A01. Specialised Respiratory

Respiratory services deal with patients with breathing difficulties. Respiratory disease services are usually provided by respiratory physicians in local hospitals. However, some diseases are very rare while other more common ones can lead to complex problems.

Scope

This Clinical Reference Group (CRG) covers:

• services for people with severe and difficult-to-control asthma
• services for people with interstitial lung disease
• services for people requiring management of complex respiratory disease who will need complex assisted ventilation at home
• services for people with pulmonary hypertension, including complex surgery
• services for people with cystic fibrosis.

Membership

Chair: Professor Mike Morgan, Consultant Respiratory Physician, University Hospitals of Leicester

David Kiely, North
Andrew Jones, North
Martin Allen, Midlands & East
Ravi Mahadeva, Midlands & East
Ian Balfour-Lynn, London
Simon Gibbs, London
Matthew Masoli, South
James Calvert, South
Anna Murphy, Lead Pharmacist
Amanda Bevan, Lead Pharmacist
Joe Farrington-Douglas, Patient & Public Voice
Nick Medhurst, Patient & Public Voice
Sarah Mcfadyen, Patient & Public Voice
Kathy Blacker, Lead Commissioner, kathy.blacker@nhs.net

Products

A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.

Service Specifications

Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.

The following service specifications fall within the scope of this CRG:

• Adult primary ciliary dyskinesia
• Ataxia telangiectasia service (Adult)
• Chronic Pulmonary Aspergillosis Service (Adults)
• Cystic Fibrosis Adult
• Cystic Fibrosis Children
• Interstitial Lung Disease (Adults) Service Specification
• Lymphangioleiomyomatosis service (adults)
• Pulmonary Hypertension Centres (Adult)
• Pulmonary Hypertension Shared Care (Adult)
• Pulmonary Thromboendarterectomy (Adults and Adolescents)
• Respiratory Complex Home Ventilation (Adult)
• Specialised Respiratory Services (adult) – Severe Asthma

Policies

A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.

The following policies fall within the scope of this CRG:

Commissioned:

• Selexipag for treating pulmonary arterial hypertension (adults) (effecive from 1 April 2019)
• Levofloxacin nebuliser solution for chronic Pseudomonas lung infection in cystic fibrosis (adults)
• Balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension (all ages)
• Riociguat for Pulmonary Arterial Hypertension
• Ivacaftor for children aged 2-5 years with cystic fibrosis (named mutations)
• Inhaled Therapy for Adults and Children with Cystic Fibrosis
• Ivacaftor for Cystic Fibrosis (Named Mutations)
• Targeted Therapies for Pulmonary Hypertension Functional Class II
• Targeted Therapies for use in Pulmonary Hypertension in Adults

Not routinely commissioned:

• Continuous aztreonam lysine for cystic fibrosis (all ages)
• Infliximab for Progressive Pulmonary Sarcoidosis in adults
• Rituximab for connective tissue disease associated with interstitial lung disease
• Selexipag for the treatment of pulmonary arterial hypertension (all ages) (effective until 31 March 2019)