Respiratory care is currently one of the most expensive pathways in the NHS, costing a total of £11 billion annually. In addition, hospital admission rates are rising three times faster in respiratory care than in general admissions, with a disproportionate impact on disadvantaged groups and areas of social deprivation.
A lack of GPs, nurses, and other aspects of the workforce has resulted in gaps in primary and secondary care. In addition, morale is low among staff both post-covid and as a result of inflation, leading to industrial action across multiple NHS groups. Inflation has also exacerbated challenges around resources and finance. A perfect storm is brewing between this, the burden of the elective care backlog, and ongoing workforce challenges.
As Anoop succinctly puts it, ‘it comes down to people, money, and stressed services.’
Anoop Chauhan is a consultant respiratory physician, a professor of respiratory medicine, a researcher, and executive director of research at Portsmouth Hospitals University NHS Trust. He also set up the Portsmouth severe asthma service, which has grown from a ‘one man band’ into one of 15 national specialist-commissioned severe asthma services.
Professor Anoop and his team at Portsmouth are working with Sanius Health to empower patients to manage their health, improve treatment adherence, and explore how large-scale digital interventions can improve patient outcomes systemwide.
A System Under Strain
On top of these broader challenges facing the NHS, Anoop identified challenges unique to respiratory care. ‘If we map out the journey from when a patient first begins with respiratory symptoms to receiving specialist care, there are challenges and opportunities along the way.’ The first is access to diagnostics - access to spirometry or access to primary care teams that can diagnose and monitor disease is not always easy.
‘While we might have online GPs, many people more likely to have respiratory diseases are older, poorer, and therefore less likely to access digital care.’ That digital inequality increases general social inequality and leads to poor healthcare outcomes.
Alongside these challenges, respiratory care typically deals with older, frailer, comorbid populations seldom seen for just a respiratory condition. Therefore, recognising the comorbid conditions and how to treat them effectively can be a major challenge.
The Challenge of Treatment Adherence
While medicines that can help manage severe asthma are readily available, people don't always take them. In the real world, Anoop estimates about 15 or 20% of people usually take their medication when they're supposed to.
Consistently taking medication can significantly improve outcomes, but ensuring this regularity is challenging. However, patients under observation - such as during a research trial - are much more likely to have better treatment adherence. This potential for improved adherence is where the new programme with Sanius Health can help; by incentivising patients through vouchers for services they regularly use (such as Amazon and Netflix), Sanius adds additional motivation to take medication on time and report outcomes.
Alleviating System Strain
The Sanius Health programme that the Portsmouth Hospitals University NHS Trust team is engaged with will empower patients to monitor and manage their condition from home. As well as promoting better medication adherence, this remote monitoring will enable teams to better identify and target poorly controlled disease.
The programme will reduce the burden of outpatient follow-up, ensure appropriate referral types, and improve access to specialist care for those who need it. In addition, reducing the burden on outpatient specialist services will improve the patient experience across the system due to access.
As well as improving self-management and facilitating bespoke plans to reduce exacerbations, Anoop notes that the programme ‘also maximises and builds on the skills of healthcare staff in the post-pandemic virtual ward.’
This virtual care environment will improve patient treatment and adherence and integrate clinical physiological and wearable device data with patient-reported outcomes for clinical teams. This intervention will be NHS-compliant and integrated into NHS apps, aligning with the digital goals of the NHS. Overall, the programme ‘will reduce costs across the system by reducing exacerbations and unscheduled care.’
Powering Research and Driving Better Outcomes
For Anoop, the benefits for providers and the benefits for patients are inextricably linked, largely because Sanius Health’s approach allows the patients to immediately benefit from the research they are involved in:
‘The beauty of this is what I would call a Participatory Action Research programme. It’s not a purely hands-off research study where you can't change things; it’s an all-welcome discovery platform that benefits everyone. And more importantly, the participants can also be the researchers.’
Research programmes are often blind, meaning that when you know someone's symptoms are worsening, you can’t intervene. However, with Sanius, the patients can reap the benefits of the programme while it’s underway. ‘The ability to change your intervention along the pathway is invaluable.’
‘This programme is building on the technology that [Sanius has] developed already in rare diseases, but now the disease group being targeted is deliberately not rare - there are millions of people in the UK with asthma - so the number of people who are likely to benefit from this proposal is huge.’ In addition, anyone who has asthma can enrol in the programme, maximising the data collected on patients to power discovery research.
Anoop notes that the programme will have a positive knock-on effect on other comorbid conditions as patients are encouraged to potentially adopt a more healthy lifestyle. However, if their condition worsens, the Sanius platform allows patients to access primary care online and potential specialist care when needed.
The programme helps patients improve competency with digital technologies, provides access to free wearables and disease monitoring, and offers incentives for regular engagement. All of this helps improve treatment adherence and the patient’s confidence in managing their disease. And, as a consequence, it'll improve their quality of life and reduce their exacerbations.
To learn more about the work Sanius Health and Portsmouth Hospitals NHS Trust are doing to support patients, visit: www.saniushealth.com
