Three years on: keeping lungs healthy

We made recommendations about preventing lung disease. Here’s what’s happened in 2021.

Comment from the Taskforce’s Chair, Alison Cook

With COVID-19 there has understandably been a massive focus on vaccination this year, both for COVID-19 and for flu. There has been an expansion of the free eligibility criteria for the flu vaccine and a welcome focus on the vaccination rate of people with health conditions and among health and social care workers.

Other areas of prevention have not fared so well. With regard to reducing smoking rates, the government’s Tobacco Control Plan is still to be published. There has been a reduction in investment in stop smoking services, and too few GPs are receiving essential training on how to deliver Very Brief Advice.

In tackling air pollution, a key cause of poor respiratory health, almost all areas of the UK exceed the newly tightened WHO Air Quality Guidelines. Only three of the most polluted cities and town have implemented Clean Air Zones and we still have no national air quality alert system.

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

The outlook for local stop smoking services remains uncertain, with continuing delays to the long-awaited Tobacco Control Plan and no government response to the 2019 Green Paper ‘Advancing our Health: prevention in the 2020s’.

In 2019/20 funding for local public health in England was £850 million lower in real terms than initial allocations in 2015/16. Consequently, although the government committed to maintaining the Public Health Grant in real terms at the 2021 Autumn Spending Review, this is at a far lower level of funding than just six years ago.

Furthermore, statistics from NHS Digital show that overall spend on stop smoking services in England fell by 51% between 2014/15 and 2019/20. Consequently, the number of people who were helped to quit smoking halved from more than 229,600 to less than 114,200. Given that we know that COVID-19 has put significant additional funding pressure on local authorities, and with social care demands accelerating, we are concerned that the postcode lottery of stop smoking provision will only get worse without increased funding from central government.

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

Research published in 2021 by Asthma + Lung UK, into the training needs of UK GPs on Very Brief Advice (VBA) for smoking cessation, found that more than half of GPs in the UK have never had any training in how to deliver Very Brief Advice. Worryingly, just 2% of GPs say they have received VBA training that they felt was comprehensive, and only 8% of GPs use VBA daily. Taskforce intends to continue to make the case for increased training and use of VBA within primary care, with this ever more important as the number of people able to be supported through stop smoking services declines.

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

There have been some positive steps in 2021 on delivering clean air zones (CAZs) in the most polluted towns and cities in England.

As of December 2021, Portsmouth (Class B), Bath (Class C) and Birmingham (Class D)have set up Clean Air Zones and London has expanded its Ultra-Low Emissions Zone, which will improve air quality across the capital. However, given the health consequences of air pollution we are extremely concerned that 90% of all local authorities are still breaching legal limits of NO_2,and Derby and Southampton, who were both told to establish their own CAZs by 2020, have failed to do so.

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

The long-awaited Environment Bill 2021 has finally received Royal Assent and is now an Act of Parliament. The campaigning of Taskforce members, along with others, has helped push the government to commit to include a legally binding duty to bring forward into legislation at least two new air quality targets by 31 October 2022. These target objectives include reducing the annual mean level of fine particulate matter (PM_2.5) in ambient air and reducing population exposure to PM_2.5.

In September 2021, the WHO revised its Air Quality Guidelines (AQGs), slashing the limits for most air pollutants. The recommended limits for nitrogen dioxide (NO₂) dropped from 40μg/m³ to 10μg/m³ and for PM_2.5 from 10μg/m³– 5μg/m³. This means that we are even further away than we were in 2020 in ensuring that no-one in England lives in an area with an annual average level of fine particular matter which exceeds WHO recommended limits, as measured by DEFRA.

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

There is still no national system for air pollution alerts, and the various local options that are available are not widely or consistently used. This means that when people are seeking localised air pollution data to help them make decisions about their lives and their health, it is likely to be of varying quality and reliability. This is borne out by the results of a 2021 survey undertaken by Asthma + Lung UK among people who live with asthma, a group highly sensitive to air pollution levels.

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

The current 2021 flu programme is the biggest in UK history and there is an ambitious target of vaccinating over 35 million people. This is in response to predictions that this winter there will be higher levels of flu in circulation, alongside COVID-19, with people more susceptible after last year’s social distancing led to low levels of transmissions.

To help increase protection levels the government has expanded the eligibility criteria for the flu vaccine to cover all secondary school pupils, as well as 50-64 year olds, and we hope these groups will continue to be included in future programmes. There is also an aim to vaccinate 75% of people with underlying health conditions which is in line with Taskforce measures of success. Uptake in 2020/21 for people with chronic respiratory disease was 57.9%, an increase on figures for previous years which have hovered around 50%, and we hope 2021/22 figures will show a further increase.

There continues to be a steady rise in frontline NHS workers receiving the vaccine, with 76.8% getting the jab in 2020-21, meeting the 75% target for the first time. However, variations between the vaccination rates of different trusts and staff groups remain. Similar issues are impacting social care workers, with the vaccination rate reported last year for the first time at a disappointing 60.45%, a rate Taskforce wants to see increase significantly this year.