Respiratory care action plan draft: consultation report

Question 4: Increase access to pulmonary rehabilitation 

Commitment 4 – We will support NHS Boards to increase access to pulmonary rehabilitation. We will design pulmonary rehabilitation pathways based on examples of best practice and test them in areas where improvement is required. We will look at ways of providing support to a wider group of people with rehabilitation and self-management support

A total of 116 people responded to this question, with 71 responses being expanded to include comments. Of those, a majority (104) agreed with the commitment on pulmonary rehabilitation.  No respondents disagreed with the commitment while 12 did not know. 3 people did not answer the question. To further breakdown the figures of those who responded:

• NHS (boards and organisations) 11
• Third sector organisations 13
• Private sector companies 7
• General public individuals 85

Overall, the general themes that came out of the responses to this question were: the right to rehabilitation; inequalities and variation in access; self-management and person-centred; technology, and staff and staff training.  As seen in the number of 'yes' responses there was wide agreement about the importance of access to Pulmonary Rehabilitation (PR). Although nobody disagreed with the commitment, there were a large number of expanded responses offering suggestions as to how this commitment could be strengthened. 

Breakdown of the most common themes:

Inequalities and variation in access 

Within the breakdown of keywords, a clear majority of respondents noted concerns over access to and delivery of PR, suggesting ways in which they believe the service and commitment can be strengthened.  

The biggest concern raised by respondents to this question was the variation in availability of PR across the country, with some respondents expressing concern that current provision is a "postcode lottery". It was suggested that mapping current provision across health boards would give a clearer indication of where the areas with less provision sit; for example, remote or rural areas may have a lack of accessible venues and local services, which disproportionately impact on the hardest-to-reach communities and groups.  Concerns were also raised over waiting times for access to PR programs based on locality.

A number of respondents provided suggestions as to how reduce inequalities, with many respondents calling for more options to engage with the respiratory community. Suggestions include flexible delivery of PR courses and groups, including evenings and weekends, to help accommodate those who are employed and may struggle to attend or take time off work to attend courses. An increase in community services was also suggested as a way to reduce waiting list numbers, increase uptake and potentially remove some geographical barriers. 

Alternative PR examples were given, including walking groups, exercise programmes, physiotherapy, yoga or singing. 

Self-management and person-centred

There was a consensus amongst respondents on the importance of PR to self-management of symptoms, as well as PR plans needing to be person-centred.

Technology

Several responses noted that use of digital technologies could increase uptake and practice of pulmonary rehabilitation amongst people who may otherwise struggle to do so (for example, those with mobility issues or those who live in remote or rural areas).  

The use of technology was also highlighted as important given the current situation with Covid- 19, encouraging self-management of respiratory conditions and limiting unnecessary travel.

Staff and staff training

The importance of staff was another highly considered area, with respondents highlighting the importance of having appropriately trained staff with accredited qualifications raised. Investment in the development of staff – for example, educating GPs and practice nurses in the benefits of PR – was also seen as important. 

There was some concern raised by respondents regarding the lack of reference to the role of Allied Healthcare Professionals, with some suggesting that community pharmacists for example could also be used as a referral source. 

General

Several respondents were of the view that this commitment could be more ambitious with clearer links to the commitment on mental health. Clarification was also requested by a number of respondents on what "increased access" means in practice. 

A chart showing phrases from the Q4 responses. Inequalities had 21 mentions; technology had 6.

A chart showing phrases from the Q4 responses. Inequalities had 21 mentions; technology had 6.