Thank you Rob [Stockley, clinician] and Sue [Hill]. And may I start by congratulating you both for turning this event into such a major highlight in the international calender.
And may I thank all of you for coming here today. COPD represents one of the big challenges of modern healthcare and – as your presence confirms – very much an issue of global importance.
A century ago, events like this would have been organised around the challenge of infectious diseases. Thanks to their efforts, those challenges, while not eradicated entirely, are today far less of a concern. Certainly in the developed world.
But even in the developing world, the progress has been extraordinary. You will all remember how, early this year, India was removed from the list of countries where Polio is endemic. An incredible achievement.
But today we face new challenges. Today the challenge is of the growing threat of non-communicable diseases. Diseases like cancer, diabetes and, of course, COPD. Threatening disability and early mortality – and in many cases wholly avoidable.
COPD is a real problem for us here in England.
· Some 3 million people have COPD, many of whom remain undiagnosed.
· Our death rates are around double the average across the European Union.
· And the quality of care varies across the country such that, if all care was at the level of the current best 25%, over 7,000 lives could be saved every year.
When someone develops a disease like COPD, the cost – both human and financial – is huge. Not only on their own lives, but on the lives of their loved ones, their family and on the wider community.
The gravity of the situation is such that, if we do not act with boldness, vision and determination to tackle diseases like COPD, our health systems face collapse.
So what do we do? Across the world, we need to act differently, and we need to act together in common cause.
At the global level, the World Health Organisation is developing a monitoring framework for non-communicable diseases. Of course, our ambition must always be achievable and acceptable to individual countries, but this can go a long way to catalysing action around the world.
We stand ready to play our part.
Here in England, we know that if we are to make real progress, we can’t see this as a challenge for our National Health Service alone. That’s why we’re taking a ‘whole Government’ approach to non-communicable diseases. Tackling the wider social determinants of health and improving the environment in which people live are just as important.
To this end, we’ve introduced our own framework of measurable outcomes:
· that focuses on prevention;
· that gives healthcare professionals and local communities the freedom and resources to focus on outcomes;
· that empowers individuals to take control of their own healthcare;
· that brings the whole of society together to promote healthier lives, including industry; and
· that aims to create a healthier environment.
In the two years since this conference last met, we’ve made significant progress. Changing our approach to the prevention, detection, diagnosis and treatment of COPD along these lines.
In July last year, we published our Outcomes Strategy for COPD and Asthma. The result of significant collaboration with patients, clinicians, commissioners, charities, professional bodies and industry.
The Outcomes Strategy speaks to all parts of the healthcare system in England – to public health, to our National Health Service and to social care – as well as to other parts of national and local government, business, charities, communities and most importantly, to people with COPD and their carers.
It calls for a change in approach to COPD.
· To raise the awareness of lung health and the symptoms of the disease among both health professionals and the general public.
· That focuses on the importance of early diagnosis, to slow progression and improve lives.
· That puts patients in control of their own care – fully informed and sharing in the decisions made about them.
· That helps them to manage their condition. Controlling it, rather than it controlling them.
· And one that is based on the best and latest evidence. Making sure that people get the drugs, the care and the support they need.
Early and accurate diagnosis
As I said, in England there are an estimated three million people with COPD. But less than a million of these have an actual diagnosis.
That’s over two million people in England who have COPD and don’t even know it. Two million people who are not getting the help and support they need to stop it getting worse. Two million people who don’t know that there are things they could be doing to make their lives both longer and better.
That’s why early and accurate diagnosis is so important.
It means people can act to slow the progression of the disease. It means they can learn to manage their condition, and know what to do when things go wrong.
It means that local areas can plan services that are appropriate and proportionate to their needs because they have a better idea about who has COPD in their community.
And, importantly, it means no more turning up to Accident and Emergency because things have spiralled out of control.
This is what has happened in St Helens in the north west of England. By promoting early detection, more people are diagnosed and helped in the early stages of the disease, improving their quality of life and preventing avoidable hospital admissions.
In 12 months, they made over 400  new diagnoses, reduced COPD-related hospital admissions by almost 10% [9.2%] and demonstrated a dramatic increase in patients’ awareness and understanding of the disease.
But things don’t stop at diagnosis.
We then need to focus on managing the disease – taking treatment and support out of the hospital and into the community and people’s homes wherever possible. Helping people to live longer and better with their condition in a way that suits them.
This is what they are doing in South Sefton, in the north east of England. Working in partnership with GlaxoSmithKline, GPs have identified their at most risk patients, and concentrated their resources accordingly. Those at highest risk are assessed either in their own community or in their own home, their care optimised by a community respiratory specialist nurse and a self-led care plan agreed to help patients look after themselves.
This has seen emergency admissions and the length of stay in hospital both cut by a fifth [21% and 20% respectively], all the while saving the local NHS almost £180,000 – about $280,000.
While we need to do everything we need to do to keep people healthy and out of hospital, crises do happen. That is when high quality acute care and – vitally – proper, effective discharge really comes to the fore.
Imperial College Healthcare Trust in London, working with other local NHS organisations have developed a package of discharge care for COPD patients. The aim – to improve care and reduce readmissions.
By improving COPD awareness and training among staff, by creating multi-disciplinary teams – from both primary and secondary care – to monitor patients, by making it easy for patients to get help from allied health professionals and by providing a patient management plan upon discharge...
... they have seen:
· An almost 20% [19%] drop in acute admissions;
· A two thirds [66%] fall in readmissions;
· And a fall in the number of patients presenting without a previous COPD diagnosis.
Earlier this year, I visited the Chelsea and Westminster Hospital where I met some of the healthcare professionals who are delivering this COPD discharge care bundle.
I met patients who could not talk more highly of the service they received and the positive impact it had made on their lives.
We have some significant challenges in England when it comes to COPD. But by embracing this new approach, we’re beginning to see a real improvement in outcomes.
Clinicians across the country are making the difference, and we in government are providing the tools and resources to support them.
We’ve published our Outcomes Strategy – setting out the high-level vision of what we want the whole health and care system to achieve, and an NHS Companion Document, stating what role our National Health Service will play within this.
We’ve developed a Commissioning Toolkit – to be published shortly, to give local commissioners the support they need to create robust, effective local services.
We’ve developed a network of support – from the National Clinical Directors, such as Sue, to the NHS Improvement: Lung Programme, to the regional respiratory clinical leads across the country.
We’re opening up and publishing new data – so important for local areas to see how they are performing, in comparison with others across the country – and across the world. We’re also creating a core data set for respiratory disease, that local areas can use.
But there is more to do – thousands more lives to be saved each and every year.
That’s why conferences like this are so important. To hear from each other. To learn from each other. To forge connections between one another.
In America, there is a much more systematic approach to managing people with a long term condition.
In Australia and New Zealand there has been a huge amount of work developing and implementing guidelines for the management of people with COPD. And also for those with asthma.
And in Europe, the European Respiratory Society has developed a roadmap for respiratory disease, setting out the steps we need to take to mobilise expertise, resources and commitment to improve the respiratory health of all of Europe’s citizens.
But whichever healthcare system we look at, we can see a common thread... a similar approach.
· To prevent people from getting the disease in the first place, reducing their risk factors,
· To diagnose early,
· To manage effectively, including helping patients to manage their own condition, and
· To ensure access to specialist services should their condition deteriorates
The international GOLD [Global initiative for Chronic Obstructive Lung Disease] and BOLD [Burden of Lung Disease] initiatives show exactly how by pooling our experience and sharing our knowledge, we can make a difference. I want to thank clinicians in this country and across the world who are contributing significantly to both to improve outcomes in COPD.
And I want to finish by thanking all of you here today for all the work you do driving improvements in COPD.
Together we can save lives. And we can make lives better.