Foreword: Chair of the Taskforce

19 January 2023

I was delighted to take over as Chair of the Taskforce for Lung Health last year after more than four years of Alison Cook’s expert leadership. We owe Alison huge thanks for all her hard work, commitment to amplifying the voice and experience of people with lung conditions, and steadfast belief in the power of collaboration.

I am highly aware that I’ve joined the Taskforce at a very challenging time to influence national policy making. There have been three changes of Secretaries of State for Health and Social Care in just seven months and several new faces amongst Health Ministers. The pressures on the NHS and waiting lists are at an all-time high, and we are in what Professor Sir Stephen Powis, NHS National Medical Director, has said ‘is likely to be the NHS’s most challenging winter ever”. The Government has announced a Major Conditions Strategy, which includes a specific workstream on chronic respiratory disease and has committed to an NHS Workforce Plan in Spring, both of which very welcome and we are looking forward to influencing. However, it is still unclear how this relates to the NHS Long Term, now that a planned refresh of that document looks unlikely, or how the strategy will address health inequalities now that the Health Inequalities White Paper will not be published and whether the Tobacco Control Plan will emerge.

For me, this shows why the Taskforce remains as vital as ever. It was through the collective efforts of the Taskforce that we made the case for lung health to be included in the Long Term Plan and for this to be delivered by a National Clinical Director for respiratory, with a delivery team and a respiratory network to progress improvements in patient care. Given the current financial and political environment, we now need to keep fighting to ensure respiratory care remains a priority. We need to build on, rather than lose, the progress made to date – and ultimately raise the ambition for lung health even further. This is especially important with manifestos being written in 2023 for a possible general election in 2024.  

I am optimistic about what we can achieve, and in the short time I have been Chair, there have been some important developments that have the potential to deliver substantive improvements in our approach to lung conditions:

Breathlessness pathway

The first of these is NHS England’s pre-diagnosis breathlessness pathway, which Taskforce fed into. With pilots underway we hope to see this become embedded into frontline clinical practice, particularly in primary care, and we will be looking closely to make sure people with lung conditions receive clear and appropriate information about what to expect at each stage. Good patient communications are also vital to underpin the fast-growing network of Community Diagnostic Centres. At the time of writing, it is encouraging that 92 are now up and running, and the expectation is that these will give access to a wide range of diagnostic tests without the need to attend acute hospital sites, as well as reducing the time waiting for tests to take place and the number of appointments needed. We will have valuable evidence about the extent to which people currently wait for a diagnosis when the research Taskforce commissioned from Imperial College London publishes its findings in 2023. This will serve as a valuable benchmark against which we hope to see improvement.

Spirometry 

A vital requirement to support the accurate diagnosis of respiratory conditions is a return to the comprehensive use of spirometry. Spirometry was severely disrupted as a result of COVID-19 but its use in 2022 remains patchy and unacceptably low. Our recent ‘Future of spirometry’ webinar was attended by more than 250 people and many expressed their frustration and a high appetite to see a full resumption and extended training provision. We have also held very constructive discussions with NHS England about the need for research on the benefits of spirometry in Targeted Lung Health Checks and will continue to make this case. This will remain a Taskforce priority in 2023.  

SABA Inhalers 

We are encouraged that Taskforce’s concern about unnecessarily high prescribing rates for short-acting beta-2 agonist (SABA) e.g., salbutamol inhalers in people with asthma, continues to be supported by NHS England. Investment and Impact Fund (IIF) incentives have also been introduced to encourage the prescribing of preventer inhalers and decrease of SABA prescribing. We are hoping to see a reduction in people being overprescribed SABA and we will continue to monitor the situation. An important mechanism to achieve this is for patients to have annual reviews and regular inhaler technique checks, and we still need to see much more progress on these. We believe a key enabler for this would be to increase the role and responsibilities of community pharmacists.  

Focus on workforce 

With Rt Hon Jeremy Hunt MP becoming Chancellor, we are hoping he will support a strategic and transformational NHS Workforce Strategy. He chaired the House of Commons Health and Social Care Committee, and their report ‘Clearing the backlog caused by the pandemic’ gave unequivocal recommendations about workforce, and this has been a regular focus of his. It is timely then that in 2022 Taskforce established our Workforce Working Group. Our group brings a strong perspective from across the respiratory community, including patients and carers, professional associations representing frontline clinical workers, and industry partners. With our member, British Thoracic Society saying this year that 82% of hospitals reported vacant respiratory consultant posts in 2021, the Taskforce is committed to working together to push for the urgent delivery of the NHS Workforce Strategy in 2023, and to make sure there is a tangible plan for how to accelerate, train and retain a more robust respiratory workforce.

Thank you to our dedicated members and supporters for all their efforts this year. I look forward to working together in 2023 to continue to raise the profile of respiratory issues in the hearts and minds of national policymakers and ensure the delivery of healthcare services that improve our nation’s lung health.

– Henry Gregg