Draft respiratory care action plan: consultation

Chapter One

Respiratory conditions

Although respiratory condition is a general term used to describe a large group of conditions that impair airways and lungs, this plan is aimed at five specific lung conditions. Other conditions affecting the lungs (for example, cancer and rare diseases) are already included within other Scottish Government strategies^[1].

What are respiratory conditions?

Respiratory conditions are diseases of the airways and other structures of the lung and are a major contributor to ill-health, disability and premature mortality. The most common conditions are chronic obstructive pulmonary disease (COPD), and asthma.

Although most long term respiratory conditions are not curable, various forms of pharmacological and non-pharmacological treatment have been shown to help control symptoms, increase the quality of life, and reduce premature mortality.

The World Health Organisation has identified chronic respiratory disease as one of the four leading non-communicable diseases worldwide, along with cardiovascular disease, cancer and diabetes^[2].

Impact of respiratory conditions

Many people struggle with chronic respiratory conditions. These conditions have a major impact on their lives and the lives of their families. Some experience loss of time from work or school, and difficulty participating in social activities. Anxiety and depression are common, and are associated with worse quality of life, increased medical symptom reporting, more frequent exacerbations and hospitalisations, prolonged length of hospitalisation, and increased mortality.

We know that respiratory conditions affect people and their families in different ways. We know that for some people and their families a respiratory condition is a life changing diagnosis, affecting the person’s ability to live independently, achieve personal ambitions, sustain their personal identity or life roles, work or drive. Any of these factors can cause anxiety, stress and depression for the person and their family/carers, and increase their sense of isolation.

It is also common for people with respiratory conditions to have additional long-term conditions such as hypertension, coronary heart disease, or diabetes.

Developing the draft Respiratory Care Action Plan

The Plan focuses on 5 conditions:

• Asthma
• Bronchiectasis
• Chronic Obstructive Pulmonary Disease (COPD)
• Idiopathic Pulmonary Fibrosis (IPF)
• Obstructive Sleep Apnoea Syndrome.

These 5 conditions, although not fully comprehensive, cover a wide range of issues facing people with respiratory conditions in Scotland today. Some are unique to specific conditions, some are common to more than one.

Dr Tom Fardon worked with condition specific multidisciplinary groups in order to gather an understanding of the care and support that is currently available, the existing gaps in service provision, as well as identifying examples of good practice and priorities for improvement.

The issues raised at the condition specific workstream meetings are reported in Annex C.

The Plan takes into account inputs and comments from healthcare professionals, policy makers and third sector organisations.

Scottish Access Collaborative

We have also worked across a range of Scottish Government policies. Part of this involved linking up with the work that the Scottish Access Collaboration (the Collaborative)^[3] is undertaking.

The Collaborative was established in the autumn of 2017 and is making real progress to reform elective services. The Collaborative includes a focus on a number of challenges including improving referral processes, giving people more choice on when they have return outpatient appointments, and improving service capacity planning. We will continue to work with the Collaborative during the consultation period, and beyond.

The Collaborative is led by Paul Hawkins, Chief Executive of NHS Fife with Professor Derek Bell, Chair of the Academy of Medical Royal Colleges, and is made up of a range of professional bodies including clinical professional groups, patient representatives, clinical and service leaders and Scottish Government officials.

The Collaborative has developed a number of principles which will shape and prioritise the way services are provided in the future.

A key early strand of the Collaborative’s work was the delivery of the Speciality Group series of design-led workshops, supported by the Digital Health and Care Institute (DHI), which developed high level mapping of each clinical area to identify clinically led and person centred sustainable improvements. The ongoing Specialty Group implementation programme is taking forward delivery of these improvements.

Scottish Access Collaborative and Respiratory Speciality Group

Members of the Specialty Group came from 16 specialist areas and 6 different NHS board areas, giving the sub-group both a broad geographic and functional reach.

The first step was to identify common respiratory symptoms, noting their importance. Issues were mapped for each symptom and areas to focus on agreed. This symptom based approach to respiratory care provides useful counterpoint to the disease specific approach provided by this Plan; both documents work together to provide a vision for the care of people with respiratory conditions in Scotland.

We know that there is a need for change. People feel treatment is “done to them” and want instead to be partners in their care. This requires support, both for health and social care professionals and individuals, to be able to shift the balance of power to a more equal relationship, good communication, and improvement in how care and support are delivered, if we are to meet the need to provide truly person centred care.

Interaction with other Scottish Government policies

Our Plan sits alongside a wide range of government policy. In particular, this draft Plan should be read alongside tobacco^[4], air quality^[5], immunisation and diet and healthy weight policies^[6].

We seek coherence across a range of other policy areas and we will continue to work collaboratively across the Scottish Government to ensure that appropriate links are made and maintained.

Our vision and aims

This draft Plan outlines a strategic approach to support NHS Boards in the prevention, diagnosis and treatment of respiratory conditions. It also recognises and reflects the approach taken in other Scottish Government strategies and plans.

Sitting above all of this is Scotland’s National Performance Framework^[7]. Two of the aims of the Framework are to increase the wellbeing of people living in Scotland and to reduce inequalities.

The priorities in the Plan will contribute to the National Performance Framework and its outcomes. We will know this by measuring progress against the following performance indicators: Healthy life expectancy, Health risk behaviours, Quality of care experience, Premature Mortality.

Our Vision:

Everyone with a respiratory condition will be able to access the care and support they need to live well, on their own terms.

Our aims

We will realise our vision by working with national, regional and local services to:

• Support people to manage their condition as appropriate to their needs;
• Develop integrated and co-ordinated models of care and support with the respiratory community;
• Support Health and Social Care Partnerships (HSCP) to embed mainstream models of care that ensure personalised support in every case, and options over the level of control the individual and their family choose to take, in accordance with the Social Care (Self-Directed Support) (Scotland) Act 2013;
• Test and introduce innovative ways of delivering health and social care and support;
• Improve our understanding of the respiratory population in Scotland;
• Improve ways of measuring quality of care outcomes via better data collection and use of outcome measures.

Question 1 – Vision and aims

Do you agree with the overall vision and aims of this draft Plan?

Yes/No/Don’t Know

Please expand on your answer if you wish to.