The Government has committed to delivering three big shifts that our National Health Service needs to be fit for the future: from hospital to community; from analogue to digital; and from sickness to prevention. All of these are relevant to improving respiratory health in all parts of the country.

Through our community diagnostic centres we are building capacity for respiratory testing and enabling people to get diagnosed closer to home. 101 community diagnostic centres across the country now offer out of hours services, 12 hours a day, seven days a week, meaning patients can access vital diagnostic tests around busy working lives. This is alongside action being taken to expand capacity and improve the quality of pulmonary rehabilitation services to support patients living with respiratory conditions.

We are also taking action to reduce the causes of respiratory conditions such as enabling a smoke free generation and cross-Government action to improve air quality.

The steps taken include the production of the Paediatric and child health advanced practice area specific capability and curriculum framework, which was co-produced by NHS England and the Royal College of Paediatrics and Child Health. The framework is available at the following link:

https://advanced-practice.hee.nhs.uk/wp-content/uploads/sites/28/2025/01/Paediatric-and-child-Health-advanced-practice-area-specific-capability-and-curriculum-framework-NHSE.pdf

The framework outlines area specific capabilities and a curriculum addressing the full spectrum of paediatric health needs, including recognising and managing cardiac and respiratory conditions.

Everyone in the National Health Service is responsible for delivering high-quality care. As announced in the 10-Year Health Plan, as well as an overall quality strategy, the National Quality Board will oversee the development of a new series of service frameworks to accelerate progress in conditions where there is potential for rapid and significant improvements in the quality of care and productivity.

Early priorities will include cardiovascular disease, severe mental illness, and the first ever service framework for frailty and dementia. The Government will consider other long-term conditions with significant health and economic impacts for future waves of modern service frameworks.

The Department of Health and Social Care has not made an assessment of the availability or trends in the use of extracorporeal membrane oxygenation machines in the NHS.

The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health. This includes advice on use of extracorporeal membrane oxygenation machines.

The 10-Year Health Plan will deliver the three big shifts the National Health Service needs to be fit for the future: from hospital to community, from analogue to digital, and from sickness to prevention. All of these are relevant to improving respiratory health in all parts of the county.

More tests and scans delivered in the community, better joint working between services, and greater use of apps and wearable technology will all help people manage their long-term conditions, including respiratory conditions, closer to home. Earlier diagnosis of conditions will help people manage their conditions, prevent deterioration and improve survival rates.

Currently there are no plans to include spirometry and FeNO testing in the GP contract. In many areas, spirometry and FeNO testing services are delivered through Local Enhanced Services (LESs), which are funded separately to global sum payments.

Integrated care boards, as commissioners of primary care, are responsible for commissioning LESs which practices can opt into, which vary in scope and funding to fit the needs of local areas. In areas where spirometry and FeNO testing are not commissioned through a LES, it is the commissioner’s responsibility to ensure these services are available to patients.

The number of children vaping has tripled in the last three years. Due to highly addictive nicotine content and the unknown long-term harms, vaping carries risk of harm and addiction for children.

This is why on 4 October 2023, the Prime Minister announced that we will be cracking down on youth vaping, by consulting on measures to reduce the appeal, availability and affordability of vapes to children.

Despite being an effective tool to help adults quit smoking, vaping is not risk free and there are unknown risks on the long-term harms. The Nicotine vaping in England: 2022 evidence update summary report agrees that, while the literature has grown considerably, there is no available evidence related to whether vapes cause respiratory diseases. More information is available at the following link:

https://www.gov.uk/government/publications/nicotine-vaping-in-england-2022-evidence-update/nicotine-vaping-in-england-2022-evidence-update-summary#chapter-10-respiratory-diseases

The Department will continue to closely monitor the evidence base on vapes, including their long-term impact on health and health behaviours.

The UK Health Security Agency (UKHSA) position on incinerators is that modern, well run and regulated municipal waste incinerators (MWIs) are not a significant risk to public health. This view is based on detailed assessments of the effects of air pollutants on health and on the fact that these incinerators make only a very small contribution to local concentrations of air pollutants.

Public Health England funded a study by the Small Area Health Statistics Unit at Imperial College London which found no link between exposure to emissions from, or living close to, MWIs and infant deaths or reduced foetal growth. The study also found no evidence of increased risk of congenital anomalies from exposure to MWI chimney emissions, but a small potential increase in risk of congenital anomalies for children born within ten kilometres of MWIs. A causal association between the increased risk of congenital anomalies for children born close to MWIs has not been established.

UKHSA has not received or commissioned any assessments on disposing of plastic waste by incineration. UKHSA’s position is that well run and regulated modern MWIs are not a significant risk to public health when incinerating the general municipal waste mix which includes plastic.

When consulted, UKHSA provides an expert and independent opinion to the regulator (Environment Agency) on the potential impacts on human health of emissions including nitrogen oxides arising from existing or proposed regulated facilities, such as MWIs. Emissions from existing regulated facilities are closely monitored and regulated by the Environment Agency.

The UK Health Security Agency (UKHSA) position on incinerators is that modern, well run and regulated municipal waste incinerators (MWIs) are not a significant risk to public health. This view is based on detailed assessments of the effects of air pollutants on health and on the fact that these incinerators make only a very small contribution to local concentrations of air pollutants.

Public Health England funded a study by the Small Area Health Statistics Unit at Imperial College London which found no link between exposure to emissions from, or living close to, MWIs and infant deaths or reduced foetal growth. The study also found no evidence of increased risk of congenital anomalies from exposure to MWI chimney emissions, but a small potential increase in risk of congenital anomalies for children born within ten kilometres of MWIs. A causal association between the increased risk of congenital anomalies for children born close to MWIs has not been established.

UKHSA has not received or commissioned any assessments on disposing of plastic waste by incineration. UKHSA’s position is that well run and regulated modern MWIs are not a significant risk to public health when incinerating the general municipal waste mix which includes plastic.

When consulted, UKHSA provides an expert and independent opinion to the regulator (Environment Agency) on the potential impacts on human health of emissions including nitrogen oxides arising from existing or proposed regulated facilities, such as MWIs. Emissions from existing regulated facilities are closely monitored and regulated by the Environment Agency.

The National Institute for Health and Care Excellence has made no recent assessment of the effectiveness of its guidelines that were issued following the outbreak of COVID-19 in respect of drugs that cause respiratory depression.

The Government, via the National Institute for Health and Care Research and the Medical Research Council, invest significantly in research and development into respiratory diseases. This investment is aligned to the aims and ambitions of the proposed Respiratory Mission, outlined in the Life Science Vision, to reduce the morbidity and mortality associated with respiratory disease.

The Office for Life Sciences will continue to work with public, private and philanthropic partners to identify options and funding opportunities that could allow a specific Respiratory Mission to be set up and delivered.

The Environment Agency manages the United Kingdom’s national air quality monitoring sites on behalf of Department for Environment Food and Rural Affairs and the Devolved Administrations. There are around 300 Environment Agency managed air quality monitoring sites across the UK.

In 2018, UK Health Security Agency published an estimation of the potential health burden and costs to the National Health Service and social care system arising due to diseases related to air pollution. The model found that reducing fine particulates in England by 1 µg/m³ could prevent an estimated 50,900 cases of coronary heart disease, 16,500 stroke strokes and 9,300 cases of asthma by 2035 across England.

In 2022, the Committee on the Medical Effects of Air Pollutants published a report suggesting possible links between air pollution and dementia. It is known that small particles can affect the heart and blood vessels, including to the brain.

My Lords, there are many viruses that cause mild and severe respiratory tract infections, with vaccination programmes against

influenza and Covid-19 and a target immunisation offer against respiratory syncytial virus for children at high risk in England. The Joint Committee on Vaccination and Immunisation has recently published advice on influenza and Covid-19 for 2023-24, and is reviewing new products for potentially improving and expanding the RSV immunisation offer. The Government will announce those in due course.

To ask His Majesty’s Government when they expect the Joint Committee on Vaccinations and Immunisations (JCVI) will announce the national immunisation programme for respiratory viruses for the winter season 2023/2024.

I thank the noble Baroness for her question and pay tribute to the work that she does on behalf of us all as the allergy champion in Parliament. In line with the JCVI recommendation, the NHS currently offers a targeted monoclonal antibody programme to a small number of infants at high risk of severe complications from RSV infection. However, there are potential changes to this programme: a new monoclonal antibody which provides longer-term protection than the one currently used has been developed, and the JCVI is reviewing this in time for the 2023-24 season. The new monoclonal antidotes and vaccines are being reviewed by the JCVI for potential expansion of the current programme, including a universal offer. The JCVI is expected to conclude advice on this later in 2023. I assure the noble Baroness that I have asked for a specific date, and once I receive one I will certainly notify her.

I thank the Minister for his Answer, but obviously I am looking for a little more on a time and a date for that vaccination programme for next winter, which could see the introduction of several new immunisations for RSV. Indeed, I understand that one vaccine received its licence from the MHRA last November. What are the Government doing to ensure that the Joint Committee on Vaccination and Immunisation is able to rapidly access these new technologies in time for the next winter season, and thus help to mitigate the problems faced by the National Health Service?

I thank my noble friend for that question. The Government are guided by the independent JCVI on vaccinations and immunisations. The intention of the vaccination offer to children is to increase the immunity of vaccinated individuals against severe Covid-19 in advance of a potential future wave. When formulating advice in relation to childhood immunisations, the JCVI has consistently maintained that the focus should be on the potential benefits and harms of vaccination to children and young people themselves; prevention of severe Covid-19 hospitalisations and deaths in children and young people is the primary aim.

My Lords, can my noble friend the Minister say why the Government are advocating the vaccination of healthy, not-at-risk children for Covid-19?