Five years on: Keeping lungs healthy

Chair of the Taskforce’s Foreword

In the last 5 years, the Taskforce has been driving progress in policymaking, amplifying the voice of the respiratory community. The Taskforce’s 5-year plan outlined 43 recommendations to prevent more people from developing lung disease and transform the care of people living with respiratory conditions. Our focus has been refined around early intervention and ‘secondary’ prevention, with working groups being established for diagnosis, access to treatment, workforce and better data on respiratory care and treatment. This chapter covers many recommendations that focus on keeping lungs healthy and fall outside the remit of the Taskforce’s reframed purpose and themes.

We are pleased with the tangible progress made in the last 5 years to support the prevention of lung disease. The Government has published several key documents that will help shape prevention work, including the policy paper, ‘Stopping the Start,’ which outlines how the Government will create a smoke-free generation. Additionally, last year the Government announced additional funds for smoking cessation services. While this is a welcome announcement, funding will still be below the levels required to create comprehensive stop-smoking services throughout England.

In 2023, the Government also published its Environmental Improvement Plan, which outlines how it will tackle air pollution. However, we believe that the Government’s targets to reduce Particulate Matter (PM) pollution are not ambitious enough and will mean that people with existing lung conditions will be forced to breathe toxic air until 2040.

In the last 5 years, our colleagues in the Healthy Air Coalition have advocated nationally and locally for the introduction of Clean Air Zones. They have made considerable progress, with Clean Air Zones being established across England. However, only 4 cities have introduced Category D, the most effective version of Clean Air Zones.

Last year, NHS England published its vaccine strategy, which outlines plans to make vaccinations more accessible for all communities. Flu vaccination levels amongst NHS frontline staff and people with pre-existing lung conditions have been too low. We hope this strategy will help to improve the uptake of flu vaccinations amongst these key groups and ensure that people with respiratory conditions are kept out of hospital over winter.

In the next 2 years, we need the Government to commit to introducing policies that tackle smoking, air pollution and the low uptake of flu vaccinations. Moving forward, the Taskforce for Lung Health will support the vital work of our members to ensure that people with lung disease are kept healthy.

Recommendation 1a: Plan and fund effective, high-quality stop-smoking services which are accessible to everyone who wants to quit

Smokers are about 3 times more likely to quit with support from a stop-smoking service. We know that smoking is the biggest cause of health inequalities and is responsible for half of the difference between the richest and poorest in society. In October 2023, the Government published a policy paper entitled ‘Stopping the Start: Our New Plan to Create a Smokefree Generation.’ It includes proposals to reduce the appeal and availability of vapes to children and to ban tobacco being sold to children who turn 14 years old this year or younger.

As part of its plan to create a ‘Smokefree Generation,’ the Government will provide an additional £70 million per year for local smoking cessation services. In 2022, according to the Health Foundation public grant funding for smoking services and tobacco control was 41% lower in real terms per person since 2015/2016. This additional investment will more than double the existing funding through the public health grant. Including this new funding only £138 million will be spent on smoking cessation services. However, Asthma + Lung UK estimates that in England stopping smoking services will require £266 million of funding per annum. Our colleagues in Asthma + Lung UK will continue to campaign for additional funding so everyone can access specialist stopping smoking services.

Recommendation 1b:All healthcare professionals to be trained in offering very brief advice on smoking cessation 

Public Health England published updated guidance on stopping smoking in December 2023, which outlined how GPs should advise patients who smoke that the most effective way to quit is a combination of behavioural and pharmacological support. Additionally, this guidance stated that mental health clinicians and midwives should offer stop smoking support.

However, we worry that many healthcare professionals have not received adequate training. In 2021 research conducted by Asthma + Lung UK revealed that more than half of GPs in the UK have received no training on advice for smoking cessation, while only 2% of respondents believed the training that they had received was comprehensive. The Taskforce will continue to support the work of Asthma + Lung UK to ensure that all healthcare professionals are trained to provide brief and effective advice on stopping smoking.

Recommendation 1c: Introduce Category D Clean Air Zones in the most polluted towns and cities across England

We know air pollution threatens human health, shortening people’s lives across the country each year. The UK’s air pollution contributes to up to 43,000 premature deaths per year. We are pleased with the progress achieved by our colleagues in the Healthy Air Coalition. According to modelling by DEFRA, Clean Air Zones is the policy with the largest impact on air quality and produces the most significant reduction in nitrogen dioxide levels. The Coalition has successfully made the argument to both local and national governments that Clean Air Zones are the most effective tool to reduce air pollution within England.

From August of this year, in London, the Ultra Low Emissions Zone (ULEZ) has been expanded to cover all boroughs. In total, there are 11 Clean Air Zones across England. Only London, Birmingham, Oxford, and Bristol have established Category D Clean Air Zones. Category D Zones are the most effective, as they include restrictions on private use vehicles.

Category C Clean Air Zones do not include restrictions on cars and have been introduced in Bradford, Bath, Newcastle, Gateshead, and Sheffield. It has been announced that in Manchester a Category D Clean Air Zone will not be introduced, as the Mayor rejected the measure of charging private-use vehicles. Unfortunately, in 2022 Liverpool City Council rejected plans for a Clean Air Zone.

This exemplifies that despite significant progress there is still a lot of work that needs to be done to improve air quality in towns and cities across England. The Taskforce for Lung Health will continue to support the important work of our colleagues in the Healthy Air Coalition.

Recommendation 1d:Place new restrictions on particulate matter (PM) emissions from all sources 

The Environment Act 2021 provides the UK Government with a framework to deliver on air quality targets, setting out new long-term targets for fine particulate matter (PM) emissions. In 2022, the Government committed to an annual concentration target- a limit of 10 micrograms per cubic metre (µg/m3) to be met across England by 2040. However, this target will mean people with a lung condition will continue to see their quality of life diminished by poor air quality until 2040. In addition, the Government’s target lacks ambitions, as exemplified by the World Health Organisation’s call for countries to set a target of 5 µg/m3.

We are pleased that in 2023 the Government published its Environmental Improvement Plan, which outlines how the Government will achieve its ambition to cut overall air pollution by tackling the key sources of emissions and challenge councils in specific hotspots to improve air quality.

However, urgent action needs to be taken to reduce PM emissions. The Government has already missed an emission reduction commitment for dangerous pollutant fine particulate matter PM2.5 in 2021. According to projections published by DEFRA in March 2023 the Government’s PM2.5 emissions commitments will be missed in 2025. Our colleagues in the Healthy Air Coalition will continue to push the Government to meet their commitments regarding air quality, as 2030 emission ceilings will be missed without further action.

The Healthy Air Coalition has been working with local, regional, and national Governments to place new restrictions on PM emissions. In the future, we will assist the Healthy Air Coalition and our member Asthma + Lung UK to raise awareness of the impacts of poor air quality on lung health.

Recommendation 1e: Government to introduce a national system of air pollution alerts with health advice

In the last 5 years, there has been little progress towards the creation of a national system for air pollution alerts. Short periods of high air pollution can be particularly dangerous for people with lung conditions, causing the exacerbation of their symptoms and increased hospital admissions. People with lung conditions who currently want to access air pollution data must rely solely on local data, which can be inaccurate and inconsistent. The Taskforce will continue to support Asthma + Lung UK to push for the establishment of a national system of alerts with health advice.  

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 

We are pleased that in December 2023 NHS England published its vaccination strategy with its emphasis on convenient access within communities that experience health inequalities. Flu vaccination levels amongst at-risk groups, such as people with lung conditions, have been too low. According to the UK Health Security Agency, the proportion of people with chronic lung disease receiving a flu vaccine was 56% in England in 2021/2022.

This strategy also reiterates that all healthcare workers are eligible for a free flu vaccination. However, in the 2022-2023 season, only 49.4% of all frontline health workers in NHS trusts with direct patient care received a flu vaccination. The Taskforce believes that if this strategy is fully implemented, making vaccinations more convenient, it will increase flu vaccination coverage of clinical at-risk groups, front-line NHS staff and social care staff.

The proportion of people with chronic lung conditions as well as health and social care workers that receive a flu vaccination can be viewed on our Lung Health Data Tracker.  The Taskforce’s Vaccine Sub-group will work to increase the uptake of flu vaccinations and other vaccines relevant to winter pressures. We will also continue to support Asthma + Lung UK to push the Government and NHS England to prioritise vaccinating these key groups.