Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Environment, Food and Rural Affairs:
To ask the Secretary of State for Environment, Food and Rural Affairs, whether his Department has conducted modelling on the impact of the potential removal of medical exemption to the F gas phase down schedule on the cost of medicines.
Answered by Steve Double
Defra is reviewing the F-gas Regulation, which includes an exemption from the hydrofluorocarbon phasedown for metered dose inhalers (MDIs). The review will consider the implementation of the current F-gas Regulation and options for future policy development. The implications of removing the exemption for MDIs, including the potential impact of this on cost and supply, will be included in the analysis.
NHS England is in the process of reducing the use of MDIs containing high global warming potential propellants and has produced cost estimates for the switch from MDIs to currently readily available alternatives. These cost estimates will be incorporated in Defra’s work.
Defra is working on this review jointly with the Scottish and Welsh Governments and we plan to consult on proposed future policies next year.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Environment, Food and Rural Affairs:
To ask the Secretary of State for Environment, Food and Rural Affairs, if he will hold discussions with the Secretary of State for Health and Social Care on a timescale for the phasedown of the use of fluorinated gases in asthma inhalers.
Answered by Steve Double
Defra has a legal duty to undertake a comprehensive review of the F-gas Regulation. As part of this work, Defra will identify additional action that can be taken with regard to F-gases and their contribution to net zero. At COP26, Defra committed to an accelerated hydrofluorocarbon (HFC) phasedown. Defra intends to publish an assessment report by the end of 2022 as the first stage of the review. It will focus mainly on analysing the effects of the current Regulation, together with the current state of play in relevant industry sectors and international commitments. The second stage of the review will involve a public consultation on proposals for any legislative changes.
The F-gas Regulation currently includes an exemption from the HFC phasedown for metered dose inhalers (MDIs). The continuation or removal of the exemption for MDIs will be considered as part of the policy development and analysis into future options, as well as implications of the HFC phasedown on MDIs. To support this work there is ongoing engagement between Defra, the NHS and the Department of Health and Social Care.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Business, Energy and Industrial Strategy:
To ask the Secretary of State for Business, Energy and Industrial Strategy, what measures he has put in place to (a) assess and (b) control the release of silica dust into urban areas; and what steps he is taking to lower the risk of exposure to that dust among the general public.
Answered by Jane Hunt
This is not a matter for the Department for Business, Energy and Industrial Strategy.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Work and Pensions:
To ask the Secretary of State for Work and Pensions, whether she plans to introduce further measures on prevention of respiratory conditions in the workplace.
Answered by Chloe Smith
The Health and Safety Executive (HSE) continues its activity to help prevent work related respiratory ill health by using the best available evidence to design interventions that will improve health outcomes. HSE delivers a wide range of regulatory activity to prevent work related respiratory ill health, focusing on steps employers and workers can take to control occupational exposures.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Work and Pensions:
To ask the Secretary of State for Work and Pensions, whether she plans to introduce real-time exposure monitoring for workers exposed to respirable crystalline silica.
Answered by Chloe Smith
The Health and Safety Executive (HSE) is aware of developments in real time monitoring instruments claiming to measure aerosols containing respirable crystalline silica (RCS) onsite.
HSE will continue to monitor developments, as validation data to confirm accuracy remains limited. As with all advances in technology claims made for any of these instruments would need to be examined further and substantiated with robust data.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Work and Pensions:
To ask the Secretary of State for Work and Pensions, what steps she has taken to help reduce exposure to respirable crystalline silica in the workplace.
Answered by Chloe Smith
The Health and Safety Executive (HSE) has a well-established regulatory framework in place to protect workers from the health risks associated with exposure to hazardous substances at work.
Under the Control of Substances Hazardous to Health Regulations 2002 (COSHH) employers have a duty to prevent or adequately control worker exposure to hazardous substances such as Respirable Crystalline Silica (RCS). COSHH sets out the hierarchy of control that must be implemented and, if managed appropriately, should result in achieving a level below the Work Exposure Limit (WEL) as detailed in HSE Guidance ‘EH40/2005, Workplace exposure limits’.
HSE also delivers communications campaigns to support its regulatory activity. These campaigns inform duty holders and workers of the hazards faced and how these should be controlled and monitored. HSE’s dust campaign which ran in late 2021, included silica exposure, and involved social media and press activity to support awareness of the risks and how to control them.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Work and Pensions:
To ask the Secretary of State for Work and Pensions, whether she plans to make silicosis a notifiable disease under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013.
Answered by Chloe Smith
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR) are made under the Health and Safety at Work etc. Act 1974 and apply to all sectors and workplaces in Great Britain.
The 2013 regulations clarified and simplified the list of reportable ill-health conditions (occupational diseases), as a result of a recommendation made by Professor Löfstedt in his report “Reclaiming health and safety for all: An independent review of health and safety legislation,” published in 2011.
The Health and Safety Executive (HSE) keeps the regulations, including specified injuries and reportable diseases, under review. The list of current reportable occupational diseases, including silicosis, will be considered as part of the next formal post-implementation review of RIDDOR, which is due to report in October 2023. HSE will engage with a range of stakeholders as part of the review process.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Work and Pensions:
To ask the Secretary of State for Work and Pensions, if she will reduce the Workplace Exposure Limit in the UK for silica related work to 0.05 mg/m3 in line with other countries.
Answered by Chloe Smith
The Health and Safety Executive (HSE) does not currently intend to review the Workplace Exposure Limit (WEL) of Respirable Crystalline Silica (RCS) in Great Britain. HSE contributed to the more recent European Union (EU) assessment of the limit in January 2019, where the EU reclassified RCS as a carcinogen and implemented the same occupational exposure limit as already existed in GB.
HSE will continue to monitor international developments in this area and the evidence base to consider the range of interventions that might be suitable, including any change to the exposure limit in GB.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department for Work and Pensions:
To ask the Secretary of State for Work and Pensions, if she will introduce an industry awareness campaign on the potential effects of exposure to silica.
Answered by Chloe Smith
Over the last three years the Health and Safety Executive (HSE) has delivered several month-long inspection campaigns encompassing risks arising from silica in the construction industry. These campaigns also ran over the period impacted by coronavirus restrictions. HSE used these campaigns to highlight risks from dust, including silica, and used repeated messaging to drive sustained behaviour changes. The campaigns involved inspectors across the country visiting around 1000 sites identified as being likely to have dust risks present.
HSE also delivers communications campaigns to support its regulatory activity. These campaigns inform duty holders and workers of the hazards faced and how these should be controlled and monitored. HSE’s dust campaign which ran in late 2021, included silica exposure, and involved social media and press activity to support awareness of the risks and how to control them.
Asked by: Yvonne Fovargue (Labour - Makerfield)
Question to the Department of Health and Social Care:
To ask the Secretary of State for Health and Social Care, what alternatives to oral corticosteroids treatment are available for asthma and COPD patients.
Answered by Gillian Keegan - Secretary of State for Education
While the National Institute of Health and Care Excellence’s (NICE) guideline ‘Asthma: diagnosis, monitoring and chronic asthma management’ does not specifically make recommendations on oral corticosteroids, NICE is working with the British Thoracic Society and the Scottish Intercollegiate Guidelines Network to produce United Kingdom-wide guidance to update and replace this guideline. Evidence on pharmacological management, including the use of oral corticosteroids, will be reviewed during this process.
The 2022/23 Quality and Outcomes Framework incentivises general practitioners to assess asthma control through a questionnaire, which records of the number of exacerbations, an assessment of inhaler technique and a written personalised action plan, to monitor potential over-prescribing. The Impact and Investment Fund currently contains two indicators which aim to improve the care of people with asthma, including recognising Primary Care Networks which reduce in the percentage of patients receiving six or more Short-Acting Beta Agonists (SABAs) prescriptions per year.
NICE’s guidelines for asthma and its guideline ‘Chronic obstructive pulmonary disease in over 16s: diagnosis and management’ recommend oral corticosteroids and alternatives. For adults with asthma, these include SABAs, leukotriene receptor antagonists and long-acting beta2 agonists. For chronic obstructive pulmonary disease (COPD), NICE recommends smoking cessation, SABAs and short-acting muscarinic antagonists, Theophylline tablets, oral mucolytic therapy, oral anti-oxidant therapy, oral anti-tussive therapy, oral prophylactic antibiotic therapy, long-term oxygen therapy, ambulatory oxygen therapy, short-burst oxygen therapy, non-invasive ventilation and pulmonary rehabilitation. NICE has also published technology appraisal guidance on biologics for those with severe asthma, such as Omalizumab for treating severe persistent allergic asthma.
No specific assessment has been made of the cost of caring for and treating adverse events in patients prescribed frequent or maintenance prescriptions of oral corticosteroids. However, in developing its guidelines, NICE has recommended a number of medicines for patients with severe asthma, such as mepolizumab, which considered the costs and benefits relating to a potential reduction in the use of corticosteroids.
NHS England and NHS Improvement’s Severe Asthma Collaborative is developing capacity in severe asthma centres to streamline patient pathways to biologic therapies and reduce variation in prescribing and patient management. A toolkit has been produced to support clinical teams.
The Royal College of General Practitioners’ guidance on long term condition recovery asks clinicians to consider all high-risk patients with COPD and asthma who have not received a review for more than 12 months and have been prescribed either three or more SABAs in the last 12 months; those aged five years old and over not on the asthma or COPD register who have received two or more courses of oral steroids in 12 months; and those on the asthma or COPD register to be prioritised for review.