ACTasONE

RESPIRATORY PROGRAMME ANNUAL REPORT APRIL 2020!MARCH 2021 CONTENTS

Foreword ...... 3

Background ...... 5

COVID-19 ...... 8

Post COVID syndrome service ...... 11

Flu ...... 13

Next steps ...... 16

Acknowledgements ...... 18

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 2 FOREWORD

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 3 FOREWORD

In a year like no other where we have had to respond quickly to the threats and challenges posed by a global pandemic, we have really demonstrated how we Act as One in our respiratory programmes. In a normal year there are seasonal pressures which we can plan for, with the odd exception, but COVID-19 has been unparalleled and has had an impact on all our lives. Among the tragic stories of personal loss, there have been reasons for optimism as our communities worked together to collectively respond to the pandemic and we have seen partnership working at a scale which would have been barely imaginable just over a year ago from the time of writing. We are particularly impressed with how we have worked across services, teams and organisational boundaries in response to COVID-19. This included setting up long COVID care pathways, which were featured nationally by Channel 4’s Despatches programme. We have also established the COVID@Home service – you can read more about this in our annual report. While we have been dealing with the impact of COVID-19 on our health and care services, we have continued to make progress in our Act as One Respiratory Programme. We had our most successful flu vaccination programme with more than 25,000 additional people taking up the offer of a flu jab this year compared to 2019. But hidden in this data is the continuing challenge of varying uptake across our place, with lower uptake in areas that are economically challenged. This low uptake of the flu vaccine in some parts of our place highlights the need for us to really understand and respond to health inequalities that have been further widened since the pandemic began. Our focus will be on continuing to innovate but we are committed to understanding our communities and ensuring we can respond to their needs. This means we will be person and not service led throughout our programme, supported by the relationships we have through our voluntary and community sector organisations. This has been an extraordinary year, we cannot forget the human impact of the pandemic yet we must also hold on to the rapid transformation that is helping our communities and making best use of our people to improve outcomes.

Karen Dawber SRO for the Act as One Respiratory Programme

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 4 BACKGROUND

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 5 BACKGROUND

Respiratory diseases are diseases that affect the air passages, including the nasal passages, the bronchi and the lungs. They range from acute infections, such as pneumonia and bronchitis, to chronic conditions such as asthma and chronic obstructive pulmonary disease (COPD). With some of the greatest ill health locally associated with asthma and COPD, these respiratory conditions contribute to health inequalities, ill health and premature death.

‘Lung conditions, including lung cancer, are estimated to cost wider society around £9.9 billion each year. Respiratory disease affects one in five people in , and is the third biggest cause of death. Hospital admissions for lung disease have risen over the past seven years at three times the rate of all admissions generally and remain a major factor in the winter pressures faced by the NHS. Over the next ten years we will be targeting investment in improved treatment and support for those with respiratory disease, with an ambition to transform our outcomes to equal, or better, our international counterparts.’ NHS Long Term Plan

Our Joint Strategic Needs Assessment highlights the following:

More than people die from respiratory disease every year in the district. An estimated 25% of these deaths are preventable.

With rates of early death (before the age of 75) from respiratory disease in District amongst the highest in England and the second highest in and Humber, respiratory disease is a leading cause of dying early in Bradford District.

deaths (on average) per year due to respiratory disease in the under 75s. The main 180 causes of death are COPD and pneumonia. y t

Mortality rates in Bradford i District and have l shown an increase since a Bradford t 2011, whereas rates for District and r

respiratory disease in Craven o England and Yorkshire and Humber have shown m a steady decline.

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 6

There is a strong association of Bradford’s neighbourhoods fall between mortality and deprivation, 34% within the 10% most deprived in with the most deprived parts of the England, an additional three district having the highest neighbourhoods since 2015 (2019 premature mortality rates. Indices of Deprivation). 21st most deprived out of 317 local authorities

of the population are from Black, Asian 33% and Minority Ethnic backgrounds, with 27% from Asian/Asian British backgrounds.

Air pollution is associated with a number of adverse health impacts. It particularly affects the most vulnerable in society: children and older people, and those with heart and lung conditions. There is also often a strong correlation with equalities issues, because areas with poor air quality are also often the less affluent areas. 13,362 asthma higher prevalence 43,613 COPD than England average These numbers are likely to be an underestimate of the actual number as many people remain undiagnosed. The proportion of people undiagnosed varies between GP practices. Whilst some degree of variation is expected, the variation described suggests that some GP practices are better than others at detecting COPD, and that there is capacity for improvement.

Disease rates for COPD are lower in parts of Bradford , in part, a reflection of the younger age structure of the population. As the number of older people increases, the number of people with COPD is expected to increase.

One of the main challenges in managing COPD and asthma is that many people are unaware that they have the condition and aren’t diagnosed until the disease is at an advanced stage. Late diagnosis has a substantial impact on symptom control, quality of life, outcomes, and cost.

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 7 COVIDF19

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 8 COVIDF19

We know that people living in deprived areas and people from Black, Asian and Minority Ethnic backgrounds are at considerably increased risk of COVID-19 infection and mortality. Some of the reasons for this include people working in key worker roles and in densely populated areas, making exposure more likely. There are also high rates of conditions that we know put people at increased risk of COVID-19, e.g. diabetes. Data from the Quality and Outcomes Framework (QOF) suggests that diabetes prevalence is 8.7% in the former NHS Bradford districts CCG area and 11.1% in the former Bradford City area, compared to an average of 7.1% in England. Our work has predominately been shaped by our response to the pandemic. COVID-19 struck us hard in our population. We needed to react quickly, effectively and efficiently to develop pathways to safely support both patients with COVID-19, and those who needed non-COVID care and treatment. Some of our services developed within the pandemic will become routinely commissioned and we will be engaging with our system and our local people to understand what worked well and how we can develop services further.

COVID@Home service At the beginning of January 2021, the COVID@Home service went live in the Digital Care Hub (DCH). A virtual ward was set up to which people with suspected/proven COVID-19, had access to support and oximetry for a 14-day period. Patients on the virtual ward are supported 24/7 by the DCH clinical team. Patients report their oximetry readings and any symptoms using the Luscii App or a daily paper diary and the DCH clinical team review those who deteriorate. The service was initially set up to provide support for people identified in the community and/or emergency department (ED) with COVID-19, who are safe to be cared for at home with the aim of reducing complications as a result of silent hypoxia. This was quickly expanded to those in hospital who could be discharged early, also with remote monitoring and support at home. The referral criteria consisted of all adults over 65 testing positive or with COVID-19 symptoms, or under 65 and from the Clinically Extremely Vulnerable (CEV) groups who do not require hospital inpatient treatment. This included those who had pre-existing hypoxia (e.g. COPD patients) but not those for whom escalation of care to hospital would be inappropriate (e.g. end of life). All GPs and ED teams were provided with pulse oximeters and clear guidelines for referral. All patients were asked for feedback on discharge and comments encouraged throughout their time on the caseload. Outlined below are two examples of the feedback. The first shows patients’ experience of the service as excellent, the second suggests that nothing could be improved upon.

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 9 Overall, what was your experience of Is there anything you feel we could the COVID@Home service? improve on?

Excellent: Yes: Very good: No: Good: Poor: Very poor: Don’t know:

Great service and Jo was excellent whe“n she called Very reassuring service to have and nice to talk to anoth“er human being Fantastic service, was on the same level, as he lovely to have the back felt doctors were ground“ support 24/7, unemotional when he felt overwhelmed with spoke to them all the support given

Was nice to have support and be able Really grateful to pho“ne whenever for the service, I needed anything always at the end “of the phone

We have seen a steady increase in referrals for both the pulse oximetry at home (PO@Home) service and the virtual ward showing that the need is evident in the population. The benefit this service has provided to patients is reflected in the positive feedback received, and through challenging times, the learning from this service should be considered in future planning specifically supporting patients in the community. A pilot has successfully taken place with 50 COPD patients using the Care@Home model. Patients are contacted and supported to remain safely at home. This @Home model has been approved for further expansion and will incorporate the Luscii App allowing patients to submit their readings virtually. Working together as part of the Act as One collaboration results in improved links with other services such as smoking cessation, air quality and, importantly, prevention and education. Linking our service reduces duplication and waste, providing seamless services for patients by improving access to health and social care provision.

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 10 POST COVID SYNDROME SERVICE

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 11 POST COVID SYNDROME SERVICE

In the UK, as of 10 January 2021, there have been around 3.02 million confirmed cases of COVID-19. As the scope of testing widens, the number of patients reporting long COVID symptoms is also increasing. In a survey by the UK Government's Office for National Statistics in November 2020, around one in five people who tested positive for COVID-19 had symptoms that lasted for five weeks or longer, and one in ten people had symptoms that lasted for 12 weeks or longer. These figures equate to an estimated 186,000 individuals in England who had symptoms persisting between 5 and 12 weeks. These symptoms range widely, some mild and some very complex, with breathlessness, fatigue and brain fog being the highest reported problems. To help support people in their recovery, our post COVID syndrome clinic will become operational in May 2021. The pathway will consist of patients who have been under the care of primary care for a number of weeks, who are not seeing any progress in a reduction in their symptoms. A referral will be made to a clinical coordinator who will triage the patient into the most appropriate service, ranging from voluntary care services to secondary care specialist clinics. Our relationship with the voluntary sector has ensured that our patients will be provided with a holistic service, that meets their needs. Our pathways have, at the heart of them, the need to reduce inequalities and access to the right health and social care support. The service will comprise of a number of health care professionals working in a multidisciplinary team way to ensure people receive the right care at the right time and by the right person. We have a post COVID syndrome clinic running in our local hospital. Paul Whitaker, our Respiratory Consultant, heads up this multi-disciplinary team and is recognised nationally. Our support for people post COVID-19 recently featured on Channel 4’s Despatches programme showcasing the challenges faced in our local population from the impact of COVID-19 and the dedication of our teams to care for our people.

Very reassuring that there’s somebody there, especia“lly at this time with Really pleased with Covid, if you can’t get Mycare24. I would call through to GP. Can be you and have you tell me frightening, you need the “ where to go or what to assurance and I felt quite do. It’s lovely to have assured with everything. someone check on how you are after coming out of the hospital.

When I needed someone to talk to you Very good, were there, you need reassuring to have “ that. With isolation nice supp“ort available. to have someone there when needed.

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 12 FLU

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 13 FLU

Every autumn the NHS embarks on a process of vaccinating millions of people nationally against flu. Flu is a serious illness, often causing significant sickness in patients, additional strain on NHS services and even mortality in some vulnerable groups. In 2020, maximising the uptake of the flu vaccine was even more important than normal to help keep people well and reduce pressure on already stretched NHS services. At last count in December 2020, in excess of 25,000 people had their flu vaccination in 2020 as compared to the previous year – a significant achievement. Historically, however, there hasn’t been an annual review of flu seasons undertaken and it’s clear that the uptake of the vaccine is not uniform across Bradford District and Craven place – some GP practices report uptake figures in excess of 80%, while others (often in more deprived neighbourhoods) report uptakes around the 30–40% mark. In some eligible groups these figures are even starker – so this issue relates strongly to the health inequalities agenda. It was proposed that a review is undertaken to understand activity during 2020/21 so that lessons can be learned for future campaigns. The review should include recommendations to be taken forward and used in the flu campaign for 2021/22, including actions to address any disparities in the uptake of the vaccine across the place. An aim of the 2020/21 review is to identify interventions that can be delivered in the community to increase the uptake of the flu vaccination, particularly in clinical risk groups. Highlights of the flu vaccination campaign include the introduction of a drive-through vaccination clinic organised by one GP practice, the introduction of the flu bus, which travelled to different locations across our place and helped augment school-children vaccinations this year and the targeted “deep dive” analysis by the CCG of those clinical ‘at-risk’ groups with low vaccination uptake. Targeted communication messages following intelligence gained from these deep dive analyses were being prepared. The introduction of the COVID-19 vaccine meant that attention was diverted away from the second half of the flu vaccination campaign, which resulted in a shortened campaign.

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 14 Aged 65 years and over 7.1% increase on 2019/20

Eligible Target # vaccinated % vaccinated 2019/20 uptake 99,311 74,483 79,597 80.1% 73%

In clinical at risk group 4.1% increase on 2019/20

Eligible Target # vaccinated % vaccinated 2019/20 uptake 102,484 76,863 48,287 47.1% 43%

Pregnant women

Eligible Target # vaccinated % vaccinated 2019/20 uptake 7,116 5,337 2,909 40.9% 43%

Carers 7.7% increase on 2019/20

Eligible Target # vaccinated % vaccinated 2019/20 uptake 8,735 6,551 2,773 31.7% 24%

Care home residents

Eligible Target # vaccinated % vaccinated 2019/20 uptake 3,493 2,620 2,780 79.6% N/A

50–64 years old

Eligible Target # vaccinated % vaccinated 2019/20 uptake 72,004 0 23,578 32.7% N/A

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 15 NEXT STEPS

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 16 NEXT STEPS

Our Strategy Day, planned for April 2021, will give us the opportunity to review and revise our plans, learning from both the challenges we have faced with COVID-19 and the successes, such as the @Home developments including remote monitoring. Our population health data will help us understand the need in our local communities and our patient voices will tell us what we need to do to make sure services are accessible and do not widen our health inequalities. We are looking to take many of our pathways into the virtual world in the future. However we recognise that this will not be suitable for everyone. Therefore we need to tailor care to that individual and, if needed, offer support to either help people become comfortable using digital support or consider alternative options. This will include supporting people to access local health and social care and giving people the tools to help themselves look after not only themselves but their friends, families and their communities.

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 17 ACKNOWLEDGMENTS

We would like to say thank you to all our colleagues who have supported our work (in alphabetical order).

Adele Thornburn – NHS Bradford District and Craven Kashifa Zia – Kensington Partnership CCG Kate Hilditch – Airedale NHS Foundation Trust Alan Hart Thomas – Airedale NHS Foundation Trust Kath Helliwell – NHS Bradford District and Craven CCG Amanda Grice – Bradford Teaching Hospital NHS Katherine Hickman – NHS Bradford District and Craven Foundation Trust CCG/WY&H ICS Amanda Jowsey – Bradford Teaching Hospital NHS Laura Siddell – NHS Bradford District and Craven CCG Foundation Trust Maire Buchan – Airedale NHS Foundation Trust Ameela Iles – Bradford Metropolitan District Council, Mark Evans – Bradford Council Department of Health and Wellbeing Mark Hindmarsh – Airedale NHS Foundation Trust Amy Paffett – NHS Bradford District and Craven CCG Mary Law – NHS England Andrew Leng – Airedale NHS Foundation Trust Matthew Fay – NHS Bradford District and Craven CCG Ben Cross – The VCS Alliance Nancy O'Neill – NHS Bradford District and Craven CCG Carla Moore – Bradford District Care NHS Foundation Trust Nicky Knowles – Metropolitan District Council, Department of Health and Wellbeing Caroline Tomes – Bradford Council Nicola Sheehan – Bradford Teaching Hospital NHS Catherine Gregson – Airedale NHS Foundation Trust Foundation Trust Charles Strachan – Low Moor Medical Practice Pat Campbell – Bradford Teaching Hospital NHS Christos Fysarakis – Bradford Teaching Hospital NHS Foundation Trust Foundation Trust Paul Rice – Bradford Teaching Hospital NHS Foundation Claire Lawless – Airedale NHS Foundation Trust Trust David Tatham – NHS Bradford District and Craven CCG Paul Southern – Bradford Teaching Hospital NHS Dinesh Saralaya – Bradford Teaching Hospital NHS Foundation Trust Foundation Trust Paul Whitaker – Bradford Teaching Hospital NHS Eilish Owen – Bradford District Care NHS Foundation Foundation Trust Trust Phillipa Hubbard – Bradford District Care NHS Foundation Elizabeth Stoppard – Airedale NHS Foundation Trust Trust Emma Bascombe – NHS Bradford District and Craven Pippa Bird – Bradford Metropolitan District Council, CCG Department of Health and Wellbeing Frances Towers – Bradford Council Rachel Binks – Airedale NHS Foundation Trust Freya Sledding – Airedale NHS Foundation Trust Rachel Pring – Dyneley House Surgery Himat Thandi – Leylands Medical centre Richard Haddad – NHS Bradford District and Craven CCG Humma Nizami – Race Equality Network Rupert Allen – Bradford Teaching Hospital NHS Ian Day – City of Bradford Metropolitan District Council Foundation Trust Jackie Loach – Bradford Teaching Hospital NHS Ruth Taunton-Smith – Bradford Teaching Hospital NHS Foundation Trust Foundation Trust Jacqui Griffin – Bradford Teaching Hospital NHS Samantha Moorehouse – Bradford District Care NHS Foundation Trust Foundation Trust Jamie Moseley – Samantha Taylor – NHS England Jan Burrows – Carers’ Resource Sandra Knight – Bradford District Care NHS Foundation Trust Jennifer Bromley – Bradford University Sarah Byers – Airedale NHS Foundation Trust Jennifer Clark – Airedale NHS Foundation Trust Sari Harenwell – Bradford District Care NHS Foundation Jeremy Gee – Airedale NHS Foundation Trust Trust Jill Asbury – Airedale NHS Foundation Trust Sophie Carrow – Airedale NHS Foundation Trust Joanna Rayner – Airedale NHS Foundation Trust Tracy Gatson – NHS Bradford District and Craven CCG Julia Nixon – Airedale NHS Foundation Trust Victoria Pickles – Airedale NHS Foundation Trust Justin Tuggey – Airedale NHS Foundation Trust Karen Dawber – Bradford Teaching Hospital NHS Foundation Trust

ACT AS ONE RESPIRATORY PROGRAMME ANNUAL REPORT 18 If you would like to know more about our Act as One Respiratory Programme and the work we have done please contact our Programme Lead [email protected] or email [email protected] You can follow Act as One on Twitter: @ActAsOneBDC