Respiratory care - action plan: 2021 to 2026

Clinical Forward

Respiratory illnesses present commonly to primary care teams, and represent over one third of acute medical intake in most Scottish hospitals. The ageing population, advances in primary and secondary prevention of cardiovascular diseases, and improvements in acute and chronic management for respiratory complaints means the pressures placed on secondary care respiratory units is far greater than ever before. Ensuring people see the right health care professional, in the right setting, at the right time, continues to be demanding. We face challenges of prioritisation of those people with serious illnesses; providing access to diagnostic testing to allow primary care clinicians to make independent decisions with their patients; streamlining referral pathways to ensure those with the greatest need are seen quickest, while providing support to those who wait longer; and providing high quality ongoing care for people with chronic respiratory disease.

In 2020 and beyond, Scotland faced the largest public health challenge of a generation in the COVID-19 pandemic. Primary and secondary care teams faced an overwhelming burden of disease which presented mainly as respiratory distress; secondary care respiratory clinicians held a key role in the assessment and management of people with COVID-19, including treatment of critically unwell patients. COVID-19 changed the way respiratory clinicians work: the effects of these changes will be felt for years, in many respects respiratory medicine will never be the same again. It is essential that we recognise the effects of COVID-19 on those people who were infected, those whose disease management was altered due to the pandemic both directly and indirectly, and those people who will develop new chronic symptoms, or have worsening of their underlying condition, due to infection. There have been improvements to services due to the COVID pandemic: increased use of remote consultations has improved access to clinical care, reduced the burden of travel, and released clinicians from the constraints of clinical space; closer working between primary and secondary care teams to provide joined up care during the patient journey has been welcomed; increased awareness of infection control measures in the community has reduced the incidence of viral and bacterial respiratory illnesses dramatically in 2020. However, critical services such as pulmonary rehabilitation classes have been severely limited due to social distancing guidelines – an issue that needs to be tackled with the upmost priority.

The respiratory conditions in this Plan - asthma, COPD, idiopathic pulmonary fibrosis, bronchiectasis and obstructive sleep apnoea syndrome - make up the majority of the workload of respiratory physicians in Scotland. Although each presents its own challenges, there are problems common to all respiratory conditions. There is a strong evidence base for these conditions, and straightforward measures that can be taken to improve outcomes. Pulmonary malignancy is a clinical priority covered by other guidance.

Respiratory medicine will never be the same as it was pre-COVID. Investment in respiratory medicine has never been as important as it is now – provision of high quality, joined-up respiratory care across Scotland must be the priority. New investment in well trained, multi-disciplinary healthcare teams is critical, right now. The Respiratory Care Action Plan provides the key priority areas for large scale improvement in respiratory care in Scotland.

Dr Tom Fardon
Consultant Respiratory Physician
NHS Tayside