NHS Long Term Plan

The NHS Long Term Plan was published in January 2019. It sets out key ambitions for health and care over the next 10 years.

Lung health is now a clinical priority for the NHS for the first time. This is very important progress. It will drive investment to identify lung disease early and make sure people have the right diagnosis and get the right medicines and treatment. 

The Taskforce was approached by NHS England to help inform the NHS Plan and played a critical role in raising awareness of the urgent need to make lung health a priority.

The Taskforce has ensured that NHS England has included the right priority areas and that it has given a real voice to patient representatives in the governance for the plan. This has been a notable achievement.

 “Thanks to the Taskforce, patient organisations are now embedded at every level in the structure of NHS England’s Long Term Plan. This is a remarkable change from old practices and ensures that the patient’s view will always be considered in the development of new services.”

Mike Morgan, NHS England Respiratory National Clinical Director until October 2019

“The Taskforce shows the importance of the patient voice in bringing about improvements in treatment and care. We have been involved from the earliest stage and have always felt that our experience and input mattered.”

“The health service can improve the way it manages change by involving patients, alongside clinicians and commissioners, as early as possible. If you alter the way something has been done for a long time, you need to provide information in a way that clearly sets out the benefits to patients.”

Lynn Willacy, NHS England Respiratory Delivery Board patient representative

Taskforce recommendations included in the NHS Plan

A number of Taskforce recommendations have been included in the NHS Plan:

  • access to stop smoking support to pregnant women and people with mental health problems and to NHS-funded tobacco treatment services to everyone admitted to hospital by 2023-24 (recommendation 1a) 
  • a review of the vaccination programme to boost uptake including for flu (recommendation 1h)
  • action to reduce the NHS contribution to air pollution (recommendation 1d)
  • development of a breathlessness pathway (recommendation 2a)
  • action to reduce variation in quality of spirometry testing (recommendation 2a)
  • expanded role for pharmacists in supporting people to manage long term conditions (recommendation 2b and 4e)
  • a pilot programme to deliver lung health checks. They will aim to diagnose early stage lung disease, but will also pick up other lung conditions like chronic obstructive pulmonary disease (COPD) (taking steps towards recommendation 2e)
  • additional support for patients to receive and use the correct medication. There is also a pledge to trial smart inhalers (recommendation 3d)
  • a personalised care plans for people with long-term conditions (recommendation 4a)
  • expansion of pulmonary rehabilitation (PR) services over 10 years, with better access to services. A commitment to enable more people with cardiac and lung disease to do joint breathlessness rehabilitation (recommendations 4b and partially 6k)
  • end of life care training for staff and provision of personalised care planning for everyone identified as being in the last year of life (recommendation 5e)

“The NHS has worked closely with the Taskforce for Lung Health and the British Lung Foundation to develop a national programme for respiratory and cardiovascular disease. This is now a clinical priority for the NHS and the government is committed to driving it forward. We are working with the British Lung Foundation and the NHS to deliver the plan.”

Baroness Blackwood of North Oxford, Under-Secretary of State at the Department of Health and Social Care

To oversee the delivery of these commitments, NHS England has established working groups to implement the NHS Plan’s respiratory programme, three of which have been mirrored by those of the Taskforce.

All local health systems have prepared implementation plans for how they will deliver the respiratory ambitions of the NHS Plan in their areas. It is expected that the draft plans will be published this winter.

In the summer, the Taskforce contacted every local area with localised statistics of respiratory disease prevalence urging them to prioritise respiratory. We offered them our support in the preparation of their implementation plans. We have had follow-up face-to-face meetings and telephone calls with a number of these organisations.

We have also been working closely with NHS RightCare, a body helping local areas to use data and evidence to improve their services. We have attended their local and regional respiratory events, highlighting to delegates the respiratory elements of the NHS Plan and the Taskforce’s Plan recommendations. This work will continue to provide opportunities to influence the plans of local health care systems, especially around case-finding for COPD, spirometry testing, PR and inhaler technique.

“The Taskforce for Lung Health demonstrates the importance of working collaboratively with industry, patients and the NHS to improve access to the best quality treatment and care for people with lung disease.”

“The progress we have already seen, such as the inclusion of Taskforce recommendations in NHS England’s Long Term Plan, shows what impact this partnership can have in improving respiratory care.”

“We look forward to continuing the discussions and hard work to make a difference to patients.”

Danielle Ross, GSK

Tracking the progress of the NHS Plan

The Taskforce has provided feedback to NHS England on the measures it is going to use to track the progress of the NHS Plan. Our advice has resulted in some changes to the draft metrics:

  • The expansion of the metrics to include both COPD and asthma where appropriate rather than just one or the other as both are of primary importance.
  • The inclusion of Accident and Emergency visits as a measure of how well people are able to manage their disease. This will be used to give a more rounded picture of how effective a health care solution is. Previously, only data for unplanned admissions was being captured, but for patients staying healthy enough to avoid any visit to A&E is important. 
  • The inclusion of prevalence data (the total number of people living with a disease) for asthma and COPD to provide a baseline so we can see, for instance, how many people have a diagnosis and need to access NHS treatment.

There is more influencing work to be done on:

  • Measuring patient-reported outcomes – asking patients if they themselves have seen an increase in their quality of life as a result of a health care solution. This is to ensure patients are at the forefront of the work being done.
  • Breaking out the analysis of demographic factors (such as gender, income and ethnicity) when looking at inequalities in diagnosis or access to treatment, rather than using a combined measure of deprivation. This increased detail will give a better understanding of health inequalities.
  • The exploration of a measure for ‘unplanned interactions’, which will cover all touch points patients have with the health care system. This could include, for example, A&E visits, being seen by a paramedic, hospital admissions, NHS 111 calls and even GP visits. People interact with the health care system in many different ways and it’s important to monitor all of them to see if health care solutions make it easier for people to manage their disease themselves and stay as well as possible.

The confirmed NHS metrics will be useful to monitor the NHS Plan. But the Taskforce will continue to champion the importance of more, and better quality, data, including the establishment of national respiratory measures of success as exist for cancer and cardiac disease. We are still lacking data on a number of significant areas, including speed of diagnosis and referrals to pulmonary rehabilitation, for example.