World Asthma Day

Luke Evans Excerpts

Thursday 15th May 2025 Westminster Hall

[Dr Luke Evans (Hinckley and Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Dr Huq.

I would also like to place on record my thanks again to the hon. Member for Strangford (Jim Shannon). Those unkind might say he chases the spotlight of Westminster Hall, but they would be grossly mistaken: he chases purpose, which is why we find him everywhere, with boundless energy, trying to make a difference, and nowhere more so than in health. This must be the sixth debate I have had with him, if not more, so I take my hat off to him—he really is a champion in this space—and I thank him for what he does.

Asthma teaches us never to take a single breath for granted. When simply breathing becomes a conscious effort, we realise just how much strength it takes just to stay alive. I have seen that as a clinician working in A&E and as a GP; one of the scariest moments is when a child comes in having an asthma attack, or worse still, has one in the GP surgery, and having to manage the inhalers, the puffs they take and what to do when they deteriorate.

I have a personal story too—if we are declaring interests—to share with the hon. Member for Bournemouth West (Jessica Toale). I suffered from mild asthma growing up as a child and into my teens, but I ended up in an intensive care unit after having my appendix taken out. I ended up with bilateral pneumonia. That is highly unusual in the first place, but even more so when it is a doctor involved—we seem to be the most complicated to treat. It meant that afterwards I was left with significant breathing problems and symptoms that behaved like asthma—so much so that I would need steroids to solve them. I was also under the brittle asthma clinic in Oxford when I lived there.

I know at first hand what it is like to suffer when it is impossible to breathe, when someone’s ability to run is taken away or, worse still, they up in the middle of the night in a panic. This is a very timely and important debate that the hon. Member for Strangford has brought forward, and he has my sympathies and gratitude for doing so. On that line, I also thank Asthma + Lung UK for all the work it does to highlight this issue. As we have heard, with 7 million people suffering, this is the bread and butter of the NHS: from primary care to secondary care, day in, day out, people are being diagnosed with and treated for asthma.

As we await the 10-year plan for the NHS next month, this debate provides the chance for us to ask where we have got to with the Government. The last Government had come forward with the major conditions strategy but, alas, the new Government decided to take a different direction. Of course, that is their prerogative—no Government are bound by their predecessors. However, it does raise the question: what next? The Government will need to set out what they will do as an alternative to tackle asthma and other respiratory conditions.

It would be helpful to hear from the Minister today what assurances she can give about the inclusion she may have made of these conditions in the plan. Can she also set out what engagement her Department has had with patient groups such as Asthma + Lung UK, who put a lot of time into previous submissions to ensure the last Government understood what was needed? It would be sad to see that replication being needed, but at least the work would not be lost.

Part of dealing with asthma and respiratory conditions is vaccines and prevention. Work is clearly needed to increase uptake of the respiratory syncytial virus vaccine. I welcome findings that there was nearly a 30% reduction in hospital admissions among those aged 75 to 79, thanks to this vaccine, but the UK Health Security Agency has warned that many more older adults remain unprotected from RSV. To illustrate that point, up to the end of March, only half of eligible older adults had been vaccinated and more than 1 million people were yet to receive their vaccine.

I think we all share concerns about the significant increase in the number of bed spaces occupied by people with flu in the 2024-25 winter. That was partly due to vaccination rates among eligible groups being below what we would hope for. This winter, three times as many people as in the previous year were hospitalised because of the flu, which contributed significantly to waiting times in A&E departments. Without a clear increase in vaccination, the NHS will continue to face difficulties in urgent and emergency care. What steps will the Minister take over the next few months to increase the uptake of RSV, flu and pneumonia vaccines, particularly by those who suffer with asthma and COPD?

As a clinician, I remember over the years having to deal with different sets of guidelines. The hon. Member for Strangford hit the nail on the head. It was great to see the BTS, NICE and SIGN guidelines all coming together in November 2024, but there is a challenge in having guidelines, rolling them out and making sure clinicians are educated on the changes. What steps have the Government taken to ensure that ICBs and royal colleges are aware of the guidelines and that they are percolating down to everyone who might need to see them?

Access to fractional exhaled nitric oxide—FeNO—testing is an important step in diagnosis. There is also spirometry. Given the success of community diagnostic centres, have the Government given any thought to how such apparatus could be rolled out to communities so that more people might get access to it?

One thing that is really important with respiratory diseases, especially asthma, is smoking cessation. The Tobacco and Vapes Bill is going through Parliament, but is there any targeted approach for those who suffer with asthma to help them to reduce smoking?

Much of asthma care is delegated to nurses, not doctors. How does that fit into the forthcoming workforce plan? Will special consideration be given to respiratory nurses in both primary and secondary care? After all, they have become the experts in exactly what to prescribe and when.

Finally and most importantly, what steps are being taken to reduce asthma deaths, especially preventable ones? The word “preventable” is the biggest key here. I am keen to hear from the Minister how the Government intend to tackle this problem.

Breathing: it is the first and last thing we do, but we rarely notice it until it has gone—or, in the case of asthma, until it is threatened. I know the Minister understands that, and I know the people out there watching understand it. I hope that understanding transforms into policy.

[The Parliamentary Under-Secretary of State for Health and Social Care (Ashley Dalton)]

It is a pleasure to serve under your chairship, Dr Huq. I thank the hon. Member for Strangford (Jim Shannon) for bringing this timely debate forward as we mark last week’s World Asthma Day. It shows real leadership from the chair of the APPG for respiratory health. In that spirit, I would be delighted to take him up on his offer of a meeting. We will arrange that as soon as we possibly can—I am keen to do it.

I thank hon. Members for their contributions. I am more than happy to meet the hon. Member for Birmingham Perry Barr (Ayoub Khan) to discuss the issues that he raised, including prescription charges. There are currently no plans to review the list of medical conditions that entitle someone to apply for a medical exemption certificate. However, approximately 89% of prescription items are dispensed free of charge in the community in England and a wide range of exemptions are already in place. Eligibility depends on factors such as the patient’s age and whether they are in qualifying full-time education, are pregnant, have recently given birth or are in receipt of certain benefits. People on low incomes can apply for help with their health costs through the NHS low income scheme. Children are of course entitled to free prescriptions.

NHS England’s children and young people’s transformation team have been working closely with the MHRA on dose counters being added to inhalers. The “British National Formulary for Children” has been updated with guidance and supportive resources for patients and clinicians, which have been widely shared. We are awaiting an update on progress on making dose counter inhalers dominant in the supply chain from the pharmaceutical industry. I will be more than happy to update the House when we have it.

I thank my hon. Friend the Member for Bournemouth West (Jessica Toale), who focused on air quality, which is a priority for the Government and part of our prevention strategy, and the technology to help to manage asthma. There are a range of technologies available to help people to manage their asthma, and NHS England and NICE are exploring the potential for the platforms for digital self-management of asthma to be evaluated, but that depends on the technology readiness level. Guidelines developed jointly by NICE, the Scottish Intercollegiate Guidelines Network and the British Thoracic Society to harmonise recommendations across the organisations were published in November 2024, and I hope they are useful.

Before I respond to the Front-Bench contributions—if there is anything I do not cover, please let us know and we will endeavour to write with the relevant details—I want to pay tribute to charities and campaigners: people who are doing the hard yards of helping to equip our hospitals and supporting people to manage their conditions in their day-to-day lives. I thank Asthma + Lung UK, Beat Asthma and the Asthma Relief Charity, to name just a few. The shadow Minister, the hon. Member for Hinckley and Bosworth (Dr Evans), asked about the contributions by charities to the major conditions strategy. I reassure him that engagement with such stakeholders has been central to the development of the 10-year plan. All submissions made to the major conditions strategy have been taken into account—nothing was wasted.

As the hon. Member for Strangford outlined, asthma is the most common lung condition, affecting nearly 5.5 million people in the UK. Just under one in 10 kids live with asthma, and more than 12,000 people have died from asthma attacks in the last 10 years. World Asthma Day is not just about treating a condition; it is about shining a spotlight on inequalities. I strongly agree with the hon. Gentleman that everyone, regardless of where they live or how much they have in their bank account, has the right to access the inhaled medications they need to control their condition and treat attacks.

Nevertheless, statistics published by Asthma + Lung UK just this month show that Asian people with asthma from the most deprived quintile in England are almost three times more likely to have an emergency admission to hospital than their white counterparts. Black people with asthma from that group are also more than twice as likely to be admitted to hospital. This is a burning injustice. As if that were not enough, the annual economic burden of asthma in the UK is around £3 billion a year. Lung conditions collectively cost the NHS £11 billion annually. That is why we must act.

I will update Members on NHS England’s activities in this space before moving on to wider Government efforts. NHS England is taking steps to support integrated care systems to improve outcomes for people with asthma through its national respiratory programme by providing targeted funding, clarifying what systems should be doing to ensure that people with asthma receive a high-quality and timely diagnosis, and working with key partners, industry representatives, patient groups and clinicians to support improved respiratory disease management. That will include shared decision making on inhaler choice and making better use of inhalers to reduce the overuse of reliever inhalers and encourage the use of preventer inhalers.

The hon. Member for Strangford raised the issue of access to and roll-out of treatments. Healthcare Quality Improvement Partnership, on behalf of NHS England, commissioned a national audit across respiratory care, which includes asthma, and all data from the audit is published for open access. NICE is working with BTS, SIGN, NHS England and others to review the resources available to support implementation of the guidelines, and plans to publish a respiratory toolkit. To support implementation of NICE guidance, NHS England has been engaging with health system partners across the country to co-ordinate resources and implementation efforts to make sure that patients are on the appropriate treatment regime.

NHS England is also protecting our children and young people through the national bundle of care. It is putting asthma care at the top of the agenda by giving asthma a higher priority within systems, providing funding for regional leadership, and strengthening governance and accountability to improve outcomes. It has also played a crucial role in making training easier and more readily available for staff by bringing together existing guidance and resources with a structured training scheme. Since its publication there has been a noticeable reduction in hospital admissions.

The hon. Member for Strangford and the shadow Minister both raised spirometry, a diagnostic test for asthma as well as other respiratory diseases. NHS England is working with a range of partners, including Asthma + Lung UK, the British Thoracic Society, the Association for Respiratory Technology and Physiology and clinical leads to make sure that systems have everything they need to increase the number of people receiving early and accurate diagnosis for respiratory disease. In the past year the Government have made extra funding available to make sure that staff have the proper training and accreditation to use spirometry effectively.

On inequalities, NHS England is taking steps to uplift the most deprived quintile through Core20PLUS5. That initiative focuses on five areas of improvement, of which chronic respiratory disease is a key part. There are targeted interventions to detect and treat asthma. The PLUS population groups include ethnic minority communities, people with a learning disability, autistic people, coastal communities, people with multimorbidity and protected characteristic groups. Core20PLUS5 also has a dedicated workstream for children and young people. The primary focus is to address over-reliance on reliever medications while decreasing the number of asthma attacks. That has made some progress, with clear reductions in the over-prescribing of reliever inhalers over the past few years. Between April 2022 and February 2025 the proportion of patients with asthma who received six or more reliever inhaler prescriptions fell from just under 20% to under 16%. The Government are supporting systems to take innovative approaches to expanding access to their diagnostic services, with a particular focus on addressing health inequalities.

Finally, the NHS rightly offers the flu vaccine free of charge to people with severe asthma as seasonal illnesses pose more of a threat to them than others. NHS England has been working with the severe asthma collaborative to develop the capacity of severe asthma centres to improve patient access to biologic treatments and to reduce variation in prescribing and patient management. That work has shown improved identification of patients with potential severe asthma in primary and secondary care, resulting in referral to severe asthma centres for consideration of their eligibility for biologic therapy. For four in 10 asthma patients with severe asthma those treatments can significantly improve their quality of life. However, it is vital that biologics are prescribed only following specialist assessment. Currently, the NHS is deploying six biological treatments approved to treat severe asthma.

The shadow Minister raised the issue of vaccines. I reassure him that a strategy and action are being delivered to increase vaccination uptake, including RSV and flu, because that is a priority for the Government. Returning to biologics, significant work was undertaken to drive uptake and access to them through the NHS England severe asthma collaborative, and patient outcomes are submitted to the UK severe asthma registry. That has improved the identification of patients with potential severe asthma, and has resulted in those people being referred to the relevant care pathways.

Every member of the Government is committed to raising the healthiest generation of children in our history. We are taking steps to protect our kids from obesity and smoking, which are major risk factors; each one is responsible for roughly a third of asthma deaths. We are taking action through the Tobacco and Vapes Bill, which I am pleased to say has just passed Second Reading in the other place.

In her autumn Budget, my right hon. Friend the Chancellor took steps to ensure that the soft drinks industry levy remains effective. We have not just uprated the levy to bring it in line with inflation; we also published a consultation just last month on two proposed changes—reducing the lowest sugar tax threshold from 5 grams to 4 grams of total sugar per 100 ml, and removing the exemption for milk-based and milk substitute drinks. Finally, my right hon. Friend the Secretary of State for Energy Security and Net Zero is cleaning up our air with Great British Energy and a raft of other measures.

My Department will shortly be publishing its 10-year plan for health to make our NHS fit for the future. We will shift the focus of our NHS from sickness to prevention, hospital to community, and analogue to digital. Until then, we are already taking steps on prevention by helping people to lose weight and quit smoking or vaping, and by helping to clean up our air. We are helping people to get diagnosed closer to home by requiring community diagnostic centres to provide spirometry tests. The Government remain committed to ensuring that existing CDCs, where they are not already, are rolled out at full operational capacity at their permanent site.

[Dr Luke Evans]

The Minister mentioned spirometry. Could she comment on FeNO, and if not, could she write to us? The guidelines are built around that, but access is going to be an issue.

[Ashley Dalton]

Yes, I confirm that I will write to the shadow Minister on FeNO at a later date. NHS England is also piloting a digital annual asthma check.

I am sorry, Dr Huq, this is highly irregular, but I am feeling extremely unwell; I need to go and make myself okay. [Interruption.] Thank you for your forbearance, Dr Huq. Crohn’s is not something that we have debated in this Chamber; if we did, no doubt I would be the responding Minister, and I can assure you that I would be able to speak from personal expertise.