Cynulliad Cenedlaethol Cymru
|
National Assembly for Wales
|
Y Pwyllgor Iechyd, Gofal Cymdeithasol a
Chwaraeon
|
Health, Social Care and Sport Committee
|
Ymchwiliad I wasanaethau Nyrsio Cymunedol a Nyrsio
Adal
|
Inquiry into Community and District Nursing
services
|
HSCS(5) CDN09
|
Ymateb gan British Lung
Foundation
|
Evidence from British Lung
Foundation
|
1.
Treatment of respiratory conditions has improved in Wales since the
first Respiratory Health Delivery Plan in 2014. However, a
Public Health Wales Observatory Report (2018), Health and its
determinants in Wales found that the respiratory disease
continues to place a huge burden on Wales.
2.
8% of the Welsh public, a higher proportion than the UK average,
are living with a respiratory condition, contributing to around 16%
of all deaths in Wales.
3.
70,000 people are living with COPD and 250,000 are living with
asthma, which includes
nearly 60,000 children.
4.
Respiratory illness is twice as likely
to be reported amongst individuals living in the most deprived
communities (11% in the most deprived areas compared to 6% in the
least deprived).
5.
Chronic respiratory disease contributed to more than 16,000 years
lived with a disability, nearly 31,500 years of life lost, and
nearly 48,000 Disability-adjusted life years in Wales in 2016.
6.
Projections suggest that there could be more than a 20 per cent
increase in chronic, life limiting diseases by 2035.
7.
Hospital and GP Admissions
7.1
Admissions related to respiratory conditions have increased by 27%
over the last five years.
7.2
Emergency admissions have increased by 28% over the same time
period.
7.3
The number of readmissions within 30 days of discharge for
respiratory conditions has increased by 35% in the last five years.
This increases to 55% for pneumonia patients.
7.4
The cost to the NHS per admission can be between £1,900 and
£5,000 per patient each time.
7.5
The table below demonstrates the annual increases in the number of
emergency admissions by Local Health Board between 2012/13 and
2017/18.
LHB
|
2012/13
|
2013/14
|
2014/15
|
2015/16
|
2016/17
|
2017/18
|
ABMU
|
8,215
|
7,652
|
8,461
|
8,964
|
10,124
|
10,100
|
Aneurin
Bevan
|
9,214
|
9,636
|
10,365
|
11,657
|
11,742
|
11,143
|
Betsi
|
10,939
|
10,022
|
11,341
|
11,952
|
12,290
|
13,443
|
Cardiff &
Vale
|
6,437
|
6,921
|
6,985
|
8,013
|
8,162
|
8,189
|
Cwm Taf
|
5,764
|
6,041
|
6,256
|
6,617
|
6,946
|
7,225
|
Hywel Dda
|
5,657
|
5,199
|
5,720
|
6,053
|
6,512
|
5,994
|
Powys
|
1,617
|
1,634
|
1,794
|
1,915
|
2,018
|
2,180
|
Total
|
47,843
|
47,105
|
50,922
|
55,171
|
57,794
|
58,274
|
8.
We therefore need to see greater investment in initiatives to
reduce the risk of patients needing unnecessary and avoidable
hospital admissions.
9.
Community nursing support would ensure that more patients can
access support, advice and care in the community, reducing the need
for hospital admissions.
10.
It also contributes to better self-management and self-referral as
and when needed to more accessible community-based services. As
noted above, with respiratory disease more prevalent in more
deprived communities, access to localised services rather than DGHs
would benefit those communities.
11.
Equipping patients with the knowledge to identify symptoms of
exacerbation and rapid use of antibiotics or corticosteroids, or
both, can also reduce the need for those living with COPD or other
conditions to visit their GP for care.
12.
Integration and Referral
13.
Pulmonary Rehabilitation
14.
Pulmonary rehabilitation is an NHS run exercise and education
programme specifically for people with a lung condition. PR is
typically offered to those diagnosed with chronic obstructive
pulmonary disease (COPD), however there is growing evidence that PR
is cost effective for other chronic respiratory conditions such as
interstitial lung disease (ILD), chronic asthma and
bronchiectasis.
15.
‘Gold standard’ PR programmes give patients access to
the range of professions, contains exercise and education and
includes links with National Exercise Referral Scheme (NERS)
professionals. This includes education on self-care, dietary
advice, occupational therapy, psychology and social
support.
·
The range of support on offer is provided by a team of;
·
Occupational Therapists
·
Specialist Respiratory Nurses
·
Dietician
·
Pharmacist
·
Psychologist
16.
Unfortunately, not everyone is able to access appropriate exercise
services such as this; in fact, just 1 in 10 people with chronic
lung disease access PR in Wales. Referral rates also vary
significantly between LHBs and GPs.
17.
Community nursing would aid in improving awareness of and referral
to initiatives such as Pulmonary Rehabilitation and the National
Exercise Referral Service which are proven to have long-term
benefits for self-management, isolation and loneliness, and slowing
decline of the condition.
18.
Referral to stop smoking services
19.
Smoking causes over 80% of instances of COPD and lung cancer and
causes or worsens all other respiratory conditions. However, no
Health Board succeeded in achieving a major performance target;
namely that 5% of all smokers are treated by a specialist
service.
20.
We want to see improved referral of those with a lung condition to
specialist stop smoking services. Stopping smoking is important as
it leads to improvements in COPD symptoms and delays disease
progression. Stopping smoking at age 30 can lead to 10 years extra
life expectancy, with quitting at age 60 leading to three
more.
21.
Improving access to community-based services through community
nursing support may help to improve uptake with Help me Quit among
respiratory patients and improve the rate of successful quit
attempts.
22.
Improving take-up of influenza vaccination
23.
People with Chronic Obstructive Pulmonary Disease (COPD) and other
chronic respiratory diseases are at increased risk of serious
influenza related complications.
24.
Vaccinations can reduce the number and severity of acute
exacerbations in those with COPD, which in turn may reduce the
chance of hospitalisation.
25.
Despite this, uptake of influenza vaccine among those aged six
months to 64 years in any clinical risk group was only 46.9% in the
2016/17 flu season in Wales against a target of 75%. For those with
chronic respiratory disease the uptake of influenza vaccine was
46.5%, which has remained static for the last five
years.
26.
In the winter of 2017/18, Wales saw the highest number of winter
deaths anywhere in the UK. The figure was 32.8% more - higher than
anywhere else in the UK.
27.
Of these deaths respiratory diseases were the primary cause of
death, with more nearly 17,500 deaths across the UK. This is 84.9%
more respiratory deaths in the winter months compared with the
non-winter months in 2017 to 2018. This is likely associated with a
higher prevalence of influenza during the period.
28.
The number of excess winter deaths in 2017 to 2018 was the highest
recorded since winter 1975 to 1976.
29.
We want to see an increase in the number of those diagnosed with a
chronic respiratory disease receiving an annual influenza vaccine
to reduce the risk of influenza related complications and of
hospital admissions.
30.
Access to community-based nursing support which will improve
self-management and self-referral would help improve uptake of the
flu vaccine among at risk groups.
About the British Lung Foundation
The
BLF is the only UK charity looking after the nation’s lungs.
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and cures. We help people who struggle to breathe to take control
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