated that, with correct asthma management, up to 90 per cent of deaths from asthma, and up to 75 per cent of hospital admissions due to asthma attacks, could be prevented. Today I want to highlight the fact that much more needs to be done and to urge the Government to focus on driving up standards of asthma care and treatment by introducing a national clinical strategy for asthma. Many people assume that asthma is not serious because it should be possible to control in most cases, and most people have little conception of what an asthma attack is like. But asthma is serious. On average, one person dies from asthma every seven hours in the UK. Hospital admissions for asthma are increasing, having previously declined. Too many people suffer in silence with symptoms that are bad enough to cause them difficulty sleeping and to interfere with their usual activities. An Asthma UK survey of more than 1,000 people with asthma found that 69 per cent of people did not have their asthma under control as defined by Royal College of Physicians standards. Asthma UK’s recent Wish You Were Here? report identified a postcode lottery in hospital admissions. Most shockingly, children living in Liverpool have an almost eight times higher chance of emergency hospital admission for asthma than children living in Richmond and Twickenham. Asthma is one of the top five causes of emergency hospital admissions among children in England. The knock-on effect can be severe, particularly if children have to miss school through asthma attacks and frequent appointments with specialists. Without adequate support, asthma damages their life chances. The postcode lottery also applies to people of all ages living in neighbouring areas. There is almost a threefold difference in admissions between adjacent PCTs. Afro-Caribbeans are twice as likely, and south Asians three times as likely, as white people to end up in hospital with an asthma attack, despite small differences in the rates of asthma within these communities. Outcomes are worse in poorer areas, with 86 per cent of spearhead PCTs having higher than average emergency admissions for asthma. An asthma attack is a frightening and distressing experience, not only for the patient but also for their family. A person’s chances of accessing treatment good enough to put an end to the attack and keep them out of hospital should not depend largely on where they live. However, we should be optimistic about what, after improvements, the NHS could achieve through a sustained focus on asthma. A survey showed that 20 per cent of nurses with lead responsibility for respiratory care have no accredited training in asthma. People with asthma say that the lack of specialist nurses affects quality of care. A national strategy could address this. Only a quarter of people with asthma say that they have a written personal asthma action plan setting out the treatment plan that they have agreed with their doctor and telling them when to seek help. As patients are four times more likely to have an emergency admission without one, these plans need to be part of a clear set of national standards. Anecdotal evidence suggests that asthma reviews, as required by the Quality and Outcomes Framework, often take place without basic checks on peak flow and inhaler technique. Indeed, some GPs do not know the correct way to use an inhaler. Clearly, a stronger focus is needed on getting asthma care right. An acute NHS health trust report highlighted difficulties both in identifying patients who are frequently admitted with asthma attacks and in following people up after hospital admissions. Healthcare professionals with a special interest in asthma and respiratory conditions report that the clinical asthma guidelines developed by the British Thoracic Society are still not widely used. They also say that asthma-specific recommendations in the National Service Framework for Children, Young People and Maternity Services, published four years ago, are not being widely implemented. This may help to explain why asthma is still one of the top five causes of emergency admissions among children. Although there is clear need for improvement, there are also some fantastic initiatives that could make a huge difference if there was a national strategy to replicate them elsewhere. Following funding provided by Asthma UK, Liverpool PCT, which has the highest admissions for asthma in England, is developing a whole-systems approach involving all the relevant organisations, including the PCT, the local authority and the local education authority, to improve standards and quality of care for people with asthma. The approach aims to empower both people with asthma and healthcare professionals to manage asthma effectively and improve the quality of services provided, with the overall aim of reducing emergency hospital admissions for asthma in Liverpool. Neighbouring PCTs in Oldham and Knowsley have recently joined in this major initiative in the north-west of England. It costs three and a half times as much to treat someone who has an asthma attack as it does to care for someone whose asthma is well managed. That is important. Surely the money wasted on preventable emergency admissions would be better spent getting asthma management right, quite apart from the distress to patients and their families, which can and should be avoided. Despite all the problems that I have spoken about today, I remain optimistic that we can drive up standards of asthma management to the level of the very best. Huge gains can be made, but that will happen only if the NHS makes asthma a sustained priority. This focus must include a national clinical strategy for asthma to drive up standards of asthma care, rather than the current patchwork of poorly implemented standards and guidelines. Department of Health officials are currently finalising a national clinical strategy for chronic obstructive pulmonary disease, which will include initiatives that an asthma strategy could build on. At the same time, Scotland, Wales and Northern Ireland all have or are developing national asthma strategies and frameworks that could inform such a strategy in England, the only country without one. I urge Ministers to seize the opportunity that these developments represent to construct a national clinical strategy for asthma.