Lung disease is the third biggest killer in the UK. Mortality rates have barely shifted in the past 10 years and one in five of us has a lung condition. This costs the NHS almost £10bn a year. The burden of lung disease is particularly felt in winter months when there is a significant increase in hospital admissions.
Despite how common lung disease is, the picture of current care is poor. Access to the best services, such as pulmonary rehabilitation, is fragmented across England. Opportunities for diagnosis are missed, often because lung disease is poorly understood. While committed staff across the country deliver the best care they can, a historic lack of national focus on lung disease has caused stagnation.
Despite how common lung disease is, the picture of current care is poor. Access to the best services, such as pulmonary rehabilitation, is fragmented across England.
This was the impetus which united organisations and patients to come together as the Taskforce for Lung Health in 2017. Representatives including charities, people with lung disease, professional bodies and industry developed a single five year plan to improve lung health in England. This plan is the first of its kind and has the backing of the whole respiratory community.
In total, there are 43 recommendations in the plan for changes to policies and services across prevention, diagnosis and treatment. Some of these are the responsibility of government and NHS England, while others can be implemented by trusts.
Spotlight on lung health
Our plan coincided with a new national focus on respiratory. Shortly before the plan’s publication, NHS England made lung health a clinical priority area in its long term plan. The Taskforce was pleased to see many of our recommendations included in the plan. We look forward to continuing our work with NHS England to implement these.
One area of focus for the Taskforce and NHS England over the coming months is pulmonary rehabilitation. It is one of the most effective treatments for lung disease for patient outcomes and cost-benefit. It involves a six to eight-week programme of exercise and education, and significantly improves patients’ exercise capacity and ability to self-manage. If all eligible patients were referred to pulmonary rehabilitation, more than 25,000 hospital admissions and 100,000 bed days would be freed up. Unfortunately, only about 15% of those currently eligible are referred.
One area of focus for the Taskforce and NHS England over the coming months is pulmonary rehabilitation. It is one of the most effective treatments for lung disease for patient outcomes and cost-benefit.
Despite the benefits of pulmonary rehabilitation being widely recognised, it is an underused treatment
The Taskforce warmly welcomes the long term plan’s commitment to expand pulmonary rehabilitation services and to increase referrals. The focus on addressing health inequalities is particularly important. Respiratory conditions are about twice as common among the most deprived 20% of society.
Where the long term plan falls short though is on its ambition for pulmonary rehabilitation. The NHS plan’s focus is on people with severe chronic obstructive pulmonary disease. Many patients with other or less severe lung conditions would also benefit from the increased availability of pulmonary rehabilitation.
Improving access to pulmonary rehabilitation
The Taskforce wants to see improved access to pulmonary rehabilitation so that every person who would benefit is identified, referred to, and has the opportunity to complete, a programme.
There can only be benefits to going above and beyond the parameters of the long term plan. By providing equal access to all lung patients, trusts would see a reduction in service demand as patients learn to self-manage. Ensuring patients can attend local exercise classes or gyms after completing pulmonary rehabilitation will also help them maintain the benefits gained.
NHS England will be providing funding to support service expansion, with the initial, limited wave of funding coming in spring 2020 to those health systems who successfully applied. National fair shares funding will then be available to all systems in 2022/23.
Whether your trust leads your local sustainability and transformation partnership or is a constituent member, you will likely have been considering your ambitions for pulmonary rehabilitation over the past few months as part of the long term plan implementation system planning. We would encourage you to bear in mind this funding and the Taskforce’s ambition for a more holistic pulmonary rehabilitation service as you do.
For more information, please get in touch with the Taskforce at firstname.lastname@example.org.