Four years on: keeping lungs healthy
We made recommendations about preventing lung disease. Here’s what’s happened in 2022.
Comment from the Taskforce’s Vice-Chair, Sarah MacFadyen
There has been little tangible progress in national policy making in 2022 to support the prevention of lung disease. Government has yet to publish several important documents that will help shape prevention work. These include the Tobacco Control Plan and the Health Inequalities White Paper. New targets have been published to reduce air pollution as required by the Environment Act, but they lack ambition and will leave us all breathing toxic air for many years to come.
Funding for stop smoking services is being reduced in real terms, and with the additional squeeze on public finances we are concerned that in 2023 services will be cut still further.
Whilst more Clean Air Zones have been established, these are largely not the Category D versions with the tightest regulations that include private vehicles. Consequently, it is estimated that there are still 22 million people living in areas that breach legal limits for nitrogen dioxide.
Flu vaccination uptake showed encouraging signs in 2019/20 and 2020/21, and although it has fallen in 2021/2022 it is still higher than pre pandemic levels. This is likely to be in response to the heightened awareness of the benefits of vaccination during the pandemic. We hope higher uptake is maintained; however, we remain concerned by the stubbornly lower uptake amongst health and social care workers given their interactions with vulnerable people.
In 2023, we urgently need government to commit to introducing tighter policies and more resources to support the delivery of prevention work to tackle smoking, air pollution, occupational risks, and flu vaccinations.
Recommendation 1a: Plan and fund effective, high-quality stop smoking services which are accessible to everyone who wants to quit
Unfortunately, the longstanding uncertainty for local stop smoking services remains. While the Khan Independent Review of Tobacco Legislation, published in June 2022, made a wide range of strong recommendations, which have huge support across the health sector, it remains unclear if any of these will be taken forward by government. There has still been no government response to the 2019 Green Paper ‘Advancing our Health: prevention in the 2020s’, and the updated Tobacco Control Plan originally slated for publication in summer 2021 has still not emerged.
We know that tobacco was due to feature in the Health Inequalities White Paper, but while this was scrapped by the Truss administration, it is not yet clear whether the Sunak government will revive it. Ministers have restated their commitment to the Smokefree 2030 target, but it is clear that this will be missed without a significant step change in activity, and there are currently no indications that this is forthcoming.
We know that according to data from NHS Digital, between 2011/12 and 2021/22 the proportion of current smokers accessing stop smoking services decreased by more than two thirds. Clearly this trend will need to be dramatically reversed if the 2030 Smokefree ambition is to be achieved.
And yet, there is a worrying downward trend in the financing for stop smoking services. In autumn 2022, The Health Foundation calculated that the public health grant for stop smoking services and tobacco control was 41% lower in real terms per person since 2015/16. This is a larger cut than for any other public health grant funded area of activity. Given that we know that the financial outlook for local authorities is extremely difficult, we are concerned that the postcode lottery of stop smoking provision will only get worse without increased funding from central government. It is for this reason that a polluter pays levy on the tobacco industry, as recommended in the Khan Independent Review of Tobacco Legislation, would be greatly welcomed, as this would generate the funding needed to properly support local stop smoking services and achieve the 2030 Smokefree ambition.
Recommendation 1b: All healthcare professionals to be trained in offering very brief advice on smoking cessation
Taskforce wants to see a significant increase in the number of GPs receiving training on how to deliver Very Brief Advice (a 30-second conservation with patients who smoke). Research from Asthma + Lung UK published in 2021 found that more than half of GPs in the UK say they have never had any training in Very Brief Advice for smoking cessation and only 2% report having training they felt to be comprehensive. We are worried that as a consequence of the decline in public health funding for stop smoking services that there is likely to have been a knock-on reduction in the delivery of smoking cessation training to healthcare professionals, impacting the pace and coverage of VBA to all patients who smoke. However, the current situation is uncertain because information on training levels is not available publicly. As part of Taskforce’s work on data we will continue to push for relevant metrics to be gathered and made public.
Recommendation 1c: Introduce category D Clean Air Zones in the most polluted towns and cities across England
This year we have seen Clean Air Zones introduced across the country, with Bradford, Bristol, and Sefton now up and running. Oxford is piloting a Zero Emissions Zone, there’s been an announcement in Cambridge that they will look to introduce a traffic reduction scheme, and the Mayor of London has announced plans to expand the Ultra Low Emissions Zone (ULEZ) from August 2023 to cover the whole of Greater London. Unfortunately, there have been some setbacks in Greater Manchester and Liverpool, and we need to see greater political leadership at the local level in these areas. There is considerable variety in the quality and design of the 14 proposed clean air zones across the country and unfortunately only four (Birmingham, Bristol, London, and Oxford) are Category D zones, which are deemed most effective because they include restrictions on private use vehicles.
Worryingly, Taskforce member Asthma + Lung UK have calculated that in 2021 there could be up to 24 million people breathing toxic air in areas that are above legal limits for nitrogen dioxide (NO2).
Recommendation 1d: Place new restrictions on particulate matter (PM) emissions from all sources
The Environment Act 2021 required the government to set new legally binding air quality targets for fine particulate matter by 31 October. Unfortunately, this deadline was missed, but in December 2022 the Government did publish its environmental targets, including those for air quality. However, we are deeply disappointed by the lack of ambition on two counts. Firstly, it sets the goal for cutting annual average levels of dangerous pollutant fine particulate matter PM2.5 to 10 micrograms per cubic metre across England by 2040 and this is double the World Health Organisation’s guideline limits of 5 micrograms per cubic metre. Secondly, we feel it is an unnecessary delay for people to have to continue to breath toxic levels of air pollution up until 2040.
The next step is for Government to publish its Environmental Improvement Plan, expected in January 2023. This is crucial as it will set out in more detail how the targets will be achieved. We will be reviewing this carefully to ensure appropriate action is taken to reduce the exposure to bad air as quickly, and for as many people, as possible.
Recommendation 1e: Government to introduce a national system of air pollution alerts with health advice.
In 2022, there has unfortunately been little progress towards the establishment of a national system for air pollution alerts. Consequently, people looking for air pollution data must continue to rely on local options, which vary in terms of accuracy and consistency. The Taskforce will continue to support the work of our member, Asthma + Lung UK to push for a national system.
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
In 2021/22, flu vaccination in patients aged 6 months to under 65 years old in one or more clinical risk groups was similar at 52.9% compared with 53.0% in 2020/21. However, we are encouraged that this still represents an increase on the pre-COVID-19 level of 48.0% for the same group in 2018/19.
For those living with lung conditions specifically, the proportion of people receiving a flu vaccination fell to 56.1% in 2021/22 from 57.9% in 2020/21, but this remains higher than the proportion of around 50% from 2016-20. Overall, we are concerned that progress is much too slow and inconsistent to deliver the step-change needed to reach our target rate of 75%.
The picture for frontline NHS staff is especially worrying as the data shows that the reported vaccine uptake has fallen from a really encouraging 76.5% in 2020/21 to just 60.5% in 2021/22, lower than the proportion that were vaccinated in 2016/17. This is of significant concern given that healthcare professionals and social care staff work with vulnerable people. Also, flu has a major impact on workforce absence because of sickness. In hospitals and community health services in 2021 almost 1.9 million working days were lost due to cold, cough, and flu.