I became a specialist respiratory nurse in 1995 and was appointed as a community based consultant nurse in an area of social deprivation with a long mining history in 2003. Respiratory disease was prevalent then, with a heavy reliance on secondary care for diagnosis, assessment and management. This was reflected in the high number of hospital admissions and above-average length of stay. COPD prevalence was poorly recorded and life expectancy was lower than the national average with respiratory disease a significant cause of mortality.
From its inception, the consultant nurse role was seen as key to reforming health services with particular emphasis on working across professional and organisational boundaries (reference 1: NHS National Plan 2000). Locally, I was tasked with leading change within the key functions of the consultant nurse role (reference 2: Department of Health). I formed a project implementation group representing a range of clinical professions from primary and secondary care.
Pathways have reduced hospital admissions by 25% and informed the development of pulmonary rehabilitation and oxygen services delivered from the community
Incorporating evidence-based best practice, patient focus group outcomes and mapping services underpinned our respiratory strategy to develop efficient, cost effective, comprehensive and holistic integrated respiratory services that optimised use of existing resources. I used novel and creative approaches to integrate knowledge that underpinned delivery of care and worked to create a culture that put the needs of the patients at the centre of delivering care, with patients supported to make shared decisions.
Developing an integrated respiratory service is an evolving process and 14 years later the process is well established.
The project implementation group has been replaced with a respiratory clinical network where primary care and all 5 hospitals around our locality are represented by members of the multidisciplinary team. The vision is of a fully integrated respiratory service where perceived and actual barriers are overcome through joint working to develop supported cost effective clinical pathways. Such pathways have reduced hospital admissions by 25% and informed the development of pulmonary rehabilitation and oxygen services delivered from the community in a wide variety of settings to best meet the patients’ needs.
Support for the ideology of integrated care is enshrined in the Trust’s strategic vision for delivering personalised care of the highest quality.
Hospital physicians lead twice-weekly MDT meetings and provide community clinics across the locality supported by specialist physiotherapy, nurse and oxygen clinics to manage all aspects of respiratory disease. Rapid assessment for acute exacerbations of COPD / asthma / Bronchiectasis/breathlessness maintain reduced hospital admissions. MDTs based in GP practices are being evaluated and rolled out across the locality, and Gold Standards Framework register meetings are utilised to work across hospice, practice and community teams to improve end of life management.
Initiatives have increased knowledge and skills in practice staff resulting in improved quality of care and increased patient and staff knowledge and satisfaction scores.
Support for the ideology of integrated care is enshrined in the Trust’s strategic vision for delivering personalised care of the highest quality. Additionally, I have been involved with the wider team to plan service delivery to support this vision.
Respiratory input to the development of non-specialist teams (e.g. intermediate care, district nursing), clinical support for design and implementation of IT systems, integration of social care to the organisation and development of a single point of access have further reduced fragmentation and delays in the patient pathway.
1. Department of Health (2000) The NHS plan: a plan for investment, a plan for reform, London: DH
2. Department of Health (1999) Nurse, midwife and health visitor consultants: establishing posts and making appointments, Health Service Circular 1999/217, London: DH