Disease (COPD) What do we know? Summary is a long-term condition, which is affecting increasing numbers of people. There is a wide range of interventions to address COPD, from prevention to the ongoing management of the condition. COPD is a health issue that is managed across the whole health sector, and therefore a 'joined-up' approach to the prevention and management of this condition is particularly vital. The Joint Strategic Needs Assessment for Lincolnshire has a number of topics that are relevant to COPD, including smoking, for example. The Lincolnshire Health and Wellbeing Strategy has a number of themes which give priority to the prevention and management of COPD. Facts and figures COPD is a broad term that covers several lung conditions, including chronic bronchitis and emphysema. It usually develops because of long-term damage to the lungs from breathing in harmful substances, such as cigarette smoke or chemical fumes. The condition makes breathing difficult. COPD is common. It is estimated that approximately three million people in the UK have COPD. However, the condition has not been formally diagnosed for many of these people. COPD mainly affects people over the age of 40, and becomes more common with increasing age. It is more common in men than in women. COPD kills about 25,000 a year in England and Wales, accounting for approximately 5% of deaths. It is the fifth biggest cause of mortality in the UK. A wide range of data provides information across various issues relating to COPD, such as prevalence, management of the condition, hospital admissions and mortality. It is not possible to provide the full range of data in this JSNA topic briefing, nor on the Lincolnshire Research Observatory. However, the briefing does identify some useful data sources, should further information be required. Public Health England has produced Respiratory Profiles (2013), which outline the causes and effects of COPD (and asthma). They provide information on such issues as prevalence, prevention, primary care, secondary care and mortality. The National General Practice Profiles provide some information, at General Practice level, on a range of indicators included in the Quality Outcomes Framework (QOF). This provides comparator 1 of 5 Mar 2014 (v2.0)
information for the CCGs and England, showing how practices are performing against the ongoing management indicators in the QOF. The Health and Social Care Information Centre (HSCIC) also provides data on a range of issues, such as mortality and the QOF indicators (registers and management) in relation to COPD. The adult smoking prevalence in Lincolnshire (2011/12) is 20.98%; this is above the East Midlands (19.82%) and the England (19.96%) averages. Four of the seven districts (Lincoln, Boston, West Lindsey and East Lindsey) have seen an increase in prevalence since 2010-11. The current highest prevalence is seen in Lincoln (28.33%) and the lowest in South Holland (14.69%). In 2012/13, 2.05% of the adult population in Lincolnshire (15,418 people) were on general practice COPD registers. This compares with 1.7% for England. There are variations within the county: Lincolnshire East CCG South Lincolnshire CCG South West Lincolnshire CCG Lincolnshire West CCG 2.4% (5,778 people) 1.9% (3,015 people) 1.7% (2,237 people) 1.9% (4,388 people) In Lincolnshire (from 2010 to 2012), the directly age standardised mortality rate (DASR) for COPD (and asthma) for people aged under 75 years was 10.24/100,000 with the highest rates being in Lincoln (14.5), East Lindsey (13.36) and Boston (12.26). Trends In 2012/13, 2.05% of the Lincolnshire population were diagnosed, and on a general practice register for COPD. (The figure for England was 1.7%.) This compares with a rate of 1.9% in 2010/11. (The contemporaneous rate for England was 1.6%.) It is estimated that 3.32% of the Lincolnshire population could have COPD (2010/11), and this is projected to increase to 3.4% in 2015 and 3.5% in 2020. In some areas, such as Boston and East Lindsey, it is predicted the prevalence will rise above 4%. Targets Various strategic frameworks have COPD as a key, or related, component. The NHS Outcomes Framework includes five key domains, which have a range of overarching indicators and improvement areas. The domains specifically relating to COPD are 'preventing people from dying prematurely' (e.g. mortality from respiratory disease) and 'enhancing quality of life for people with long-term conditions' (e.g. people supported to manage their condition). The Public Health Outcomes Framework includes four domains, each of which has associated objectives and indicators. The domains with particular relevance for COPD are 'health improvement' (e.g. smoking prevalence) and 'healthcare, public health and preventing premature mortality' (e.g. mortality from respiratory disease). 2 of 5 Mar 2014 (v2.0)
The QOF financially rewards general practices for the provision of quality care, and helps to standardise improvements in the delivery of primary medical services. COPD is one of the clinical domains in the Framework, and has a range of associated indicators, including records and ongoing management (e.g. people with COPD who have had influenza immunisation). Performance As outlined in the 'Targets' section, there is a range of indicators which are relevant to COPD. The national Outcomes Frameworks have a range of indicators which are relevant to COPD, and these form part of the performance reporting of CCGs and local authorities. The QOF provides information about the quality of care that is provided in general practice for people on a COPD register. The LRO and the HSCIC provides some information on how Lincolnshire is delivering against some of these indicators (some of which are provided in the facts and figures section of this briefing). Various data sources provide information on how Lincolnshire compares to other geographical areas, for example, in relation to prevalence, primary and secondary care indicators and mortality (see 'some sources of additional information section'). What is this telling us? Summary COPD is a key health issue in many national and local strategies. Various interventions are commissioned and provided to address the prevention, management and care of COPD for the Lincolnshire population. Some of these will be included as part of Lincolnshire Health and Care (formerly the Lincolnshire Sustainable Services Review) work. Local views Lincolnshire Health and Care is focussing on how health and social care will be delivered in the county. A wide range of organisations and stakeholders are involved in designing the future delivery model. National and local strategies Various national strategies and plans include COPD as a health issue. These include: The NHS Outcomes Framework The Public Health Outcomes Framework Putting Patients First the NHS England Plan An Outcomes Strategy for Disease and Asthma in England 3 of 5 Mar 2014 (v2.0)
Also available is a wide range of National Institute for Health and Clinical Excellence (NICE) guidance that addresses both the prevention and management of COPD. Locally, COPD is an intrinsic part of various strategies, including: Lincolnshire Joint Strategic Needs Assessment Joint Health and Wellbeing Strategy for Lincolnshire CCG Commissioning Plans Lincolnshire's Tobacco Control Strategy Current activity and services COPD prevention and care is provided across the whole healthcare system. Local authorities commission and provide a range of preventative interventions. For example, Lincolnshire County Council commissions smoking cessation services and a Making Every Contact Count (MECC) programme. General practices maintain a register of people with COPD, and provide ongoing support for patients to manage their condition. Lincolnshire Community Health Services provide respiratory services for patients with COPD. These include community nursing and a home oxygen service. They also provide a smoking cessation service. United Lincolnshire Hospitals NHS Trust and other secondary care providers also contribute to the provision of care for COPD patients. Key inequalities There is a range of health inequalities relating to COPD. Inequalities are evident in the major risk factor for COPD, i.e. smoking. There is a strong link between cigarette smoking and socio-economic group. Long-term smokers have the highest levels of mortality and illness related to their smoking activity. People with COPD also have a reduced life expectancy. Key gaps in knowledge and services There is a wide range of information about COPD, including the extent to which it is affecting the population, evidence about groups at increased risk of developing the condition, and evidence about interventions for managing the condition. 4 of 5 Mar 2014 (v2.0)
Lincolnshire Health and Care (formerly the LSSR) is planning for the future delivery of health and social care in Lincolnshire across four areas: proactive, urgent, elective and women's/children's. Risks of not doing something COPD is a long-term condition that is becoming increasingly prevalent. Smoking is the greatest risk factor for COPD, and therefore it is essential that interventions to reduce the prevalence of smoking continue to be applied. COPD can lead to serious health complications if the condition is not managed well. Consequently, it is essential to promote self-care across the health and social care system. What is coming on the horizon? Lincolnshire Health and Care (formerly the LSSR) will bring significant changes to the way that both health care and social care are provided across Lincolnshire. What should we be doing next? We should continue taking action to implement the Lincolnshire Joint Health and Wellbeing Strategy, particularly Theme 1 (Promoting healthier lifestyles) and Theme 3 (Care for the major causes of ill health and disability). Some sources of additional information PHE Respiratory Profiles - http://www.nepho.org.uk/respiratory/index.php General Practice Profiles - http://fingertips.phe.org.uk/profile/general-practice NICE guidance - http://www.nice.org.uk/ 5 of 5 Mar 2014 (v2.0)