The COPD strategy offers a huge opportunity to transform patient care, but how will nurses deliver this agenda if they are not trained and educated to do so, asks Monica Fletcher
The COPD draft strategy for England is a step closer to publication following an extensive consultation that ended in April (Department of Health, 2010). But I can hear groans: “We are already creaking at the seams on the frontline and now another top-down strategy to contend with.”
Let me assure you its development has involved many nurses and this document will make a real difference and address the challenges faced by many people with COPD. More people die from respiratory diseases in this country than any from other condition and this strategy will start to make inroads in tackling this huge problem.
It feels like we have been waiting an age. We have been reassured that the result of the general election will not scupper its publication. The appointment of respiratory leads by strategic health authorities around the country and the development of the lung improvement programme are clear signs that this will be the case. I am delighted to see that some of the vitally important SHA appointments are being filled by nurses, in job shares with medical colleagues.
Sadly, the main problem with the draft document is its length; at first glance it looks like a phone directory, which will put many of you off even picking it up! But if you visit the DH website and download a chapter, you may find it much more palatable.
The draft strategy encourages the NHS to: get more involved with preventing COPD, in particular smoking cessation and prevention; improve diagnosis; help people to self-manage; reduce hospital admissions; and improve end of life care.
Nurses, along with other allied health professionals, have the potential to grasp this strategy and transform the lives of the millions of people living with and dying of the condition each year. However, it is a concern that the needs of the workforce are not clearly explored in the document. How will nurses deliver this agenda if they are not trained and educated to do so? COPD is a complex condition and, like many other long term conditions, it needs staff with special skills and competencies to ensure high quality and effective care.
We know there is very little new money to deliver this strategy and as pressures mount on all public services to cut costs, I do not foresee healthcare organisations rushing to train their workforce in COPD. Yet this is just what they should be doing - and doing it now - before the strategy becomes policy. As much of this care will be delivered in primary and community care settings, there must be significant investment in training and preparing the workforce who are mainly, although not exclusively, nurses.
The General Medical Services contract acknowledges that all nurses employed by GP practices should have access to appropriate training, professional advice and continuing professional development. Yet this is not universally embraced across the country and in my experience in some of the areas of greatest need and deprivation, access to training is at its worst. This is a problem as COPD historically affects people from lower socioeconomic backgrounds.
Nurses need to stand up and demand education and training in both COPD and spirometry. The management of this condition has become more complex over the years, the outlook for many people has improved as a result and nurses need to keep pace with these changes to ensure best care for their patients. Nurses can deliver the strategy. It is a huge opportunity for our patients and should not be missed.
MONICA FLETCHER is chief executive, Education for Health
Department of Health (2010) Consultation on a Strategy for Services for Chronic Obstructive Pulmonary Disease (COPD) in England. London: