• Charity launches new ICS Respiratory Review showing state of local respiratory care across England
• Half of ICSs can’t meet demand to test for chronic obstructive pulmonary disease
• Charity estimates that at least £40 million is needed to deal with backlog
A leading lung health charity is warning that hundreds of thousands of people could be missing out on diagnoses for incurable lung conditions, because of an alarming lack of capacity for testing in local healthcare services.
New research by Asthma + Lung UK shows a bleak picture of the state of respiratory care in England. Over half (16 out of 27) of the Integrated Care Systems (ICSs) in England that responded to a survey by the charity said they did not have enough spirometry testing capacity to meet the demand in their area, while only eight of the ICSs that responded reported having enough capacity to carry out all the tests needed.1,2 This gap means hundreds of thousands of people with debilitating symptoms of chronic obstructive pulmonary disease (COPD) may wait years for a diagnosis, or not get a diagnosis at all.
1.7 million people in the UK live with COPD, with around 600,000 more living undiagnosed and previous research from the charity shows that one in five people with COPD waited over a year to receive a diagnosis after their initial GP appointment.3,4
The data, collected as part of Asthma + Lung UK’s first annual ICS Respiratory Review, provides a vital snapshot of respiratory care across local health systems in England, from diagnosis and provision of basic care to hospital admissions. The review also highlights the intrinsic link between poverty and poor lung health, with the data showing worse outcomes for people with lung conditions in ICSs in areas with higher levels of deprivation.5
Worryingly, the survey responses also reveal large gaps in data collection. Most of the ICSs that responded were unable to say how many referrals for spirometry tests they had received, or how many tests were performed in their area in the past year, making it impossible to gauge the true scale of the problem or resources needed to ensure everyone waiting for a diagnosis can be tested.6
The lack of diagnostic capacity and the lack of data pose real questions about how local NHS systems will be able to achieve key waiting time targets within the NHS Constitution.7 The charity is worried that the recently published NHS Operational Planning Guidance 25/26 makes no mention of this issue, meaning that ICSs may deprioritise work in this area.
Asthma + Lung UK says that in order to make a real difference to the devastating impact lung conditions have on millions of people every year, respiratory health must be prioritised in the upcoming NHS ten-year plan. Crucially, they are calling for a £40 million spirometry fund to ensure equitable access to testing across England so anyone with symptoms of a lung condition can receive a quick, accurate diagnosis and start receiving vital treatment as soon as possible.
Untreated, COPD gets progressively worse and causes 30,000 deaths every year in the UK. Breathlessness brought on by the condition can be terrifying and limit people’s ability to get on with their daily lives. It can also mean people stop being as active, so they become more prone to other medical problems such as high blood pressure, heart disease, obesity, and diabetes.
Early detection is crucial for treating and managing lung conditions such COPD. It can lead to a reduction in hospital admissions and improvement in quality of life and healthy life expectancy, so the fact that people don’t have access to testing across large swathes of the country is unacceptable.
Sarah Sleet, chief executive at Asthma + Lung UK, said: “Lung conditions are the third biggest killer in the UK, the top cause of emergency hospital admissions and the driver behind the NHS winter crisis every year. It’s a scandal that they’re still not being prioritised in local health systems in half of the country people who are struggling to breathe can’t even get the basic tests they need for a diagnosis. The situation is even worse for those living in the most deprived communities, who are five times more likely to die from chronic obstructive pulmonary disease (COPD).
“We’re really grateful to have the support of the ICSs across England who helped us pull together this data, giving us a true gauge of the current state of respiratory care. We hope we can continue to work together, sharing examples of brilliant innovative practice and supporting them to make change. Now we need the government to recognise the importance of good respiratory care. They must provide local healthcare services with sufficient funding to ensure everyone gets the test they need, with a focus on providing more resources in areas with the highest levels of deprivation.”
Asthma + Lung UK believes that a better collective understanding of regional outcomes and approaches for respiratory conditions will improve patient care. The ICS Respiratory Review is a resource for healthcare professionals and commissioners, the first report of its kind, bringing public and ICS data together in one place. It gives a deep insight into respiratory care in each local healthcare system, as well as showcasing innovative practice taking place across the country. The charity is already working with a number of ICSs who want to improve their provision or respiratory diagnostic tests and encourage other ICSs with this ambition to get in touch with them.
CASE STUDY
Dr Matthew Swallow, a GP and one of the senior respiratory clinical leaders in the Birmingham area, is one of six ‘Respiratory Champions’ appointed as part of a pilot programme by Asthma + Lung UK.
As part of the programme, Dr Swallow is leading the redesign of the local pathway for diagnosing lung conditions. This will allow more patients to access vital diagnostic tests quickly, improving outcomes for those with respiratory conditions across Birmingham and Solihull.
Dr Swallow said: “People struggling to breathe are waiting too long for an accurate diagnosis due to inconsistent access to tests. In Birmingham and Solihull, we have a lower-than-average rate of diagnosed COPD and asthma—not because these conditions are less common, but because they are not being properly diagnosed.
“People struggling to breathe are waiting too long for an accurate diagnosis due to inconsistent access to tests. In Birmingham and Solihull, we have a lower-than-average rate of diagnosed COPD and asthma—not because these conditions are less common, but because they are not being properly diagnosed. We are working towards a community-based diagnostic service where people can access advanced lung function tests close to home, without long waits or the need to visit a hospital. My focus has been on improving access to essential tests like spirometry and FeNO, which are currently patchy and fragmented. By setting up a sustainable, community-level diagnostic service, we aim to change this. We are working with stake holders to move this forward to have something setup as soon as possible. This is a crucial step in transforming respiratory care in Birmingham and Solihull.”
-Ends-
Asthma + Lung UK’s ICS Respiratory Review shows key metrics from publicly available data for all Integrated Care Systems. This data is combined with information received from a survey we sent out in October 2024 to all 42 ICSs in England. 32 ICSs responded to tell us about how they are diagnosing, treating and supporting those living with a lung condition.
The ICS Respiratory Review provides a snapshot of respiratory services across England while shining a light on innovative work taking place across the country. We would like to thank all ICSs who participated in the survey.
References
1. Asthma + Lung UK ICS Respiratory Review survey, October 2024 - 16 out of the 27 ICSs who are commissioning spirometry across the whole system responded to say they did not have enough spirometry testing capacity to meet the demand in their area.
2. Asthma + Lung UK ICS Respiratory Review survey, October 2024 - eight of the ICSs who are commissioning spirometry reported having enough capacity to carry all the tests needed
3. Stone et al. Prevalence of Chronic Obstructive Pulmonary Disease in England from 2000 to 2019. Int J Chron Obstruct Pulmon Dis. 2023. Accessed here.
4. Asthma + Lung UK’s annual Life with a Lung Condition Survey 2024, COPD respondents in England.
| How long did you have to wait between talking about your lung condition symptoms with your GP or healthcare professional, to receiving a formal diagnosis? | % respondents | # respondents |
| One month or less | 44% | 1137 |
| 1-2 months | 13% | 327 |
| 3-6 months | 12% | 313 |
| 6 months – a year | 12% | 308 |
| More than a year | 18% | 482 |
| Total | 100% | 2567 |
5. ICS Respiratory Review – Key Outcomes.
6. Asthma + Lung UK ICS Respiratory Review survey, October 2024 – 22/27 ICSs that responded were unable to say how many referrals for spirometry tests they had received or left this question blank, or how many tests were performed in their area in the past year [14/27 were unable to say or left this question blank].
7. The NHS Constitution includes a pledge that patients should not wait more than six weeks for a diagnostic test, with a legal right to treatment within 18 weeks of referral.