The National Strategy for COPD It’s taking shape!

1. The National Strategy for COPDIt’s taking shape! Monica Fletcher Chief Executive Education for Health Chair European Lung Foundation

2. COPD care: a change in attitude The past few years have revealed an attitudinal shift in COPD care ‘From Unjustified Nihilism to evidence based Optimism’ (Celli et al 2006) Diagnosing Predicting Preventing Treating Optimistic Pessimistic

3. The COPD Vision: To that everyone diagnosed with COPD receives equitable, responsive, high quality and effective health and social care services from the right person, at the right time, in the right place. On going commitment is to ensure that all communities can expect better prevention strategies for COPD, quicker identification for those at greatest risk, clear standards of care and treatment that ensure dignity and respect that lie at the heart of the patient journey

4. The public consultation document contained 24 evidence based recommendations to improve care • Combined with NICE/BTS guidelines should be enough to kick start service delivery of high quality COPD and asthma care • Ministers currently considering how to turn it into an outcomes based strategy

5. Why do we need to wait for the DOH strategy The political wheels turn very slowly

8. COPD in 40–65 year olds ages them and creates frustration “I feel like I am old. I feel like I am really old, and I am 51.” UK patient “We had a very big group of friends and relatives, but since my wife got ill only 2 or 3 people are left.” U.S. Spouse “She is throwing her life away and she is throwing my life away.” U.S. Spouse “I hate not being able to do something and that my wife has to help me. It is infuriating. I have never depended on anyone.” Spanish patient “I’m totally disgusted with my life.” U.S. patient “A bad day is when you need to sit down because you can’t handle it anymore but you need to make it to the office and deal with 200 emails.” Spanish patient “The most important thing I’ve lost is probably getting together with my dad and playing outdoors.” UK son Fletcher at al 5th IPCRG World Conference, June 2010,

9. The Number of COPD patients diagnosed 900,000, but actual estimated prevalence 3.7million…….. these are the “Missing Millions” Shawab et al Thorax 2006 (Graph based on DH unpublished estimate, 2009).

10. Spectrum of COPDPrevention and Awareness toEnd of Life Care • Access to supportive care for patient and family through to bereavement stage • Managed according to guidelines, e.g. Liverpool Care Pathway The earliest point at which airflow obstruction may be detected by spirometry • Raising awareness of early signs and symptoms Damage Unaware of lung health Aware of lung health No symptoms Symptoms but no diagnosis MILDstage MODERATEstage SEVEREstage VERY SEVEREstage Well At-risk With COPD diagnosis

11. DH focus for improving outcomes Earlier identification: More proactive management: Care closer to home: Integrated care

12. What has been accomplished so far by DOH? • Published national consultation document • Developed clinical leadership and joint partnership working including with industry and patient organisations • Gathered evidence on what is working well • Testing different models of care • Introduced measurement of performance • Changes to systemlevers and incentives • Funded pilot and research studies • Aligned with new and emerging policies

13. DOH Practical help for you • We have an approachable team at the DOH, with strong leadership • The NHS improvement Lung Improvement team and their website for inspiration • Worked on competences and a range of educational programmes with more on the way to support staff development • We have respiratory leads in every SHA who can share local benchmarking data

14. Implementation Paul Corris Sharon Haggerty John Williams June Roberts Stephen Gaduzo • Tasks: • Set up high level steering group • Develop communities of practice • Support improvement programme • Benchmarking data • Annual report of progress John White Mike Ward Jane Scullion Dermot O’Ryan SHA Respiratory leads Colin Gelder Sandy Walmsley Tony Davison Leanne Jongepier Louise Restrick and team Steve Holmes James Calvert David Halpin Jo Congleton Jo Wookey Julia Bott Maxine Hardinge

15. Despite their widespread promulgation, there is unequivocal evidence that guidelines have: limited effect on changing physician behaviour, marginal improvement in patient outcomes and their cost effectiveness is called into question! Lomas et al(1989), Woolfe et al(1993), Grimshaw et al 2004, Thomas et al (2005)

16. Why don’t physicians use guidelines?Cabana M. (1999)JAMA • Systematic review • 5658 articles reviewed • 76 published studies at least one barrier • 76 articles included 120 different physician surveys • Identifying 293 potential barriers!!! • Clustered these into 7 main themes • Developed three groups: Knowledge, attitude and behaviour

17. KNOWLEDGE ATTITUDES BEHAVIOUR Lack of Agreement with: Specific guidelines Guidelines in general Lack of familiarity External Barriers: • Patient Factors • Guideline Factors • Environmental Factors Lack of outcome expectancy Lack of self-efficacy Lack of awareness Lack of Motivation Cabana 1999

18. Clinical ExperienceMaking the same mistakes with increasing confidence over an impressive number of years “If you always do what you have always done, you will always get what you always got”

19. 2.5% 13.5% 34.0% 16% 34.0% Early Late Early Innovators Laggards Majority Adopters Majority Diffusion of InnovationsRogers (1995)

20. Achieving behaviour change VALUE Enlist Behaviour Engage Commitment Under-standing Educate Aware-ness Inform ACTIVITY

21. Implementation of change : Your role EDUCATION SOCIOLOGY PSYCHOLOGY COMMUNICATIONS MARKETING

22. Where are you at? • Where do you want to get to? • What is stopping you getting there? • So what are you going to do about it?

23. Early outcomes or long term perspective Tangible rewards or do you gain rewards in other ways Naturally a doer or do you prefer to facilitate others Do you personally prefer a high or low profile Are you a follower or a leader Happy on your own or in a team Questions to ask yourself

24. Powerful Charismatic High achiever High risk Impersonal Distant Short term gains Death of the Lone Ranger

25. Scarecrow: The Brain Tin Woodsman: The Heart Lion: Courage Dorothy.. The Wizard of Oz!

26. Conceptual thinker Emotional intelligence Systems thinker Accomplishing tasks Critical view of self Brain

27. Challenge the status quo Draw out and deal with conflict Risk taker Learn from failures Instil courage in others to follow Lead change Lion

28. Outstanding leaders appeal to the hearts of their followers – not just their minds Passion and compassion Mission driven Relationships Interpersonal Heart

29. Humanity Strong communication Ability to harness diversity Dorothy

30. Others must…… • Trust you • Have faith in you • Believe in you • Essentially you have to believe in yourself! • Be prepared to challenge! • Control the ‘I can’t’ • Don’t take no for an answer • Be a boundroid

31. Enabling qualities • Sense of humour • Empathetic • Energetic • Passionate • Sensitive • Visionary

32. There’s no place like home

33. There are three kinds of people: • Those who watch Things Happen • Those who wonder what happened • Those who make things happen • Where do you fit??? Lee Lacocca CEO Chrysler