‘Huge’ regional inequalities in COPD care – Respiratory Clinical Lead

Ireland has taken a “visionary approach” to chronic obstructive pulmonary disease (COPD) care, but significant regional inequalities remain, the HSE National Respiratory Clinical Lead has said.

Prof Breda Cushen delivered a presentation on the changing face of COPD care in Ireland at the recent Irish Thoracic Society Annual Scientific Meeting. She said the multidisciplinary and patient-centred approach to COPD care had resulted in improvements, but challenges needed to be addressed.

“Nationally, we have to overcome the huge regional inequalities which have arisen through funding restrictions,” she said.

“We also need to adapt to meet the needs of all people with COPD, those who have more severe and complex symptoms, and also our younger patients.”

It is estimated that approximately 400,000 people have a diagnosis of COPD. According to recent data from the GP chronic disease management (CDM) programme, 12 per cent of enrolled patients have a COPD diagnosis. 

Prof Cushen praised the CDM programme as hugely successful, adding that pulmonary rehabilitation is now accessible to patients all around Ireland.

Acute hospitals have also had an uplift to support services for COPD patients, while outreach teams have created a bridge from hospital to home. There are 26 COPD outreach teams nationally, an increase from 12 in 2021. These are all linked to model 3 or model 4 hospitals. All the consultants are employed on a 50:50 basis and are supported by nursing and physiotherapy staff.

“Unfortunately, changing national priorities have led to a lot of unfilled posts,” said Prof Cushen. “So initially, when this ECC [enhanced community care] was funded, there were 444.5 posts allocated to the respiratory integrated care programme. In the acute setting, the funding for 18 per cent of these posts was withdrawn, and in the community, 42 per cent of posts have been lost due to funding being withdrawn.

“In particular, our ability to deliver diagnostics in the community really suffered with the loss of 58 per cent of post funding. This has led to huge variation across the country in terms of staffing of our services and the service that each of our sites can deliver. This means that the implementation of our model of care for COPD has been hugely variable.”

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