There has been a “concerning” fall in access to specialist nurse services for patients admitted with chronic obstructive pulmonary disease, a major audit has found.
There has been a 9% drop in access to specialist respiratory nurse care – down from 80% in 2008 to 71% in 2014, despite an increase in the number of COPD admissions, according to findings from the latest national audit of services in England and Wales.
Both the Association of Respiratory Nurse Specialists and the Royal College of Nursing raised concerns about the decline in access to specialist nurse care.
“We cannot overstate the importance of access to clinical nurse specialists”
The audit measured the degree to which essential aspects of care were being provided by hospitals for COPD patients in England and Wales.
A report on the audit’s findings – titled COPD: Who Cares? – was published today to coincide with World COPD Day.
Overall, it concluded that care for those with the condition had improved but some hospitals were still “falling short” of national service standards for COPD.
This needs to change, it said, noting that the national standards described what COPD care should look like and all hospitals should be adhering to them.
“We are disappointed to note that there has been a 9% drop in access to specialist respiratory nurse care”
In particular it highlighted “unacceptable variation” in access to specialist care and recommended that all patients admitted with a COPD exacerbation should be cared for by respiratory specialists on a respiratory ward.
The report also warned that only 21% of hospitals had an on-call respiratory service operating seven days a week and only 30% of critical care outreach teams operated out-of-hours during weekdays – while 20% do not operate at all at weekends.
In addition, 37% of units have no inpatient smoking cessation services, with an additional 34% reporting less than 0.5 of a whole time equivalent member of staff available to undertake this activity.
However, the report did point out significant improvements in COPD care since 2008, including an increase in the average number of respiratory consultants and improvement in the availability of palliative care services – up from 50% to 87%.
The management of patients with respiratory failure has also improved and there is better access for patients with COPD to teams who can support an early discharge from hospital, it added.
Its “key” recommendations said that “above all else” COPD patients admitted with an exacerbation should be “cared for by respiratory specialists on a respiratory ward, seven days a week”.
In addition, all hospitals/units should have a fully-funded and resourced smoking cessation programme delivered by dedicated smoking cessation practitioners, and post-discharge pulmonary rehabilitation services should be available within four weeks of referral.
Spirometry results should be made “universally” accessible from every computer desktop via data sharing agreements between primary and secondary care, it recommended.
Dr Robert Stone, COPD audit clinical lead for secondary care, said: “More patients have access to supported discharge teams and assisted ventilation services are better organised.
“However, many patients in England and Wales are still unable to access specialist respiratory care on the right ward from the respiratory team,” he said.
“The availability of smoking cessation services and access to spirometry results is inadequate,” he said. “The way we manage patients’ discharge from hospital needs to improve.”
Rebecca Sherrington, chair of the ARNS, said: “We are really pleased to see that this audit has demonstrated that there have been significant improvements in care for people with COPD since 2008, including an improvement in the availability of palliative care services.
“The management of patients with respiratory failure has improved and there is better access to teams who can support an early discharge from hospital,” she said.
“However, we are disappointed to note that there has been a 9% drop in access to specialist respiratory nurse care despite an increase in the number of people admitted with COPD,” said Ms Sherrington.
“ARNS strongly supports the call for people with this disabling disease to be able to access expert nursing support to help manage their condition,” she added.
Janet Davies, director of nursing at the RCN, said: “We cannot overstate the importance of access to clinical nurse specialists, who can give exemplary support and treatment to both patients and other professionals.
“The focus has to be on helping patients to manage their conditions, and specialist nurses are in the best place to do this. It is very concerning that many patients cannot access specialist care when they need it,” she warned.
The National COPD Audit Programme is commissioned by the Healthcare Quality Improvement Partnership, as part of the National Clinical Audit Programme.
The programme is led by the Royal College of Physicians, working closely with the British Thoracic Society, the Primary Care Respiratory Society UK, the British Lung Foundation and the Royal College of General Practitioners.