COPD treatment fails quality standards despite five-year improvement

This is the main finding of the latest national audit into the acute care of COPD. The disease is the fifth biggest killer in the UK, the second most common cause of emergency admission to hospital and one of the most costly in-patient conditions treated within the NHS.

The National COPD Audit 2008 measures what progress has been made into the care of the condition since the last audit in 2003.

The audit is part of the broader, Health Foundation funded, National COPD Resources and Outcomes Project [NCROP], a partnership between the Royal College of Physicians' Clinical Effectiveness and Evaluation Unit, the British Thoracic Society and the British Lung Foundation.

Drawing on data from 98% of Acute NHS Trusts, the audit team's main findings were that:

• There has been a significant increase in the provision of some COPD specific services, such as early discharge programmes (44%–59%) and the availability of Non-Invasive Ventilation (NIV), in cases of acute respiratory failure (44%¬–59%).
• While staffing that meets the needs of COPD patients has improved, many units still fall below the levels recommended by the Royal College of Physicians.
• The quality of information patients are given across all COPD services shows serious deficiencies. Information about the use of NIV, end of life care and the availability of local services is particularly poor.
• The provision of end of life and palliative care services is highly variable, with generally poor provision standing alongside excellent examples of good practice.
• Only a minority of units fully audit the services they provide, meaning it is difficult for them or others to judge the quality of their COPD care.

The audit concludes by recommending trusts invest in additional staffing levels, that units carry our regular audits against national quality indicators and provide better information to patients, and extra resources to improve palliative care provision for COPD patients are put into place. The national audit should also be embedded in the National Strategy for COPD to contribute to the long-term driving up of standards.

Professor Mike Roberts, Consultant Respiratory Physician and Chair of the NCROP steering group said: ‘The 2008 review shows that while trusts have managed to widen the range of COPD specific services available to patients, the lack of an audit culture among many units is compounding some of the existing deficiencies this project has unearthed.

'The National Services Framework due out next year is an excellent opportunity through which to embed a commitment towards audit, and we hope the Department of Health will seize upon it’.

Wendy Buckley, Assistant Director, the Health Foundation said: ‘The COPD auidt has revealed that there are clear challenges and there is a long way to go, but progress is being made.

'We are delighted with the success of Professor Roberts from the Royal College of Physicians with colleagues from the British Thoracic Society and British Lung Foundation in reaching nearly all acute services in the UK through their audit and associated work.

'The examples of very good practice they found demonstrate that excellence is possible and will encourage further improvement’.