Supporting people living with chronic lung disease and other respiratory conditions

Deborah Lee, Chief Executive of Gloucestershire Hospitals NHS Foundation Trust, explains how One Gloucestershire is supporting people living with chronic lung disease and other respiratory conditions to manage their conditions and have the best possible quality of life.

Over 50,000 people in Gloucestershire are currently living with a respiratory condition. Ranging from asthma to incurable conditions like chronic obstructive pulmonary disease (COPD), these illnesses can be extremely difficult to deal with, but we are determined to make things as easy as possible for these patients.

The changes we have been making in the past few years are designed to ensure patients receive the right care in the right place at the right time. For many, this will be closer to their homes – avoiding unnecessary trips to hospital and increasing the speed at which they get seen.

Respiratory illness has always been a big priority for health services in Gloucestershire and we’ve been working towards a whole-system approach for a long time; the move to the One Gloucestershire Integrated Care System (ICS) has given us a real opportunity to transform what we’re doing.

Early diagnosis is key. When you look at the figures for emergency respiratory admissions in our hospitals, around a third of the patients who end up being classed as having COPD have not yet had a formal diagnosis. If we were getting to these patients sooner, diagnosing them in the community and helping them to self-manage their condition, we would see far fewer people ending up so ill that they need hospital treatment.

As a result, we’ve provided more training for general practice staff on recognising the signs and symptoms. A grant from Health Education England has enabled us to put 46 GPs and practice nurses through an accredited spirometry course (a method of measuring lung function), giving them the skills to diagnose conditions in their surgeries.

We also want to ensure that those who have a diagnosis only end up in hospital when they really need to be there. Our new ‘hot’ service harnesses the skills of those working in the hospital setting but allows patients to benefit from them at an earlier stage.

A hotline gives general practice staff access to the advice of a hospital consultant around the clock. If a patient does need to be seen at hospital they can be referred directly to one of the ‘hot clinics’ in the respiratory department, bypassing the need for an unnecessary Emergency Department (ED) appointment.

Living with a respiratory condition can be extremely hard and it’s common for people to suffer with their mental health too, which can then exacerbate physical symptoms. Our approach aims to look at both, helping to keep people fitter for longer.

That’s why we’ve been working together with organisations like MindSong to provide fantastic activities like the Breathe In Sing Out groups. Participants benefit not only from learning breathing exercises, but also from the social aspect of getting together with a group of like-minded people once a week. Feedback has been amazing, with many patients seeing a real boost to their health.

We’ve also upped the work we are doing around pulmonary rehabilitation (PR) – which is offered to all patients who’ve been discharged after a hospital stay. It’s currently a seven-week programme, which requires attendance twice a week, but we recognise this is a big commitment and can be difficult for patients who don’t have their own transport, so we’re continually looking at different ways of offering this, including more evening and weekend options.

Changes have also been made to the way patients can access this service. Hospital staff can now place them on the waiting list themselves, rather than having to refer them back to the community teams. Our take-up rates are already 20% higher than last year, meaning dozens more patients are getting access to this vital care.

This streamlined working between the hospital and the community has been essential to the success of our plans, and we’ve implemented a number of other initiatives that have helped to smooth the path between the two, including ensuring hospital and community staff now have access to the same clinical systems, giving them easier access to patients’ information.

We’ve also introduced rotational posts, to allow staff to be more flexible about the areas to which they can be deployed, which will help to cater for seasonal peaks and troughs in demand. For example, in the winter, when hospital admissions are traditionally higher, staff who usually work in the community could be called in to help out at our hospitals.

We’re in the early days of change, but already starting to see real improvements and I’m immensely proud of the way everyone has pulled together and of all that we’ve achieved so far. Both staff and patients benefit from the reduced duplication in the system and we’re making strides in getting patients the care they really need. Those who don’t need to be in hospital are avoiding unnecessary admissions, meaning those who do need to be there can be seen more quickly and efficiently.

One Gloucestershire (Integrated Care System – ICS) is the working name given to the partnership between the county’s NHS and care organisations to help keep people healthy, support active communities and ensure high quality, joined up care when needed