Guiding the future of Complex Home Mechanical Ventilation services: British Thoracic Society publishes new Model of Care

HMV is used in the UK to help patients with a diverse range of respiratory, neuromuscular and chest wall disorders. Individuals who use HMV as part of their care generally require long-term support that allows them to continue their lives in the community setting. Examples of conditions that may benefit from HMV include Chronic Obstructive Pulmonary Disease, Obesity-Related Respiratory Failure, Motor Neurone Disease, and Duchenne Muscular Dystrophy.

Although patients with different conditions benefit from HMV, this can result in variation in the care provided, therefore an outline of best practice in HMV is needed. Improving the standardisation and co-ordination of HMV care is essential in ensuring that care is both equitable across the community, and of high quality even when patients leave hospital, with individuals having a clear care plan that is established and utilised.

The document provides guidance in a number of areas such as commissioning, governance, workforce, service and patient pathway development and is informed by the expertise of a multi-professional group of HMV clinicians. Some of the suggested measures included:

• Setting out a novel 3-tier system for organising care – tier 3 being a complex HMV service, tier 2 for patients not meeting criteria for complex care and tier 1 for acute NIV providers.
• Establishing minimum staffing levels and referral numbers for complex HMV services.

·         Advocating for a national registry, to capture data on patient numbers, diagnoses and equipment use.

• Providing guidance to ensure that care is well co-ordinated between tiers of services and that there is consistency in quality and safety of care regardless of setting.

Dr Ben Messer, Consultant in Home Mechanical Ventilation and Critical Care Medicine, comments,

“Patients with chronic ventilatory failure requiring home mechanical ventilation often have complex clinical needs and include patients with progressive neurological disease, patients in need of tracheostomy ventilation and those requiring ventilation for the majority of a 24-hour period. These patients often experience poor outcomes such as hospital admission, readmission and early mortality. 

“It is essential that teams caring for these patients in a community or hospital setting have the resources and skills to enable them to deliver consistently high-quality care. This document provides a roadmap for how this can be achieved, by setting out key information on commissioning, governance, staffing, service design and pathway development for Complex HMV services.”  

This new Model of Care is part of a series and builds on other BTS guidance produced in recent years in the field of enhanced respiratory care including Respiratory Support Units: Guidance on development and implementation in 2021, and the Model of Care for Specialised Weaning Units, published in 2023. It is intended to be used alongside these other Models and adapted suitably for local requirements. Although it focuses specifically on England, the principles are still applicable to the wider UK.

On the Model, Professor Jonathan Bennett, President of the British Thoracic Society, added,

“We hope that this sets the standard for ensuring that services providing home mechanical ventilation can be resourced appropriately and have the necessary skills to deliver the best possible care to all patients who may require such treatments.”

Access the new model of care here.