World Asthma Day
The final item of business is a members' business debate on motion S1M-2966, in the name of Mrs Margaret Smith, on world asthma day, which was on 7 May 2002. The debate will be concluded without any question being put. I invite members who wish to speak to press their request-to-speak buttons. As the chamber has almost cleared, I call Margaret Smith to open the debate.
Motion debated,
That the Parliament notes that World Asthma Day is on Tuesday 7 May 2002 when, in the United Kingdom, the National Asthma Campaign will highlight childhood asthma; is aware that over 113,000 (around 1 in 6) children in Scotland have been diagnosed with asthma and that the incidence is highest amongst children; commends the National Asthma Campaign Scotland for its work on childhood asthma, including its publication of the first childhood asthma audit and its programme of asthma information sessions for adults working in the early years sector; further notes the soon to be published Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines for asthma and invites the Scottish Executive to devise a national asthma strategy to ensure that these guidelines are implemented across the country and matched by any necessary resources.
I thank colleagues of all parties who have supported the motion in my name to mark world asthma day, which was yesterday, although we are considering all week a range of issues that relate to asthma. Close to 50 per cent of MSPs who can sign motions have signed my motion, so perhaps the minister should note that that represents a great deal of concern throughout the chamber.
Why have so many members supported the motion? Like me, many have first hand and family experience of the impact that asthma can have on an individual and the quality of life of that person and his or her family. After some difficulty, my mother was diagnosed at 54 with late-onset asthma. I am happy to say she has it under some control through using inhalers night and morning. However, by her own admission, she is one of the lucky people—she has had few asthma attacks and her condition is responding to medication.
One of the main reasons why members signed the motion is that Scotland has more than 400,000 asthma sufferers, which is about 7,000 per constituency. The prevalence of the disease is on the increase. It costs the national health service in the United Kingdom an estimated £850 million a year, but that does not begin to represent its true cost to Scotland and its people.
We still do not know for certain what causes asthma. The scientific consensus is that the disease is genetically based, but that it has mostly environmental triggers, of which traffic pollution, smoking, damp conditions and dust mites are among the most common. Members can see from that list that the issue is not only for the Minister for Health and Community Care, but for the minister who is responsible for transport—along with everything else—and for the Minister for Social Justice.
Only last week, the World Health Organisation, in a report into childhood ill health and the environment, set out that childhood asthma was a
"major public health concern in Europe"
and urged Governments to cut urban air pollution and reduce traffic levels. Research by the University of Nottingham seems to suggest that children who live near a busy road might be at increased risk of wheezing and asthma.
Meanwhile the Executive's recent fuel poverty statement notes that
"Children are particularly vulnerable to respiratory conditions such as asthma which have been linked to cold and damp homes".
Proper ventilation is also crucial.
It is essential that the Executive does all that it can to reduce smoking, because smoke acts as a trigger for about 80 per cent of people who suffer from asthma. Asthma is also a crucial issue for the ministers whose responsibility is for education, because one in six children—or 113,000 children—is diagnosed with asthma at some point. According to the National Asthma Campaign, asthma is Scotland's most common long-term childhood illness.
The campaign's recent report "Sleepless Nights, Anxious Days" reveals that children and their parents often feel let down by the health and educational services. Parents reported problems in gaining accurate and early diagnosis, lack of support from schools, negative experiences at accident and emergency departments, substandard care from general practitioners and continuing anxiety about medication and lack of access to information.
The National Asthma Campaign and others were closely involved in the creation and administration of the guidelines on medicines in schools. I would be obliged if the minister would tell us what progress local authority education departments have made in implementing those guidelines.
I would also like to highlight the work of the National Asthma Campaign in its childhood asthma audit. Surely that audit will assist the Executive and local authorities in the provision of services. Some of the statistics make sobering reading—more than 4,500 child hospital admissions last year were for asthma and most of those were kids under five.
Think about the worry and the concern, the anxiety and fear behind those statistics. Think of families living with attacks, constant medication and the worry of not knowing what long-term damage childhood asthma has done to their children's respiratory systems or whether their lives have been threatened by it.
Asthma affects the day-to-day existence of every family that has a sufferer. Those families have made it clear that they have experienced variable standards of care in the NHS. Many parents want greater teacher support from the education system. Parents have told of horrifying experiences that their children have had in schools. I was shocked to read in the report that I mentioned earlier a quote from the mother of a four-year-old. That four-year-old relayed the comment of a classroom assistant who had said:
"Even if he is blue and laying on the floor, until he goes … unconscious I'm not allowed to say to him ‘do you want your puffer'".
We must ensure that we have got right the regulations that cover the administration of medicines in schools. We must also ensure that school staff are given the necessary back up and training that enables them to feel able to do that part of their job.
It is crucial that children and adults are cared for by professionals who are properly trained in asthma care. However, at present, only one in five nurses who are running asthma clinics have the appropriate qualification to do so. Instead of GPs having the time to explain the condition to patients, they must squeeze their diagnosis and information into a short appointment. GPs believe that they need at least 20 minutes to explain properly a diagnosis to patients and their parents.
Last week, we debated the Executive's primary care modernisation group's report. The section on chronic disease management, which will greatly assist those with asthma, was welcomed by all parties in the chamber. That part of the report included measures such as: greater access to primary care team members within 48 hours; better liaison between primary care and the acute sector; and local plans for chronic disease management. All those measures will benefit those who suffer from asthma.
The sharing of best practice throughout the country, better training for a range of health and educational professionals, including pharmacists and teachers, and the greater involvement of groups will also contribute to better services. There is excellent practice in some parts of Scotland. The Scottish Executive, through the Scottish Intercollegiate Guidelines Network and the Clinical Standards Board for Scotland, needs to establish minimum standards of asthma care. That way, patients and their families would know what to expect from the NHS throughout Scotland. Guidelines for managing asthma are soon to be published by SIGN and the British Thoracic Society, but it is clear that published guidelines are only part of the solution—guidelines must be acted on.
The Executive can put in place a number of measures. Health boards need to view asthma as a priority—currently, it is not—which will encourage them to provide services that do not exist at present.
A national strategy for asthma would raise the standard of care, but the Executive could also do that by recruiting and training more asthma nurse specialists and by giving local health care co-operatives the resources that they need to give local priority to asthma services. The Executive could also make Her Majesty's Inspectorate of Education responsible, as part of its assessments of schools, for monitoring support for people who have medical needs. Last, but certainly not least, the Executive and the UK Government, working with organisations such as the National Asthma Campaign, can fund research into the cause of the disease. Better treatments, including non-steroid treatments, could be found and better services provided.
The ministers who have responsibility for health hear requests all the time from competing voices asking for even more support—tonight's debate is no exception. Every year, 150 Scots die from asthma. Every year, the lives of 400,000 sufferers will be made worse by passive smoking. Every year, the one in six kids who suffers from the condition will suffer attacks and lose time from school. Every year, patients and parents will struggle to secure good local services from trained professionals. All those issues and more are in the hands of the Deputy Minister for Health and Community Care and her colleagues. I ask her tonight to hear the voice of asthma sufferers, for once loud and clear, and to move forward with a national strategy and a clear purpose to tackle the disease together.
I congratulate Margaret Smith on securing the debate and particularly on highlighting childhood asthma.
I begin by recounting the experience of a young woman and her family. That young woman was diagnosed at the age of 10 weeks as suffering from bronchitis. She was prescribed antibiotics and everything appeared to clear up. However, over the ensuing 20 months, she suffered continual colds and chest infections, on occasion being prescribed back-to-back antibiotics. Her mother was naturally concerned by the continual use of antibiotics and the effects that they had on her general health. Eventually, the GP was persuaded to make a referral to a paediatrician.
While she was awaiting that appointment, the child again presented with a heavy cold, and this time her breathing became very difficult, she became quite listless, and her lower limbs became cold and blue. The out-of-hours GP eventually arrived. He examined her and stated that she required to be admitted to hospital and that he would take her and the mother to the accident and emergency unit rather than inconvenience the ambulance service. When they reached the accident and emergency unit, the GP took the child immediately into A and E, bypassing reception, and connected her to oxygen. She was later transferred to the medical paediatric unit, which commenced oxygen therapy together with steroids and salbutamol. That continued for two days. Only then was asthma mentioned, and only in passing.
When the child was discharged, the mother was advised that a review appointment would be issued for six weeks' time, but the child was readmitted within four weeks. Eventually, there was a firm diagnosis of asthma. No support or advice was given to the parents, who had been advised that the reason why the GP had taken them to the hospital was because they did not have time to wait for an ambulance because the child's condition was deteriorating rapidly. Members can imagine how those parents felt, with a very ill child—an only child—and not much knowledge of asthma. After a further three admissions, it was agreed that the child should be introduced to a nebuliser at home. From then on, she experienced less severe attacks and the time between them increased. Eventually and much to their relief, her parents obtained an electric nebuliser; their legs were suffering from use of the foot pump.
Prior to starting school, the child was introduced to a preventive spinhaler, and a significant improvement was noted in her general well-being. However, that was jeopardised when she started school, because the educational staff were not prepared to supervise her medication and she suffered some setbacks. However, her health began to improve. By the age of seven she had gone for a year without having had an attack and her asthma medication was withdrawn.
She has never had to be prescribed drugs for asthma since, but she is aware that in certain circumstances she must make it known that she is an asthma sufferer, which she had to do yesterday, when she sought mortgage insurance. Her experience started 18 years ago, but sadly, some young people and their families still face similar situations to that which my daughter and I faced.
The National Asthma Campaign asks for the same rights that other disease groups have. It wants a national strategy that directs national health service boards in the management of asthma. For too long, individual GPs have been left to develop—or not develop—their expertise in asthma.
My local healthcare co-operative has appointed a respiratory nurse to co-ordinate practice, develop services and work in partnership with the asthma liaison nurse to facilitate the interface between acute and primary care. One of its chronic disease management programmes is aimed at asthma—that does not happen throughout Scotland. That programme means that there is better recognition, diagnosis and management of asthma. In turn, the number of referrals to paediatric consultants has decreased.
Last week, during a discussion with Dr Michael Blair—to whom I owe a great deal and to whom my daughter owes her life—he spoke to me about the situation in Ayrshire and Arran. He brought me up to date and told me that the service is evolving into what we agreed looked like a mini-managed clinical network at local level.
However, there is still some way to go. The link with education staff is poor, but it is within our reach with the guidance that was issued in 2001, if we give teeth to that guidance. I urge the minister to consider ensuring that that guidance becomes part of the inspection process in pre-five schools and in all our schools. We owe it to our young people who suffer from asthma to provide a safe environment in which their lives are as active as their condition permits.
I support the motion.
I neglected to set a time limit, which is my fault entirely. I ask members to stick to about four minutes so that every member who wants to speak may do so.
I congratulate Margaret Smith on securing this important debate to mark world asthma day.
Yesterday, to mark world asthma day, I visited a new project that is being established at Ninewells hospital. I want to say something about that project. It is called asthma in retreat—AIR—and is a collaboration between the University of Dundee's asthma research unit, the Tayside Institute of Child Health, the University of Glasgow and the royal hospital for sick children in Glasgow. It aims to create an educational tool that will be used with children aged between two and 16 years old and their parents who present to emergency departments in Glasgow and Dundee.
The education that is provided in the project will be guideline based, individualised and targeted at patients and their parents. The project is about attack management and prevention. I looked at the tool, which is multimedia based, and was extremely impressed. The children that I know are certainly more computer literate than I am. There is a touch-screen interface and children are shown using inhalers and other tools. It is important to overcome some of the fear that children might have, particularly of inhalers, which can seem very large and frightening devices to a small child. Those tools were shown in use and children spoke about their fears and how they overcame them.
The project will give children the confidence to manage their asthma, and it is hoped that emergency admissions will be prevented. It will also give confidence to parents for whom the process can be huge and fearful, as Margaret Jamieson outlined well. Often they do not know what to do. I hope that the tool will be available not just in a hospital context, but at a local level. Given the prevalence of asthma—one in nine children is being treated for asthma symptoms—we must look at the whole range of tools to ensure that we can prevent emergency admissions and encourage self-help as much as possible.
I will conclude by paying tribute to the staff involved in this innovative project, which I think is the first of its kind. I hope that the Deputy Minister for Health and Community Care will listen to some of the very constructive suggestions that have been made this evening and will respond in a positive manner to the issues raised during the debate.
I also congratulate Margaret Smith on securing this debate. One of the tremendous strengths of the Parliament is that we can use members' business to highlight an issue that is of serious concern throughout Scotland.
I welcome the fact that the motion emphasises that the National Asthma Campaign highlights childhood asthma. When I read the Scottish Parliament information centre briefing, I was shocked by the increase that it outlined in childhood asthma. It shows that for males aged up to four there has been an increase of 198 per cent over 10 years and for those aged five to 14 there has been an increase of 135 percent. For females aged up to five there has been an increase of 295 per cent and for those aged five to 14 there has been an increase of 217 per cent. I realised why the National Asthma Campaign highlights childhood asthma.
It is shocking that more than 113,000 children in Scotland are diagnosed as asthmatic. Many of us tend to think that asthma is caused by pollution. However, I can tell members—Margaret Smith mentioned this—that there are very high asthma levels in the Isle of Skye, although there is certainly no pollution there. Much more research has to be done to find out the causes of asthma. Pollution may be a contributory factor, but it is certainly not the only one.
We discovered recently that children in the UK who are aged 13 to 14 have the highest rate of asthma symptoms in the world. However, in Scotland only four out of 15 health boards designate asthma as a priority in their health improvement plans.
I was pleased to look up "The Administration of Medicines in Schools." I thought that it was an excellent document but, as an asthma sufferer, I was surprised that only five lines are dedicated to asthma. There is also a note. Having been a lecturer for 20 years, I know that if someone had had asthma in one of my classes, I would not have found the five lines of great assistance. I realise that teachers cannot be experts in everything, but I do not think that there is quite enough information to help a teacher in a school when a child suffers from asthma.
I was surprised recently when I was out with the Inverness police. They had an asthma inhaler in the station. Doctors do not come out to the police station at night, so there was an inhaler that could be used by anyone who was asthmatic. The police were not trained, but at least there was something there to assist someone with asthma.
I congratulate the National Asthma Campaign on its excellent document, "Who Cares about Asthma in Scotland?" It is a first-class summary of the issues and highlights the great contribution that patient groups can make towards conditions in Scotland.
In response to a written question that I lodged about how the Executive
"plans to reduce the number of serious asthma cases presented at accident and emergency departments"—[Official Report, Written Answers, 28 September 2001; p 176.]
the reply mentioned the SIGN guideline, the Scottish asthma management initiative, a project called "Asthma Attack—Targeting Emergency Asthma Contacts in Children" and grant funding to the National Asthma Campaign Scotland. Those are all highly worthy, but I am concerned that there is very little in the way of a co-ordinated and joined-up approach.
It took me almost 20 years to be diagnosed as having asthma, although I had described my symptoms. I can describe my experience from a patient's point of view. I went to the chest clinic and was told that everything was fine. I went to the ear, nose and throat department and was told that everything was fine. I went to the asthma clinic and was told that I perhaps had asthma.
I now have a speech therapist and find that speech therapy is of tremendous benefit to an asthma sufferer. I am looking not only for a co-ordinated approach with strategies, consultations and reviews, but a joined-up approach from the patient's point of view. Speech therapy could play a much greater role in helping to control not only adult asthma, but children's asthma.
I declare an interest as an asthma sufferer. As for speech therapy, that is why I went for singing lessons. My mother sent me to singing lessons to help my breathing. Like Margaret Smith, I am also the mother of an asthmatic, and I am a member of the National Asthma Campaign's advisory committee. I thank Margaret Smith for bringing this debate to Parliament.
Yesterday was world asthma day, and today we mark the event by a debate in the Scottish Parliament. That is no sign of victory, however. All the indications are that asthma is on the increase. There are now more than 1,500 children with asthma in the average constituency and the UK has the highest rate in the world of severe wheeze among children aged 13 to 14. Even if they do not have asthma themselves, most constituents have friends, family members or neighbours who have to deal with the problems that childhood asthma brings. There are few things worse for anyone than watching their child struggle to breathe.
There is still much to be achieved if we are to provide the help that the families of asthma sufferers deserve. We need earlier diagnosis. We also need better support in schools, through teacher training. All the people who are involved in schools, including the nursery nurses, janitors and auxiliary workers, need to know about asthma. I feel strongly that every child needs to be able to control their own asthma and that they should have the right to have their puffer in their pocket. That is important. As a parent, I went through all sorts of hoops to ensure that my child had the right to have her inhaler in her pocket. Without it, she would not have participated in sports and all the other activities that allow children to lead a normal life.
We must provide better information about self-management of asthma and we must deal with acute episodes better. It is too late to think about how to deal with the condition when a child or adult is ill in hospital. There are ways of avoiding some of the worst effects of asthma. We must also ensure that all GPs have a thorough and up-to-date understanding of asthma and that they devote enough time to addressing parents' anxieties about medication and to helping children and their parents to learn how to control the condition. Qualified asthma nurses play a key role in education and self-management.
The National Asthma Campaign is calling for minimum standards of asthma care so that people with asthma will know what rights they have and what they can expect from the national health service in Scotland. It wants more research to be undertaken into the development of asthma and its treatment and it is calling for the implementation of the 2001 guidance on "The Administration of Medicines in Schools".
Asthma should be a national priority, with health workers, teachers, local authorities and national Government working together to provide children with asthma and their families with a better quality of life. I congratulate the National Asthma Campaign on the work that it is doing to achieve that. It is raising awareness, educating the public and professionals and sponsoring research. The time has come for the Scottish Executive to adopt a national asthma strategy, and I ask it to look favourably on the soon-to-be-published SIGN guidelines on managing asthma.
I congratulate Margaret Smith on securing the debate. I am the parent of a former asthma sufferer. From the day on which he was born until he approached his teenage years, my son suffered from extremely bad asthma attacks. As my wife and I had a modern marriage, it was decreed that I should be the one to get out of bed and look after him in the terrifying wee small hours—members will know what I mean by that. As the asthma attacks were accompanied by panic attacks, one could see the gravity of the situation multiplying before one's very eyes. By the grace of God, I managed to develop a technique of giving him his puffer, calming him and bringing him back down to earth. Eventually, he would drift off to sleep. However, they were terrible years and the terror of dealing with the situation is still etched on my mind.
It was great that I was able to develop a certain technique, but I have often felt that it would be useful if parents could be given advice about calming a child down. As a result, I am greatly heartened by the initiative that Shona Robison outlined and hope that such a service can be made widely available through real people such as nurses and GPs as well as through touch-screens. It could greatly benefit other parents. Although my son has grown out of the condition, I would not want any other parent to go through the same situation. Moreover, a very close friend of my mother's died of asthma when she was in her 50s, because the attack was so severe and help could not be found quickly enough. We must not forget that asthma kills.
Because the issue is about real people such as GPs and nurses, I want to use this opportunity to raise an issue of which Mary Scanlon is also aware. A number of GPs have recently resigned in Caithness—a GP has resigned in Lybster as have GPs in Wick who are husband and wife. Furthermore, one of the two Thurso practices has withdrawn from the accident and emergency service at Dunbar hospital. The situation is deeply worrying. It is not fair to press the minister on the matter in this debate, because she would need to go away and think about things and, in any event, it is only right and proper to take the matter to the health board first, to find out what is happening, but, as members might imagine, my constituents—not just asthma sufferers but anyone who faces sickness—are concerned about the situation. I make no apologies for making this point. Right now in my part of the world, there is a fear that asthma treatment is being rolled back. We do not know why that should be, and we will see what happens.
I am so glad that this excellent debate has come before the Parliament. As Mary Scanlon has rightly pointed out, such a debate dignifies the Parliament.
With 113,000 children involved in this issue, the debate is one of the most important ever held in the Parliament. I pay tribute to all the MSPs who have declared that they are asthmatic. We need only remember how much lung power is needed to be an MSP. In Cathy Peattie's case, she is also a singer. Cathy, Mary Scanlon and so many others have triumphed over the condition.
I am one of the many people with a relative who has died of asthma. Towards the end, she had to move abroad in an attempt to extend her life a little longer. I saw her when she was younger, gasping and fighting for breath, her face darkening. Somehow she managed to raise her family and was quite heroic. She came from Glasgow more than 50 years ago, but I see thousands and thousands of children in the city today in exactly the same condition. A teacher in the east end of Glasgow told me that nine of the 25 children in her class carry inhalers.
Housing plays a part in all of this. For a start, it worsens what people are already suffering. The asthma of one of my constituents is so severe that every so often she has to be moved to Glasgow royal infirmary. Her 11-year-old daughter also has severe asthma. However, although her son also suffers from asthma, he manages perfectly well and hardly ever has an attack. Perhaps the secret is that the son lives with his father in what is called a dry house. It is clear that all sorts of pressures both inside and outside affect asthmatics.
Margaret Smith rightly mentioned the guidelines on the administration of medicines in schools. It would simply be terrible if teachers became nervy and frightened about helping as quickly as they might do because of red tape. The children in the same class could be taught about asthma and not to panic when they see someone having a severe attack.
There are mysteries about asthma that we have to solve. Some children with early and severe symptoms go on to develop persistent asthma; others get over asthma between the ages of three and six. We used to think that such examples existed only in our grannies' tales, but that is not true: the National Asthma Campaign confirms that. Why is that the case? Why does one child go on to have a life free of this horrible complaint while another is condemned to suffer for life? That is one of the mysteries that I hope that we can solve. Solutions must be found. Please support the motion.
I congratulate Margaret Smith on securing the debate and welcome the National Asthma Campaign's report, "Sleepless Nights, Anxious Days", which reveals that a lack of time and resources means that GPs in schools are putting children at risk.
More research is needed to explain all the causes of asthma. Mary Scanlon is right when she points out that, in the Isle of Skye and some other rural areas, there are low levels of pollution but high levels of asthma.
In September 1999, in one of my first speeches in the Scottish Parliament, I raised the issue of damp housing and asthma in connection with a debate on public health and the white paper, "Towards a Healthier Scotland". I said then that I would return to the subject over and over again and I make no apology for doing so. We know that 362,000 children in Scotland live in damp housing and we also know that a study of damp housing and asthma in Glasgow that was published in 1996 stated:
"The greater the severity of dampness or mould in a home the more likely the patient is to have severe asthma."
I was disappointed that the Scottish Executive's central heating scheme did not make children living in damp homes a priority, as it did for pensioners. I mention that because that was not the case south of the Border, where children living in damp homes were made a priority. We have still not got to grips with the problems of dampness, condensation and mould and the effect that they can have on people's health.
Many members have said that we need to have a minimum standard of asthma care. It is right and proper that we highlight that and I hope that the minister can address that tonight. I recognise that she cannot address the problems of damp homes but I am sure that she will lean on some of her colleagues.
Teachers and GPs need to be better trained to ensure that asthma is recognised and diagnosed at an early stage. They need to be given the tools and resources to allow them to deal with the problem.
I was moved when Margaret Jamieson highlighted the problems that she had with her daughter's asthma. The strength of the Scottish Parliament is that people from many backgrounds come to the Parliament with differing experiences and can, in debates such as this one, passionately bring to the attention of the rest of us the problems that they have faced.
I congratulate the National Asthma Campaign once again and urge the minister to respond positively to the debate.
I congratulate Margaret Smith on securing the debate. I also congratulate the National Asthma Campaign, with which I have been associated for some years. I should declare that I am a member of the club: I was a late-onset asthmatic. My asthma evolved out of a sporting activity up a large mountain. It can strike at any time of life.
It is shocking that one child in six is diagnosed as asthmatic. We do not have a national strategy and, even worse, we do not have any centrally held statistics, even though the biggest tool in the management of medicine today is trend analysis. During the first year of the Parliament, I was staggered to find that statistics were held only by health boards instead of being co-ordinated. We must start by rectifying that situation.
In carrying out a piece of research during the Parliament's first year, I wrote to all the education authorities to find out what protocols were in place for teachers to manage asthmatic children. I was staggered at the range. When I went into the matter further, I was also staggered to find that, although the protocols may have existed in some form or another, they were not enforced and teachers were not given training. Teachers were in a dilemma about their responsibilities. They worried that they might get sued if they got something wrong or intervened in the wrong way.
Many teachers did not seem to understand that there are two types of treatment. One is what, when I was a pharmacist, I used to call the insurance policy, which minimises breakthrough attacks. The other is the relief treatment. I spent years in community pharmacy trying to run medicines management clinics for people in the community. What struck me most is that most health care workers in primary care do not have the necessary qualifications. That is improving, but it is happening slowly.
Parents are the greatest victims. They panic when their children suffer. I have three asthmatics in my family. We must have early intervention. A screening programme will pick up some of the allergic responses. We should also consider inherited traits, on which we are not doing enough work. Isolated work is going on, but a combined effort is needed.
The economic cost to the family income of work lost through asthma is immense. The disruption of education is immense. The fact that people cannot get involved in sport, which is part of their development, is frightening. The list goes on and on. I do not wish to paint a horrible picture, but the debate has been an opportunity to highlight some genuine concerns. I think that it was Jamie Stone who said that, throughout Scotland, there are sufferers of asthma in all age groups without exception. There is poor recognition of asthma. Accident and emergency departments do not always recognise the problem. People at work—even first-aiders—do not necessarily recognise the difficulties.
We must also teach self-management to give people the confidence to use their medicines. Medicines must not become a prop that sufferers use only when they are half dying in a gym because they did not want to lose face in front of their pals by puffing on an inhaler—they wanted to be brave and to keep going. We must accept that asthma is normal for some people. It must be identified in school early on so that the staff are prepared and the parents are given support.
One could blether all night about this important subject. The education of parents, primary care staff and children is a good starting point, but it must be accessible throughout Scotland. We must also have early diagnosis. There should be proper support for medicines management and we must have a programme of follow-up consultations once someone shows the possibility of developing asthma.
I start by congratulating Margaret Smith on securing this topical debate, which will be of interest to all who suffer from asthma, but particularly children and young people with asthma, their parents and those who care for or support them. World asthma day, which was yesterday, represents an opportunity for us all to review current thinking on the prevalence of, causes of and action necessary to deal with childhood asthma.
The incidence of asthma, which was a much less common condition even 50 years ago, has been steadily increasing in the developed world. That increase has been particularly noticeable among children. We know that the United Kingdom has a particularly high prevalence of diagnosed asthma. We also know that the incidence of asthma attacks is now some three or four times higher in adults and six times higher in children than it was a quarter of a century ago.
It is important to bear in mind the fact that the increase in asthma is not simply a Scottish problem. As Mary Scanlon and other members have said, evidence from the Highlands counters the common belief that asthma is primarily an urban problem. A rise in the incidence of diagnosed asthma is common throughout the developed world.
It would be wrong for anyone to suggest with any certainty what the causes of the increase in the prevalence of asthma might be. There is a widespread belief that our hygiene culture plays a part. Air pollution, ozone and the house dust mite are also thought to be contributory factors and I note what Tricia Marwick said about dampness in housing. However, she said that the Executive did not prioritise the installation of central heating for asthma sufferers. In fact, the Executive has made huge strides in investing in our housing stock and it will continue to do so, having regard to the exacerbation of problems suffered by those who have asthma. There is some evidence to suggest that lack of exercise and poor diet may also be involved, but there is no certainty about the reasons for that.
It is essential to bear in mind the fact that each child who suffers from asthma is an individual who needs to be treated in a way that reflects the circumstances of his or her own case. That is why I believe that asthma is handled most effectively at the primary care level, in the context of close co-operation between patient support groups and health professionals. I acknowledge Margaret Jamieson's point that managed clinical networks are developing of their own accord as clinicians come together on the issue. I assure her that we will continue to review those developments and ascertain how we can support them.
The health plan, "Our National Health: A plan for action, a plan for change", highlighted children and young people as a new priority for the national health service in Scotland and singled out asthma as one of the chronic medical conditions whose sufferers need easy access to the care and treatment that they require, which is usually administered outside acute hospital settings. The health plan emphasises that the management of chronic conditions falls largely to patients, their families and supporters and that services must empower and support them effectively. It identifies the value of the close involvement of patient support groups in service design and delivery at both local and national levels.
We have already moved some way in the direction of those aspirations. A number of SIGN guidelines relating to the management of acute and chronic asthma are in place. The motion notes
"the soon to be published Scottish Intercollegiate Guidelines Network/British Thoracic Society guidelines for asthma".
I understand that those guidelines are to be published this summer.
Asthma forms one of the chronic disease management programmes for which there is separate payment to GP practices. More than 90 per cent of practices receive payments; in return, they are expected to comply with a number of detailed requirements. The clinical resource and audit group—CRAG—has recently received a report from the Scottish asthma management initiative, which audits the management of asthma in primary care based on existing guidelines. The key elements of the audit have been used to establish criteria for clinical effectiveness in primary care and will inform advice on care management that is being developed for health care professionals.
A growing number of GPs have direct access to detailed lung function tests. In addition, and as the technology develops, spirometers have become portable and now form part of the equipment in some GP surgeries. Domiciliary oxygen therapy, along with the appropriate professional support, is available to those who require it. Peak-flow meters are now widely used by doctors and by patients themselves to monitor their asthma and to adjust their treatment as necessary. Modern inhalers have significantly improved the quality of care that is available to patients, both in preventing asthma attacks and in treating attacks when they occur.
Those changes will improve the management of asthma, but we need to work on the factors that cause asthma in so far as we can recognise them. Smoking cessation activities are expanding and exercise is being promoted. Substantial resources have been committed to such work through the health improvement fund. We are making progress and we are backing it with resources. Chronic disease management is one focus of the primary care modernisation group's recent report and there has been corresponding investment from the Executive.
I apologise for not having the most up-to-date information on the guidance to schools on the administration of medicines. However, I take on board the points that members have made and will seek to provide them with the up-to-date information that they have requested.
I would not like to close this evening without paying tribute to the work of the National Asthma Campaign Scotland, not just because representatives are in the gallery—we hope to join them later—but because of the positive working relationship that exists between it and the health department. My officials have regular contact with NAC Scotland to discuss areas of mutual concern. In the current year, we are funding a project of particular relevance to the motion—an asthma parents support project. I hope that the sound working relationship can continue, because it enables us to improve services for asthma sufferers in partnership with an effective and well-informed part of the voluntary sector.
The active partnership that we enjoy with the National Asthma Campaign and the greater understanding of childhood asthma issues that will result from world asthma day and, I hope, from the debate this evening will only benefit all those with asthma and those who support them.
Meeting closed at 17:56.