ICS respiratory review - challenges

In our survey, we asked ICSs to think about the biggest local barriers for improving respiratory outcomes. We listed 6 options for ICSs to rank in order of concern. Answers were then combined to give a regional overview. It is important for ICSs to recognise the barriers they are facing to be able to provide good quality respiratory care, so that these can be tackled at both a national and local level.

What the data shows

Funding was identified as the top barrier in 6/7 regions, this is unsurprising considering the financially constrained health system ICSs are working within. Workforce was the second biggest barrier.   

There is a wider spread of rankings given to the other barriers across the country. Some localised patterns can be seen: workforce is listed as a greater problem in the North of England than the South, and whole system working/local relationships appear stronger in the North than the South.  

What is Asthma + Lung UK calling for?  

• To reduce funding as a barrier, the upcoming review of the Quality and Outcomes Framework (QOF), a primary care incentive-based funding mechanism, should be used as an opportunity to redesign how incentives could work better for respiratory patients and services, lead improvement of these metrics at the integrated neighbourhood team level, and improve the provision of quality basic care for respiratory patients.
• We also want to see the treasury provide spirometry recovery fund of £40 million over the next two years, with more funding to those ICSs experiencing higher levels of deprivation.
• Reducing workforce related barriers cannot be achieved without a better understanding of respiratory staff numbers, vacancies and skills shortages across England.  We want to see a review of respiratory workforce size and skill set. Dedicated professional development support is needed for all respiratory team members. In the meantime, primary care networks should use their additional roles reimbursement resource (ARRS) to help patients access social prescribing and health coaching in the community. 
• To improve whole system working/local relationships, we urge the government to improve data collection and analysis across the care pathway to bring together primary and secondary data, and make high quality, publicly available data which will help ICSs target care where it is needed and ensure accountability. This will also help to improve the interface between primary and secondary care.
• To reduce existing contracts as a barrier, the 10-year plan should establish sustainable routes to funding and diminish reliance on short term funding mechanisms.
• To improve the prioritisation for respiratory conditions, the government must include respiratory as a focus in the upcoming 10 year NHS plan. At a local level, every ICS should have respiratory clinical lead to ensure that respiratory conditions are referred to the Joint Forward plan and that there is dedicated respiratory plan in every ICS.