Taskforce: summary of recommendations

Here’s a list of everything we’re recommending as part of our five year plan. 

Keeping lungs healthy

  • Plan and fund effective, high-quality stop smoking services which are accessible to everyone who wants to quit
  • All health care professionals to be trained in offering very brief advice on smoking cessation
  • Introduce category D Clean Air Zones in the most polluted towns and cities across England
  • Place new restrictions on particulate matter (PM) emissions from all sources
  • Government to introduce a national system of air pollution alerts with health advice
  • Improve the awareness of and compliance with the Control of Substances Hazardous to Health Regulations 2002 (COSHH) to prevent and control workplace exposures
  • Embed understanding of occupational lung disease in undergraduate and postgraduate health care professional training and ensure continuing professional development programmes in relevant clinical groups maintain knowledge in this area
  • Increase rate of flu vaccination among the clinical at-risk groups and front-line NHS and social care staff who have contact with patients

Identifying lung disease early

  • Create a clear patient pathway with services for timely, accurate and complete diagnosis for all people with breathlessness and other respiratory symptoms
  • Develop a formal referral system to enable community pharmacists to refer people directly to general practice or other appropriate organisations
  • Develop a single consistent guideline for diagnosis and management of asthma, including referral to tertiary services as appropriate for difficult or suspected severe asthma and ensure appropriate resources for implementation
  • Introduce targeted case-finding for people who have symptoms suggestive of COPD in general practice, with follow-up care and services
  • Implement a comprehensive national lung cancer screening programme, targeting those at high risk of developing lung cancer, and offering them low dose CT screening

Better care for all

  • Establish clear best practice in assessment, referral and regular monitoring of all people who would benefit from a lung transplant
  • Establish clear best practice in assessment, referral and regular monitoring of people with advanced chronic obstructive pulmonary disease (COPD) and advanced breathlessness who would benefit from a lung volume reduction procedure
  • All surgery units to employ enhanced recovery after surgery (ERAS) guidelines with a specific focus on lung health
  • Improve inhaled therapy, by developing a clear pathway for accurate prescribing and adherence, and promoting new technology such as smart inhalers
  • The government and pharmaceutical industry should work together to improve access to antifibrotic drugs for idiopathic pulmonary fibrosis (IPF), cystic fibrosis transmembrane conductance regulator (CFTR) modulators for cystic fibrosis and monoclonal antibodies for severe asthma
  • Fully implement British Thoracic Society (BTS) home oxygen therapy guidelines to improve use of home and ambulatory oxygen. Fully implement the NICE quality standard on IPF to ensure people have access to beneficial home and ambulatory oxygen therapy
  • Respiratory guidelines should involve positive interventions for people with mental health problems

Living with a lung disease

  • Every person with lung disease to have a personalised care and support plan. Patients, families and carers should have access to relevant information about their condition, treatment and management 
  • Improve access to pulmonary rehabilitation so that every person with an MRC breathlessness score of grade 2 and above is identified, referred to and has the opportunity to complete, a programme
  • Expand the use of non-pharmacological treatments for breathlessness and cough 
  • To promote and signpost people living with lung disease, their families and carers to support groups which are run in joint leadership between people affected by lung disease and health care professionals
  • Expand the delivery of NHS Medicines Use Review and NHS New Medicine Services in pharmacies and remove the cap on the number of these they can deliver

The right care in the last year of life

  • Every person with lung disease and their carer(s) should have access to a shared decision-making programme where they can identify areas where they need additional support 
  • People with lung disease should be supported to stay at home where appropriate
  • Health care professionals should be aware of the range of therapies that can help with and mitigate breathlessness, pain, depression and anxiety at the end of life
  • Generalist and specialist respiratory and end of life services should work together to deliver end of life care
  • All health care professionals should be able to offer basic end of life care advice

A workforce for the future

  • NHS England to provide a vision of required health care professionals for a developed workforce for quality provision of respiratory care to Health Education England by 2020, with evidence of progress towards achieving this within five years
  • Expand the NHS England drive to ensure that as many health care professionals as possible work at the highest end of their remit, for example advanced clinical practitioners and assistant practitioners
  • NHS England and Health Education England to refresh GP strategy with a focus on retention as well as recruitment
  • Create an additional 100 respiratory speciality training posts over 5 years (20 per year)
  • NHS England and the government must focus on recruitment and retention of nurses, including reviewing the funding mechanisms for training and continuing professional development programmes
  • The Royal College of Radiologists, supported by the British Society for Thoracic Imaging, to introduce national standards for speed of reporting
  • Invest in sufficient workforce and equipment to ensure all departments are reporting at the speed of the fastest 
  • Create regional thoracic imaging networks to share expertise between hospitals
  • 500 additional training places to be made available by Health Education England, and delivered by the National School for Healthcare Science, to fill the current gap in the respiratory and sleep physiology/health care scientist workforce, with commissioners and providers being aware that business cases for new respiratory consultants should include the need for greater respiratory and sleep physiology/health care science workforce capacity to support them
  • Continue to increase physiotherapy training places to meet target of at least 600 additional physiotherapists over five years
  • Where appropriate, commission joint community rehabilitation services (for instance linking with cardiac rehabilitation) to support patients with co-morbidities while making best use of the workforce
  • Provide more training places for pharmacists in GP practices
  • Include consultant pharmacist posts in strategic workforce plans