Introduction

Pulmonary rehabilitation (PR) is an exercise and education programme designed to help people with lung disease in managing symptoms of chronic breathlessness.

This document sets out standards that good pulmonary rehab services should aim for. The standards will help providers of pulmonary rehabilitation services identify areas of focus for their planning and delivery.

Commissioning teams can use the standards to understand the extent to which service providers are in a position to meet local needs through good quality, sustainable services.

The Standards

1. Understand local population needs using data and other intelligence, and work to identify eligible population and demographics. This should include approaches such as active patient finding.
   • Support available: Patient finding and prioritisation tool (FutureNHS)

2. Work with primary care, secondary care, community partners and patient and public voice representatives (PPVs) to ensure that individuals identified as eligible receive an inclusive and suitable offer of PR.
   • Support available: Let’s Talk About PR (FutureNHS)

3. Commission and plan sufficient capacity to meet population needs of those living with chronic respiratory disease.
   • Support available: Predicted capacity requirements for localities can be identified through NHS England’s PR modelling tool (under development). Commissioners should use this tool and also reflect this in workforce planning.

4. Create a joined-up and collaborative approach to addressing and narrowing health inequalities in understanding, experience and outcomes in PR services. Using data, health equity audits and contacts to identify population groups that need support to participate in PR; co-produced delivery models; multi-agency support; community participatory approach. Systems should understand the value delivered through completion of PR to enable appropriate resourcing of pathways to reduce health inequalities.

5. Improve equity of access (locality based). Ensure eligible patients can access services on an equitable footing. Equitable access can mean many things, but consideration needs to be given to: accessible information; accessing services; accessing support. There are a number of groups and communities that may be disproportionately affected by barriers to PR such as transport, site accessibility and class times.
   • Support available: Examples of improving access to PR – FutureNHS and webinar recordings; a health economics report that provides the cost effectiveness of PR in terms of life years gained and reduced average hospital days for people who complete PR will be published after peer review.

6. PR services should adhere to the BTS Clinical and Quality Standards for PR care, which include measurable markers of good practice to ensure confidence that the services being commissioned are high quality, economically viable and sustainable.
   • Support available: British Thoracic Society clinical statement on PR

7. All patients should receive quality assured PR through accredited services or services that are actively working towards accreditation.
   • Support available: PR Service Accreditation Scheme standards

8. Services should participate in the National Respiratory Audit Programme (NRAP) on pulmonary rehabilitation and aim for all patients to be included in the audit by explaining its benefits. Benefits include having a reliable source of data about PR services with key lines of enquiry available at sub-system, system, regional and national level.
   • Support available: National Respiratory Audit Programme – Pulmonary Rehab

9. Plan for a sufficient, adapting, and skilled multidisciplinary workforce with appropriate competencies. Workforce planning must consider how to increase workforce numbers while maintaining an effective, safe programme with appropriately trained staff. Innovative ways of working should be considered to optimise the talents of those who may work outside of the traditional scope of PR.
   • Support available:
   • Staff calculation (under development)
   • Guidance for growing and developing the pulmonary rehabilitation multidisciplinary team

10. Support people to live well with chronic lung disease. Individuals should have access to support to live well, be active and exercise before and after a PR programme.
    • Support available: Patient resources collated by Lung Health @Home (FutureNHS)

Publication reference number: PRN2093