Tackling a disease that won’t go away

NHS England’s National Clinical Director for Respiratory Services looks at improving our approach to the deadly effects smoking can have:

NHS RightCare today launches its latest pathway aimed at addressing Chronic Obstructive Pulmonary Disease (COPD).

It sets out to health commissioners and providers how to ensure early detection with accurate diagnosis and optimise long-term management to reduce exacerbations, hospital admissions and premature mortality.

The pathway has been developed by NHS England in collaboration with the British Lung Foundation, the British Thoracic Society, Respiratory Futures, the Primary Care Respiratory Society (PCRS-UK), and the National COPD Audit Programme.

As NHS England’s National Clinical Director for Respiratory Services, I explore the impact of COPD, how treatments have developed and what more can be done to improve the outcomes for people with this condition.

Many people view COPD as a self-inflicted, untreatable, progressive condition that will pass in to history as smoking rates decline. In fact, this is far from the truth as we learn more about this complex condition.

Current figures show:

  • 2 million people in the UK have diagnosed COPD.
  • Up to three times as many people have not yet been diagnosed.
  • Almost 30,000 people die from COPD annually.
  • Over 1 million bed days per year are taken up by COPD patients.

Not everybody who smokes will develop COPD and non-smoking causes of COPD are becoming more evident. The epidemiological evidence suggests that future emergency admissions to hospital will rise rather than decline as the population ages and treatments improve.

These days, treatment options for COPD have multiplied and include improved inhalers, rehabilitation and even surgical options for emphysema. Emergency treatment has been revolutionised with the introduction of acute non-invasive ventilation.

The organisation and delivery of care has also improved with the development of integrated care models and self-management strategies for admission avoidance. Despite this, early and accurate diagnosis remains poor and there is a four-fold variation in hospital admission rate that cannot be explained by case mix.

While this complex landscape may tax providers and health professionals, it also generates a challenge to commissioners who will need to be more aware of the requirement for an integrated approach to commissioning.

The NHS RightCare pathway provides a template for best commissioning practice. There are clear advantages to Clinical Commissioning Groups (CCGs) and Sustainability and Transformation Partnerships (STPs) that take a population approach by commissioning the whole clinical pathway and adopt risk stratification to ensure that patients are treated in the most suitable location by the appropriate health professional.

If these steps were taken CCGs could annually achieve:

  • 1,400 fewer unexpected deaths.
  • A £49million cost saving.
  • Earlier detection of 210,000 patients.

Accurate diagnosis and high value treatments including smoking cessation and pulmonary rehabilitation are known and should be prioritised over those that are known to be less effective. If this approach is taken, then CCGs can expect reductions in avoidable mortality, hospital admissions and reduced cost.

There is no cure for COPD but the condition can be detected much earlier and managed more effectively with simple steps and a change in attitude.

Mike Morgan is the National Clinical Director for Respiratory Services in England.

He is a consultant respiratory physician at the Department of Respiratory Medicine, Allergy and Thoracic Surgery at the University Hospitals of Leicester NHS Trust at Glenfield Hospital and Honorary Professor at the University of Leicester.

His career interests have included the assessment and management of respiratory disability, particularly in COPD and he has over 20 years’ experience of clinical management in developing and leading the respiratory services in Leicester.

Mike is a past President and Chairman of the British Thoracic Society and editor of Chronic Respiratory Disease.