After seven years, strategy is warmly welcomed

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Following seven years of campaigning, Dame Helena Shovelton, chief executive of the British Lung Foundation, welcomes the publication of the outcomes strategy to tackle Chronic Obstructive Pulmonary Disease (COPD) and asthma.

For those who don't know – what is COPD?

COPD, Chronic Obstructive Pulmonary Disease, is an umbrella term which covers a range of respiratory diseases from chronic bronchitis through to emphysema.

You estimate that the strategy could reduce hospital admissions for COPD by half; why will it have such a dramatic effect?

This is a personal estimate rather than one that the Department of Health has made. I think this is possible, because the strategy enables you to locate people much earlier and offer them a more comprehensive diagnosis at an earlier disease stage. This could mean that they don't progress so much and then, hopefully, you will reduce admissions in the future. At present, people are often only found to have COPD when at the moderate and severe end of the disease, often when they are admitted to hospital for the first time.

The second half of this is, if you change the way care is supplied, it should mean that much more can be managed at home rather than necessarily resulting in a hospital admission. On the other side, what it is most likely to mean is that the people who do have to be admitted, might have to be admitted for longer.

Do you think introducing the strategy will make savings for the NHS?

I think the savings will need to be used to a larger extent to supply the services in the community. My ambition would be that you can operate a better service for less money. The government is going to publish another document in the autumn, which is an economic impact assessment, which should demonstrate that better.

How important is the strategy in terms of early intervention and involving people in their own health outcomes?

It is absolutely crucial. At the moment if you are diagnosed with COPD, the chances are you have never heard of the disease, you don't know how to do anything about it, the right information is not necessarily given to you. So you do all the things that will make you get worse rather than better.

As a result of the involvement of many patients throughout the seven years, we have reached a point where there is an acceptance that doing things differently, and involving and empowering patients better, will actually result in lower healthcare costs and less impact on the patients themselves.

Throughout the seven years of campaigning, what has your involvement been in putting the strategy together?

We identified, along with others in the respiratory community, that unless we had a strategy which was then called a national service framework, respiratory disease would never achieve the prominence to ensure that there were the improvements made in the service such that you could deliver all of these good things.

So the British Lung Foundation and the British Thoracic Society, and all kinds of different organisations, were instrumental in persuading Liam Donaldson to call for a national service framework on COPD, in his report as chief medical officer way back in 2004.

That was the start of things, and from then on it was accepted in 2005 that this should happen. We in the organisation have been part of the external reference group; we have supplied all of the patients, we have taken it away and discussed it with all of the patient groups, and really insured that the patient voice has been heard in this particular strategy, in a way that I don't think it has always been heard in previous strategies.

Sadly, of course, what that means is that we have had the deaths of some of those people who were on the external reference group. Basically what we are looking at now is the fact that we have a lot more people who are prepared to be user representatives, work with the Health and Well-being Board and carry out all of the things that are necessary with the primary care trusts until they cease to be in existence, if they do.

This has empowered the entire patient representative bodies that are within the Breathe Easy Group, which is the patient group side of the British Lung Foundation. There have been moments when the campaign for the strategy has stalled, and by galvanising those patients each time this has come back up the agenda. So they have been instrumental, not only in ensuring that they are asking for things that are really important, but in making sure that the campaign didn't disappear.

You say the strategy has been stalled on numerous occasions: are you disappointed that it has taken so long for the strategy to be published?

Well, I would have obviously preferred it to have been done much more quickly. But the vast bulk of the time was with the previous government, not with the present coalition.

I think considering that the Health Bill is going through Parliament, we have done quite well to get it out, in just over a year since the coalition government took office. I am grateful for the fact it has appeared in that sort of timescale. I was disappointed that it took longer under the Labour government to get to the consultation stage.

Now that the strategy has been published, what happens on the ground: how quickly do you see it being implemented?

They have published the headline messages. In the autumn they are planning to produce a guide for the NHS on how to implement it; the economic impact assessment will come alongside that.

In between they will publish three commissioning guides, so that is how it is going to start to take shape. Until the autumn document comes out, the NHS does not have a clear steer on how it is expected to do this.

I would be disappointed if the National Commissioning Board (NCB), as this is its first outcomes strategy, didn't decide to pick it up and get the overall commissioning guide produced. This will amalgamate a combination of things from Quality, Innovation, Productivity and Prevention (QIPP), the National Institute for Health and Clinical Excellence (NICE) and the strategy, to the point where you have an all-encompassing commissioning guide.

That would be very good, that is the next stage – we are at the end of the beginning.