UK: What does 2018 hold for respiratory medicine?

When the limbic asked British Thoracic Society President Professor Mark Woodhead what he expects to be the biggest challenges in respiratory medicine in the UK this year, he laughed and said: “Well you’ve just seen the biggest challenge – that’s the seasonal flu outbreak.”

“We get it every year, it varies in size, it varies in its exact timing but our ability to plan for it seems to be very poor indeed.”

This is because we never know exactly when it’s going to come and also because the National Health Service is not good at workforce planning, explains Professor Woodhead, a consultant and Honorary Clinical Professor of respiratory medicine at the University of Manchester.

“There has been a failure of workforce planning for as long as I’ve worked in the health service to a greater or lesser degree,” he said.

He also blames cutbacks in hospitals in the UK, which inhibit the ability to flex the acute medicine and respiratory workforce when patient numbers change.

“Hospitals do not run with empty bed capacity any more…. so they cannot flex from low numbers of admissions to suddenly high numbers of admissions.

“Even if you open up extra beds for patients or you stop surgical admissions, you don’t suddenly create an increase in the medical workforce to look after the patients,” he said.

Staff shortages

Compounding these problems the UK is struggling to maintain its respiratory workforce of doctors, nurses and physiologists.

Professor Woodhead flags this as a major issue for the year ahead, noting there are recruitment problems, vacant posts and an ageing workforce in all areas of respiratory medicine.

“Certainly for consultants there are already vacant posts all over the country and there aren’t enough trainees coming through,” he said.

“So just standing still is going to be difficult for the next 12 months or longer, as is maintaining the quality of the respiratory service that we try to deliver.”

More respiratory illness

At a time when the workforce is already under pressure, the incidence of respiratory complaints appears to be rising in the UK.

“We’re certainly seeing more people being admitted with respiratory infections of one sort or another,” Professor Woodhead said.

“We’ve got a growing elderly and frail population who get respiratory flare ups– be it exacerbations of COPD, episodes of pneumonia or other respiratory tract infections.

“The population is also getting fatter so we’re seeing more respiratory problems related to obesity. There’s obstructive sleep apnoea, a syndrome of asthma related to obesity and disordered ventilation in relation to obesity; all of which are becoming more common.”

Yet against this background there is a lack of funding for research into respiratory diseases in the UK, he says.

“Considering how common respiratory conditions are and how important they are, the amount of money that goes into respiratory research is less than other comparably important areas.”

“It’s a continuing challenge to use research monies appropriately for respiratory research,” he explained.

Asthma guidelines confusion

It will be interesting to see how things play out this year with the ongoing debate about the differences between the recently launched National Institute of Clinical Excellence (NICE) asthma guidelines and the BTS/SIGN guidelines. [see our previous story here]

Professor Woodhead says the new NICE guidelines are “a little bit controversial because they don’t necessarily agree with the preceding guidelines, and nor do they cover quite the same areas”.

“So by having multiple guidelines that don’t say the same thing, the guidelines for asthma are starting to the make the management of asthma more confusing rather than being helpful,” he said.

“You need a unified guideline that everyone has signed up to, not guidelines that conflict, so that needs to be resolved.”

 TB figures awaited with interest

Professor Woodhead also highlights one of his specialty interests, tuberculosis, as something to keep an eye on this year.

After three or four successful years where the number of cases of TB in the UK declined by about 10% a year, the fall in 2016 (the last year for which numbers are available) was only small in comparison.

The 2017 figures, out later this year, are awaited with interest, he says.

“Was it just a blip and the fall in numbers is going to go up again, or are things actually stalling and the decline in TB cases is now slowing down?”

Developments in lung cancer

A challenge of a positive nature being looked at this year is the roll out of screening for lung cancer in high-risk individuals in supermarket car parks across the country.

Professor Woodhead says the move follows initial positive reports from pilot studies showing the screening units helped pick up lung cancer earlier.

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