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BTS statement on Winter Pressures and the Respiratory Workforce

Winter Pressures, defined by the surge in attendances to health care services and in hospital admissions caused by the increase in people suffering acute respiratory illnesses and exacerbations of their chronic lung conditions during the winter months, continue to be a significant problem for the NHS and particularly for the respiratory teams who have the clinical skills to give the best care to these patients.

The winter pressure is predictable, but lack of national planning leaves respiratory departments short of beds and staff to manage the surge in these patients. COVID-19 has exacerbated the situation as respiratory teams now care for these patients with Acute COVID-19 illness and also Long COVID-19, as well as all the patients with other respiratory conditions.

Workforce shortages continue to impact the full multi-professional respiratory team throughout the year.  As an example, annual BTS workforce surveys have shown, repeatedly, high levels of unfulfilled respiratory consultant posts. These workforce pressures are heightened significantly during the winter months.

Our 2019 survey of Consultant respiratory hospital leads reported that 50% of hospital Trusts had vacant respiratory consultant posts, a figure that has been increasing since 2016, and ongoing significant difficulties in filling these vacancies.

The GIRFT Respiratory Medicine report (1), still under embargo, shows the everyday, dramatic extent of these shortages and their impact on patient care. The GIRFT Report found that across the NHS, there is huge variability in the proportion of patients with lung disease admitted to a hospital who are looked after by a respiratory specialist team. In only 10 hospitals more than 70% of such patients were in the care of a respiratory team and in several trusts less than 10% of respiratory patients were managed by their specialist respiratory team.

It is particularly disappointing, from a patient perspective, that more than three in ten people admitted to hospital with a respiratory condition will not be under the care of a respiratory specialist team.

BTS has and continues to explore ways to highlight these issues to policymakers and NHS leadership, other healthcare organisations, and the wider public.  We have produced and will continue to produce workforce statements and reports, the latest in 2020, to build a stronger case for investment in respiratory specialist teams and to highlight the pressure respiratory departments are under in winter and throughout the year.

Effective partnership working with key stakeholders across the NHS and beyond remains a key objective. The Society has close working relationships with the NHSE&I National Clinical Director (NCD) for respiratory medicine, the respiratory leadership teams in the other three devolved nations, the Royal College of Physicians London, the Primary Care Respiratory Society (PCRS), the Association of Respiratory Nurse Specialists (ARNS), the Association for Respiratory Technology and Physiology (ARTP), the Intensive Care Society (ICS) and other professional bodies working in the respiratory landscape.

BTS also works in collaboration with the British Lung Foundation - Asthma UK partnership and with other Third Sector respiratory organisations and patient groups through the Taskforce for Lung Health to reinforce our calls for action.

We continue to be proactive in highlighting these issues and our solutions to the attention of national media, in all its forms, to raise the profile of respiratory medicine (2).

Awareness is important, but we believe it should be followed by action, and that is why we continue to put forward a number of pragmatic and deliverable short-, medium- and long-term solutions that can bring about effective, positive change to the people working in respiratory healthcare and, most importantly, for our patients.

Our recent submission to the Academy of Medical Sciences call for evidence on Planning for Winter Pressures provided an opportunity to us to highlight, the main areas where action is needed and our proposals for change, which included:

  • An increase of at least 200 higher respiratory specialist training places and more respiratory specialists all round.
  • Closer and more effective integration between secondary and primary care to deliver integrated respiratory care in the community and reduce the need for hospital visits.
  • Expanding Pulmonary Rehabilitation services, to reduce emergency admissions due to exacerbations and to support COVID patients.
  • Better prevention of acute exacerbations of respiratory disease, using preventative measures in the community, such as vaccinations, rescue packs, and more access to specialists.
  • Flexibility in respiratory outpatient clinics planning, so that more can be held in the summer and fewer in the winter to re-direct workforce to cope with extra acute admissions, and annualised staff scheduling that reflects the seasonal imbalance of care demand.
  • Developing advice for patients on non-pharmacological interventions that can prevent exacerbations, and better public education on the risks of spreading infection when ill.
  • Establishment of Respiratory Support Units (RSUs) in all acute Trusts to manage the sickest patients with respiratory disease, with dedicated funding and staff.

The Society will continue to work hard so that the voice of the respiratory community is heard, and so that action is taken to solve the chronic staffing and resourcing issues that have affected the respiratory workforce for years.

 

References

1- Respiratory medicine: GIRFT Programme National Specialty Report, unpublished but available under embargo from the GIRFT Best Practice Library,

2 – Published news releases

 British Thoracic Society 17 Doughty St
London, London WC1N 2PL 03/02/2025 15:02:36