The number of attendances at A&E departments in England for lung illnesses – including pneumonia, flu, COPD & asthma – has nearly doubled over a 7-year period (2010/11 – 2017/18) – with nearly a million (913,646) A&E attendances between April 2017 & March 2018 according to a data review by the British Thoracic Society.
The data also shows how the winter months see a dramatic increase in the number of people being admitted to hospital after coming to A&E with lung problems:
- Hospital admissions resulting from A&E attendances for respiratory disease almost double in the Winter months
- In December 2016, there were 32,492 admissions resulting from A&E attendances for respiratory disease – which is over 3 times the average (10,652 cases) for the 20 most common issues that cause admission
- In 2016–17, 61.9% more people died from a respiratory condition in the Winter compared with the non-winter months
Lung specialists believe the reasons behind the rise in A&E admissions for lung disease are complex but include:
- a rise in older people who are potentially frail because of lung disease and other multiple health problems
- a lack of sufficient investment in, and uniform access to, proven treatments that could prevent people with pre-existing lung disease needing hospital admission – including pulmonary rehabilitation (a programme of exercise and education for people with chronic lung disease) and stop smoking support
- the need for the NHS to work far more effectively between hospitals and the community to ensure people can be cared for and monitored closer to home
- the potency of ‘flu strains and other viruses during some winters
- the need for further increases in ‘flu vaccination uptake by health professionals and at-risk groups
- the role of indoor and outdoor air pollution in causing lung disease flare-ups
The BTS is calling on the Government and NHS to ‘break the winter cycle’ and look beyond short-term national funding injections to deliver a long-term national review and plan on how to reduce future Winter Pressures.
The Society believes the upcoming NHS Long Term Plan could have some key clinical policies to help address the problem – but other pivotal areas such as addressing deficiencies in the NHS workforce and public health – where funding may lie outside of the Plan – still need to be addressed in a cross-cutting review.
The Society has agreed a broad 4-point plan to help reduce respiratory pressures on the NHS in the Winter:
1. Strengthen prevention activity to reduce the number of people experiencing respiratory infections in Winter and reduce the number of people with pre-existing lung disease having flare-ups of their condition that need admission to hospital
This would include:
- A national plan to diagnose lung disease earlier
- Ensuring patients being discharged from hospital with respiratory diseases such as pneumonia and COPD have a thorough assessment - including a review of their medication and inhaler technique to promote better self-management of their condition
- Greater access to highly cost-effective treatments such as stop smoking support and pulmonary rehabilitation which can increase quality of life for people with respiratory disease and help prevent future hospital admissions
- Continued promotion of ‘flu jabs to health professionals and high-risk groups – with a key focus on increasing the number of people in some higher risk groups getting vaccinated
- Continued investment in public awareness campaigns on how to cope with winter illness
2. Urgent action to address the current shortages in the NHS lung specialist workforce
Approximately 4 in 10 hospitals in England had at least one vacant respiratory consultant post in 2017 (a situation which has persisted for at least 2 years.)
One key problem is that the UK respiratory specialty training programme is not training enough doctors to meet increasing demand.
The BTS is calling for an additional 100 respiratory speciality training posts to be created over the next 5 years – and a ‘national summit’ with NHS England and partners to address workforce deficiencies across the sector.
3. Scale best practice in lung teams working across NHS to help treat patients closer to home
A number of local areas across England have formed integrated lung teams which operate across the whole of the NHS and care systems. But they do not exist across the country.
Data shows this joined up care has delivered both health and economic benefits – including faster access (in some areas within 2hrs) to specialist respiratory expertise in the community, vital changes to patient medication & treatments, and reductions in hospital admissions.
The Society believes NHS England should provide a vision and plan on how good integrated respiratory practice will be scaled and shared across the NHS.
4. Invest in targeted respiratory research
In 2014, the UK government spent around £28 million on respiratory research. Twice as much was spent on cardiovascular disease research (£56 million), and over three times as much (£103 million) was spent on research into cancer. If spending by charities is analysed, the gap is much wider. 30% of charity medical research spend in the UK is allocated to cancer, 10% for cardiovascular disease, with less than 2% on respiratory disease.
But despite the national lack of funding – the UK has strong world-leading research teams who are shaping new technology, treatments and ways of delivering services that could help improve patient outcomes and reduce severe flare-ups of disease.
The Society is calling on Government and research bodies across all sectors to agree a target for spend on respiratory research - equivalent to 1% of the economic burden of respiratory disease (£11 billion) - £110 million a year. An appropriate allocation of research funding should be linked to delivery of key national goals – including reducing premature mortality.
Dr Jonathan Bennett, incoming Chair of the British Thoracic Society’s Board and consultant lung specialist said:
“Nearly every Winter the NHS struggles to cope with a surge of people with lung disease being admitted to hospital through A&E. This surge is to some extent predictable as cold weather can weaken the immune system and make us more prone to viruses that circulate.
Short term NHS funding injections are welcome & NHS staff work valiantly to treat the major increase in demand. However, we really need a more proactive, long term and co-ordinated plan that works across all parts of the NHS to prevent serious lung illness happening in the first place.
This should have a major focus on prevention, education and workforce policies.”
For more information please contact:
Charlotte Sutton: t: 07958 279240
Alessandra McKenna t: 07967 976652
Ed Gyde t: 0780 9574801
Note to Editors:
The British Thoracic Society is the UK’s professional body of respiratory specialists. The Society seeks to improve standards of care for people who have respiratory diseases and to support and develop those who provide that care. A registered charity, it has about 3,500 members including doctors, nurses, respiratory physiotherapists, scientists and other professionals with a respiratory interest.
The British Thoracic Society Winter Meeting takes place between 5-7 December 2018 at the Queen Elizabeth II Conference Centre in Westminster, London.