Update on the National Strategy Dr Robert Winter Joint National Clinical Director, Respiratory Programme

Staying healthy Mental health Children’s health Planned care Long term conditions Acute care Acute care Acute care Acute care Acute care Acute care End of life care Maternity and newborn COPD – ‘a disease without a beginning’ 5th biggest cause of death 2nd most common cause of emergency admission One of the most costly, in terms of acute care (£930m) Total cost to UK £3900m 170,000 prescriptions for oxygen Inhaler therapy in top 3 for PCTs

ensure that everyone diagnosed with COPD receives equitable, responsive, high quality and effective provision of health and social care services from the right person, at the right time, in the right place, that are cost effective and provide good value for money for taxpayers. support people with COPD and their carers by offering practical advice and education on managing their disease. advise how local communities can prevent people getting COPD, understand the risks of having poor lung health, secure improvements to the diagnosis and care of people with the disease, and reduce health inequalities. National COPD Strategy – 24 recommendations

What a GP on weekend call in Enfield knows about criteria for referral for COPD? What a pharmacist in Chesterfield knows about teaching inhaler technique? What a person with COPD in Huddersfield knows about keeping healthy in winter? What people in Great Yarmouth with COPD know about the quality of their service? What commissioners in Doncaster understand about the quality of oxygen services? National COPD Strategy – who is responsible for

Hierarchy Network

COPD Strategy – the first six months Accurate Diagnosis Transforming acute care Models of chronic disease and self- management Pulmonary rehabilitation Home oxygen assessment and review End of life care Consultation 119 responses 51 Regional Programmes selected for support JanuaryFebruaryMarch April May June 10 SHA events 5 patient events Programme board established 10 SHA Respiratory leads Election and new administration

Professor Tony Davison Lianne Jongepier Jane Scullion Dr Dermot Ryan Dr Mike Ward Dr Jo Congleton Julia Bott Jo Wookey Dr Maxine Hardinge Dr John White Professor Paul Corris Sharon Haggerty Dr Stephen Gaduzo June Roberts Dr John Williams Dr Colin Gelder Sandy Walsmley Dr Louise Restrick Ms Maria Buxton Dr Craig Davidson Dr Vince Mak Dr James Calvert Dr Steven Homes SHA Respiratory lead clinicians

Accurate Diagnosis, 6 Better Oxygen prescribing, 12 Transforming acute care, 12 Self-management, 11 Rehabilitation, 2 End of life care, 7 NHS Improvement Projects

New Secretary of State set 5 clear priorities: A patient-led NHS: strengthening patients' choice and management of their own care, and ensuring they have a voice in the NHS Delivering better health outcomes: shifting focus and resources towards better health outcomes, including national health outcome measures, patient-reported outcomes, and patient experience measures A more autonomous and accountable system : creating a long-term sustainable framework of institutions for the NHS, with greater autonomy from political interference and greater accountability to patients and the public, focused on outcomes Improved public health through a new public health delivery system: promoting better public health for the nation by focusing on public health A focus on reforming long-term care: improving accessibility and options for long-term and social care by focusing on prevention, personalisation and partnership delivery.

New Secretary of State set 5 clear priorities: A patient-led NHS: strengthening patients' choice and management of their own care, and ensuring they have a voice in the NHS Delivering better health outcomes: shifting focus and resources towards better health outcomes, including national health outcome measures, patient-reported outcomes, and patient experience measures A more autonomous and accountable system : creating a long-term sustainable framework of institutions for the NHS, with greater autonomy from political interference and greater accountability to patients and the public, focused on outcomes Improved public health through a new public health delivery system: promoting better public health for the nation by focusing on public health A focus on reforming long-term care: improving accessibility and options for long-term and social care by focusing on prevention, personalisation and partnership delivery.

New Secretary of State set 5 clear priorities: A patient-led NHS: strengthening patients' choice and management of their own care, and ensuring they have a voice in the NHS Delivering better health outcomes: shifting focus and resources towards better health outcomes, including national health outcome measures, patient-reported outcomes, and patient experience measures A more autonomous and accountable system : creating a long-term sustainable framework of institutions for the NHS, with greater autonomy from political interference and greater accountability to patients and the public, focused on outcomes Improved public health through a new public health delivery system: promoting better public health for the nation by focusing on public health A focus on reforming long-term care: improving accessibility and options for long-term and social care by focusing on prevention, personalisation and partnership delivery.

New Secretary of State set 5 clear priorities: A patient-led NHS: strengthening patients' choice and management of their own care, and ensuring they have a voice in the NHS Delivering better health outcomes: shifting focus and resources towards better health outcomes, including national health outcome measures, patient-reported outcomes, and patient experience measures A more autonomous and accountable system : creating a long-term sustainable framework of institutions for the NHS, with greater autonomy from political interference and greater accountability to patients and the public, focused on outcomes Improved public health through a new public health delivery system: promoting better public health for the nation by focusing on public health A focus on reforming long-term care: improving accessibility and options for long-term and social care by focusing on prevention, personalisation and partnership delivery.

New Secretary of State set 5 clear priorities: A patient-led NHS: strengthening patients' choice and management of their own care, and ensuring they have a voice in the NHS Delivering better health outcomes: shifting focus and resources towards better health outcomes, including national health outcome measures, patient-reported outcomes, and patient experience measures A more autonomous and accountable system : creating a long-term sustainable framework of institutions for the NHS, with greater autonomy from political interference and greater accountability to patients and the public, focused on outcomes Improved public health through a new public health delivery system: promoting better public health for the nation by focusing on public health A focus on reforming long-term care: improving accessibility and options for long-term and social care by focusing on prevention, personalisation and partnership delivery.

Speaking to an audience of patients, carers and staff at an event in London on 8 th June, the Health Secretary challenged the NHS : make a cultural shift. From a culture responsive mainly to orders from the top- down, to one responsive to patients, in which patient safety is put first. devolve power through the unleashing of meaningful information to patients. Comparative data about standards and patient experience will drive up standards, as the data will influence patient choice. A transparent NHS is a safer NHS. engage people in their care so that, “no decision is made about me, without me”, and give patients the opportunity to provide feedback in real time, reflecting the experience of their care. embrace leadership by setting NHS professionals free from a target-centred and bureaucratic system that compromises patient care, to one focussed on the quality, innovation, productivity and safety required to improve patient outcomes. adopt a holistic approach by looking at the entire patient pathway from preventative health and well-being measures, through to hospital and community care. align payments in the NHS to drive up the quality of care that patients receive. In the first instance, through introducing payments which encapsulate a more integrated care pathway by giving hospitals responsibility for a patient’s care for 30 days after they are discharged.

COPD and the New Administration Existing commitments and programmes currently under review Conservative Green Paper on Health outlined an objective `To reduce premature mortality from lung disease to below, or converging with, EU averages by 2020 as classified by OECD’ Establishment of NHS Commissioning Board White Paper to be published 6 th July

Some of what we do is clinically effective Some of what we do is not effective but necessary BUT Much of what we do is not effective Quality and Productivity variation unnecessary/duplicate investigations ineffective prescribing and treatments unproductive bureaucracy

Added value from doing things right (quality improvement) Added value from doing the right things (making the right decisions) High Value High Value High Value Low Value

All programmes – relating outcome to expenditure

Implementing the strategy and the importance of data Nationally Doing the things that will support clinicians locally –e.g. getting the right people and ensuring they have the right tools and evidence to do their jobs Locally Clinicians working to look at how to get the best care – This is what we are going to be exploring today

Hierarchy Network

Tools to support implementation Workforce competencies Pulmonary Rehab’ guidelines Spirometry guidelines NIV guidelines Commissioning toolkit COPD indicators and dataset NICE clinical guidelines

Timelines for implementation Review COPD/Asthma registers Review oxygen registers Evidence based interventions ie pul rehab Asthma action plans Develop pro-active approaches to managing people with COPD Effective management of existing caseload 2014 Transforming acute care Models of chronic disease management/self management Reduce admission rates for asthma Home oxygen assessment and review End of life care Identifying, Implementing and spreading best practice 2015 Pro-active case finding Opportunistic case finding Prevention NHS Improvement programme

Making the COPD strategy a reality… Large scale change - integrated care with fewer hospital admissions Higher quality care, more personalised with better information and education Care more accessible, closer to home, supported by telemedicine ‘The patient will see you now, doctor’ Supported by actionable data on outcome, that are clinically led and owned Plans now need to be agreed by regional and local clinical networks, PBC/commissioners and phased in