§ Mr. Mark Oaten (Winchester)It is often dangerous to draw too many conclusions from statistics, but I start the debate by drawing to the House's attention a few alarming statistics. In the past 10 years in this country, the number of children with asthma has doubled. In the United Kingdom, 1.5 million children now have asthma. What is deeply concerning is that that is one of the worst rates in Europe. More troubling than that is the fact that the trend appears to be rising.
Those are harsh facts. I want to look in a little more detail at some of the reasons behind the increase in asthma and to give the Minister a chance to set out the Government's response to those alarming figures.
Earlier this year, I carried out a survey of schools and general practitioner practices in the Winchester constituency to try to establish whether what individuals were saying to me in surgery and in writing was true. There was clearly a perception in Winchester that the number of children seeing GPs about asthma had increased.
I would not for a minute try to claim that my constituency office, with all its volunteers, is anything like MORI, the opinion survey organisation, or Government scientific advisers, although these days one is never quite sure, but we carried out a survey of schools and doctor practices in the constituency. Thirty-three schools and seven GP practices responded. Two thirds of the practices stated that, in just the past couple of years, there had been an increase in the number of children with asthma coming to their practice. Similar results came from schools. Over half the teachers involved claimed that there was a much bigger increase in children coming to school with asthmatic problems.
As I say, the findings in Winchester are certainly not scientific, but they appear to be backed by national research work, particularly by the National Asthma Campaign. I am sure that hon. Members on both sides of the House will know that, last week, the campaign revealed the results of its most recent audit; it audits asthma trends annually. It announced that a study in Leicester had found that asthma and wheezing in children under five had doubled in that location in less than a decade. In 1990, only 12 per cent. of children had been diagnosed with asthma. By 1998, the figure had risen to 21 per cent. Wheezing attacks within a 12-month period had doubled from 12 per cent. in 1990 to 23 per cent. in 1998.
The National Asthma Campaign concludes that approximately one in seven children aged between two and 15 have asthma symptoms that require treatment; that is where we draw the figure of 1.5 million children from. Although I want to concentrate purely on the effects of asthma on children, we should not forget that more than 1.9 million adults—those over 16—suffer from asthma.
All those figures and findings suggest that we have a major problem with asthma among children. I conclude that it will be in danger of getting seriously out of control if the trend goes upwards.
As well as the obvious distress and suffering that asthma causes children and their parents, the increases have other severe implications, not least the cost and 366 burden to the national health service. The total cost of asthma to the health service is estimated to be about £709 million, at today's figures. In addition, we should consider the cost involved in providing inhalers and asthma prescriptions, which is estimated to be about £500 million.
The National Asthma Campaign says that, if we go beyond child asthma and take into consideration the number of days lost and the burden on society that asthma brings, the figures increase dramatically and society has a major problem in relation to the costs involved in the health service. That, in itself, should be an argument for some urgent action to tackle the problem.
There are other hidden costs, particularly the cost to a child's education. The rising number of children with asthma means a rising number are off sick, missing school days. Having asthma is one of the most common reasons for children missing school or pre-school nursery.
In 1995, "Blue Peter" carried out an asthma survey. More than 10,000 children responded. Eight per cent. said that they had missed at least a month of school as a result of problems with asthma. A recent large study of school children aged between 12 and 14 found that a substantial proportion of adolescents had asthma symptoms that interfered with their schooling and day-to-day lives. Another concern was that many of them were not receiving treatment for that asthma. One third of the children who took part in the survey and had experienced asthma symptoms said that they were not receiving some form of medical support to back them up. That under-diagnosis of asthma and the consequential missed school days cannot be good for the children's education, or their social relationships
The most worrying factor is that we do not really know, or we do not appear to know, why all that is taking place. After we carried out the survey in Winchester, I was surprised at the findings and asked to see a Dr. Roberts, who is the asthma specialist at the Royal Hampshire county hospital in Winchester. Politicians always seek a simple answer. I just asked, "Why is it happening? What are the reasons? There must be a simple explanation."
In addition, we were involved in a battle to try to persuade the public that it would be sensible to build a park-and-ride facility in Winchester. I wanted to be able to use the asthma results to support the case for the park-and-ride facility to keep cars out of the city centre, but clearly it is not as simple as that.
The doctor explained—and my research since explains—that there are endless theories as to the cause of the big increase in asthma. Pollution and traffic are obviously the simplest arguments that people can advance, but one of the most compelling arguments that I have heard is that living in a cleaner society has an impact. In the past 10 or 15 years, facilities in homes have meant that they are cleaner. Whereas before, in a dirtier house, children had a chance to build resistance to viruses, in a cleaner society, individuals and children do not build up resistance and then are more vulnerable and susceptible to asthma.
Other theories have been put forward. Only yesterday, the World Health Organisation announced details of a study that it had undertaken in Europe, which led it to claim in the press:
Car fumes kill more than crashes.367 Again, it had clear evidence that there was a link between pollution from cars and increased cases of asthma.I have heard the other argument—particularly in a rural constituency such as Winchester—that changing farming patterns are one of the causes. Of course, the most obvious link that people are making at the moment is with genetically modified crops. They are asking whether those crops will have an impact. Letters from constituencies following publicity about the survey suggested that oil-seed rape was an increasing concern.
We know that, recently, farmers have turned much more to growing oil-seed rape. Indeed, one of ways in which to decrease transport pollution is to have transport run on oil-seed rape, but by growing more of the crop we could create asthmatic problems. An organisation representing hyperactive children, which has concerns about food additives, has raised concerns to the effect that changing diets, and the things that we are adding to food and giving to children, may be a cause.
The only conclusion that I can draw from all that information is that the only thing individuals agree on is that no one really knows what the causes of the increases in asthma are. That needs to be the starting point for Government action. We need to be able to have more research to establish what exactly the cause is.
I am aware that the Government are active on the issue. I make it clear that I did not secure the debate to criticise the Government for any inaction. Rather, I should like to press the Minister for some more information about the research that is taking place.
In a written answer to me last Friday, the Minister was helpful in explaining what the Government were doing in relation to research. He said that they were supporting a major initiative on the relationship between air pollution and respiratory diseases. Will the Minister use the debate to confirm when that report and the conclusions will be made available, and if they will be made available publicly? Will he go further and explain why the link is being made between air pollution and respiratory diseases? Are the Government planning any research to look at the connection between respiratory problems such as asthma and other issues apart from air pollution, some of which I have touched on; or is it the Government's conclusion that air pollution must be the main reason—which is why they are putting energy into research in that particular area?
I should be grateful if the Minister let me know whether the Government had plans specifically to examine the number of children who have asthma. I have quoted some data and a figure, but judging by a written reply that the Minister gave me, which looked at the number of children going into accident and emergency departments and having in-patient care in hospitals, it appeared—unless I misread the data—that there had been a decline in the number of children going into hospital with asthmatic problems. There seems to be a contradiction between research done by campaign groups and some of the Government's data. Is it perhaps worth while investing additional resources in detailed research to discover whether the increases that I have described are indeed occurring?
The Government commission an annual health survey for England. According to the 1997 survey, 29 per cent. of boys and 18 per cent. of girls aged between two and 15 have been diagnosed with asthma at some time. 368 I should be fascinated to know—perhaps the Minister will write to me on it—why boys feature so much higher than girls in those figures, and how those figures compare with previous studies done by the Government on the matter.
We should certainly be reassured that the Government are taking the issue seriously, and that their programme to address it includes much research. For me, however, the critical issue is whether the scope of the research is sufficiently wide. If it is not, the research will raise more questions than it provides answers.
I should like also to consider ways in which the Government might assist those working in the public health field, and particularly in education, in dealing with some of the consequences of childhood asthma. Currently, the response of various local education authorities to the growing problems of asthma in schools is very mixed. A recent study examined specifically how LEAs were tackling the problem, by sending, in late 1998, a questionnaire to more than 200 LEAs. Although only preliminary research has been done, and the results of the study have not yet been made public, those results are a matter of concern.
One third of LEAs said that they do not have a policy on how to deal with asthma in schools, and less than half of LEAs and schools said that they had in place a protocol on what to do if a child has an asthma attack in school. To my surprise and horror, almost half the LEAs said that they did not have a commitment to a no-smoking policy in school—which is surely one of the causes of asthma attacks.
I hope that, when the study is complete, the organisation involved will send the findings to the Government for consideration. Today, however, I should like to press the Minister to have a word with his colleagues in the Department for Education and Employment, to ascertain what advice the Government are giving to LEAs. Perhaps he will also use his reply to clarify who is responsible and accountable for securing health in schools. Although I know that there have recently been Government announcements on that issue, it would be tremendously helpful if he could say who has responsibility as the lead organisation in addressing it.
I hope too that the Government, when they are considering good health in schools, will consider also the issue of asthma, and good practice across England. Some local authorities have been working with local asthma groups to establish very good practice.
Something is wrong—and it is always very troubling when one does not know the cause of a problem. Moreover, recent trends seem to be going in entirely the wrong direction. The problem has to be tackled, not only because of the uncomfortable and unpleasant nature of asthma both for children and for parents seeing their children suffering from asthma attacks, but because it is becoming an increasing burden on the health service. The problem has to be tackled also because it is affecting children's ability to have an enjoyable childhood and to play their full part in the education system.
I hope that the Government are taking the issue seriously, and that, in a few moments, the Minister will be able to assure us that the research being done is sufficiently broad to ensure that, perhaps in a year's time, we shall better understand the problem, so that we are able to reassure parents who have children with asthma. 369 Once we have a greater understanding, perhaps the Government will be able to implement policies to tackle the causes of that growing problem.
§ The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)I congratulate the hon. Member for Winchester (Mr. Oaten) on his good fortune in the ballot, and particularly on dealing with this subject today. He has done the House a good service in drawing attention to some of the concerns that he has expressed. I am also delighted that he found my parliamentary answers helpful. It is the first time that anyone has said that to me, and I am deeply grateful to him for doing so. Perhaps we shall have to go back to the Department and re-examine how we answer questions, but I am grateful to him for those comments.
The hon. Gentleman raised some specific issues on research and on the direction of the Government's research programme, and I shall try to address them later in the debate. He also raised some technical issues, on which he said that he would be happy for me to write to him. I shall certainly take him up on that, and am sure that we shall correspond on some of those technical issues.
I reassure the hon. Gentleman, and the House, that the Government share the widespread concern that he has articulated so well today on the burden resulting from asthma, particularly among children. Asthma is the most common chronic disease in the United Kingdom. It is also the most frequently reported cause of longstanding illness among children.
Children are much more likely than adults to be treated as hospital in-patients for asthma: children under 15 currently account for almost one half of the ordinary admissions and day cases for asthma. Only 2 per cent. of the approximately 1,300 asthma deaths a year in England are among children. Although each of those deaths is a tragedy, research suggests that many of them could have been prevented by better adherence to treatment.
Asthma has a considerable financial cost—to which the hon. Gentleman referred—in addition to its human cost. The national health service spends about £600 million annually in treating asthma, including £466 million on general practitioner prescriptions in the most recent year for which data are available. We should also not forget the indirect costs of asthma, including, for children, days off from school. The hon. Gentleman was quite right to mention those other costs in his speech.
The hon. Gentleman was correct also to say that there are no comprehensive data on the number of people, of any age, with asthma. However, on the basis of all the available information, it has been estimated that
the prevalence of asthma sufficiently severe to require regular medical supervision"—in hospital or other settings—is from 4 to 6 per cent. in children.That estimate was quoted in "Asthma: An Epidemiological Overview", which was produced, in 1995, by the Department of Health's central health monitoring unit.According to the health survey for England 1997, 23 per cent. of boys and 18 per cent. of girls aged two to 15 had been diagnosed at some time in the past as 370 suffering from asthma. Similarly, in the international study of asthma and allergies in childhood which was published last year in the British Medical Journal, 20 per cent. of surveyed children aged between 12 and 14 had had a diagnosis of asthma at some time.
The prevalence of asthma was, therefore, apparently rising for three decades, up to the late 1980s or early 1990s. Since then, hospital admissions, GP consultations and mortality rates have all been levelling off, perhaps reflecting more effective treatment and higher quality medical care. However, local studies—such as the one conducted in Leicester, to which both the hon. Gentleman and the National Asthma Campaign, in its "National Asthma Audit 1999/2000", referred—suggest that, in children at least, the prevalence of asthma may still be on the increase.
We do not know for certain what causes asthma, but it is likely that an interplay between genetic and environmental factors is an important factor. It is a commonly held belief that the rise in the prevalence of asthma must be the result of air pollution, particularly from motor vehicles. However, 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.
The Department of Health's committee on the medical effects of air pollutants, in its 1995 report on "Asthma and Outdoor Air Pollution", concluded:
with regard to the initiation of asthma (that is, causing the disease in the first place), most of the available evidence does not support a causative role for outdoor air pollution".Therefore, although exposure to air pollutants can produce a worsening of symptoms in those suffering from asthma, factors other than air pollution—allergens and the role of infections, for example—are likely to have had more of an impact on the number of people suffering from asthma.Nevertheless, air pollution is associated with asthma attacks and with other diseases of the lung and heart. We remain concerned to investigate those issues further, and also to improve air quality in the United Kingdom. In 1997, the Government published a national air quality strategy, which provides health-based standards and objectives for eight of the main air pollutants that can affect human health, including carbon monoxide, lead, nitrogen dioxide, ozone, sulphur dioxide and other chemicals. The strategy brought together existing systems for controlling pollution and introduced a new system of local air-quality management.
We have reviewed the national air quality strategy to examine how further improvements in air quality could be made more effectively and more rapidly. In January 1999, we issued the report of the review for consultation. The consultation period closed in April, and the outcome will be published later in the year.
Advice to the general public about air quality is available through Teletext and Ceefax and through the air quality helpline. The Department of Health and the Department of the Environment, Transport and the Regions work together to determine how simple messages about the health effects of air pollutants can best be communicated to the public. A leaflet, "Air pollution—what it means for your health", was published last year.
The hon. Gentleman repeatedly raised the question of research. The Government continue to sponsor research on both asthma in general and possible links between 371 outdoor and indoor air pollution and asthma. A major £3 million research programme on outdoor air, jointly funded by the Department of Health, the Department of the Environment, Transport and the Regions and the Medical Research Council, has recently come to an end, and it will be fully evaluated toward the end of this year. The Department of Health intends to issue a further call for research proposals shortly, predominantly on the health effects of outdoor air pollution. A joint Department of Health/Department of the Environment, Transport and the Regions £1 million three-year research programme on indoor air is currently under way, and a number of studies are examining the effects of air pollutants on people with asthma.
The Medical Research Council spends about £2 million a year on research into prevention and treatment of asthma and related matters. The National Asthma Campaign is managing, on behalf of the NHS Executive, the NHS national research and development programme on asthma management. We welcome the participation of, and the close relations we have with, the National Asthma Campaign. The hon. Gentleman expressed concern about the future direction of asthma research, but perhaps he will draw comfort from the fact that the NAC plays a leading role in determining the course and conduct of the research effort. He also asked about the publication and review of research data: we always publish that information.
In the NHS, management of asthma, in children as in adults, mainly takes place in primary care. The Department of Health has provided a national framework for the provision of general medical services for asthma in the chronic disease management programme. In that programme, GPs set up and oversee organised programmes of care, with clearly understood arrangements for any care shared with the secondary sector; 94 per cent. of GPs now participate in the CDMP for asthma.
We recognise that proper management of asthma during school hours is a very real issue for children, their parents and their teachers, and the hon. Gentleman is right to draw attention to that problem. That is why we have ensured that information about asthma has been provided on the "Wired for Health" website, which was launched in March as part of the national grid for learning and which provides teachers with health information on a range of conditions. "Wired for Health" is the Government's main communication tool for our healthy schools initiative, which is jointly funded by Department of Health and the Department for Education and Employment and is a key part of our strategy for "Our Healthier Nation".
The "Our Healthier Nation" Green Paper set out the Government's philosophy on improving health in England. We proposed that our health strategy should have twin overarching aims: to improve the health of everyone, and to reduce health inequality—to narrow the gap between those with the best health and those with the worst. We proposed to achieve those aims by introducing the concept of a contract for health, whereby Government, local organisations and individuals all recognise and act on their share of responsibility for improving health.
At Government level, we recognise that we have a responsibility to tackle the underlying causes of ill health: poverty, poor housing, unemployment and pollution. Government must take the action which only they can so that local organisations can play their part and individuals 372 can make the decisions that allow them to take control of improving their own health. The "Our Healthier Nation" White Paper, which is due shortly, will set out the detail of how we envisage that happening and developing.
Returning to the subject of the "Wired for Health" website, I believe that it demonstrates the commitment to partnership which is a fundamental part of the Government's approach to health issues. It gives access to the National Asthma Campaign's own material on asthma. In respect of asthma in school, the website builds on work previously undertaken with the National Asthma Campaign on the guidance entitled "Supporting pupils with medical needs", which was issued jointly by the Department for Education and Employment and the Department of Health under the previous Administration, in 1996.
The NHS is making increasing use of the internet and NHSnet for posting reference material. Over the next couple of years, a number of developments should help to improve both access to and the quality of information available to the public on health and health services. For example, work is taking place to develop a national electronic library for health, to provide patients, public and clinicians with access to accredited health and health care information. The national electronic library for health will include information on healthy life styles, medical conditions, diseases and treatments, and about the effectiveness of different treatments; it will also provide a reference guide to who does what in the NHS. The library project is working in conjunction with a range of other related initiatives, including NHS Direct, which has an important contribution to make in this respect and which will be available in all parts of England by the end of next year.
I have referred several times to the National Asthma Campaign. In recent years, the Department of Health has been able to give that organisation a project grant to create a childhood asthma education officer post, as well as grants towards the costs of its asthma helpline. We also assisted the introduction of a new personal asthma card—the "Control your asthma" card—to help sufferers to manage their condition. I should like to take this opportunity to pay tribute to the sterling work that the National Asthma Campaign does to provide support and information for children and all people with asthma and their carers. We greatly value the good working relationship that we have with the National Asthma Campaign.
Let me assure the hon. Gentleman that the Government take asthma, not least as it affects children, very seriously indeed. We shall continue to do all we can to improve knowledge of the causes of asthma and to make life as normal as possible for all those who suffer from it—perhaps I should have declared an interest earlier, for I too am an asthmatic. The Government will continue to work with medical and other health professionals, the National Asthma Campaign and all those with an interest in the field, so as to ensure that our commitment to and ambition for a first-class NHS for all the people of our country applies as much to those who suffer from asthma as to those who suffer from any other condition.
§ It being before Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
§ Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), until half-past Two o'clock.