Progress in expanding pulmonary rehabilitation is still too slow despite clear evidence of the benefits. Chair of the Taskforce for Lung Health Henry Gregg explains why reforms must pick up the pace, and expand the workforce to deliver it.
In summer 2023, NHS England published the Long-Term Workforce Plan (LTWP) ‘the first comprehensive workforce plan’ for the health service, which is intended to deliver sustainable staffing and improvements in patient care.
As ever, when governments change, workplans, timelines and progress across all departments can be disrupted. Within the Department of Health and Social Care this has been most evident in the major conditions strategy. This joined the growing collection of documents on the great Whitehall shelf in the sky that were written but never published, as it was developed by a previous government.
Progress, or at least the reporting of progress, on the LTWP appears also to have been delayed as the forthcoming 10-year plan to ‘fix the NHS’ becomes the new focus. It’s now expected that the LTWP will be reviewed in the summer of 2025, and that cannot come soon enough.
The benefits of pulmonary rehabilitation
Good quality respiratory care has always been reliant on large multi-professional teams, and physiotherapy workers play a very important role in these supported by exercise professionals. pulmonary rehabilitation (PR), a course of exercise and education, has been identified as one of the ‘five fundamentals’ of chronic obstructive pulmonary disorder (COPD) care and, according to guidance, should be offered to all COPD patients who meet a breathlessness threshold. It has also been shown to benefit people living with other lung conditions.
In fact, 90 per cent who complete a pulmonary rehabilitation course experience improved exercise capacity and quality of life.
Shockingly, even before the pandemic, data from the Royal College of Physicians' National Asthma and COPD Audit Programme revealed that pulmonary rehabilitation was only being offered to 13 per cent of all eligible patients. Since expanding this offer was made an aim in the Long-Term Plan, PR provision has increased to 37 per cent of eligible COPD patients. This is a significant improvement, but this level is still unacceptably low.
Every year 20,000 people are discharged from acute wards to community beds or care homes without any rehab support at all. Many end up back at A&E. As well as piling pressure on the most expensive parts of the NHS, the revolving door of admissions and readmissions - and every unnecessary day in a hospital bed - causes untold harm to patients.
Thousands of new roles needed
To build on what progress has been made, we need a reaffirmed commitment to expanding pulmonary rehabilitation in the forthcoming 10-year plan and the LTWP review, and the expansion of respiratory physiotherapy posts, recruitment and training.
Estimates highlighted by the British Thoracic Society in 2022 suggested that at least 600 registered and 400 non-registered more pulmonary rehabilitation physiotherapy posts were required in order to meet the targets set out in the Long-Term Plan.
Modelling future workforce requirements is tricky, and in October, the Taskforce for Lung Health was a signatory to a joint letter sent by organisations (including several of the medical Royal Colleges, the Royal College of Nursing and others) to the newly appointed Chair of the Public Accounts Committee. Together we urged Sir Geoffrey Clifton-Brown to re-open the inquiry underway during the last parliament into the modelling of future workforce needs included in the LTWP. Sadly, it looks like this inquiry, which may have strengthened the plan, will not be reopened.
From hospital to community
With this (and the delay to the LTWP review) in mind the Taskforce for Lung Health has considered what separate aims it might pursue to bring about the greatest possible improvements to patient’s lives. Advocating for the expansion and upskilling the respiratory (and specifically pulmonary rehabilitation) physiotherapy workforce is an obvious choice.
The workforce working group of the Taskforce (including representatives from the CSP) has, through evidence submitted to a consultation on the 10-year plan, parliamentary representations and direct approaches to Integrated Care Systems, been calling for a continued and increased focus on the availability of pulmonary rehabilitation to all eligible patients.
This will remain a focus for the Taskforce for Lung Health over the next year and is entirely in keeping with the government's ambitions for shifting the focus of the NHS from “hospital to community”, and with the CSP’s own Right to Rehab campaign. Delivering PR in new ways, including through the government’s “Neighbourhood Treatment Centres” which will soon be trialled, and using a hybrid online/in-person approach only when appropriate also present opportunities to reach more of those in need.
The government has said it wants to shift services from the hospital to community. And with respiratory conditions being the largest contributor to A&E admissions, what better way to do this than to invest in PR, to reduce exacerbations and hospitalisations. Now is the time to use physiotherapy and the tools at our disposal to keep people well all year round to ensure we have a safer and cheaper Winter for the NHS.
The Taskforce for Lung Health is an alliance of over 40 members including the CSP, patients, carers, healthcare professionals, the voluntary sector and professional associations. Together the Taskforce works to prevent more people from developing lung disease, and to transform the care of people living with lung disease.
Number of subscribers: 1
Log in to comment and read comments that have been added