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Mr. David Drew (Stroud): I declare an interest as an asthma sufferer. Does my hon. Friend agree that one of the best changes in terms of preventive care is the way in which people's use of the drugs can be managed through advice in doctors' surgeries, often involving practice nurses? Does he also agree that as new generations of those drugs are developed, there is a need to manage carefully people's access to them? Too often, people do not know how to use the drugs in the appropriate way, and more work must be done in that area. Does my hon. Friend agree that that is a way to take the matter forward?
Mr. Chaytor: My hon. Friend speaks with personal experience as an asthma sufferer and I pay tribute to the work that he has done to raise the profile of the condition. What he says about the need to increase people's awareness of the disease and to increase their ability to manage the drugs is right and will be a theme of my remarks.
The impact of new technology in alleviating the suffering of asthma sufferers also needs to be taken more seriously. I was recently made aware of the use of mobile phone technology by one of the major mobile phone networks to enable more direct communication at the crisis point between asthma sufferers and their GPs. Again, as time goes by, with the correct level of investment and with greater understanding and awareness of the problem by both GPs and asthma sufferers, that will lead to a severe reduction in the number of deaths from asthma.
The data and statistics presented by the National Asthma Campaign demonstrate how enormous a burden asthma can be. I was shocked to discover that almost 4 million people with asthma needlessly experience symptoms. As a nation, we do not meet our international targets for asthma care. That is through no fault of the patients or the health care professionals; it is entirely because the nation and the Government do not give asthma sufficient priority. If we do not make it a priority, how can asthma sufferers and their carers be expected to meet those critical standards? The sheer number of emergency admissions—74,000 per annum—is surely evidence enough that people with asthma are not getting the support or care from the health service that would prevent so many of those admissions.
People with asthma often have low expectations of how well they can be and do not realise that their health and quality of life could be better. Almost half of all people with asthma in the United Kingdom experience significant symptoms that disrupt their daily lives, such
as difficulty in walking upstairs and interrupted sleep. The majority of people with asthma do not need to tolerate asthma symptoms. They can and should be able to go through life virtually symptom free.The sheer scale of asthma as a condition makes it an expensive business at all levels of the health service and to society as a whole. Approximately 18,000 first or new episodes are presented to GPs each week in the United Kingdom. Respiratory disease is now the most common illness responsible for emergency admissions to hospital. Asthma costs the NHS an average of £850 million a year. At the local level, the annual cost of managing asthma for an average size primary care trust is approximately £4 million. In total, asthma costs the UK economy and the NHS more than £2 billion a year. As a consequence of symptoms and inadequate care, more than 18 million working days are lost as a result of asthma each year. That could be changed by better health care.
People with asthma are frequently forced to visit hospital because their asthma is poorly managed. Much of the suffering and unnecessary journeys to hospitals that are sometimes many miles away could be avoided because most patients would prefer to visit their local GP. Today's modern medicines mean that people with asthma should lead symptom-free lives, but the asthma care system leaves a great deal to be desired. With good support from health care professionals, backed up by written information, the National Asthma Campaign believes that people can take the lead in managing their asthma and relieve the impact of the condition on their lives—exactly the point made by my hon. Friend the Member for Stroud (Mr. Drew). That in turn will help to cut the costs of emergency admissions and reduce the number of unnecessary deaths.
Our current system leaves a lot to be desired in terms both of cost-efficiency and cost-effectiveness. However, it is clear that changes should be made, many of which may have little cost implication. People with asthma are not asking the earth; they want only common-sense things such as a quick and accurate diagnosis, to meet their respiratory consultant and asthma nurses on a regular basis, to be shown how to use the inhaler device correctly, to agree a personal action plan with a doctor or nurse and to expect any person who works in the NHS to be aware of the serious risks that the person with asthma faces if their condition deteriorates. However, it is also clear that prescription charges are a major problem for most people with asthma in the UK. In a recent survey, 71 per cent. of people with asthma said that free prescriptions would be the most useful thing in improving their quality of life. Some people with asthma are quite unable to pay for all their prescribed medication, and are forced to choose which treatment to go without.
Limiting asthma treatment because of financial difficulty puts the health of people with asthma at risk. Under-treatment can lead to irreversible lung damage, lower quality of life, an increase in the frequency of asthma attacks and the ultimate burden on the NHS, which is why the National Asthma Campaign wants asthma to be added to the list of clinical exemptions from prescription charges. As with many current clinical exemptions, asthma is a long-term medical condition with variable expression that requires consistent treatment to avoid worsening symptoms. There is no
clinical reason why asthma should not be added to the list. Free prescriptions for people with asthma will save NHS resources by reducing emergency hospital admissions and will improve their quality of life. In essence, better use of prescription medicines leads to less emergency health care use, less secondary care use, fewer asthma attacks and fewer days lost from work.I would welcome a wider role for pharmacists in asthma care, as they often have immense knowledge of asthma and have a little more time to deal with patients than GPs. They could, for example, check a patient's inhaler technique—something that is vital, yet can make such a huge difference. Incorrect inhaler use means that the medication does not work effectively to control inflammation in the airways or open them when symptoms occur. I would like the inhaler check to be a standard procedure when people pick up an asthma prescription. People with asthma often underestimate the seriousness of the disease. Many put up with poor, substandard care because they have low expectations of the health care that they receive and the quality of life that they can enjoy. I urge people with asthma to take the asthma charter to their doctor to ensure that they get the best treatment and advice.
Only 3 per cent. of people with asthma in the United Kingdom have a personal asthma plan. Those plans are the single most effective non-drug-based way of controlling the condition, and can make the difference between a good quality of life and repeated admissions to hospital and all the associated health care costs. Making self-management plans a reality depends on the training of staff in asthma, which is neglected at present. There is an immense amount of good will among our nurses and health care professionals, but we need to harness that good will and provide structured plans so that training can come into force. Personal asthma plans lead to fewer asthma symptoms, improved lung function, fewer acute attacks because of the prompt response to a worsening condition, less need for reliever treatment, less need for steroids, less inappropriate use of antibiotics, improved compliance and a better quality of life.
Many people with asthma do not have the chance to speak to a trained asthma nurse or respiratory specialist before they are discharged from accident and emergency. That is a key factor in avoiding repeat admission. A thorough assessment of their asthma should be made, including, perhaps most importantly, the reason for the admission, so that we can find out what precipitated the attack and how the situation could be better managed in future. Perhaps we should look at Australia as a benchmark of good practice elsewhere. It has made asthma a national priority and has more than halved asthma deaths in 11 years. It managed to lower asthma deaths by implementing better asthma care across the board.
As a nation, we lag behind not only Australia but other European countries. In 1996, for example, mortality rates from asthma in the UK were 105 per 100,000 people, compared with 44 in France and 43 in Germany, which is why the National Asthma Campaign has long called for confidential inquiries into all asthma deaths. I want to reiterate that call so that we can know the reasons behind the 1,500 asthma deaths every year. If, as many people suspect, the reasons boil down to inadequate routine care, delay in obtaining help during
the final, fatal attack or poor adherence to medication, the Government and the NHS need to act quickly and cut the number of deaths with the easy and common-sense points on implementation to which I referred earlier.With one in every five households being affected by asthma, it is clear that we as parliamentarians need to do more to represent the views and needs of asthma sufferers. Regrettably, there remain many people, including politicians, doctors and nurses, who are not convinced that asthma is a problem. They do not seem to realise that their actions can make the difference between someone's asthma being under control and that person's being a regular visitor at the local accident and emergency department. I believe that the House can make a difference and I call on the Government to make asthma a national priority.
We need more asthma clinics run by asthma-trained health professionals offering a patient-centred approach to increase patient expectations, coupled with health care trusts ensuring that asthma is a local priority. In addition, health care professionals should adhere to the latest British guidelines on asthma management. I pay tribute to the work of the National Asthma Campaign, the voice of people with asthma, for its ceaseless campaigning to improve patient care and public awareness of asthma. We in Parliament need to take heed of that, as we know that good management can lead most people with asthma to have full and active lives, and a better quality of life overall. Admittedly, the onus does not lie solely with Westminster, but it is a good opportunity for parliamentarians of all parties to use their power and influence to unite to make asthma a national priority.
It is evident that much more work remains to be done within the NHS on behalf of the majority of people with asthma who should be experiencing a life free from symptoms. That is a problem connected with the health service, not with the health care professionals working within it. The Government should make asthma a national priority so that we can have a seamless co-ordinated system of care across primary care, accident and emergency, ambulance and in-patient and out-patient services. That in turn would cut the burden and costs incurred by the NHS and the pressure on the UK economy.
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