Most of the much needed increase in spending on the NHS in the last six years has been used to improve the quality of services and outcomes for hundreds of thousands of patients. These welcome additional resources have been targeted through n ational service frameworks (NSFs) and waiting list initiatives (WLIs). They have been much appreciated, especially by the patients who have benefited. However, a perverse effect of this has been to strangle resources required for developments in other areas,also urgently needed, but not covered by NSFs or WLIs. One of the most important of these is services for patients with respiratory diseases – diseases of the lungs and chest. These include asthma (the commonest chronic disease affecting people of all ages in Britain), chronic obstructive pulmonary disease (COPD), lung cancer, pneumonia, occupational lung diseases, sleep apnoea, cystic fibrosis (the CF gene is the commonest recessive gene in Britain), and rarer, but nonetheless important, diseases such as tuberculosis, sarcoidosis and fibrosing alveolitis.
Eight million people suffer from respiratory diseases in the UK. They are the commonest reason for general practice consultation or emergency medical admission to hospital. A third of the population visit their GP at least once a year because of a respiratory condition. COPD, pneumonia and chest infections account for more than 2.8 million hospital bed days per year. At an estimated £2.5 billion in the year 2000, the cost of respiratory disease is higher than any other disease area.
Respiratory disease kills one in four people in the UK and accounts for more deaths per year than coronary artery disease or non-respiratory cancer. The death rate in the UK is twice the European Union average; only Ireland and four former Soviet republics have higher levels in Europe.
Forty-four per cent of respiratory disease deaths are associated with social class inequalities. Smoking is much more common among lower socio-economic groups. Consequently, the smoking related diseases COPD and lung cancer are far more common among our poorer citizens. Most of the respiratory diseases mentioned above are chronic diseases requiring long term treatment. In asthma, as in several of these illnesses, this treatment is aimed at preventing deteriorations or exacerbations. There are no free prescriptions for any respiratory disease. While many patients are exempt from prescription charges, many others, often just above the threshold for exemption, are not.
Why are more resources needed? Take as an example resources required for patients with COPD. There is conclusive evidence, recently published in a NICE guideline, that in addition to stopping smoking, patients with COPD benefit from rehabilitation classes; hospital at home or early supported-discharge schemes for patients currently admitted to hospital; and nasal non-invasive ventilation for patients with acute deteriorations, diagnosed with ventilatory failure when they are admitted to hospital. We know from our national peer review scheme that very few districts provide all three of these services. Many provide one or two to a high level of expertise, but patients with COPD in every district in the country should have access to each of these services when they are required. Similar postcode provision applies to diagnostic and treatment services for patients with obstructive sleep apnoea.
Donations to and spending by the respiratory research charities are lower than for any other comparable group of diseases. This has recently been compounded by the Department of Health’s inexplicable decision not to include respiratory diseases in their research and development funding programme for clinical treatment trials.
