Bradford Breathing Better

Introduction

Long-term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment. About 15 million people in England are known to have one or more long-term condition.

The aim of the NHS Five Year Forward View is to support people with long-term conditions to manage their own health effectively, while reducing demand on NHS services. 

The Bradford Breathing Better Programme was launched on 25 January 2017 with the aim of improving the pathway of care from diagnosis, ensuring improved management of respiratory diseases with a view to reducing avoidable hospital admissions.  This programme is focused on two respiratory conditions; chronic obstructive pulmonary disease (COPD) and asthma. This is because these respiratory conditions result in large numbers of what are considered to be avoidable admissions to hospital.

People with COPD or asthma provided with the right care, at the right time can be helped to manage their conditions without the need for a hospital admission. By working to improve the management of people with respiratory conditions we aim to:

  • improve patient experience,
  • reduce health inequalities, and;
  • reduce spend through reducing the number of preventable hospital admissions. 

It is suggested that between 10-40% of people are non-compliant with both drug and non-drug-regimes and poor compliance to medication contributes to the overall management of these conditions. The reasons behind non-compliance are varied, however among the reasons is the complex nature of the drug regime, the chronic nature of the disease and inadequate inhaler techniques.

We are focusing on COPD and asthma because:

  • there is no cure for COPD, however symptom management including education on self-care strategies which should help stabilise the condition and prevent flare-ups or exacerbations. Supporting people to maintain their health and wellbeing with COPD is important as currently one person dies from COPD every 20 minutes in England - around 23,000 deaths a year.
  • asthma is a condition that affects a person’s airways and although it can be well controlled, there are around 1,000 deaths from asthma a year in the UK, the majority of which are preventable.

How are we doing?

In Bradford the prevalence of asthma is above the national average and the prevalence of COPD is rising. We have higher emergency admissions, higher mortality and higher spend that other areas of the country.

Asthma prevalence

  • nationally, the prevalence of asthma has fallen slightly from 6.0% in 2012/13 to 5.9% in 2015/16
  • in 2015/16 there were 7,914 patients registered with asthma in Bradford City CCG, however we have seen a slight rise in prevalence from 6.3% in 2012/13 to 6.4% in 2015/16
  • in 2015/16 there were 21,955 patients registered in Bradford Districts CCG, the prevalence has fallen slightly from 6.7% in 2012/13 to 6.5% in 2015/16.

Asthma is responsible for large numbers of hospital admissions, the majority of which are emergency admissions. For every 100 people on the asthma disease register there are an estimated four emergency admissions each year with each admission costs on average £1,500.  In addition, it is suggested that some 12,000 people remain undiagnosed with asthma across the whole of the district of Bradford, [source: Respiratory Health in Bradford and Airedale, March 2016, Bradford MDC]

Chronic Obstructive Pulmonary Disease (COPD) prevalence

  • nationally, prevalence of COPD has risen slightly from 1.7% in 2012/13 to 1.9% in 2015/16
  • in 2015/16 there were 1,533 patients registered with COPD in Bradford City CCG, with prevalence of COPD rising in Bradford City CCG from 1.1% in 2012/13 to 1.2% in 2015/16.
  • in 2015/16 there were 8,177 patients registered with COPD in Bradford Districts CCG, in Bradford Districts CCG prevalence has risen from 2.3% to 2.4% over the same period of time and prevalence remains above the national average for Districts CCGs.

COPD is responsible for large numbers of non-elective hospital admissions – some of which are avoidable. It is suggested that for every 100 people on the COPD disease register there are an estimated 15 emergency admissions each year.  Each admission costs on average £2,000.

Measures that we intend to monitor as part of this programme include (but not limited to):

  • under 75 mortality rate from respiratory disease
  • emergency admissions for children with lower respiratory tract infections (LRTI), or emergency admission rate for children with asthma per 100,000 population aged 0–18 years
  • non-elective admissions for COPD and readmission rate for non-elective spells for COPD
  • patients reporting they feel supported to manage their long-term condition
  • inequality in unplanned hospitalisation for ACSCs
  • health inequalities in emergency admissions for UCS
  • emergency admissions for urgent care sensitive conditions (UCS, composite measure) includes: COPD
  • urgent and emergency care: population use of hospital beds following emergency admission
  • primary care management of long term conditions: chronic ambulatory care sensitive conditions (ACSCs, composite measure) includes: asthma & COPD
  • NHS Right Care allocative efficiency: outcomes in areas with identified scope for improvement and allocative efficiency: expenditure in areas with identified scope for improvement

What we have achieved in 2016/17

Bradford Breathing Better was launched in January 2017 at an event attended by around 60 GPs and nurses and other healthcare staff from across Bradford. Going forward, this programme will ensure that good practice is spread and improvement achieved by following a similar model to the Bradford Beating Diabetes and Bradford’s Healthy Hearts programmes which have already achieved considerable success and recognition. A programme board is to be established and a lead is to be appointed.  Each GP practice is to identify its own practice respiratory lead.

Improvements will be made by concentrating on four areas:

  • self-care
  • prescribing and formulary
  • clinical template development and
  • pathways redesign

Bradford Breathing Better plans over the next two years

The planning stage for Bradford Breathing Better (BBB) is underway and will be rolled out in 2017/18. This programme aims to raise awareness for earlier diagnosis, improve clinical management and support self-management of respiratory disease. The work will involve strong partnership working across primary care, secondary care and the voluntary and community sector, as well as organisations such as The British Lung Foundation and Asthma UK. 

By working to improve the management of people with respiratory conditions we will improve patient experience, reduce health inequalities and reduce spend through reducing the number of preventable hospital admissions.  This programme will help us to realise some Quality, Innovation, Productivity and Preventions savings which will be identified through the reduction in avoidable hospital admissions for COPD and asthma

We will link work looking at support for children and young people with asthma to the Bradford Breathing Better programme in 2017/18, looking for opportunities to develop our links into schools and other community based settings.

Our Bradford Breathing Better plans for the next five years

Bradford Breathing Better programme was initiated in 2016/17 and over the next few years will focus on Chronic Obstructive Pulmonary Disease and Asthma which are the two respiratory conditions resulting in the largest number of non-elective admissions to hospital. The aim of the Bradford Breathing Better programme is to improve the pathway of care and to improve the patients’ experience.

We also aim to:

  • establish the Bradford Breathing Better programme
  • engage with stakeholders and hold workshops
  • develop clinical templates 
  • create resource packs and redesign of management plans
  • self-care management education programme
  • develop COPD management plans for secondary care and improve discharge information across primary and secondary care
  • increase referral to smoking cessation and pulmonary rehab (as part of the care pathway)
  • reduce drugs cost and waste / review prescribing (Carbocisteine) in primary and secondary care.