News release - Patients with lung disease must not be pushed to the back of the queue again

To care for the surge in COVID-19 patients, many respiratory departments have again been among the first being forced to cancel specialist clinics, such as for lung cancer, COPD and other respiratory conditions, delaying diagnosis and life-saving treatments.

Respiratory departments are now dealing with routine admissions and the second wave of COVID-19, but soon we will also have to deal the seasonal surge in acute respiratory patients, the winter pressures. It is important to remember that it’s not just flu causing these, so even with a mild flu season, we will see an increase in admissions caused by exacerbations of, for example, COPD and asthma, due to the cold and damp weather.

Professor Jon Bennett, Chair of the British Thoracic Society said: “Colleagues across the UK have seen increasing numbers of COVID-19 admissions, in some region higher than in the first wave, soon the winter pressures will begin to bite, yet we are expected to maintain the same level of care with a fraction of the resources needed. This places an unacceptable burden on a workforce already feeling the strain, which ultimately impacts patient care.

It’s not PPE or simply beds, we lack enough of the highly trained respiratory professionals needed to staff those beds and deliver care; specialist nurses, doctors, physiologists and physiotherapists to name a few.”

The need to maintain the same levels of service pre-pandemic, makes it very difficult for other specialties to help with acute and long term COVID-19 care leaving respiratory departments fending for themselves when they need the most support.

“It is hard for respiratory professionals not to feel left alone in responding to the second wave of the pandemic”, Bennett added.

At a Health Service Journal event today, Professor Bennett told NHS leaders in the audience, that while it might be too late in the immediate term, it is imperative that NHS and trusts recognise the extra pressure that respiratory wards have been under during the pandemic and every year in the winter, and truly work with the specialty to find and implement solutions.

As a start, the increased pressure on staff and resources at particular times of the year needs to be accounted for when scheduling of staffing and services, especially now that the respiratory specialty is expected to provide acute- and long-COVID care, as well as rehab and recovery for the foreseeable future.

Among the other medium and long term solutions that BTS is highlighting are:

• Annualised staff scheduling that reflects the seasonal imbalance of demand resulting from winter increase in activity.
• Service agreements that allow respiratory professionals to prioritise caring for respiratory patients and limit shifts to cover general and emergency medicine services.
• More focus on outpatient work during the summer to reduce waiting times to a minimum and so allow for a degree of slippage during winter, when there is increased work.
• Widely adopt and adapt the innovations we refined during the pandemic, like non face-to-face consultations and virtual Multi-Disciplinary Team meetings (MDTs) and remote assessments.
• Structural support to enable closer integration between secondary and primary care to deliver respiratory care outside the hospital, in the community.
• Develop IT systems that can seamless work across primary and secondary care to encourage more integrated way of working.
• A minimum of 200 more respiratory higher specialist training numbers over 5 years, and more respiratory staff all round.

The NHS buckles every winter under the pressure from the extra respiratory admissions, which on its own is unacceptable, but the situation is more acute now that COVID-19 is overloading our hospitals. That’s why Professor Bennett also stressed that any extra resilience needs to be permanently built into the respiratory workforce to be prepared for another respiratory outbreak in the future.

And that since this has not been done when there was a chance, patients with respiratory diseases now risk being left behind again.

To conclude, Professor Bennett said:

“The first wave caught us relatively unprepared, and we resorted to pause all but the most critical respiratory services. 

“Respiratory patients cannot get the care they need and deserve without an adequately staffed, well organised and resourced respiratory workforce. We cannot rely on the support of colleagues in other specialties. That would just move the problem elsewhere.

“Our patients cannot be put at the back of the queue anymore, whether because of winter pressures, COVID-19 or any other reason.”

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