Powys Teaching Health Board Respiratory Delivery Plan 2016-17
CONTENTS 1. BACKGROUD AND CONTEXT 1.1 The Vision 1.2 The Drivers 1.3 What do we want to achieve? 2. ORGANISATIONAL PROFILE 2.1 Overview 3. SUMMARY OF THE PLAN THE PRIORITES FOR 2016-19 4. PERFORMANCE MEASURES/ MANAGEMENT 5. CONCLUSION 6. ACTION PLAN 2
1. BACKGROUND AND CONTEXT Together for Health a Respiratory Health Delivery Plan was published by the Welsh Government in April 2014 and provides a framework for action by Local Health Boards and NHS Trusts working together with their partners. It sets out the Welsh Government s expectations of the NHS in Wales to tackle lung disease in adults and young people, wherever they live and whatever their circumstances. It focuses on meeting the needs of people at risk of, or affected by, a wide variety of acute and chronic lung conditions. This plan establishes: The population outcomes expected The outcomes expected from NHS care How success will be measured and the level of performance expected Themes for action by the NHS with its partners This plan is currently being refreshed at Welsh Government. However, many of the actions and requirements remain relevant for Powys Teaching Health Board (PTHB) as we move forward to 2019. 2. THE WELSH VISION: For our population we want: People of all ages to be encouraged to value good lung health, to be aware of the dangers of smoking and, take personal responsibility for their lifestyle choices to reduce the risk of acquiring a respiratory condition and maximise the benefit of any treatment. Where problems with lung health occur, individuals can expect early and accurate diagnosis and effective treatment so the quality of their life can be optimised. Our aim is for Wales to have low incidence for lung disease and improved health care outcomes. NHS Wales will use the following indicators to measure success: A reduction in prevalence of smoking as per the Tobacco Control Action Plan for Wales Incidence of Chronic Obstructive Pulmonary Disease (COPD) per 100,000 population Unscheduled hospital admissions for both asthma and COPD per 100,000 population Disease and age group specific mortality rates under age 75 per 100,000 population 3
3. THE DRIVERS Health Statistics Wales 2013 makes clear the magnitude of respiratory conditions nationally. One in seven adults (14%) in Wales reports being treated for a respiratory condition and respiratory diseases cause one in seven (15%) of all deaths in Wales. Moreover, the Welsh Health Survey 2012, which includes lifestyle information, reveals a smoking prevalence in Wales of 23% and a prevalence of overweight and obese adults of 59%. Both smoking and obesity are major contributory factors to the levels of respiratory disease. Improving the respiratory health of the population in Powys is crucial and a key opportunity to improve the lives of patients and their families. Improvements in respiratory heath care have not been achieved equally for all people and substantial differences in service provision can be found between communities. Levels of respiratory disease in areas of social deprivation are of particular concern. Powys THB will focus activity on providing services which make the most effective use of resources, whilst measurably impacting upon the quality of life for areas of population with particularly poor lung health. 4. WHAT DO WE WANT TO ACHIEVE ACROSS WALES? The National Delivery Plan sets out actions to improve outcomes and focuses on the following key areas: Preventing poor respiratory health Detecting respiratory disease quickly Delivering fast, effective treatment and care Supporting people living with lung disease Supported through: Improving information Targeting research 5. POWYS ORGANISATIONAL PROFILE Overview Powys THB is responsible for meeting the health and wellbeing needs of the people of Powys. As a rural health board with around 133,000 people living across an area that is a quarter of the landmass of Wales, PTHB looks to provide as many services as can be locally. These services are mainly through General Medical Services and other primary care services, community hospitals and community services. 4
Powys THB works closely with other organisations in Wales and England to provide services for the people of Powys. PTHB also continues to strive to bring as many services back to Powys as possible including assessment and follow up after treatment. Figure 1 Figure 2 5
6. PROGRESS TO DATE Since the local Respiratory Steering Group was established the following developments have been achieved: Smoking cessation services are available in more locations throughout Powys and are being accessed by more people. Pulmonary Rehabilitation Programmes are now available throughout Powys and run on a regular basis Access to the National Exercise on Referral Scheme in Powys has improved and more staff are being trained to deliver specialist respiratory (Level 4) programmes Everyone with Chronic Obstructive Pulmonary Disease, who has been seen by the Respiratory Nurse Specialists, is now offered a self management plan. Self Management plans are available for distribution by any professional working with people who have COPD Winter rescue plans are available to more patients 7. SUMMARY OF THE PLAN PRIORITIES FOR 2016-17 In Powys, there are over 2,750 people registered as having Chronic Obstructive Pulmonary Disease (COPD), and 8,480 people diagnosed with asthma. Respiratory disease is a common cause of severe acute illness, and therefore is a significant cause of many emergency hospital admissions which for Powys residents can be far from home. The Powys Delivery Plan focuses around the following priorities. a. Preventing poor respiratory health Raising awareness with the public on how to live healthy, active lifestyles to help maintain respiratory health, developing the work already being undertaken as part of the Invest in Your Health scheme. Continuing to promote smoking cessation services with the local population and Primary Care providers. Treating every patient contact as an opportunity to promote health and wellbeing. Encouraging staff and maximising the numbers of patients having the influenza vaccination. b. Detecting respiratory disease quickly Ensuring respiratory disease is identified accurately when a person with symptoms presents to health services. c. Delivering fast, effective treatment and care 6
Ensuring people receive prompt, effective treatment and care for their respiratory condition following appropriate National Guidelines, whether adult or child, so that they have the best chance of optimising their quality of life and improving survival; Continuing to develop and expand the Respiratory Specialist Nursing Service across Powys. Ensuring improved access to Pulmonary Rehabilitation Programmes; Working with local partners such as the National Exercise Referral Scheme to ensure that people are able to access evidence based exercise programmes and other effective community interventions; Building relationships with the Specialist Nurses, the Community Resource Teams and Minor Injury Units to develop action plans for those patients in the community most at risk of emergency admission to support people locally for as long as it is safe to do so; Working with Palliative Care teams to ensure patients with respiratory disease are fully supported in their care through to the end of life; d. Supporting people living with lung disease Ensuring all patients are given a self management plan book and have self-management plans in place; Improving information available to people with respiratory conditions to assist with management of their respiratory condition. Working with G.P. practices to undertake Peer Review of emergency respiratory admissions at a cluster level. Regularly analysing service data such as waiting times, contact numbers and admissions data to ensure that people are able to access treatment in a timely manner; Using a co-production approach to ensure that the person s experiences of respiratory care are captured and used to inform development of respiratory services; Using risk stratification tools available to identify patients most at risk in the community to provide early, preventative interventions to prevent emergency admissions. Following the review of the National Action Plan the following gaps were identified in Powys and have been incorporated into our delivery plan for respiratory health as our top 3 priorities 1) Improving access to pulmonary rehabilitation programme Our key challenges are: 7
Moving pulmonary rehabilitation programmes closer to home so that they are more accessible Ensure we have robust data on who should be attending, completion rates and outcomes Strengthening the referral process Developing clear information and education for referrers and participants Providing Consultant cover and assistant Practitioner Priority Actions for 2016-17 are: Practitioners to prioritise the running of Pulmonary Rehabilitation programmes in their job plan to ensure that there is a robust service Review skill mix of those running programmes to achieve a prudent delivery Explore possibilities for running Pulmonary Rehabilitation via telehealth 2) Individual self management plans Our key challenges are: Self management plans are not available to all patients Some people are not taking appropriate responsibility for managing their condition nor implementing strategies for managing exacerbations in symptoms Helping people to be confident in managing their respiratory conditions Priorities are: Distribution of self management plans for COPD to all practitioners working with people with the condition to maximise the number of people that are given and utilise their plans Development of health coaching training package to maximise the beneficial impact of the self management plans 3) Early diagnosis Spirometry Our key challenges are: Access to trained and accredited practitioners who can carry out spirometry Access to equipment to carry out spirometry 8
Priorities for 2016-2017: Training a cohort of practitioners in primary and community care settings to Association for Respiratory Technology and Physiology standards in the delivery and interpretation of spirometry Distribution of new spirometry equipment 4) PERFORMANCE MEASURES / MANAGEMENT The Welsh Government s Respiratory Health Delivery Plan (2014) contained an outline description of the national metrics that Health Boards will need to consider. Progress against these NHS outcomes and assurance measures will form the basis of the Annual Report on respiratory services. They will be calculated on behalf of the NHS annually at both a national and local population level. Health Board s delivery plans and their milestones are reviewed and updated annually. The PTHB s Respiratory Health steering group will continue to meet quarterly to support and performance manage the ongoing improvements and delivery. 5) CONCLUSION In the relatively short time that respiratory health steering group has been in place significant improvements have been made There is now a fully functioning group of dedicated and enthusiastic professionals in Powys who are committed to improving the delivery of respiratory care and in turn improve the lives of the people who live with these conditions. 6) ACTION PLAN The following table sets out the detailed action plan for Powys Teaching Health Board 9
POWYS TEACHING HEALTH BOARD RESPIRATORY ACTION PLAN Objective/Requirement Local Action Indicator Data Lead Progress Local Respiratory Group Quarterly Meeting N/A Ongoing Patient Groups Executive Team Member Attends Preventing Respiratory Disease Ensure smoking cessation services comply with best practice Ensure sufficient capacity and workforce to deliver Tobacco Control Action Plan requirements Meetings take place at least every three months At least one patient representative is a member of the local respiratory group The Director of Primary and Community Care regularly attends the Local Respiratory Implementation Group 5% of smokers make a quit attempt via smoking cessation services with at least a 40% validated quite rate at 4 weeks 75% of respiratory at risk groups receive flu vaccination Clinical Lead for Respiratory Health N/A Joseph Carter BLF N/A Alan Lawrie - DPCC Tier 1 Treated Smoker and CO validated quitter percentage Tobacco Control Action Plan DofPH DofPH Ongoing Ongoing 2.18% treated smoker rate for 2015/16 (434 treated smokers) 10
Objective/Requirement Local Action Indicator Data Lead Progress Raise awareness and 60.1% coverage for Tobacco Control Action DofPH implement local immunisation policies PTHB staff with patient Plan contact. 46.3% coverage (WALES) for chronic respiratory disease Detecting Lung Disease Early Identify at risk groups and offer appropriate diagnostic tests Offer Spirometry to the over-35 age group of smokers delivered by Association of Respiratory Technology and Physiology (ARTP) accredited staff Validate and improve reporting and interpretation of spirometry results 80% of smokers and people with chronic asthma and chronic cough offered appropriate diagnostic tests 90% or more of smokers aged over 35 offered spirometry, 100% of GP practices have at least 1 Association of Respiratory Technology and Physiology trained member of staff All GP surgeries are being offered ARTP training over the next 18 months. Mapping exercise to be undertaken to identify appropriate tests Numbers offered spirometry. Number of spirometry tests undertaken South LGM South LGM South LGM Target groups identified Mapping exercise to identify the number of people requiring the Association of Respiratory Technology and Physiology accredited staff has been completed Pengorof, Brecon and Crickhowell GPS surgeries have had such training. 11
Objective/Requirement Local Action Indicator Data Lead Progress All Respiratory Nurses All Respiratory to be ARTP trained Nurses/Practitioners are undertaking training Delivering Fast, Effective Care Develop enhanced hospital discharge and follow up schemes Provide patients and carers relevant, appropriate and adequate information on their condition Respiratory teams are working with GPs and VWs to identify the appropriate patients Powys is using the British Lung Foundation Self-management packs and sign posting to national and local support groups Improving the quality of information on PTHB website Numbers of appropriate individual management plans put in place for those patients identified as requiring one South LGM delegated to Respiratory Nurses As above Over 3,000 COPD self-management packs have been made available for the GPs, Practice Nurses and Respiratory Nurses to give the appropriate patients. Discharge letter for all patients with acute asthma to be delivered to GP within 24 hours/next working day 100% of respiratory patients have discharge information sent to their GP and pharmacist within 24 hours All emergency attenders discharge summary should be faxed to referrer within 24 hours As above Numbers of packs provided over eligible patients 12
Objective/Requirement Local Action Indicator Data Lead Progress Implement NICE guidelines for Chronic Obstructive Pulmonary Disease in primary and secondary care through a defined pathway of care Mapping exercise underway to identify relevant pathways As above Develop MDT led Pulmonary Rehab Programmes (PRP) to address local need and respond to NICE audit recommendations Refer patients with a MRC breathless score of 3 or greater to pulmonary rehabilitation Develop PRPs for patients admitted with acute exacerbations Adequate levels of Physiotherapy services to teach lung drainage techniques to patient with bronchiectasis 80% of referrals to a Pulmonary Rehab Programme (PRP) have successfully completed the programme 100% of patients with a MRC 3 or greater have been offered PRP, with 70% being referred to a PRP close to where they live 100% of people admitted with acute exacerbations are provided with access to a PRP 100% of GP practices have access to an appropriate physiotherapy support service All programmes reviewed on completion and linking in with national COPD audit 2017 run by RCP Uptake of Pulmonary Rehab Uptake of Pulmonary Rehab GP Practices with appropriate Physio Many pathways exist due to the various providers of secondary care Amanda Rutter MDT Pulmonary Rehabilitation programmes now running throughout Powys to agreed standards Amanda Rutter Achieved Amanda Rutter Under Review Helen Hathway/ Clare Preece Achieved 13
Objective/Requirement Local Action Indicator Data Lead Progress Ensure patients with Interstitial Lung Disease are managed through multi-disciplinary teams 80% of people with difficult and complex respiratory conditions being manage through Petula Garner/ Under review Lavina STallard/ Shirley (MDT)and have access to an appropriate MDT Pickstock specialised nursing framework support Establish pathways for the investigation of sleepdisordered breathing to assess and treat obstructive Sleep Apnoea Hypopnea Syndrome patients within established Referral to Treatment times 100% of people with sleep-disordered breathing are provided with access to an appropriate support pathway Uptake of pathway Victoria Deakins Under review Develop initiatives to promote the management of acute respiratory conditions in the patient s home and in intermediate care. Patients identified from the Respiratory Nurses caseload and GP practices who require the relevant plans Respiratory Nurses Crisis management plans are in place for identified patients at risk of exacerbation 14
Objective/Requirement Local Action Indicator Data Lead Progress Supporting People Living with Lung Disease All people with chronic respiratory conditions to have a personalised selfmanagement 80% of people with a chronic respiratory condition receive a Mapping exercise required to ensure this is being achieved Nigel Broad All patients referred to Respiratory Nurses plan in place written self- are given a self- within 3 months of diagnosis management plan within 3 months of diagnosis management plan. The British Lung Foundation Self- Management Plans are now available in every community practice throughout Powys Teaching Health All respiratory patients to have key measurements taken annually to identify early decline and prompt intervention Support development of, and encourage referral to, patient groups such as Breath Easy Groups All respiratory patients receive an annual assessment where key measurements are taken 60% of people with lung disease are provided with details of their local Breath Easy group Board Review QOF data Nigel Broad All patients on respiratory case load receive annual reviews to monitor QOF data to ensure targets are met Work with our patients and relatives and carers to ascertain they are receiving the right information TBC Patients are signposted to supportive groups by Practice Nurses, GPS and Respiratory Nurses 15
Objective/Requirement Local Action Indicator Data Lead Progress Ensure adequate and equitable access to 80% of people with advanced respiratory Review and audit respiratory caseload 6- Marion Baker All patients requiring end-oflife palliative care services for disease receive monthly care receive in end-stage respiratory disease care appropriate palliative and end-of-life case put from their local Palliative Specialist Appropriate referral to the NERS scheme to support long-term adherence to physical activity 100% of people after a PRP are referred to a NERS scheme, 50% following early stage referral Shelley Jackson service 16