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Health: Asthma

I thank the noble Viscount for securing the debate and congratulate him on timing an asthma attack so perfectly that we really need say no more. I hope that he feels well now, but I begin to wonder about my presence in the Chamber and that of the noble Earl, Lord Howe, and the noble Baroness, Lady Thornton. Whenever we are together, someone seems to have a medical emergency. Perhaps we should talk about this at some time. When I was a child, the only I person I knew who had asthma was my best friend. Every winter, I spent many weeks sitting by her bedside, rather as I sat by the noble Viscount a few minutes ago, watching her struggle for breath after contracting a cold that had precipitated her asthma. We spent many hours playing board games in her bedroom. I have to say that that was when we were not in my bedroom playing board games, because I was confined to bed with recurrent ear infections following colds. We both suffered, but I do not think that anything was quite as bad as asthma. I am well aware of what it must be like. We have all seen the increase in asthma. In my childhood, my friend was the only person I knew who had bad asthma, but among my children’s generation there seemed to be huge numbers of children with asthma. On holiday in Spain as a teenager, one of my daughter’s friends died in an asthma attack because she could not get to a hospital in time. That was not very long ago. Nowadays, as we have heard from the noble Lord, Lord Colwyn, schoolteachers seem to have many children with asthma in each class. They are well aware of it. Asthma has certainly been on the increase: we are told that there are now two or three times as many sufferers as there were 50 years ago. No one is really sure of the reason for that, although the noble Lord, Lord Colwyn, dealt with those aspects very adequately. It was interesting to hear him speak. The smoking ban will help, as air pollution was always a factor. When I was a junior doctor and a GP, the fashionable thinking was that asthma was due to house mites. The increase in the number of cases of asthma has flattened recently and I wonder whether that is linked to the fashion for wooden floors as opposed to thick carpets. That may have contributed to the flattening of the graph for asthma. Some 4.5 million people in this country have asthma, which is a lot of people. It is one of the most common long-term conditions that doctors and nurses have to deal with. Ten per cent of those 4.5 million people have very severe difficulties and very bad asthma. People may have seen the Royal College of Physicians survey, which says that 69 per cent of people with asthma do not have their symptoms under proper control. Some 38 per cent reported difficulty sleeping in the past month and 33 per cent reported interference with their usual activities in the past month. It is a serious, life-disrupting disease, with which people must live all their lives. There were 1,199 deaths from asthma in 2006. That is more than the number of deaths from cervical cancer and testicular cancer combined. There have been many initiatives and a lot of publicity about cervical cancer and we are fortunate that the Government have made great strides and that the health service is doing a lot about it, but there are more deaths from asthma. It is a huge cost to the NHS in work and money—an estimated £16 billion a year and over 65,000 hospital admissions a year. As we heard from the noble Viscount, people from the worst areas of Liverpool are more likely to go into hospital than are people in my former constituency of Richmond, which in some table or other once was regarded as the most highly educated and most well-off constituency in England. The reason why people there have better control of asthma is probably that patients’ parents and relatives and the patients themselves are so much more demanding and expect so much more in preventive care from clinicians. What are some of the things that we should be doing to help those people? First, we need a personal action plan. It is terribly important that a doctor sits down with an asthmatic patient and works out what is going to happen to them and what they need. The noble Viscount clearly demonstrated that he has a personal action plan. He knows what to do and he does not need anyone to interfere. He knows that, if he does the right things, it will get better. Many people do not have that, but they need it. However, if that is to be the case, we will need many more specialist GPs and nurses in the community. Please, please can we have more training for doctors and nurses? In particular—the Minister will know about this because I am always beefing on about it—we need more community nurses who can deal with and have specialist training in long-term conditions. Asthma is one of them. Every patient should have access to a personal care plan and to specialist GPs and nurses. They should be able to see a doctor who knows about the condition, whether or not that doctor is in their own practice. We also need a dedicated national strategic framework; every other country in the British Isles has one, but England does not. I know that things have been laid down on asthma in the children, young people and maternity services framework, but asthma is such a common long-term condition that it needs a strategic framework of its own. In some ways, it is great to have targets and frameworks, but the conditions that are left out get left behind, because PCTs and clinicians concentrate on the ones for which figures are collected. We must be very careful to ensure that asthma is not left out. I have some questions for the Minister. What national initiatives are planned for the treatment of asthmatics? How will the Government deal with the postcode lottery that the noble Viscount mentioned, comparing Liverpool and Richmond, for example? When will we have a national strategic framework for asthma, together with training for doctors and nurses, so that people up and down the country, children and adults, can deal with their asthma, as has the noble Viscount this afternoon, and not have to be unnecessarily admitted to hospital?