HC Deb 08 May 2002 vol 385 cc246-54

Motion made, and Question proposed, That this House do now adjourn.—[Dan Norris.]

10.9 pm

Mr. James Wray (Glasgow, Baillieston)

I should like to draw attention to the seriousness of the incidence of asthma throughout Britain. I have spent a great deal of time trying to get this subject debated in the House; I raised it with the Leader of the House and asked him to give time for a debate, but unfortunately there was other important business to deal with.

I also raised the issue with the Minister of State, Department of Health, my hon. Friend the Member for Redditch (Jacqui Smith), to try to find out some relevant statistics and how much has been spent on research. In a written reply, she said that she did not have those statistics because they were not collected centrally. However, the British Thoracic Society has done a great deal of research on health service expenditure, and it reckons that respiratory disease costs the health service about £2.5 billion.

I am not saying that I am a great asthma expert, but many men and women, mothers and fathers, brothers and sisters and sons and daughters have spent a great deal of time worrying about members of their families who have become emergency patients in many hospitals throughout the country because of their asthma.

This is the National Asthma Campaign's national asthma day in Scotland, and yesterday was national asthma day in England. The campaign is involved in a worthwhile cause, and it is guided by the hands of the chief executive, Liz Brodie, whose son has suffered from asthma for 25 years. I would like to do justice to the campaign's cause. It has reported on many occasions to many other committees and has sent speakers across the country.

The National Asthma Campaign's report "Sleepless Nights, Anxious Days", which was launched today, analyses the incidence of asthma throughout the United Kingdom. We have to focus on younger children first when we talk about asthma, as 1.5 million children in the United Kingdom alone have the illness. One in five children have been diagnosed with asthma at some point and one in eight have asthmatic symptoms. Nationally, more than 7,000 children visit their GPs every week to be treated for asthma for the first time. The United Kingdom has the highest rate of "severe wheeze" in the world for those aged 13 and 14. Those are very serious statistics.

A recent World Health Organisation report found that asthma in young children can be more damaging than tuberculosis and the human immune deficiency virus. That finding is extremely serious. Let us not forget that in the past we screened people for tuberculosis in Scotland and throughout the United Kingdom because of the number of lives that were lost to that disease. That is why we want the Government to focus on asthma in the United Kingdom and why I would like them to put it at the top of their list of health priorities, as the situation is likely to get worse, not better.

Triggers for asthma range extremely widely from cigarette smoke and cat fur to vehicle exhaust fumes, and there are many other causes. In such an unpredictable environment, I am sure that everyone would agree that children must get the best possible care and support. Although deaths from asthma in childhood are rare, the fact remains that asthma encroaches on the lives of many people and, unless it is manageable, it can cause undue stress and discomfort.

I want to give an idea of the impact of asthma nationally. Every 16 minutes a child is admitted to hospital because of asthma. Many of those children go through accident and emergency units, which, as I am sure everyone would agree, can be inhospitable places for children. Often, a frightening environment for children is unwittingly created. I would welcome, as would many people, measures to reduce asthma triggers in the environment, including measures to control smoking in public places and cat pollution.

I tabled an early-day motion on asthma and schools, which more than 100 Members have signed. It raises the important issue of the application of medication and knowledge of the condition in schools. In that early-day motion I reiterate my point that parents who have children with asthma must feel comfortable to leave their children in the hands of teachers and staff at schools. On average, there will be up to four children with asthma in each classroom. In my constituency, approximately 12,000 people have asthma—the majority are children. Too often, teachers do not have the training or knowledge about asthma, and could be wary when administering medication or not know what to do when a child has an attack. One parent told me that the school just didn't want to take the responsibility, they just didn't know what my son needed and he was not allowed to carry his inhaler with him". I take such comments very seriously, as children with asthma must be allowed immediate access to their medication. Locking it away in a cupboard somewhere in the school does not necessarily provide easy access. Children in reception and preparation classes may not understand their condition fully. It can be very frightening for young children to experience attacks, and it is important that their supervisors know what to do.

I tell all those who do not consider asthma a serious condition to imagine what not being able to breathe properly and struggling to take each breath feels like. In that type of situation, young children will panic, and the condition can worsen. Supervisors must provide a calming influence and not panic. Under the Health and Safety at Work, etc. Act 1974, local education authorities, or school governors in the case of independent schools, are responsible for ensuring that schools have a health and safety policy.

John Robertson (Glasgow, Anniesland)

I thank my hon. Friend for securing this debate. I have been an asthma sufferer since birth—I carry an inhaler about—and I have a daughter who has also had asthma since birth. Does he agree that not only do we need to educate teachers and parents but we must do extensive research into why children suffer from asthma from birth?

Mr. Wray

The Government have been doing a great deal—they spent in the region of £130 million on Smoking Kills, a lung disease programme, in 1998. I am very grateful to my hon. Friend for his acknowledgement of that issue.

Mr. Alex Salmond (Banff and Buchan)

I have been asthmatic all my life. When I was young, I participated in several schemes for new treatments such as broncho-dilators. At that time, in the 1960s, sensitivity tests were available that easily identified the substances to which people were allergic, which are among the causes of asthma. My understanding is that those tests are no longer available because they were subsidised by drug companies, and when generic drugs were introduced the companies no longer subsidised the tests. Now people must do a much more difficult blood test to identify allergic substances. Does the hon. Gentleman agree that it would be useful if such tests were once again available under the national health service, particularly for young people, to identify easily the substances to which people are allergic so that they can take the obvious preventive action?

Mr. Wray

One of the recommendations for which the National Asthma Campaign has been fighting is testing. It wants testing to be carried out because it reckons that it will save money for the health service—that £2.5 billion could be put to a better use.

Another important consideration for the Department for Education and Skills is provided by the Department of Health's 1996 guidelines on supporting pupils with medical needs in schools. The National Asthma Campaign has discovered that almost half of local education authority schools are without an active asthma policy. My early-day motion has called for all local education authorities to have asthma policies. Although we cannot turn teachers into asthma specialists, such policies would at least ensure that they can spot symptoms and provide medication quickly.

The National Asthma Campaign's school asthma pack has been tried and tested and, what is more, it takes only 10 hours to implement. I would welcome legislation making mandatory the 1996 Department for Education and Employment guidance on support for pupils with medical needs. In March 2002, my right hon. Friend the Secretary of State for Education and Skills pledged to contact all schools and local education authorities to remind them of the guidance issued in 1996. However, to the best of my knowledge, that is yet to take place.

The report "Sleepless Nights, Anxious Days" does not ask for a massive increase in finance, but offers a pragmatic approach and easy solutions. Asthma is seen as an invisible disease and it is not taken as seriously as some other conditions. One mother told me that, if her child were in a wheelchair, people would be more supportive.

I must raise an important point about diagnosis. A woman will often take a child who is wheezing and gasping for breath to the GP and the GP will simply say something like, "Oh, he has got asthma", give them an inhaler and pack them off without much explanation. Such practice must stop. GPs must divulge more information about the condition to the parents and to the children to ensure that they know what exactly is involved. I have spoken to a number of my constituents and I am now convinced that, to enable the 1.5 million children with asthma to lead a normal life, their carers and health professionals need to have more ready knowledge and access to information.

Parents of children with asthma do not ask for any more from public services than any other family with a sick child. Surely, it is reasonable to ask for a minimum standard of care, so that those parents can at least be confident of receiving the support that their child needs—whether in general practice, hospital or at school. As agreed minimum standards of health care for people with asthma in the United Kingdom do not exist, the reality for the 1.5 million children with asthma is that the condition is not a priority for the national health service. I would be grateful if my hon. Friend the Minister could tell me why the Government are unwilling to establish a national minimum standard or make funding available to improve the health care of people with asthma.

Perhaps my hon. Friend could respond to the calls for the introduction of a simple lung function or allergy test for asthma that could be carried out from an early age. That would allow for the right prescribed medication and put a halt to anxious parents continually bringing their children to GPs and thus creating more pressure on the health service.

In conclusion I hope that the national service framework will include asthma; that minimum standards of asthma care will be established in the health service; that resources will be provided to primary care trusts to give priority to asthma; that legislation will be introduced to ensure that all schools implement an asthma policy; and that the Government will carry out more research into asthma in children to find out its causes and to find a way to prevent it.

10.23 pm
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears)

I congratulate my hon. Friend the Member for Glasgow, Baillieston (Mr. Wray) on securing this Adjournment debate. I also thank other Members for their contributions. This is an extremely important subject for hundreds of thousands, if not millions, of people up and down the country.

I welcome the debate, not least because it gives the Government an opportunity to state clearly our policy on asthma and to point out the wide-ranging work that is going on in research and to try to advise patients of the ways in which they can manage their condition. That work is increasingly successful.

I recognise how distressing and debilitating the condition can be for individuals, their carers and their families. Asthma involves generalised airways obstruction that is reversible either spontaneously or by treatment. Its cause is not known and people can become asthmatic at any time. There are two major variants of asthma. Extrinsic allergic asthma can arise from hypersensitivity to allergens. Those can be everyday particles including grass pollen, house dust mite dung and pet fur. That condition often results in wheezing. It affects many people, especially those of a young age. The other type of asthma is known as intrinsic or non-allergic asthma. It often occurs in people in their 20s and 30s.

Asthma is the commonest chronic disease in the United Kingdom and affects people across a range of age groups. There are no comprehensive data on the number of people with asthma, but it is estimated that it affects up to 3.4 million people in the UK, including 1.5 million children between the ages of two and 15. It is estimated that 4 per cent. of adults and approximately 5 per cent. of children suffer sufficiently severely to require medical intervention.

About one in seven children have asthma diagnosed at some time and about one in 20 have asthma that requires regular medical supervision. It is clear from those figures that schools need to be aware of asthma—what triggers an attack, how to prevent it and how it can be treated. My hon. Friend made the important point that if young children are not well prepared they can panic, which exacerbates the attack. It is vital to ensure that schools have the tools, the knowledge and the power to help children in those circumstances. That is why the Department for Education and Skills and the Department of Health jointly issued "A Good Practice Guide", which is about supporting pupils with medical needs.

Mr. Wray

I asked my right hon. Friend the Secretary of State for Education and Skills about the 1974 Act. She said that she wrote to all local authorities to encourage them to be prepared. Surely that Act legally binds them to be responsible for ensuring that the children in their schools get the medical treatment that they need.

Ms Blears

Under health and safety legislation, schools are responsible for providing a safe environment for staff, pupils and anyone who uses the school environment, but they are not legally responsible for administering treatment. It is not possible under that legislation to put a legal duty on members of staff to provide medical treatment. Rather than putting staff in the position of administering medical treatment—we must remember that they are members of the education staff—we have tried to give them enough confidence, skills, equipment and knowledge to help them to help the children.

The matter is sensitive and it is important to get the balance of duties right. If we attempt to impose medical duties on non-medical staff who do not have the medical qualifications to carry out treatment, we could find ourselves in legal difficulties. I understand that my hon. Friend wants the guidance to be as strong as possible, but we need to take the staff with us on that. We do not want them to think that we are imposing a duty that they cannot fulfil. They need to be active partners in helping children to care for themselves and in ensuring that the facilities are available to them.

We produced the good practice guide to encourage local education authorities and schools to draw up medical support policies, not just for asthma but for other conditions from which children might suffer. The guide is therefore not asthma-specific. Hon. Members will know about the rare and severe times when children have an allergic reaction to a product which requires the immediate administration of adrenalin products. We want to have a wide-ranging support mechanism to help school staff to help children.

The guide includes a specific section on asthma. It states: Children with Asthma must have instant access to their reliever inhalers when they need them. My hon. Friend made that important point. The guide gives clear advice on the administration of inhalers. It states that pupils who are able to use their inhalers themselves should usually be allowed to carry them on their person. If the child is too young or immature to take personal responsibility for their inhaler, staff should ensure that it is stored in a safe but readily accessible place and is clearly marked with the pupil's name so that they know where they can get it as soon as the first signs of an attack come on.

The guide says: Inhalers should also be available during physical education and sports activities or school trips. It also recommends, as good practice, that children should be encouraged to take responsibility for using their inhaler from the earliest possible age because the safest way to manage their condition is if they are in control.

The guide stresses the importance of children with asthma being able to participate fully in all aspects of school life, including sport. Too often in the past children with asthma were discouraged from getting involved in physical activity, but it is important that they do as much as they can within the constraints of their condition. Many children can benefit from physical activity, but managing their condition carefully is important. Schools need to be aware that pupils may need to take their inhaler before joining in sporting activities, and they must be careful not to force children with asthma to take part in sport if they feel unwell. Again, we must strike the right balance between encouraging children to have as normal and active a life as they can and being conscious of the restrictions that their condition may impose.

As well as advising staff what to do if a pupil suffers an asthma attack, the guide promotes the drawing up of individual health care plans for pupils with medical needs, which should include details of the pupil's condition, medication and named members of staff who are able to support them should anything go amiss. The guide recommends that there should be clear procedures, including the reporting of information about any medical conditions that children have.

I understand that the National Asthma Campaign, which has been tremendously active in this area, produced a resource pack entitled "Danger Zone", which highlighted all these issues. That has been disseminated to all local schools in our healthy schools network, and programme co-ordinators are making good use of those materials. Healthy schools are working in close conjunction with school nurses to ensure that children and their families get the right support.

Although asthma has become more common in recent years, treatments have improved and the number of deaths has fallen. Since 1988, in England and Wales the number of deaths has fallen by about 25 per cent., but even so, in 2000, 1,272 people died from the condition, so we can see that it is very serious. Most deaths occur in middle-aged people, and there were only 14 deaths among young people aged 19 and under. Clearly, however, each of those deaths is a tragedy for the family, so asthma is extremely important to the Government.

Management of asthma mainly takes place in primary care settings. Under the chronic disease management programme, GPs are paid and encouraged, in their contracts, to provide organised programmes of care and, at primary care level, proper clinics for patients with asthma. A recently introduced programme will have a significant impact. Hon. Members may already know of the expert patients programme, which is being developed for people with a range of long-term and chronic conditions, including asthma. This is an extensive programme whereby patients themselves are trained in managing their condition and given detailed clinical information about it. After all, it is the patients, who live day to day with chronic conditions, who are the real experts on their care. Often they know far more than consultants and doctors will ever know.

Mr. Salmond

As the Minister knows, when people suffer from allergenic asthma, their allergies can change very quickly indeed. Is there a medical reason why sensitivity tests are no longer available on the NHS, or is it merely a matter of cost? I find it distressing that my young constituents do not have access to a simple test that I had access to in the 1960s, which was invaluable in stopping asthmatic attacks by allowing me to avoid the substances to which I was allergic. Why are not those simple tests available now, whereas they were available 30 years ago?

Ms Blears

I entirely understand the hon. Gentleman's point, and I was going to come to that. I was not aware that the tests were available in the 1960s, and I certainly do not know why they are no longer available—whether the reason is cost or a technicality. I would have hoped that we could make clinical advances rather than moving in the opposite direction. I do not know whether these were good, clinically effective tests, so I shall explore the clinical basis for withdrawing them. I am happy to look further into the matter, not only for the hon. Gentleman but for the National Asthma Campaign, and I shall also respond to the points made by my hon. Friend the Member for Glasgow, Baillieston about the history of this matter.

As I was saying, the expert patients programme will help us to make big strides towards progress. I am delighted that the programme has 26 pilots on a range of conditions up and down the country. The Medway primary care trust has a pilot specifically on asthma. The area has a disproportionately high accident and emergency admission rate for asthma in childhood; far too many children have attacks and are admitted to A and E. Many of those admissions could be avoided through improved self-management by expert patients. The fact that Medway has a pilot on something that particularly affects the community is extremely encouraging. Evaluating the evidence from the pilot to see if the expert patient programme can reduce the crisis in asthma will be extremely interesting and valuable for the NHS.

John Robertson

What kind of research is going on in respect of children who have asthma before they are even born, and what kind of money are we putting into that?

Ms Blears

I am happy to say that extensive research is going on. The Medical Research Council is the main body carrying out research on the Government's behalf, but we also work closely with the National Asthma Campaign to look at why asthma is caused in the first place and to investigate links between air pollution, traffic pollution, the environment and asthma. The National Asthma Campaign is funded to the tune of £5 million a year to carry out research on the Government's behalf; it is innovative of the Government to use experts to conduct research in the field via that voluntary organisation. That is a priority for the Government, even though we have not had any breakthroughs on isolating the causes of asthma. Much of our attention has centred on alleviating people's symptoms, but research into causes is equally important and we want to try and achieve a clinical breakthrough. Members have asked whether or not asthma would be subject to a national service framework.

Mr. Wray

Over the years, have Health Secretaries or Education Secretaries ever been in contact with Transport Secretaries? I read an important article in The Independent which said that most asthma cases are caused by exhaust fumes.

Ms Blears

That is a subject of ongoing dialogue. In 1995, a committee reported on the medical effects of air pollutants. There was little evidence that air pollution causes asthma, although it was accepted that exposure to air pollutants could worsen the symptoms of asthma. Again, the issue is about causes rather than the exacerbation of the disease, but we do not have strong evidence. It has been conjectured that modern fuels are more polluting than those used in the past, but there is no hard evidence of a direct causal link. One would expect there to be more asthma in urban communities where there is more traffic than in rural communities but, interestingly, there is no difference between the two; the link is clearly not as established as one might think from anecdotal evidence.

The national service framework for children will use asthma as an exemplar; it will not investigate specific diseases, but it has chosen to concentrate on asthma as an illustrative example. I reassure Members that right across the board in research—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MADAM DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twenty-one minutes to Eleven o'clock.