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Transforming support in the community for respiratory patients

How we have implemented measures to make a difference in the West Lancashire community

  • We developed a pulmonary rehab programme, run in the heart of the community
  • More than 150 patients have completed the programme so far
  • The increase in confidence that patients have experience through the programme enabled one patient to get back into employment and another to go shopping for the first time in five years
Virgin Care
Virgin Care

The challenge

As part of our adult community services portfolio in West Lancashire, we are responsible for the care of a large cohort of respiratory patients. In 2019/20 alone, our respiratory team provided assessment, advice and intervention to 490 patients. In all seven wards of the Skelmersdale area, emergency hospital admissions for respiratory patients are significantly above the England average.

An extensive programme of work has taken place over the past three years and continues, to transform the way we deliver care and improve outcomes for respiratory patients in the district.

The solution

In 2017, when we took over the running of adult community services in West Lancashire, we began to develop our clinics and home visits for respiratory patients. At the time there was a pulmonary rehabilitation group programme running in the local hospital but nothing similar in the local community for patients to attend.

We teamed up with third sector group Well Skelmersdale to develop and run an eight-week programme of exercise and education for patients with chronic respiratory conditions, with the aim of increasing activity levels, helping patients better understand and self-manage their condition, and to generally improve their quality of life.

To upskill our team, the respiratory specialist nurses and the lead physiotherapist all attended an advanced pulmonary rehabilitation course with Glenfield Hospital. Two additional physiotherapists attended the British Thoracic Society’s Pulmonary rehab training course held at Manchester University.

After carrying out pilot studies, we launched a rolling programme in May 2019.

The classes run at The Zone in the heart of Skelmersdale so they are easily accessible to people living in the community. Exercises don’t involve large equipment (such as treadmills) so that they can be easily reproduced at home, and everyone works at a pace that suits them. Regular guests include CIC company The Benefits of Music, who lead a singalong with patients and talk about how music therapy can help respiratory health problems.

Our Head of Specialist Nursing in West Lancashire also raised funds to subsidise tai chi and yoga sessions to follow on from the pulmonary rehab programme.

In response to the COVID-19 pandemic, we have been working to develop remote, virtual pulmonary rehab sessions and are raising funds to purchase iPads that can be loaned to patients who do not have IT equipment so they can take part.

In addition to the pulmonary rehab sessions, we have developed the following to ensure patients receive quality care:

  • Individualised care plans that provide safe alternatives to hospital admission, along with a strong focus on self-management to ensure patients remain in or are able to achieve their preferred place of care.
  • Optimisation clinics and home assessment for patients with a broad spectrum of respiratory disease.
  • A home oxygen register of patients that is regularly reviewed, working closely with secondary care consultants and our home oxygen provider.
  • Strong relationships with primary and secondary care colleagues so that we can proactively source patients and develop respiratory pathways.
  • Providing regular talks and updates to local groups and forums including the West Lancashire Breathe Easy group and the local care home forum to reach a wider group of patients and carers.


Our Head of Specialist Nursing in West Lancashire is also pivotal in leading the Skelmersdale Population

Health Management project, to identify the highest risk patients with respiratory disease and other vulnerabilities, so that her team, alongside primary and social care colleagues, can provide targeted respiratory assessment and interventions as part of individualised multi-disciplinary management care plans, encouraging patients to stay well for longer despite living with respiratory disease.

The outcomes

To date, 154 patients have been through the pulmonary rehab programme.

There is an average improvement of 62m in how far participants could walk from the start of the programme to the end – as measured through an incremental shuttle walk test.

Almost half of participants said their general anxiety has reduced.

Three quarters of participants said their COPD had less impact on their life than before.

The increase in confidence that patients have experienced through the programme enabled one patient to get back into employment and another to go shopping for the first time in five years.

“I enjoyed every aspect of it and the staff are all very nice, helpful and informative”

“From the first session I felt at ease with the staff. Feeling confident enough to push myself to limits I could not get to before and made me more confident to do things I had not done for a while. A* team thank you”

“Wonderful respiratory nurses and physio staff. I was not pushed beyond my limits but felt supported.”

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