Years of underinvestment have left us with a respiratory workforce in a state of constant crisis, it’s time to reverse this trend to future-proof our NHS.

It is imperative that the NHS recognises the pressure that respiratory health care professionals face, and will continue to be under after the worst of the pandemic is over, and work with the specialty to find and implement solutions to the staffing issues that turn every winter into a crisis.

This is the sentiment conveyed by the President of the British Thoracic Society, Dr Graham Burns, in his inaugural address to the Society’s Winter Meeting today, the UK’s largest and most influential meeting of respiratory health professionals.

Dr Graham Burns said:

“Even before COVID-19, respiratory disease was amongst the greatest killers in the UK and worldwide, yet patients suffering from lung disease have been cared for by an under resourced specialist workforce.

“Like with many other social injustices, COVID-19 has laid bare and amplified these inequalities. Respiratory clinics were and still are among the first to be cancelled due to staff being reassigned to COVID-care. Respiratory teams will be managing the long tail of COVID-19 well after most other services will have returned to normal.

“This crisis would have been a catastrophe were it not for the innovative spirit, and immense efforts, dedication and sacrifices of all the country’s healthcare workers, but by the nature of the disease the burden of the virus, has fallen and continues to fall most heavily on respiratory units.”

Intensive care units have been under enormous stress and have performed admirably, but it’s often not appreciated that the majority of COVID-19 patients admitted to hospital are managed by respiratory teams with the most sick being looked after on Respiratory Support Units. These are run by specialist respiratory doctors, nurses, physiotherapists, health scientists and allied professionals.

The British Thoracic Society (BTS) is warning that the UK has such understaffed and under-resourced respiratory services that they cannot both adequately deliver routine services and specialist clinics while being expected to treat acute COVID-19 patients, provide long-term care to COVID-19 survivors and run Long-COVID clinics. To compound the issue, respiratory professionals are also routinely a core component of acute general medicine care further stretching the teams to breaking point.

This translates in patients with lung disease (lung cancer, asthma, COPD, cystic fibrosis, pneumonia and many more) being deprived of access to the specialist expertise they need.

A BTS survey of respiratory leads¹ last November found that more than 70% respiratory departments didn’t have enough medical and non-medical staff to manage their workload, with 71% reporting not having enough bed space to cope with the number of patients they have.

Sarah Woolnough, chief executive of Asthma UK and the British Lung Foundation commented:

“Respiratory departments are at the frontline of the pandemic and yet they are facing chronic understaffing and resource issues at a time when they are needed most.

“Demand for vital services such as pulmonary rehabilitation is only increasing with many people suffering from breathlessness linked to long covid. Failure to address these pressure points now will mean that people with suspected lung conditions are left waiting even longer for a referral, diagnosis and life-saving treatment to start.  

“Our research found that as many as 1 in 5 people with lung conditions experienced worse symptoms as a result of delaying or avoiding care during the pandemic.² It’s crucial that the UK’s respiratory workforce is better funded to help ensure that everyone is able to access the care and support they need.”

Respiratory professionals were in short supply and great demand well before the pandemic, with many trusts unable to fill vacancies for lack of candidates³; COVID-19 has shone a light on the value of respiratory specialist teams but has also highlighted the endemic problem of inadequate respiratory resourcing and workforce.

Professor Jon Bennett, Chair of BTS said:

“So far this year, the NHS hasn’t been hit by the usual winter pressures as hard it usually does, possibly thanks to the lockdown and vulnerable patients shielding, but any benefits from this have been overwhelmed by the huge workload and stress placed upon the health service by COVID-19.

As with other services such as Intensive Care, respiratory services have been innovative, adaptable and resilient, providing the highest quality care to patients during the pandemic.  However, the ongoing success of their great works remains vulnerable due to the longstanding failure to resource all aspects of respiratory care proportionately and thus adequately.

“The UK needs a larger and better funded respiratory workforce at all levels: consultants, nurses, physiotherapists, physiologists and all other essential professionals.

“We need to build and permanently embed extra resilience in the respiratory workforce now, to cope with the ever increasing demand for care and to be prepared for any future outbreak.”

Training extra specialists each year is the most obvious solution, however it can take up to a decade to train a consultant from scratch. This is why BTS is also proposing a number of interim, short and medium term actions that will allow the NHS to make best use of the existing respiratory workforce.

These include:

• Annualised staff scheduling that reflects the seasonal imbalance of demand resulting from winter increase in activity.
• Service agreements that allow respiratory professionals to prioritise caring for respiratory patients and limit shifts to cover general and emergency medicine services.
• More focus on outpatient work during the summer to reduce waiting times to a minimum and so allow for a degree of slippage during winter, when there is increased work.
• Widely adopt and adapt the innovations refined during the pandemic, like virtual clinics and wards, telehealth and other remote services.

Notes

1. Respiratory leads are respiratory healthcare professionals, connecting BTS with the majority of NHS respiratory departments in the UK. Survey reported that:

• 71% didn’t have enough medical staff to manage their workload.
• 80% didn’t have enough non-medical staff to manage their workload.
• 71% didn’t have enough bed space to cope with the number of patients they have.

• Despite being promoted to reduce hospital crowding and improve care, only 50% said they had enough resources (staff and equipment) to manage patients virtually/remotely

3. Asthma UK and the British Lung Foundation surveyed 8495 people with lung conditions from 10 July to 15 July.
4. BTS workforce survey 2019. Of the institutions that responded to the survey, 50% had one or more vacant posts at 1 April 2019. Over 70% had tried to recruit the previous year too. 66% of institutions advertising for posts had encountered recruitment issues