As the COPD strategy sets out what patients can expect, respiratory nurse specialists must ensure that they influence how services are set up and run
As one of the key stakeholders for the national Clinical Strategy for COPD, the Association of Respiratory Nurse Specialists (ARNS) has played a significant role in its development.
However, there are now concerns that the voices of respiratory nurses may not be fully heard at local level during both the review of the strategy and the likely respiratory service redesign that will be required to ensure that the strategy is adequately implemented.
When it is published the COPD strategy will set out ‘quality requirements’ that are focused on patient experiences and outcomes, and set out the type of services that respiratory patients should expect along the whole disease pathway, from raising awareness and early diagnosis to appropriate and timely proactive care, continuing into supportive end-of-life care.
The COPD strategy will also provide ‘markers of good practice’ to guide the standard of care to be expected, but it is at a local level that decisions will be made about where, how and by whom the respiratory care will be provided.
The Clinical Strategy for COPD and its sister COPD Communications Strategy will seek to address the poor awareness of COPD and what it actually is, among both the general public and healthcare professionals. This lack of awareness has led to late presentation and delayed diagnosis, which have a significant impact on the progression of this disease and consequently on both morbidity and mortality.
National media campaigns to raise awareness of COPD will help address this, but we also need to be ready for a significant increase in the number of patients contacting their doctor to seek help, advice and ongoing care.
Are current local health structures ready for this? Is the necessary skilled and trained workforce available within general practice to diagnose COPD accurately and to manage this potential volume of patients? Who will ensure that primary care staff are adequately trained and continue to meet these competencies?
Many areas of the UK do not yet have comprehensive specialist provision of respiratory care, let alone high-quality supportive care for respiratory patients and relatives right to the end of life.
Commissioners may view a respiratory service as multiple small units of provision, but this could be risky if these are put out to tender separately and end up being provided by different organisations. This may not be the most cost-effective way of providing respiratory care - it will also make it extremely difficult to ensure continuity of care, which is likely to be unpopular with patients who usually prefer knowing the members of just one team. The challenge will be how to organise integrated multidisciplinary respiratory services that are patient centred, close to home and cost-effective.
Lord Darzi has suggested that nurses have a key role to play in the future development of NHS services. Respiratory nurse specialists (RNSs) often have a unique insight into how best to deliver care. They must not hesitate to share their ideas within a multidisciplinary arena and contribute towards the redesigning of their local respiratory services. In many areas it will be appropriate to develop RNS-led multidisciplinary community-based services to support and deliver a seamless service across primary and acute care.
ARNS urges RNSs to seek out the person at their PCT who is responsible for organising their local managed clinical network for COPD and respiratory care, and make sure that their voices are heard. It is essential that they are able to influence the future direction of respiratory services provision in their area.
Jenny Till, MSc, BSc, RGN, is clinical lead, South Lakes Community Respiratory Service, NHS Cumbria; and chair, Association of Respiratory Nurse Specialists