The CAP in people with a learning disability (LD) guidance written by the British Thoracic Society addresses the risk assessment, prevention and management of CAP in patients of all ages with LDs. How important is this guidance regarding the treatment and care of those with LDs?
The guidance is an important milestone in respiratory care, as the first national document that focuses specifically on those with LDs, who often face higher risks and poorer outcomes.
What makes it so important is that it doesn’t just highlight the problem, it offers practical, evidence-based advice for clinicians, carers, and services on how to assess risk, prevent illness, and manage treatment. It encourages a shift from reacting to crises to planning ahead and making care more inclusive and tailored.
By embedding reasonable adjustments and multidisciplinary support into everyday practice care becomes both safer and more equitable. This guidance complemented the work we were already developing in Bradford, helping to refine our approach and strengthen its impact. It has led to improved recognition of risk and reduced emergency hospital admissions for people with learning disabilities.
What changes have been driven by this guidance, and how has that impacted the provision of care across Trusts?
The Keeping My Chest Healthy (KMCH) respiratory pathway was first developed in Bradford in 2019 in response to stark inequalities in respiratory outcomes for people with learning disabilities. The publication of the BTS guidance provided a robust evidence base. It strengthened our approach and helped refine the tools and resources we had co-produced.
Specifically, it provided an evidence base for, our risk scoring tool, and reinforced the importance of health promotion and preventative measures, both of which are core components of the KMCH pathway.
Alignment with national guidance has strengthened local confidence in the pathway, supported wider adoption across other Trusts, and ensured implementation is consistent with best practice. As a result, KMCH has translated national recommendations into practical, accessible interventions that improve safety, consistency, and outcomes for people with learning disabilities across diverse care settings.
What is the online Risk Scoring Tool and what impact has it had on admissions?
The online Risk Scoring Tool, developed within the KMCH project, is a simple, quick-to-use resource that can be completed by any member of the team.
Aligned with BTS guidance and co-produced with clinicians and families, it helps identify modifiable respiratory risks in people with learning disabilities - such as dysphagia, reflux, mobility issues, and oral health. Users say it’s easy to use and has helped them spot risks they hadn’t previously considered.
It provides a clear entry point into the KMCH pathway, prompting early conversations, supporting multidisciplinary decision-making, and guiding personalised care planning.
Crucially, it shifts practice from reacting when someone is already unwell to preventing illness and promoting health, embedding proactive respiratory care into routine practice. In Bradford, its use was associated with a 76% reduction in respiratory-related hospital admissions and a 92% drop in bed days, showing the impact of structured risk assessment on outcomes, safety, and system capacity.
What advice can you offer to clinicians wanting to implement it in their practice?
Our advice is to treat KMCH not as an ‘add-on’, but as a framework for safer, more consistent respiratory care. Start small - identify a cohort and use the pathway, resources, and training to embed a proactive approach.
KMCH is simple, adaptable, and co-produced, so there’s no need to reinvent systems. Instead, align it with your local practice and build from there. The real strength of KMCH is how it brings teams together to identify and address modifiable risks. By making respiratory care “everyone’s business,” the pathway becomes a shared tool for structuring conversations, sharing responsibility, and building confidence across professionals, families, and carers.
It’s about making respiratory care part of everyday thinking, not just something we respond to in crisis. In this way, prevention becomes part of everyday practice rather than an additional task. It’s easy to start, and the benefits are quickly seen.
What do you envision for the future of this modelling tool and pathway, and how can other practitioners get involved?
We see KMCH becoming a standard approach to tackling respiratory risk in people with learning disabilities across the NHS. Beyond hospital admissions, the Bradford evaluation showed over a 40% reduction in all healthcare contacts measured – including a 57.9% drop in A&E attendances and a 40.2% reduction in antibiotic prescribing. This highlights the potential to improve safety, quality of life, and efficiency through proactive care.
Looking ahead, we are expanding KMCH into primary care to support Annual Health Checks, and into acute settings to guide care planning after respiratory admissions. This ensures the pathway adds value across the whole system. Practitioners can get involved by adopting the pathway locally, contributing feedback, and joining the growing network of Trusts already engaged. This collaborative approach will strengthen the evidence base, sustain innovation, and drive national change in how respiratory health inequalities are addressed.