1. education for health The National Strategy for COPD It’s taking shape! Monica Fletcher Chief Executive Education for Health Chair European Lung Foundation

2. education for health COPD care: a change in attitude DiagnosingPredicting Pessimistic Optimistic Treating Preventing The past few years have revealed an attitudinal shift in COPD care ‘From Unjustified Nihilism to evidence based Optimism’ (Celli et al 2006)

3. The COPD Vision:  To that everyone diagnosed with COPD receives equitable, responsive, high quality and effective health and social care services from the right person, at the right time, in the right place.  On going commitment is to ensure that all communities can expect better prevention strategies for COPD, quicker identification for those at greatest risk, clear standards of care and treatment that ensure dignity and respect that lie at the heart of the patient journey

4. education for health The public consultation document contained 24 evidence based recommendations to improve care Combined with NICE/BTS guidelines should be enough to kick start service delivery of high quality COPD and asthma care Ministers currently considering how to turn it into an outcomes based strategy

5. education for health Why do we need to wait for the DOH strategy The political wheels turn very slowly

6. education for health

8. COPD in 40–65 year olds ages them and creates frustration “I feel like I am old. I feel like I am really old, and I am 51.” UK patient “I hate not being able to do something and that my wife has to help me. It is infuriating. I have never depended on anyone.” Spanish patient “I’m totally disgusted with my life.” U.S. patient “The most important thing I’ve lost is probably getting together with my dad and playing outdoors.” UK son “We had a very big group of friends and relatives, but since my wife got ill only 2 or 3 people are left.” U.S. Spouse “She is throwing her life away and she is throwing my life away.” U.S. Spouse “A bad day is when you need to sit down because you can’t handle it anymore but you need to make it to the office and deal with 200 emails.” Spanish patient Fletcher at al 5th IPCRG World Conference, June 2010,

9. The Number of COPD patients diagnosed 900,000, but actual estimated prevalence 3.7million…….. these are the “Missing Millions” ( Graph based on DH unpublished estimate, 2009). Shawab et al Thorax 2006

10. Spectrum of COPD Prevention and Awareness to End of Life Care WellAt-riskWith COPD diagnosis No symptomsSymptoms but no diagnosis MILD stage MODERATE stage SEVERE stage The earliest point at which airflow obstruction may be detected by spirometry Damage Unaware of lung health Aware of lung health Raising awareness of early signs and symptoms VERY SEVERE stage Access to supportive care for patient and family through to bereavement stage Managed according to guidelines, e.g. Liverpool Care Pathway

11. DH focus for improving outcomes Prevention & Health improvement Early Accurate Diagnosis and Assessment Chronic disease management including self management, exacerbations and treatment Palliative and ‘End of life’ care Earlier identification: More proactive management: Care closer to home: Integrated care

12. What has been accomplished so far by DOH? Published national consultation document Developed clinical leadership and joint partnership working including with industry and patient organisations Gathered evidence on what is working well Testing different models of care Introduced measurement of performance Changes to system levers and incentives Funded pilot and research studies Aligned with new and emerging policies

13. education for health DOH Practical help for you We have an approachable team at the DOH, with strong leadership The NHS improvement Lung Improvement team and their website for inspiration Worked on competences and a range of educational programmes with more on the way to support staff development We have respiratory leads in every SHA who can share local benchmarking data

14. Implementation SHA Respiratory leads Paul Corris Sharon Haggerty John White Mike Ward Jane Scullion Dermot O’Ryan John Williams June Roberts Stephen Gaduzo Colin Gelder Sandy Walmsley Tasks: Set up high level steering group Develop communities of practice Support improvement programme Benchmarking data Annual report of progress Steve Holmes James Calvert David Halpin Maxine Hardinge Jo Congleton Jo Wookey Julia Bott Tony Davison Leanne Jongepier Louise Restrick and team

15. education for health Despite their widespread promulgation, there is unequivocal evidence that guidelines have: limited effect on changing physician behaviour, marginal improvement in patient outcomes and their cost effectiveness is called into question! Lomas et al(1989), Woolfe et al(1993), Grimshaw et al 2004, Thomas et al (2005)

16. education for health Why don’t physicians use guidelines? Cabana M. (1999)JAMA Systematic review 5658 articles reviewed 76 published studies at least one barrier 76 articles included 120 different physician surveys Identifying 293 potential barriers!!! Clustered these into 7 main themes Developed three groups: Knowledge, attitude and behaviour

17. education for health KNOWLEDGEATTITUDESBEHAVIOUR Lack of familiarity Lack of awareness Lack of outcome expectancy Lack of self-efficacy Lack of Motivation External Barriers:  Patient Factors  Guideline Factors  Environmental Factors Lack of Agreement with: Specific guidelines Guidelines in general Cabana 1999

18. education for health Clinical Experience Making the same mistakes with increasing confidence over an impressive number of years “If you always do what you have always done, you will always get what you always got”

19. education for health Diffusion of Innovations Rogers (1995)

20. education for health Achieving behaviour change ACTIVITY Inform Educate Engage Enlist VALUE Behaviour Commitment Under- standing Aware- ness

21. education for health Implementation of change : Your role EDUCATION SOCIOLOGY PSYCHOLOGY COMMUNICATIONS MARKETING

22. education for health Where are you at? Where do you want to get to? What is stopping you getting there? So what are you going to do about it?

23. education for health Questions to ask yourself Early outcomes or long term perspective Tangible rewards or do you gain rewards in other ways Naturally a doer or do you prefer to facilitate others Do you personally prefer a high or low profile Are you a follower or a leader Happy on your own or in a team

24. education for health Death of the Lone Ranger Powerful Charismatic High achiever High risk Impersonal Distant Short term gains

25. education for health The Wizard of Oz! Scarecrow: The Brain Tin Woodsman: The Heart Lion: Courage Dorothy..

26. education for health Brain Conceptual thinker Emotional intelligence Systems thinker Accomplishing tasks Critical view of self

27. education for health Lion Challenge the status quo Draw out and deal with conflict Risk taker Learn from failures Instil courage in others to follow Lead change

28. education for health Heart Outstanding leaders appeal to the hearts of their followers – not just their minds Passion and compassion Mission driven Relationships Interpersonal

29. education for health Dorothy Humanity Strong communication Ability to harness diversity

30. education for health Others must…… Trust you Have faith in you Believe in you Essentially you have to believe in yourself! Be prepared to challenge! Control the ‘I can’t’ Don’t take no for an answer Be a boundroid

31. education for health Enabling qualities Sense of humour Empathetic Energetic Passionate Sensitive Visionary

32. education for health There’s no place like home

33. education for health There are three kinds of people: Those who watch Things Happen Those who wonder what happened Those who make things happen Where do you fit??? Lee Lacocca CEO Chrysler