It’s no secret that access to healthcare is plagued with inequalities — and this is especially true for respiratory and lung disease care in the UK.
A report by Asthma + Lung UK found that those living in the poorest communities of the country were twice as likely to develop a lung condition and seven times more likely to die from it. Poor environments, poor housing, employment prospects and low incomes are all key contributors to respiratory illness — along with smoking which continues to be a major factor.
Although smoking rates have been falling since the 1970s, there are still more than five million smokers in England and 6.4 million across the UK, with a higher prevalence among men. However, evidence shows that deaths from smoking can be reduced if people have access to tobacco dependency services.
Breathing Space, Rotherham’s NHS community centre
Specialists in respiratory care are finding new ways to address the issue of access and education for people of all social and cultural backgrounds.
In Rotherham, South Yorkshire, an NHS community centre called Breathing Space has been set up to support people with Chronic Obstructive Pulmonary Disease (COPD) and other respiratory conditions across the wider community — and it’s changing lives.
The centre has its own rehabilitation gym, offers Tai Chi and yoga sessions, lifestyle and education sessions, a full oxygen assessment service, as well as support and advice for giving up smoking. Ultimately, the carers here focus on finding whatever approach works best for each patient.
“I wouldn’t go to a normal gym because I feel embarrassed by it,” explains Yvonne, a patient at Breathing Space. “The fact that I’ve got super fit people around me, while I’m struggling to breathe… I feel conscious that they’re all staring at me.”
“Having this here is marvellous, as you know everyone is in the same boat; everybody’s got the same struggles that I’ve got. So I feel really comfortable,” she says.
At Breathing Space, there’s also access to tangible education tools that patients can engage with.
“Having models, having posters, having something tactile to use in your clinic, can mean that the patient goes out with a better understanding of their anatomy and physiology than giving them a leaflet that they’re probably not going to read,” says Jacqui Pollington, Respiratory Nurse Consultant at the centre.
It’s widely reported that cultural barriers restrict access to healthcare. And for some older ethnic minority people, language and lack of access to translation services are a real obstacle to getting the care they need.
The provision of accessible communications such as multilingual education tools have been shown to greatly improve asthma care, for example.
Dr Llinos Jones, a Respiratory Consultant in Mid Yorkshire Teaching NHS Trust, was determined asthma information should be accessible to all, and found that getting closer to communities has been a real driving force for change, allowing for a more authentic experience for patients.
“We were very fortunate to be invited into community centres and mosques,” she explains in ITN Business’ news-style programme Breathing Better Together . “We trained community champions and we used that cohort to guide us, and co-produce collaboratively a suite of videos that were culturally competent – not just translated but very culturally sensitive,” she says.
“We don’t have hard-to-reach populations, we have hard-to-reach services. And that narrative needs to change so we can redress the balance.”
The British Thoracic Society has welcomed efforts by UK nations to gather better inequality data so that it can be tackled more effectively.
“It’s obviously never going to be as quick as you’d want it to be, but by ensuring that the health inequalities is part of a theme through everything we do, we can start that from now”, says John Park, Respiratory Consultant at Oxford University Hospitals NHS Foundation Trust.
“We’d like to deliver a workforce that’s more inclusive, more diverse, that helps represent our patient groups and can help us address the health inequalities as a consequence.”
Virtual wards: Remote monitoring and in-home care
John Green, a respiratory patient based in the Isle of Wight, has found huge benefits through the virtual ward that he’s a part of, at St Mary’s Hospital — a form of care which he says has taken all the “stress out of life.”
See more: Explore ITN Business’ Breathing Better Together programme
The virtual ward, supported by the Association of Respiratory Nurses (ARNS), means patients know they’re being monitored 12 hours a day, seven days a week. Specialist nurses keep a close eye on patients from the hospital hub, where virtual ward tech experts and the Community Rapid Response team look for anything outside of an individual’s agreed parameters.
The virtual ward in the IOW links each patient’s equipment, via Bluetooth, to their tablet, and then from their tablet the readings come through to an online platform. Patients are then visited by nurses in the home.
Consultant Nurse Joanne King at Frimley explains why these virtual wards are proving so important to respiratory care services.
“Respiratory illness is a huge burden to our healthcare system, especially over those winter months — respiratory admissions are one of the highest that we see in hospitals in emergency care. But with our respiratory nursing groups, we can provide that care outside of the traditional hospital setting […] and give good specialist care to patients at the same level of excellence that they get in hospitals.”