How much exercise did it take?

What about when I’m out of university?

This article has been developed and funded by Chiesi UK&I

The true burden of COPD

COPD affects around three million people in the UK, yet nearly two million remain undiagnosed.¹ Symptoms such as breathlessness, fatigue and persistent cough are often dismissed as ageing or lifestyle-related, meaning many are only diagnosed once their condition is advanced. COPD exacerbations are the second leading cause of emergency hospital admissions in the UK and a major contributor to winter pressures on the NHS,^2,3 costing the NHS approximately £1.9bn annually.⁴

The burden of COPD is not evenly distributed, with health constituency data showing that the highest prevalence is concentrated in the North of England,⁵ and likely higher due to the number of people living with undiagnosed COPD.

Rethinking the case for COPD screening

The UK has a strong track record of delivering targeted screening programmes in areas of high need. Three national cancer screening programmes exist for bowel, cervical and breast cancers, and now a lung cancer screening programme is being rolled out across England.

The UK NSC is currently reviewing screening for COPD in the general adult population. Given the breadth of the NSC’s review, it is unsurprising that the committee recommends against population-wide screening for COPD.

This is not a new position. In 2018, the UK NSC determined that population-wide screening did not meet the recommendation criteria, citing uncertainty around cost-effectiveness and clinical benefit.⁶ Whilst that assessment remains reasonable, population screening is not the only option to achieve improved outcomes for people living with COPD symptoms but who are undiagnosed and potentially untreated.

Importantly, the committee has expanded its remit to consider targeted screening, mirroring the approach in lung cancer, where the NHS does not screen the entire population but instead focuses on defined high-risk groups such as people aged 55-74 with a history of smoking.^7,8 The Welsh Government has also committed to introducing a similar national targeted lung cancer screening programme, confirming this will include standardised protocols for managing incidental findings of other conditions, such as COPD.⁹ The current consultation represents a timely opportunity to evaluate how a targeted approach could improve COPD outcomes.

Learning from lung cancer screening

In England, the NHS Lung Cancer Screening Programme is identifying large numbers of people with suspected COPD through incidental CT scan findings, which are detailed scans that can help identify problems in the lungs.¹⁰ Of the approximately 1.2 million lung health checks completed to date, over 7,000 lung cancers were diagnosed, and, incidentally, over 100,000 cases of emphysema were also found.¹¹ While people with lung cancer entered specific care pathways, no consistent pathway exists for diagnosing and managing suspected COPD. This means that for every patient receiving a lung cancer diagnosis and treatment, 13.5 people with emphysema are not getting the opportunity for the same level of care.

A strong case for targeted screening

Recognising the challenges with timely COPD diagnosis, Chiesi is working with the NHS to understand the feasibility and value of targeted case finding in high risk groups through hospital-based and neighbourhood programmes. One example is our FRONTIER Hull programme, a collaborative working project with Hull University Teaching Hospitals NHS Trust, which invites individuals identified through the NHS Lung Cancer Screening back for COPD assessment.

Nearly 50 per cent of people assessed were diagnosed with COPD.¹² Health economic modelling also suggests that targeted COPD case finding could save the NHS an estimated £33m over 10 years.^13,14 Beyond cost savings, earlier identification enables earlier intervention, shifting care from avoidable exacerbations and emergency admissions towards prevention, proactive management and improved outcomes.

“Data generated as part of our FRONTIER Hull project clearly demonstrate that case-finding among high-risk individuals with features of disease, rather than population screening, identifies a significant number of people with undiagnosed COPD. COPD is a progressive disease that becomes highly debilitating over time – these patients are often unable to work and struggle with simple day-to-day activities such as walking up the stairs. Earlier identification and diagnosis can enable people to access evidence-based treatments to improve their outcomes.”  

– 

Professor Michael Crooks, Consultant in Respiratory Medicine at NHS Humber Health Partnership and Professor of Respiratory Medicine, Hull York Medical School, University of Hull.

Advertisement

Looking forward

This approach doesn’t require new systems. As the FRONTIER Hull project demonstrates, COPD assessment can be integrated into existing services, with other community models also emerging.

As Lung Cancer Screening and Community Diagnostic Centres expand, we have a pivotal opportunity to align respiratory care with the NHS shifts from hospital to community and from sickness to prevention. The question isn’t whether to screen everyone, but how to scale targeted approaches for those most at risk.

This consultation offers a timely chance for the UK NSC to refocus by conducting a new evidence map that explores targeted screening over a population-wide approach.

Find out more about FRONTIER Hull here.

March 2026                                                                                             UK-CHI-2600116

References

Advertisement
1. NICE Clinical Knowledge Summaries. Chronic obstructive pulmonary disease: Prevalence and incidence. Available at: https://cks.nice.org.uk/topics/chronic-obstructive-pulmonary-disease/background-information/prevalence-incidence/. Last accessed: March 2026
2. The Health Foundation. Variation in patient pathways and hospital admissions for exacerbations of COPD: linking the National Asthma and COPD Audit with CPRD data. Available at: https://www.health.org.uk/funding-and-fellowships/projects/variation-in-patient-pathways-and-hospital-admissions-for. Last accessed: March 2026.
3. NHS England. Respiratory disease. Available at: https://www.england.nhs.uk/ourwork/clinical-policy/respiratory-disease/. Last accessed: March 2026.
4. NHS England. Respiratory high impact interventions: Available at: https://www.england.nhs.uk/ourwork/prevention/secondary-prevention/respiratory-high-impact-interventions/#:~:text=The%20annual%20economic%20burden%20of,the%20UK%20%C2%A311billion%20annually. Last accessed: March 2026.
5. House of Commons Library (2025) Constituency data: health conditions (How healthy is your area?). UK Parliament. Available at: https://commonslibrary.parliament.uk/constituency-data-how-healthy-is-your-area/. Last accessed: March 2026.
6. UK National Screening Committee. (June 2018) Screening for chronic obstructive pulmonary disease (COPD) in the general adult population: External review against programme appraisal criteria for the UK National Screening Committee. Solutions for Public Health. Available at: https://view-health-screening-recommendations.service.gov.uk/document/86cb8a05-d1d5-4dcd-84ec-e848631bb4ba/download
7. UK National Screening Committee. Updated definition of targeted screening will help clarify remit of expanded UK NSC. Available at: https://nationalscreening.blog.gov.uk/2022/05/26/updated-definition-of-targeted-screening-will-help-clarify-remit-of-expanded-uk-nsc/. Last accessed: March 2026.
8. NHS. Lung cancer screening. Available at: https://www.nhs.uk/tests-and-treatments/lung-cancer-screening/. Last accessed: March 2026.
9. Welsh Government (2025). Written Statement: A National Lung Screening Programme for Wales. Available at: https://www.gov.wales/written-statement-national-lung-screening-programme-wales. Last accessed: March 2026.
10. NHS. Chronic obstructive pulmonary disease (COPD): Diagnosis. Available at: https://www.nhs.uk/conditions/chronic-obstructive-pulmonary-disease-copd/diagnosis/. Last accessed: March 2026.
11. UK Parliament. Written question 67321: Lung Cancer: Screening (answered 25 July 2025). Available at: https://questions-statements.parliament.uk/written-questions/detail/2025-07-14/67321. Last accessed: March 2026.
12. Chiesi Ltd. FRONTIER Hull data reveals 50% diagnosis rate in COPD case‑finding programme… Available at: https://www.chiesi.uk.com/media/press-releases/frontier-hull-data-reveals-diagnosis-rate-in-copd
13. Brindle K, Watkins K, Gilroy-Cheetham J, Maxted C, Niazi-Ali S, Crooks M (2025). The burden of undiagnosed COPD among lung cancer screening participants. Presented at the European Respiratory Society (ERS) Congress 2025.
14. Chiesi UK and Ireland. Data on File.

Polly Billington MP (Photography by Dinendra Haria)

9 min read47 min

Polly Billington is something of a Westminster lifer – she spent several years as a BBC political reporter before becoming an adviser to Ed Miliband, including during his time as Labour leader.

But now, at the second time of asking, Billington is a player herself rather than a journalist or adviser. And since her election as Labour MP for East Thanet, the 58-year-old has positioned herself as a champion of coastal communities.

Psephologists may argue about why it was that Labour won so many coastal seats. Was it really down to ‘Whitby woman’ switching to Keir Starmer – or just the type of seat profile where the vote split evenly between Reform and Conservatives? If Labour wants to hold any of them, however, it had better deliver meaningful change to coastal voters.

It’s a message the former journalist is pushing hard, while also representing backbench concerns to the party’s leadership as a Parliamentary Labour Party (PLP) committee rep. But she is vocal too in her defence of her former boss. Miliband, she says, was right before his time on the key political questions of the day. And, as battle lines begin to be drawn up over AI and the environment, Billington is prepared to question just how much we should sacrifice to energy and water-hungry big tech.

We’ve now got more coastal Labour MPs than we’ve ever had

Advertisement

“I set up the Coastal PLP again for the first time since the New Labour government because we’ve now got more coastal Labour MPs than we’ve ever had, even in 1997 and especially in 1945 when Margate, Broadstairs and Ramsgate did not go Labour,” she says, name-checking the towns which make up her seat.

“So, we’re a considerable chunk of the PLP, and that gives us not only an electoral opportunity but also a policy obligation and a delivery obligation,” she adds. “Labour’s majority is partly rooted in those communities and we therefore need to deliver for them.”

Nine out of the top 10 areas in 2025’s English indices of multiple deprivation, she points out, are in coastal areas. Seven of those 10 alone are in Blackpool. Life expectancy can often be significantly lower, and public transport links poorer.

Billington insists the group is not simply playing “deprivation bingo”. Rather, she and her colleagues are arguing that their constituencies contain untapped economic potential and can make a key contribution to the government’s growth mission.

The MPs want to see the government produce a bespoke coastal strategy that recognises the nation’s seaside as a “strategic economic region” in its own right. In the absence of that strategy, less well-off coastal areas like Billington’s risk being lumped in with affluent parts of inland Kent.

“I’ve got more in common with Lowestoft, Scarborough, Blackpool, Worthing, Bournemouth, Truro, than I have with Tunbridge Wells and Sevenoaks,” she says. “That’s why we need to start seeing those places as having a specific economic strategy and approach.”

Billington also wants to see the creation of a coastal minister, though she refuses to say whether she is volunteering for this post herself.

“Listen, those decisions are absolutely ones for the Prime Minister, not me.”

 Would any of her colleagues do a good job of it?

“I’m not going to name anybody, am I?” she replies, before adding: “I am pitching the role, but I think the discussions about personnel need to be done with the people making the decisions – not in The House magazine.”

The Coastal PLP has already secured some wins, she argues, as the recent schools white paper contained a ‘Mission Coastal’ commitment, while the National Cancer Plan pledged to “rebalance cancer and diagnostic medical training places to remote, rural, and coastal areas”. Changes to the Treasury Green Book are a further source of optimism.

Billington now wants to see ministers use “other economic levers” to generate growth on the coast, especially where funding has already been allocated or institutions already established.

“The National Wealth Fund, GB Energy, the British Business Bank. How can they, like the Green Book, be rewired in order to be able to prioritise growth in our coastal communities?”

The MP also hints at possible future tax changes that may benefit the hospitality sector on which many coastal economies depend. Currently, once a business’ taxable turnover exceeds £90,000 in any 12-month period, they are suddenly required to register for VAT. According to Billington, “ministers themselves will acknowledge” that this threshold “drives fraud and keeps businesses small”. 

“I’m not expecting a massive VAT cut. We continue to talk about how the VAT regime, and particularly the VAT threshold, causes unintended consequences and perverse incentives. Ministers are not unalive to that.”

After 15 years as a BBC journalist, Billington left the corporation to become Miliband’s special adviser in Gordon Brown’s government, then worked on Miliband’s leadership campaign, and finally advised him on communications during his first 18 months as leader.

Ed [Miliband] was right, really early on, about the squeezed middle and intergenerational fairness

Despite his failure to win the 2015 election – and her own failure to win the marginal seat of Thurrock that year – she remains convinced that Miliband was ahead of his time in his diagnosis of the nation’s ills.

“Ed was right, really early on, about the squeezed middle and intergenerational fairness,” says Billington.

“I remember him doing a speech very early after he’d got elected as leader. He was talking about this anxiety that he had about the country, that people no longer had confidence that their children would have a better life than they did.

“Even some of his greatest supporters were scratching their heads and saying, ‘I don’t know really what you’re talking about’. That’s 16 years ago, and he saw then the big economic trends which were causing these levels of intergenerational unfairness…

“There’s the housing crisis, but not only the housing crisis. Pensions, social care and so forth – those things Ed saw a long time ago.”

Her time working for Miliband also taught her that “being right is not enough – especially in opposition”.

Now a member of the Energy Security and Net Zero Select Committee, Billington is tasked with scrutinising the man she used to advise – and the work of his department, which is trying to achieve its clean power target by 2030.

But concerns have been flagged over recent weeks about whether the government’s plans to rapidly grow the number of AI data centres across the country could put that target at risk. At a January select committee meeting, Billington pressed Miliband’s junior minister, Michael Shanks, on whether the government is open to data centres using gas power to get around grid connection delays. He suggested those discussions were ongoing.

“We’ve got to have a national conversation about this,” says Billington. “You can’t have a situation where you have data centres asking to be powered by gas, which is clearly counter to the government’s overall decarbonisation plan.”

She then raises a more fundamental issue with the UK’s race to become an AI superpower.

“We have to ask some questions about whether we want data centres which take up an enormous amount of water, and an enormous amount of electricity, and don’t create very many jobs.

“We can hurtle towards a data centre future, but is that overall in the best interests of the country? For the kind of jobs that we want, the kind of growth that we want and for our natural resources, like water and how we want to manage our energy supply?”

As well as holding Miliband’s department to account, Billington is also vice-chair of the PLP and sits as one of six Labour parliamentary committee reps, tasked with relaying concerns from the backbenches to the party’s leadership.

What does she make of complaints from longer-serving MPs that she and the other reps – most of whom were first elected in 2024 – are not being robust enough in passing on those complaints to the Chief Whip and the Prime Minister?

“I think anyone who were to be a witness to those meetings certainly wouldn’t come to that conclusion,” she replies. “We feed back, where we can, to the people who raise those questions.

“We have worked on a number of different ways of making sure that we have constructive feedback loops, but I think what is most important about that is that the first people to know about what happens in parliamentary committee are members of the PLP.

“We as backbench committee reps take it extremely seriously to ensure that it is our colleagues who are the first to know, not members of the press.” The now gamekeeper clearly feels the need to keep her former fellow poachers in their place.

Billington is also clear that, following Morgan McSweeney’s departure from No 10, more fundamental changes will be needed to overhaul what some have characterised as the “boys’ club” in Downing Street.

“Personnel is one thing,” she says, “but culture, and understanding about how misogyny works, is another.

“That’s why myself and many of my colleagues in the women’s PLP were delighted to hear Keir say that there was such a thing as structural misogyny.

“We look forward to, and continue to engage with No 10 about, seeing a plan to change things significantly, to challenge that structural misogyny.”

But she emphasises this will be “a lifetime-long battle”, adding: “You don’t smash misogyny by one sacking, one resignation… This is not something that happens quickly or easily, or simply with a few movements or reshuffles.

“This has to be a different way of exercising power, of conducting professional politics, because without that change, we will not have the kind of transformed, fairer, more respectful, equal society that those of who came into politics for the Labour Party actually want to see.” 

What to do if your teen is disconnected

Tony Blair’s former speech writer, the journalist and academic used to say that the perfect speech is when “you can’t see the scaffolding”.

He meant – one suspects thinking of the good ones he penned – when you can’t see every focus group appeal line, the elephant on the room dodge, the botch welding of two seemingly contradictory positions into one. When you can’t hear the dog whistle, the over blown clarion call, or the deliberately obfuscating wording to ensure you don’t say the thing you can’t say out loud. The scaffolding.

I have long applied this to political communications. When it’s clumsy but trying to be clever, you can ‘see the scaffolding.’

While the US and Israel turn Iranian regime buildings, and – let’s not ignore – a school to rubble, Labour, and the Greens have rapidly built towers of visible scaffolding having spotted an opportunity to try and pick at, and pick off the Conservative position on the Iran war.

Let’s be clear. The foundations for this scaffolding were laid some time ago. Donald Trump is may not now be as popular in America but here, he’s down right unpopular. Within the British public the only Western leader liked less is Netanyahu. Then add a cementing layer of the result of the Gorton and Denton by-election. Labour know that being seen to side with Trump is toxic for them, being seen to side with the Palestinian cause is better and war, especially in the middle east, after the second Iraq war is kryptonite.

Given Starmer is no superman, and was the most unpopular PM of modern times before Trump issued a single pilot into the skies these domestic electoral concerns have become mainstays of the scaffolding erected hastily in recent days.

Labours Comms, and it is transparently co-ordinated, has looked at Reform’s biggest weakness – something that comes out of many focus groups and polling –  the perception that they are too close to Trump, use a Trump playbook, and are trying to emulate the Trump  election success of 2024. Miriam Cates argues this morning on ConHome that endless polling is getting in the way of political principle. Here I’d argue is a case study.

Labour also know, and frankly I’d be shocked by a country that didn’t, that most of the public don’t ‘like’ war. Who would? In the four years I’ve monitored both the public and not so public evidence of the realities of war in Ukraine it is ugly brutal and dehumanising.

Nobody sane wants or likes war, and those that do seldom fight them.

Yet they happen all the same, presenting such countries with stark and difficult choices.

The facts are that a third of the US fleet arrived weeks ago in the Gulf. Trump repeatedly threatened – not least when the Iranian regime was murdering thirty thousand of its own citizens for protesting– that he could resort to bombing Iran. No idle threat since a year ago he did. Netanyahu has had a forty year desire to take the Islamic Republic out of the middle east equation for good. We know that the US requested the potential use of the base at Diego Garcia that the Prime Minister is still wedded to paying billion to give away, and RAF Fairford.

Since a GCSE student in these circumstances could divine that an attack on Iran was very possible, and many officials could divine how Iran, and Iranian proxies might respond, based on track record and perceived enemies, it seems very odd that Starmer ended up vacillating, lacking foresight and damaging diplomatic relations far beyond the ‘special relationship’ and why HMS Dragon has only just left port for the Med, while Macron visits a French vessel already in the area.

A weakened and unpopular Prime Minister before was open to valid criticism of his decision not to allow the use of our bases and to have been flatfooted in the face of something that was happening whether he decided to be ‘involved’ or not. Note Iran does not reward those who are ‘not involved’ it shoots at them anyway. Iran backed Hezbollah – most likely – fired on RAF Akrotiri in Cyprus. British sovereign territory. With our service personnel on the site.

The Conservative position was that Government’s first role is to defend its people. Kemi Badenoch suggested since the war was happening regardless of Britian’s position the bases should be used to allow targeted strikes on “the archers not just the arrows”. In the context of the strike on Akrotiri this meant strikes on Hezbollah launching areas, and stockpiles in southern Lebanon.

Quite clearly a narrative has been built in Labour, from top to bottom, and across its supporters and allies to spread a message. A very distorted version of the truth.

This is a cocktail of their narrative, from numerous sources, freely available for others to find but goes something like this:

‘Kemi Badenoch and Nigel Farage are Trump’s poodles, two war mongers who back bombing women and children, and support illegal wars in a bid to try and be relevant. Thank God Starmer is in charge’

The fact that within days the Government were actually doing, and still are, almost exactly what the Conservatives first proposed is not to be mentioned. Verboten. The only difference is that Labour are letting others do our defending for us.

Now it is true, that still drunk on the so called Cold War peace dividend almost every party in every European country spent decades shrinking defence spending because the world was a safer, rules-based place and America would always step in, but the world has changed and those choices look poor for all parties. It is the Conservatives who have suggested a way to fix it.

It’s also worth remembering that whilst being accused of ‘slashing defence’ the Conservatives still ensured the UK stepped up to help Ukraine as a nation when threatened with total eradication by Vladimir Putin. I didn’t get that from CCHQ, I’ve heard it hundreds of times – from Ukrainians.

So, you can see the scaffolding of this Labour narrative from space.

According to one shadow Cabinet member “Labours comms plan seems to be make out the right are recklessly gung-ho, or dangerous, even war mongering freaks, who appal the public but still slavishly support Trump’s illegal war! It’s cynical rubbish”. I would go further and say Labour are simultaneously draping themselves in a mantle of being ‘sensibly cautious, thoughtful custodians of common sense’ who claim, and I’d bet will again at PMQs today, that politics should be left at the door and opposition should just respectfully agree. And how awful that they don’t.’

It’s an argument.

It’s just not a very good one when all the scaffolding tells you there is politics literally dripping from their position. We should all deplore real anti-Muslim hostility – though whether we need a Tsar or a definition for it is moot at best – but confronting Islamism would seem long overdue. It’s an odd thing to see parts of the left hate Trump and Israel so much they’ll put in a good word for the murderous mullahs of Tehran. Even cardboard cut out ones.

Badenoch isn’t itching to ‘do war’. She’s advocating defending British interests, and if you think Starmer hasn’t damaged those in the long term, even as John Redwood argues this morning, before all this started, then you are living in an isolationist virtue bubble that has no basis in reality or realpolitik.

When this very dangerous and difficult situation is over, and indeed we don’t know how and with what result – part of Trump’s real problem here – the ramifications of our own Government’s early position to sit atop a global fence and watch which way to jump will become very apparent.

You can book mark that.