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Diagnosing breathlessness

In conversation with Professor Mike Morgan, NHS England’s Respiratory NCD

Wednesday, May 18, 2016

  • In March 2016, NHS IQ concluded a national pilot programme which aimed to improve speed and accuracy of diagnosis in patients experiencing the symptom of breathlessness 
  • Following its evaluation, we ask Mike Morgan whether the results continue to have national and local relevance

The NHS IQ Breathlessness pilots were initiated in 2014. Having seen the recent evaluation, do they now seem ‘of their time’ or is this programme still very relevant for NHS England’s New Models of Care agenda?

The breathlessness pilots are entirely in keeping with the NHS England roadmap of the 5YFV and the delivery priorities set out in the 2016/17 Business Plan. Although there is no specific respiratory programme within NHS England, there are priorities around prevention and early diagnosis and the transformation of models of care. The symptom based approach to diagnostic services is also in line with the ambition to streamline clinical commissioning pathways.

Do you think the three pilot reports present many workable, if early, solutions that could be rolled out nationally to improve speed and accuracy of diagnosis in patients with breathlessness?

All three pilots have demonstrated that they can accelerate accurate diagnosis and reduce unnecessary referrals in different settings. However, the principle of the drive to transformation is that there will be different local solutions determined by local priority. There is no universally correct approach but the principles of access, accuracy and timeliness are paramount.

The evaluation makes 12 wide-reaching recommendations, from the importance now of developing a national, standardised set of breathlessness indicators to aligning this work with broader local programmes and priorities. Could you suggest three priorities which should be followed up quickly?

It is hard to pick a top three from the recommendations but I would lump 3 & 4 and 10 & 11 together and add recommendation 5. The first priority therefore would be to disseminate the learning amongst the professional community and the public. Awareness that the symptom of excessive breathlessness should be taken seriously and investigated promptly is in both communities interest.

Recommendations 10 and 11 deal with the development of integrated services and integrated commissioning along the lines of an agreed clinical pathway. This should be incorporated in to the local health economy sustainability and transformation plans (STPs).

Finally, we must take the long view and acknowledge that investing in early diagnosis must improve longer term outcomes in conditions where interventions can prevent premature death or disability.

Your roles, both as NHS England’s Respiratory NCD and Respiratory Consultant at Glenfield Hospital, Leicester, must present you with all kinds of innovation. Have you come across any ‘stand-out’ one-stop-shop diagnostic initiatives for supporting patients experiencing breathlessness within primary care but involving respiratory and cardiology specialists?

I often see good examples of joint working between specialities and professional disciplines. It is difficult to pick one out but it is clear that commissioners particularly need a forum to share innovation and best practice. I have high expectations that Respiratory Futures can perform this role.

Thank you, Mike, we certainly hope so.


Full information about the pilot, including the scoping research project and evaluation report, can be found on the NHS IQ Breathlessness Pilots programme page.