How the NHS is working to address the disproportionate impacts of respiratory disease
Health inequalities and lung disease
We know how distressing the impact of chronic respiratory symptoms can be. They can shrink peoples’ lives, leading to inactivity and isolation at all ages and stages of life. Yet many people aren’t accessing the support required, whether that’s because they aren’t well-served by existing service models or because they don’t recognise the severity of their condition.
Chronic lung diseases have stark health inequalities, with dramatically different morbidity and mortality outcomes depending on geography, ethnicity, and level of deprivation. It is against this unequal backdrop that our work to improve the outcome of people with lung disease becomes so essential.
The work of the NHS Long Term Plan
We know that across all care settings there are high-value and transformative interventions that are effective irrespective of the deprivation or ethnicity of the individual. For people with lung problems, it is lack of diagnosis and timely subsequent support that is a major driver of health inequalities. This was recognised in the NHS Long Term Plan in 2019 which made respiratory diseases a national clinical priority for the first time, and which continues to be a key area of focus for the NHS.
A national programme of work led by NHS England is focusing on supporting systems to provide an early and accurate diagnosis and, building on that, the fundamentals of care which can help people better manage their conditions. Delivered at scale, this has the potential to improve quality of life, reduce hospitalisations and improve healthy life expectancy.
Such fundamentals include support for tobacco addiction, the take-up of vaccination, regular reviews and help to optimise treatments such as inhalers (and reduce carbon footprint), provide access to pulmonary rehabilitation, and support for self-management. It is also essential that people can receive high quality and timely specialist care in community and hospital at the time of crisis, receiving the best evidenced care if diagnosed with conditions such as pneumonia.
The work of the NHS England respiratory programme has been boosted by the establishment of respiratory clinical networks who have provided clinical leadership for the delivery of the ambitions set out in the Long Term Plan. For example, we have seen the crucial role networks have played in partnership with their systems to drive change and transition to new models of delivering quality assured spirometry, addressing backlogs, and working towards restoring diagnosis rates to exceed pre-pandemic levels.
A need to transform
There is enormous change happening right across the NHS now, and despite the relentless pressure on services, this does bring a great opportunity for the respiratory community. Integrated Care Boards (ICBs) are taking on more responsibility for NHS services, including those that are specialised such as interstitial lung disease and asthma over the next couple of years. At the same time efforts are being made to create strong neighbourhood teams and support work across organisational boundaries.
Access to good quality data and analytics that enable systems to better understand the needs of their communities and provide targeted symptomatic case finding as well as linked interventions is essential. NHS England is leading a national respiratory data strategy to develop a clear, ambitious, and achievable data architecture that delivers a range of respiratory metrics, tools and resources. This will give us a shared understanding on how well we are doing in tackling the poor outcomes and health inequalities that exist.
To improve outcomes and address health inequalities in people with lung disease, each person needs evidence based and high-quality support, close to home wherever possible in a timely manner. Changes to the way specialised services are commissioned and provided will mean that there is more opportunity for local and networked pathways for specialist support for severe asthma, interstitial lung diseases and complex home ventilation, expanding access to treatments. Integrating pathways within systems from locality diagnosis to recognition of need for specialist and highly specialist support will be key.
Thinking about both the short- and long-term future
Winter brings a worrying time for many of with a respiratory disease and for those who care for them. We are working hard to understand what we can support to happen proactively to help our vulnerable patients remain well ahead of the winter months, and how to enable them to access expert support at times of crisis.
In the longer term, we are also seeing a refreshed policy focus on respiratory disease. The Department of Health and Social Care has made chronic respiratory disease one of six priority conditions within its major conditions strategy, detailed in the case for change document that was published earlier this year.
We are committed to taking this work forward in close partnership with our key stakeholders; with a common sense of vision and a shared purpose across Asthma and Lung UK, the British Thoracic Society as well as the National Respiratory Audit Programme. The amount of support colleagues and patients get from these and other professional organisations and charities is immense.
In summary, it’s a time of considerable change and opportunity and you’ll see evidence of this in practice in the great work highlighted in this issue.
Tobacco dependency treatment programme
Dr Robyn Fletcher introduces the BTS improvement programme for tobacco dependency.