One year on: keeping lungs healthy
Our Taskforce Plan made recommendations about preventing lung disease. Here’s what’s happened in the last year.
Recommendation 1a: Plan and fund effective, high-quality stop smoking services which are accessible to everyone who wants to quit
Recommendation 1b: All health care professionals to be trained in offering very brief advice on smoking cessation.
The government’s prevention green paper was published in July, with an ambition for England to become smoke free by 2030, which is a positive step forward. However, the number of people attempting to stop smoking through a specialised service has continued to fall.
The Taskforce is committed to reversing the decline in stop smoking services, which play a vital role in supporting people to quit. The NHS Plan includes a new model of stop smoking support in hospitals to become available by 2023-24, funded by the NHS. This service will initially be available at selected hospitals before a wider rollout.
There is still a mixed picture of support available in the community for people who smoke. While it was positive to see a real-terms uplift to the public health grant announced in the most recent spending round, there’s still uncertainty over whether significant cuts to public health funding will be reversed in the future. Positively, the requirement to provide a hospital-based service is encouraging some areas to improve the service provided more widely in the community. We will keep a watching eye on how, where and when this happens.
Recommendation 1c: Introduce category D Clean Air Zones in the most polluted towns and cities across England
Recommendation 1d: Place new restrictions on particulate matter (PM) emissions from all sources
Recommendation 1e: Government to introduce a national system of air pollution alerts with health advice
The Queen’s Speech in October 2019 featured an Environment Bill to set legally-binding improvement targets, which included powers to set new limits for particulate matter. The then government pledged to have the most ambitious air pollution targets in the world. We will be working with environment, health and transport campaigners to ensure legislation is brought back in the new parliamentary session to set new targets to reduce particulate matter levels in line with World Health Organisation (WHO) recommendations.
Clean air zones are already cutting pollution
The Ultra Low Emission Zone (ULEZ) launched in London, charging older diesel and petrol vehicles to enter the centre of the city. The number of non-compliant vehicles entering the city centre fell by a third in the first three months. However, there have been delays in the introduction of similar zones in other cities, including Birmingham, Leeds and Bristol. This is extremely disappointing and we will continue to press for action in cities to reduce the use of heavily-polluting vehicles.
The government published its Clean Air Strategy for dealing with air pollution in January, recognising it as one of the UK’s biggest public health challenges and promising better public information on pollution levels.
Public Health England published a review of available interventions to improve air quality. This made a number of recommendations, including the introduction of clean air zones and encouraging low emission fuels and electric cars.
The introduction of the ULEZ in central London in April 2019 has contributed to better air quality and a projected fall in carbon emissions. Data gathered by City Hall has found that there are now 13,500 fewer non-compliant cars entering the zone on an average day, a reduction of 38%. With 77% of vehicles entering the zone now compliant with designated emissions standards, the amount of roadside nitrogen dioxide (NO2) pollution has reduced by 36% from 2017 levels. The analysis estimates that the reduction in NO2 pollution solely attributable to the ULEZ is 29%.
Under the ULEZ, diesel vehicles that were registered before 2015 and therefore do not meet Euro 6 standards, and petrol cars and vans that were registered before 2006 and therefore do not meet Euro 4 standards, will be subject to a £12.50 charge for every day they enter the marked Zone.
Recommendation 1f: Improve the awareness of and compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) to prevent and control workplace exposures
- The Health and Safety Executive, a member of the Taskforce, is addressing occupational lung disease as part of its Health and Work Programme.
- In 2019-20 the focus is on reducing exposure to substances that cause cancer and asthma through the use of integrated campaigns, with particular emphasis on reducing the cancer risk from exposure to welding fumes. In addition, occupational lung disease workplace inspections and related communications will target the construction, woodworking, bakery and fabricated metal sectors.
The data tracker shows what is happening with the distribution of cases and deaths from recorded occupational lung disease
Currently, there are significant gaps in data collection around occupational health. Our data tracker reinforces the case for better records to improve safety at work. This includes the means to monitor the gap between self-reported breathlessness and recorded occupational lung disease as this indicates there is a missing population of people who are not being diagnosed.
Recommendation 1h: Increase rate of flu vaccination among the clinical at-risk groups and front-line NHS and social care staff who have contact with patients
There has been growing awareness of the importance of flu vaccination to protect the most vulnerable. This year has seen the biggest-ever flu vaccination campaign, with 25 million people offered vaccines for free.
However, vaccine coverage among people with a lung condition has never been high and actually decreased this year – down from 50.8% in 2017-18 to 49.8% to 2018-19. In better news, there was an increase among frontline NHS staff, from 68.7% to 70.3%.
The government was working on a new vaccine strategy in autumn 2019. We have urged the government to ensure the strategy includes a plan to boost flu vaccine uptake among people with respiratory conditions, and among health and social care workers. The strategy was due to be launched in the autumn, but unfortunately did not reach publication before the pre-general election period when new announcements are restricted. We will follow up with the Department of Health and Social Care on the next steps for the strategy now the next government is in place.
The National Institute for Health and Care Excellence (NICE) is also developing new quality standards on increasing uptake of the flu vaccine. These standards will help organisations to follow best practice in planning their flu programmes.
There is funding for care home and hospice staff to receive the free jab this year. But this funding is currently being confirmed on a yearly basis and we’d like to see more certainty about the future of funding.