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12.26 am

The Minister of State, Department of Health (Jacqui Smith): I congratulate my hon. Friend the Member for Bury, North (Mr. Chaytor) on initiating the debate. It is opportune that we are discussing asthma on world asthma day. I, too, have seen the National Asthma Campaign's 10-point charter, "A Breath of Fresh Air", which was published today. I share my hon. Friend's high regard for that campaign, with its proud record of supporting research and raising the issue of asthma, as has my hon. Friend today.

We are making progress in improving treatment and care for people with asthma, and I welcome the opportunity to outline what has been done and what more we can do. I start by recognising, as my hon. Friend explained, how distressing and debilitating the condition can be for individuals, their carers and their families. As he rightly said, asthma is the commonest

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chronic disease in the UK and it affects all age groups. Its cause, despite much research worldwide, is still not known.

Before I deal with some of the detailed points and outline some of the action that has been and will be taken, I want to give some good news. Asthma treatments have improved and the number of deaths has fallen. Since 1988, the number of deaths in England and Wales has fallen by about 25 per cent. I recognise my hon. Friend's concern about people being admitted to hospital when earlier preventive treatment could have avoided that, but admissions to hospital have fallen significantly since 1997, when they stood at 71,434 a year, to 60,134 in 2001–02. Like him, I believe that the advances in treatment are due to the commitment, dedication and expertise of the NHS and researchers.

As my hon. Friend pointed out, asthma is mainly managed in primary care. The chronic disease management programme, which was introduced in July 1993, provides arrangements for health promotion under the GP contract. Participating GPs, who currently account for about 93 per cent. of the total number, receive a fixed annual payment for running organised programmes of care for patients with asthma.

The asthma charter published today by the National Asthma Campaign sets out 10 rights that a person with asthma might expect from the NHS. GPs who participate in the chronic disease management programme are providing services that help to meet many of the charter rights. For example, the charter calls for access to nurses and doctors with specific asthma training. To participate in the chronic disease management programme, health professionals must be adequately trained in the management of asthma. Other requirements include ensuring that all newly diagnosed patients with asthma receive appropriate education and advice. My hon. Friend the Member for Stroud (Mr. Drew) was right to say that that is an important element whereby we can improve management of asthma. GPs are expected to ensure that all patients receive continuing education, including supervision of inhaler technique if necessary, and to prepare an individual management plan with the patient and ensure regular reviews.

All those requirements put participating practices in a strong position to meet many of the important charter rights. Of course, we need to build on that. Hon. Members will be aware that a new general medical services contract was launched in February. If that new GP contract is accepted by the profession, it will lead to unprecedented investment in general practice to deliver a wide range of high-quality services with better clinical outcomes for all patients, including those with asthma.

The proposed contract includes a specific quality indicator for treatment and care of people with asthma that builds on the chronic disease management programme and will expect GP practices to keep records and effectively manage and review patients with asthma in order to qualify for additional quality payments. In particular, it highlights and promotes the offering and development of smoking cessation advice for patients with asthma who smoke. It promotes an increase in the number of patients who have asthma reviews and the number who have flu immunisation. If the profession

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accepts the new contract, the quality indicators will help to drive up standards of treatment and care in that important area of primary care.

It is also crucial that the work force are in place and that we have the numbers and quality of staff needed to provide the standards of care that my hon. Friend outlined. Since September 1997, there has been a growth in the number of consultants across all specialties and a 63 per cent. increase in the number specialising in respiratory medicine. Clearly, it is important that we further increase the numbers of trained specialists available to take posts in that specialty. In addition, the Department of Health and the Royal College of General Practitioners have produced a framework for implementing a scheme for general practitioners with special interests and clinical guidelines for them.

My hon. Friend pointed out the importance of GPs and I very strongly share his view. The new guidance for the appointment of GPs with a special interest in respiratory medicine was published last month. Guidelines were written in conjunction with a range of experts, including the National Asthma Campaign and the British Thoracic Society. GPs with a special interest in respiratory medicine will be able to develop in their own services and along with their colleagues in primary care some of the improvements in treatment that we all want. They will be able to act as a clinical lead in the primary care organisation and carry out consultations with patients who may have been referred by other practitioners for advice on clinical management of problems such as asthma. That might well help to avoid the need to wait for referral to a hospital specialist or to be admitted to hospital at all.

GPs with a special interest might also be expected to help develop the competence and confidence of their professional colleagues in providing an optimal service for people with asthma, acting as a training resource, a development and a clinical leader in the local primary care area, and helping to improve treatment for those with asthma. That scheme is an example of how we are putting into place plans to improve care for people with asthma.

We recognise that not only GPs but specialist nurses have a very important role to play in the management of respiratory conditions such as asthma. Last month, the Department published "Liberating the Talents", a guide to inform the development of nurses with a special interest in primary care. Like GPs with a special interest, they could work across a number of practices, providing secondary care services to patients across the community. Alternatively, they might work out of a hospital trust on an outreach basis, perhaps supporting patients with asthma at home or in a local health centre.

We need to ensure that we have more and better-quality professionals, but there is also an important role for developing the approach of patients with asthma to managing their own condition. People with asthma will benefit from the emerging expert patients programme, which, from 2004 to 2007, will provide mainstream NHS training in self-management skills for people with long-term chronic conditions. The programme is piloting courses in selected primary care trust sites. We expect that it will develop to give individuals the skills to manage some of the generic issues around chronic conditions, including the need to deal with acute attacks, to make effective use of medicines and

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treatments, and to cope with other people's responses. We then intend to introduce specific training modules, including one for asthma, into those pilot programme processes. Experience to date suggests that expert patients can reduce the severity of their symptoms and increase their quality of life—an area where there may be some important benefits.

Asthma has a major impact on children. Alongside the work that we have done with the Department for Education and Skills on spelling out what we expect from schools in terms of helping children to manage their asthma and to play a full part in the life of the school, my right hon. Friend the Secretary of State for Education and Skills recently met representatives of the National Asthma Campaign to discuss what more we need to do to ensure that children have that opportunity. We are developing the national service framework for children to set standards for the care of children and young people so that all children and young people have access to good-quality care. We are developing, with input from the National Asthma Campaign, an exemplar that uses—because of its prevalence—asthma to demonstrate how services from primary care to acute care, including ambulance trusts,

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must work together to ensure that the services that we provide for children with asthma are the most appropriate.

That applies not only to children, but to adults. We recently welcomed guidance from the National Institute for Clinical Excellence on inhalers. Last year, it advised on inhalers for children aged between five and 15 and, in September 2000, for children under the age of five. We strongly support that guidance, which emphasises the importance of ensuring that the device suits the individual needs of the child. That fits with my hon. Friend's comments on making sure that we prepare patients and educate them properly about the use of drugs, and more broadly.

On smoking, the Government's ban on tobacco advertising, work to educate parents about the effects of smoking, and support for the licensed hospitality industry's charter to improve facilities for non-smokers in pubs, bars and restaurants will be important contributions to helping to tackle asthma.

I pay tribute to the role of the National Asthma Campaign as one of the largest funders of asthma 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.


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