Asthma Outcomes

Jane Hunt Excerpts

Tuesday 7th December 2021 Westminster Hall

[Jane Hunt (Loughborough) (Con)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I am delighted to follow the hon. Member for Strangford (Jim Shannon), and I congratulate him on securing this excellent debate. I thank him very much for what he has said. My speech will be less wide-ranging than his, but I want to deal with two particular aspects. First, I should declare an interest, in that my brother works in this industry. Having said that, we never talk about work, so that is literally as much as I can say about what he does. However, I have had several meetings with representatives of Kindeva, a company that deals in the asthma industry, and visited its site. It is based in my constituency, so I will refer to the company in some detail. I will first discuss the change in drug delivery that is proposed by DHSC, before talking about prescription charges.

Asthma can be an incredibly dangerous condition. As Asthma UK data show, there are around 75,000 asthma-related emergency admissions to hospital every year in the UK and, sadly, asthma causes the death of around 1,200 people every year. Thankfully, however, although there is no cure, there are simple and, importantly, accessible treatments that can help keep the symptoms under control, including inhalers. That being said, the fact that people are still dying from this condition shows that more work needs to be done, and I was encouraged by the response from the Minister for Care and Mental Health to the debate on access to salbutamol inhalers last week, during which she set out the steps that the Government and NHS are taking to improve asthma outcomes. I was particularly encouraged to learn that the NHS long-term plan includes respiratory disease as a national clinical priority and sets out a number of respiratory interventions, including plans for early and accurate diagnosis of respiratory conditions. I would welcome reassurance from the Minister that the Government will work with the NHS to achieve the aims set out in the long-term plan.

I want to take the opportunity to mention an issue that has been raised with me by Kindeva, a pharmaceutical contract development and manufacturing organisation, when I visited its state-of-the-art research, development and manufacturing facilities at Charnwood Campus in my constituency, which is the very first life sciences opportunity zone that is based in the UK. During my visit, I saw the production of pressurised metred-dose inhalers, or PMDIs, and I heard about Kindeva’s work to transition to green propellants. I am delighted that as part of this, Kindeva and Loughborough University formed a knowledge transfer partnership to proactively address the inhalation drug delivery industry’s move to develop PMDI propellants with lower global warming potential, or GWP, than exists currently in marketed propellants. That is a fantastic example of universities and businesses working together to turn a cutting-edge idea into a marketable product, and it reflects the success of Charnwood Campus.

That being said, I understand that the NHS’s current target to reduce the carbon impact of inhalers by 50% by 2028—by switching patients from PMDIs to dry powder inhalers—coupled with the Government’s review on the use of fluorinated gases, is creating uncertainty for the industry. Specifically, I have been informed that the NHS switchover policy is shrinking the size of the UK PMDI market, and that Department for Environment, Food and Rural Affairs’ proposals to remove the essential medical use exemption of F gases in PMDIs would put considerable pressure on the market before green propellant alternatives are widely available.

Although I fully support the Government’s net zero strategy and their commitment to build back greener from the pandemic and level up all areas of the country in the process, if we are to achieve these aims, we must work with industry to ensure that we do not unintentionally drive innovation out of the country, along with opportunities for inward investment and long-term, highly skilled jobs, particularly in the east midlands and, from my point of view, most particularly in Loughborough. We have a fantastic opportunity to be a world leader on green propellants, and we have the willingness of industry to make the necessary changes. I therefore ask the Minister and the NHS to work with the industry and, most importantly, afford it the time needed to transition to greener propellants, by delivering the current NHS emissions reduction targets over a longer timeframe, and maintaining the current medical use exemption for F-gases until 2030.

Consider the situation, imagine the scene, of struggling for breath. Constituents have that problem across the country every day. They need consistency of treatment to enable them to trust the medication and have it delivered quickly and accurately. When they need the medication, it is very often an emergency. They need the drug delivery to be accurate and timely. Let us take that into consideration when looking for net zero outcomes in medications and treatment.

Asthma UK called for a suspension of prescription charges for asthma medications and for them to be added to the medical exemptions list. I think we would all agree, particularly in the case of the son of the hon. Member for Strangford, who was born with the condition, that this is not something that can be avoided. Therefore, why should patients pay for those prescriptions?

--- Later in debate ---

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

It is a pleasure to serve under your chairmanship, Mr McCabe, in what is an extremely important and timely debate. I thank the hon. Member for Strangford (Jim Shannon) for securing it, and I know that the issue is very close to his heart. He exerts such energy, enthusiasm and dedication through his work with the all-party parliamentary group on respiratory health, and the issue also has a very personal resonance for him, as we heard, given that his son has been diagnosed with asthma. The hon. Gentleman has first-hand experience of asthma’s impact on a young person and a family, of the concerns that it brings to the whole family and of the need for improved, ongoing care for everybody affected.

The hon. Gentleman set the scene extremely well, and in a detailed manner. He raised with the Minister the issues that clearly need to be addressed, and ensured that we are all aware that we should be speaking more about asthma and its implications, given its impact on so many people across the United Kingdom. He gave some startling figures, including that three people a day die as a result of this treatable disease. We should be doing far more to ensure that those deaths do not happen and that the interventions required are delivered in a timely manner. Those who need additional support must get access to the trained nurse clinicians and the annual reviews that they so desperately need.

I also thank the hon. Member for Loughborough (Jane Hunt). I do not believe I have had the pleasure of speaking to her personally in this place yet, because of our absence during the covid pandemic. I look forward to speaking with her about her particular interest in health. I say that as a clinician, as the chair of the all-party parliamentary health group and as someone with an interest in taking these issues forward. She raised such important matters, including the move towards climate change-friendly, net-zero alternatives. She said that the move must be staged so as not to be too quick for the people who desperately need the medication to catch up, and that it must be done in a very pragmatic way so that it does not impact on those UK organisations that she spoke about, including in her own constituency. Those organisations are working so hard to ensure that science is at the forefront and that, while we achieve net zero, we put patient health at the forefront of all of the decisions that are made in this context. She spoke extremely well on that matter.

The hon. Member for Blaydon (Liz Twist) always speaks eloquently on health-related matters, and I very much welcomed her person-centred approach to the debate. She detailed the impact of asthma on people’s lives, and contributed that first-hand information to the debate. Asthma has a devastating impact on individuals, and people must have access to the biologic treatments that she described. Where there is innovation and excellence in our NHS, it must be available to everybody who needs treatment. That is why, importantly, she told the Minister that individuals must have access to community hubs for diagnosis, linked with early prevention and prescribing. There should be no postcode lottery; no matter where people live in the United Kingdom, they should have access to the treatment that they so desperately need.

While I think about hon. Members’ contributions, I will also briefly mention prescription charges, which the hon. Member for Loughborough also discussed and are extremely important. The Scottish Government abolished prescription charges in 2011, but in England the current charge is £9.35 per item. Since 2011, those suffering from asthma in Scotland have had access to free inhalers, meaning that no person is ever left without an inhaler because of cost. A recent survey conducted by Asthma UK found that three quarters of people living with asthma in England had struggled to pay for their prescriptions and that individuals had often turned to skipping doses of their inhaler to cut costs—again, the impact of poverty and deprivation causing detriment to those who have asthma.

[Jane Hunt]

I thank the hon. Lady for letting me intervene. I understand her point about Scotland, but there is available an annual prescription charge, which is far less. However, my point was really about the fact that asthma sufferers cannot help it, essentially. Is there something we could do there?

[Dr Cameron]

Absolutely, and the hon. Lady makes an excellent point. While the choice in Scotland has been to abolish prescription charges, I note that she did not suggest that to the Minister. However, she did suggest—perhaps because we know that asthma often starts in childhood and is not something that people have much control over—that an exemption could be applied. Following that recommendation from the hon. Lady, I would be interested to hear the Minister’s thoughts on the matter.

Cost itself should not mean that someone cannot access healthcare, and in a developed country such as the United Kingdom, there should be no prohibition owing to charges and costs, particularly for something for which people often need daily medication. We have heard from Asthma UK that that is happening—people are skipping doses and many are struggling to pay for their prescriptions in England.

In 2021, the Scottish Government published their respiratory care plan, which is a care plan covering 2021 to 2026. It includes a workstream specifically on asthma, and I am pleased that that is being taken forward at that level. We know that asthma attacks across the UK, including Scotland, have increased by a third over the last decade, and the number of people affected in the UK is among the highest in the world, with about 5.4 million receiving treatment for asthma. That is equivalent to one adult in every 12, and one child in every 11, so we know that asthma is widespread and that it needs to be a priority for Government action.

Asthma affects people of all ages, as we have heard, and often starts in childhood. I must declare that I have been diagnosed with asthma and have had asthma since childhood. I say to the Minister that there is absolutely nothing worse than the feeling of struggling for breath. I have found wearing a mask difficult at times, but I have continued to do so, and there are exemptions for people with severe health conditions. However, asthma comes upon people suddenly and can leave them with a feeling of such a lack of control, so it is important to have specialist advice from the nursing staff, which the hon. Member for Strangford spoke of.

I do not believe that I received such advice when I was younger; I think I was given an inhaler, told to go off home to practice and learn to use it myself. I wonder whether the issue that the hon. Gentleman raised—people overusing their inhaler medication—is down to there not being enough early intervention and education on how to use an inhaler properly.

I say to the Minister that although the recommendations have been raised on the Floor of this debating Chamber, we need meaningful data. We need to know about overuse, and the rationales and reasons for that overuse. Do people need more education and intervention from clinical nursing staff in the community hubs? Does the cost mean that people in poverty struggle to access treatment, and is that contributing to the death toll? That data is crucial.

As has also been widely mentioned, Asthma UK has indicated that NICE should develop comprehensive guidance on severe asthma. Can we also make sure that the newer treatment options—the biologic treatments—are widely available to everyone who needs them?

I thank everyone who has taken part in this debate, which has been an extremely positive one. I particularly thank the hon. Member for Strangford, because this issue is so important to so many people in the United Kingdom, and I look forward to hearing the Minister’s response.