§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. Kirkhope.]
10.30 pm§ Mr. David Tredinnick (Bosworth)I hoped—and still hope—to raise some of the problems facing asthma sufferers, but I had not bargained on having to make a speech just a day after a leadership challenge and on the night of a reshuffle. One's chances of getting some coverage in the newspapers tomorrow morning may be severely curtailed because of the remarkable events that have occurred.
The background to the debate is simple. There are now more than 3 million asthma sufferers in Britain. Reports quote some 2,000 deaths nationally due to asthma every year, of which it is estimated that 80 per cent. are preventable. Research shows that 13 per cent. of children aged five to 17 have been diagnosed with asthma.
The cost to the national health service in terms of prescriptions is astronomical—about £400 million a year—and the number of prescriptions has increased by more than three quarters in the past 10 years. In addition, the cost to the economy is something in the region of 7 million working days a year, £70 million in sickness benefit and £400 million in lost productivity.
Why is the problem getting worse? Why is asthma the only treatable chronic condition in the western world which is increasing in frequency and severity? I suggest that there are various reasons. One that has been much in the news recently is house dust mites, which thrive in badly ventilated houses. We suspect that additional problems are caused by diet, smoking and traffic pollution with which I shall deal in a moment.
There is a great deal of confusion among the public about the extent of the problem because conflicting messages are reaching them through the press. Many of those messages are scare stories. A recent report stated that asthma cases had doubled over the past 20 years and that one in five children suffered asthma symptoms after exercising. Another report said that 7 per cent. of boys and 8 per cent. of girls were taking medication for asthma. Those contentions need to be validated. My hon. Friend the Minister could do a lot worse than to commission studies enabling accurate statistics to be put across. Although I do not dispute the figures, the reports are evidence of great concern.
In Leicestershire, a county of which I am proud to represent a part, an average of 20 people die from asthma each year, and there are approximately 50,000 sufferers there. A third of the people with asthma in Leicestershire have a substantial amount of time off work, and a third of asthmatic children are confined to bed for up to 10 days a year. A quarter of all the children with asthma have restricted sporting activity, and two thirds lose substantial time at school. In Leicestershire, we are addressing the problem through an asthma strategy group, which has been set up with the specific objective of increasing awareness through a guidelines pack, which is readily available, by supporting a school nurse asthma project for training nurses in schools, and by encouraging the development of parent support groups.
493 Leicestershire is at the forefront of counties which are addressing the problem of asthma, and I suggest to my hon. Friend that there are some lessons there that could be taken on board nationally. Leicestershire has made asthma a priority. The steering groups's developments include agreement for funding the appointment of a district asthma co-ordinator, the redistribution of £10,000 from the "Health of the Nation" budget, the development of a disease specification, which will be introduced in 1995–96, and the appointment of asthma nurse specialists in all acute units. The objectives in the local plan include a review of the adoption and implementation of clinical standards, asthma training for 90 per cent. of local nurses by 1995–96, and an audit of hospital admissions.
Those initiatives, with the new nurse practitioner network and a community awareness and public education campaign, have greatly assisted the people who suffer from asthma in my constituency and elsewhere in the county to address the problem. Furthermore, in Hinckley, the main town in my constituency, there was sufficient concern about asthma for an asthma support group to be set up and for the mayor to choose asthma as her charity for the year. That demonstrates the concern on the ground. I have met parents in the Royal Infirmary in Leicester and in Hinckley who are members of that group and discussed their problems with them. Asthma is a terrifying experience for the parents of children who suffer from it.
What is important about the support groups is that they help parents to understand the condition, to understand the treatment, why it is necessary, how to respond to the changes, the different uses for inhaled drugs, peak flow meters and the difference between preventive and symptomatic treatments. There is nothing more frightening than to have a child with asthma and not know what to do about it. I declare an interest as my own son has suffered from asthma and I speak from the heart when I say that it is a very frightening experience.
Leicester city, which I do not represent, also has its own initiatives. Time prevents me from going into them in detail tonight, but pollution levels are certainly a concern. To my mind, pollution on the roads is one of the key problems that we have to address as we try to come to grips with this illness, which is on the increase. I believe that small-scale measures could achieve great effects. My hon. Friend on the Front Bench does not, as yet, represent the Department of Transport, but the need for measures to reduce the number of vehicles emitting diesel fumes is evident. There is scope for discussions with petrol supply and retail industries with a view to securing the introduction of stage II pump controls. There should be more research into the health effects of PM10s from diesel fumes. Anybody who drives along the M1, as my hon. Friend and I do many times when travelling to our constituencies, will be aware of the problems that those fumes cause.
I referred to the issue of dust mites in the home. This is a little closer to my hon. Friend's Department. Not a lot is known about dust mites, but they cause problems for small children. These minuscule bugs live in eiderdowns and blankets. We must educate people about the problems caused to asthma sufferers by blankets that are not properly sterilised and cleaned. That could be done by means of an extended education programme.
494 I also believe—my hon. Friend will say that this is not his Department's responsibility, but he may wish to pass it on to his colleague at the Ministry of Agriculture, Fisheries and Food—that oilseed rape causes a problem, with those vast fields of yellow flowers that we see in the countryside nowadays. A couple of years ago my family stayed in a house surrounded by such fields, and I have no doubt that the gas, or scent. emanating from the flowers contributed to the respiratory problems that we experienced at the time—although I confess that my research in the Library was inconclusive.
I have referred to some of the difficulties experienced by asthma sufferers, and some possible solutions. Westminster council has a welcome solution to the problem of traffic fumes: on-the-spot fines. A possible solution whose importance is underestimated, however, is alternative treatment. As my hon. Friend knows, I have been treasurer of the parliamentary group for alternative and complementary medicine for many years, and I believe that alternative medicine has a great deal to offer asthma sufferers. My son was treated by a homeopathic doctor. The Department of Health could do much worse than recognise the possibilities.
I should say, in fairness to my hon. Friend the Minister, that his colleague Baroness Cumberlege recognises the need to integrate alternative medicine into the health service generally. I believe that a number of alternative treatments are relevant to asthma—not just homeopathy, but Chinese medicine and acupuncture. It is important for fundholding general practitioners and hospital doctors to understand the scope of the alternative treatments that are available. We should aim for integration of alternative and complementary medicine into the health service; my colleagues and I have campaigned for that for a long time. We also want health authorities and GPs fundholders to be free to purchase complementary therapies that would help asthma sufferers.
As I have said, Leicestershire has been at the forefront in dealing with asthma. There are some very good support groups, such as the one in Hinckley, which help parents to understand the difficulties. There are two national requirements. First, there is poor co-ordination between the different groups responsible for asthma; voluntary groups do not have enough resources to co-ordinate their activities. My hon. Friend's Department could act decisively and effectively in that regard. Secondly, the Government could take a leaf out of Leicestershire's book and make asthma a priority in their programme. Leicestershire health authority has set aside additional resources, having reached an agreement on funding and redistributed resources from its budget.
How effective it would be if my hon. Friend the Minister could tell us tonight that the Government will make dealing with asthma a "Health of the Nation" key objective. I believe that if he did so he would win many friends throughout the country. Asthma is perhaps the only illness of its kind that is on the increase, and affects people of all ages. We have much work to do. If my hon. Friend cannot give us an undertaking tonight to make asthma a "Health of the Nation" key objective, will he please consider the possibility in the near future?
§ The Parliamentary Under-Secretary of State for Health (Mr. Tom Sackville)I congratulate my hon. Friend the Member for Bosworth (Mr. Tredinnick) on 495 raising this subject, and I commend Leicestershire health authority for the priority that it clearly attaches to asthma treatment. In doing so, it mirrors in an effective way the concerns of my Department about the burden that results from asthma, and about its increasing prevalence. I agree with what my hon. Friend said about the dreadful effects that that condition can have for children, and, indeed, for their parents.
As my hon. Friend knows, asthma is estimated to affect about 4 per cent. of the population sufficiently severely for them to require regular medical supervision. We would estimate that there are some 2 million sufferers in England, or perhaps 2.5 million sufferers in the United Kingdom. A broad range of statistics on asthma was brought together in "Asthma: An Epidemiological Overview", which was produced by my Department and which I launched on 22 March this year. Recently, I supplied my hon. Friend with a copy, and I hope that he found it useful.
Asthma costs the national health service a vast sum. The figure is about £450 million a year, of which £380 million represents NHS prescriptions. General practitioner consultations, hospital admissions and prescriptions for drugs used in asthma treatment suggest that the prevalence has been on the increase for many years.
We do not, of course, know the causes for certain, but it is likely that they are connected with both genetic and environmental factors. It has been suggested by the media and by some doctors that the recent rise in prevalence is related to increasing levels or changing patterns of exposure to air pollutants, particularly those related to motor vehicles.
As yet, there is no proven relationship between such pollution and asthma. Increasing levels of asthma have been recorded in countries such as Sweden, Fiji and New Zealand, which do not suffer from high levels of air pollutants. Other factors would seem to be involved, including air quality, maternal smoking and diet.
Episodes of poor air quality make the health of some people with asthma worse by increasing either the frequency or severity of asthma attacks, but trigger factors, as they are known, for asthma also include other substances in the environment which induce allergic reactions. As my hon. Friend has said, those include house dust mites, pollen, fungal spores, respiratory infections such as cold and flu, and events such as exercise, emotion and stress. Some trigger factors could clearly be more easily avoided, such as exposure to cold air, to which some asthma sufferers are particularly susceptible, pets and animals, some medicines such as aspirin, and cigarette smoke.
I was interested to hear my hon. Friend's comments on the possible effects of road traffic emissions on asthma sufferers. I mentioned that the effect of traffic emissions on asthma remains uncertain. Although air pollution can exacerbate symptoms, the evidence suggests that air pollution is not the main factor triggering asthma attacks in those who are susceptible to them. Nevertheless, we remain concerned to investigate those issues further and to do what is reasonable to reduce undesirable effects of traffic emissions, which may have other effects, as well as those on asthma sufferers.
As my hon. Friend mentioned, the Government have developed proposals for improved management of air quality, set out in the document "Meeting the Challenge", 496 which was published by my right hon. Friend the Secretary of State for the Environment earlier this year. That provides a framework within which effective policies can be developed to improve air quality, and some of the key legislation needed has been included in the Environment Bill.
Public health policy for asthma is aimed at keeping sufferers free of asthma symptoms, to enable as normal a life as possible. That is achieved by sufferers knowing what their individual trigger factors are and how to avoid them, and knowing what practical steps and medicines they may take to control their symptoms. Asthma is combated by provision of health care resources to enable people to manage their own conditions as far as possible.
It is, of course, a matter for the professions concerned, and the British Thoracic Society produced revised guidelines in March 1993 which included advice on how patients should manage their asthma. The Department of Health drew the guidelines to the attention of health authorities in December of that year. I remind the House that it is for local health purchasers to determine the priority to be given to asthma services for their own populations.
The Department of Health has provided a national framework for the provision of primary care for asthma in the new arrangements for health promotion and chronic disease management which we introduced in July 1993. Asthma is one of the target areas of that programme. Under it, general practitioners are eligible for fixed payments for setting up and overseeing an organised programme of care for asthma. Over 90 per cent. of all GPs have been approved to run such a programme.
The advisory group on the medical aspects of air pollution episodes has also examined the evidence relating to the effects of episodes of elevated concentrations of individual air pollutants upon normal and asthmatic individuals. Since the publication of its reports, new evidence has been continually reviewed by another committee, the Committee on Medical Effects of Air Pollutants, for a range of pollutants including ozone, oxides of nitrogen, sulphur dioxide and particles.
That committee has been asked for advice on links between asthma and exposure to low levels of air pollution. A sub-group was set up last year to examine the relevant evidence, and we expect its definitive advice in the autumn, after which a report will be published.
Across Government more widely, my Department is working closely with the Department of the Environment and other Departments. The two Departments are organising a one-day conference in November on the causes of asthma and what everybody can do to alleviate its effects. In October last year, my Department, together with the Department of the Environment and the Medical Research Council, announced a major research initiative on air pollution and respiratory disease, including the possible links between air pollution and asthma. Over the next few years, a total of up to £5 million will be available if suitable high-quality projects are presented.
Proposals were invited on a range of aspects, including the role of air pollutants, either individually or in combination, in respiratory disease, particularly asthma, and their possible interaction with other causes of respiratory disease. My hon. Friend referred, for example, to the role of factors such as house dust mites and tobacco smoke in asthma.
497 The effects of air pollution on health has also been identified as a priority area in the environmental health theme of my Department's programme, and a strategy for research is being developed. A number of relevant research projects are already being funded under the programme.
The Health and Safety Executive, which is the responsibility of my right hon. and learned Friend the Secretary of State for Employment, is responsible for policy on prevention of occupational asthma. I know that the HSE is giving a high priority to reducing the incidence of asthma in that field. Its "Breathe Freely" campaign has raised awareness of the dangers of respiratory sensitisers, which are substances that create an allergic reaction in the respiratory system.
It has also reminded employers of their duty under the Control of Substances Hazardous to Health Regulations to control exposure to them. The HSE continues to focus on respiratory sensitisers under its management of health risks campaign which it launched on 1 May.
§ Mr. TredinnickIt is interesting to hear about the range of research that is taking place. Is my hon. Friend's Department co-ordinating that research? When the Medical Research Council work and the other projects are complete, will there be a publication in which the findings will be amalgamated, so that they may be readily available to those who are concerned about asthma?
§ Mr. SackvilleThe principal body for carrying out research is the Medical Research Council, but there is a centrally commissioned programme in my Department, and we work closely with the Medical Research Council. I take note of what my hon. Friend says about the need to bring all these matters together, so that there can be some readily understood document which will tell all those concerned what is being done and outline the level of success that has been achieved.
I turn to the question of public information, which relates to what my hon. Friend the Member for Bosworth has just said. More information certainly needs to be available to the public. I am sure that my hon. Friend is aware of the marvellous work of the National Asthma Campaign—the leading voluntary organisation in the subject—in offering support and information to people with asthma and their families through its national network of 200 branches.
The NAC publishes leaflets, publications and videos, and has an asthma help line staffed by specialist asthma nurses. I understand that the help line received 20,000 calls last year. My Department is giving the NAC a grant to fund a member of staff to co-ordinate its work for children with asthma.
In that connection, the Department for Education is in the process of drawing up a draft circular on the management of medication in schools. Its officials have 498 been working closely with my Department on this and talking to interested outside bodies, including the National Asthma Campaign. We certainly favour children with asthma being encouraged to manage their own condition as early as is consistent with their development.
My hon. Friend called on the Government to include asthma as a key area in "The Health of the Nation". The House will be aware that that is the subject of a recent early-day motion. I should say, however, that, although the White Paper designated asthma as a strong contender for key area status, it was recognised that research was needed into its causes and into what could be done to prevent it.
There are three criteria for key areas status. First, the area should be a major cause of premature or avoidable ill health, which asthma clearly is. Secondly, the area should be one where effective interventions are possible. There are, of course, known interventions for asthma which can potentially improve the prognosis of people who already have asthma, but much less is known about the factors which lead to the disease developing in the first place.
Thirdly, it should be possible to set objectives and targets and monitor the progress towards them. That is certainly the most difficult of the three criteria for asthma to meet. Mortality targets, which would be one measure, would be of limited value by themselves, as—fortunately—deaths from asthma are relatively uncommon. Morbidity targets based on routine statistics would be difficult to interpret. For example, improvements in service provision could lead to an increase in numbers treated. Clearly it is important to identify effective interventions and ways of monitoring outcomes before considering whether it is appropriate to set targets.
An ad hoc expert group has recently reported to the chief medical officer on possible interventions and targets for asthma so that it might be reconsidered for key area status in "The Health of the Nation". I assure my hon. Friend that we shall give that report full and careful consideration, together with the further reports on asthma that I have already mentioned, which are expected shortly.
I reassure my hon. Friend and the House that the Government take the problem of asthma extremely seriously. I mentioned the range of national initiatives, and I am pleased that they are being developed locally in his area of Leicestershire. He suggested the need for a co-ordinated national policy. I shall therefore summarise our policy, which is quite simple.
We will continue to improve our knowledge of the causes of the disease and do everything that we can to make life as normal as possible for those who suffer from this very distressing condition.
§ Question put and agreed to.
§ Adjourned accordingly at two minutes to Eleven o'clock.