1. Integrated Nurse Led Respiratory Service Sandy Walmsley RGN, MSc Lead Respiratory Nurse Specialist –Solihull Care Trust Co Respiratory Clinical Lead – West Midlands SHA

2. Session Overview Background Current service Future projects/developments Reflections

3. How did it all start? Offered job in September 2005 Remit was to initiate Pulmonary Rehabilitation in Community Funding also available for full time physiotherapist

4. If at first you don’t succeed…… Physiotherapist who was originally appointed declined the offer After much discussion a Service level Agreement (SLA) was agreed with local Acute Trust

5. Friends need to be made! GPs Practice Nurses Consultants Commissioners Professional Executive Committee (PEC) Patients

6. Progress……. Referrals started to come in from GPs, Practice Nurses & consultants Nurse led clinics initiated to assess patients for PR Community PR successfully initiated But……….. More staff were needed to help manage referrals

7. What happened next? Presentation of business case to PEC Agreed to appoint Another nurse Occupational therapist Admin assistant

8. Community Pulmonary Rehab expanded Additional site identified Maintenance classes commenced at both sites Local Breathe Easy group “born” out of rehab classes

9. Admission figures from Pulmonary Rehabilitation

10. But quality was needed too Further presentation to PEC to request yet more funding Funding for provision for COPD diploma for 1 practice nurse and 1 GP from every surgery Further funding awarded from SHA with proviso that training be offered to hospital nurses too.

11. Integration, integration, integration! After lengthy discussions with consultants & physiologists Business case submitted for 2 blood gas analysers Pathway developed for integrated oxygen assessment pathway Post discharge oxygen pathway

12. Rationalising oxygen use to improve patient safety and to reduce waste The IMPRESS step-by-step guide

13. Partnership working One GP consortia decided to address COPD with LES. Agreed to fund further staff for team Band 7 nurse 2 HCAs Early supported discharge to be initiated Integrated discharge planning with acute care

14. Early Supported Discharge Figures & Trends

15. NH S.........where to now?

16. The White Paper This represents a significant shift in focus for the NHS – moving away from monitoring the processes of care to monitoring the results of the care and treatment provided to patients Sets out the Government’s strategy for the NHS

17. Transforming Community Services Integrating with acute care Preparations have already started Meetings with acute & community teams Reviewing current pathways with all stakeholders

18. Current Projects Working closely with Smoking Cessation Services to identify “Missing Millions” One of 6 National End of Life projects. Working with Specialist Palliative Care Team

19. We CAN do it!! Draft consultation document & NICE Guidelines foundation for quality care Collect your data & benchmark with similar PCTs to use as rationale for service improvement and delivery Contact SHA Leads for help & support Showcase your service Identify “friends” and share best practice

20. Together we will get the whole picture