'This is the longest I've not been in hospital'

By Lisa Summers

Scotland Health Correspondent

A specialist respiratory team in Midlothian is delivering care to lung disease patients in their own home in a bid to reduce the amount of time they spend in hospital.

Jannette Huxley knows only too well what it can be like to have a flare-up of COPD (Chronic Obstructive Pulmonary Disease).

“The only way I can describe it is like drowning,” she says.

“There is no air coming in but you can feel gurgles in your chest and you feel like you are having a heart attack and the pain is so bad.”

The 70-year-old has frequently needed hospital treatment for the lung disease and it is never long between returning home and another attack.

Two months ago, Jannette was referred to Midlothian’s Community Respiratory Team (CRT) who provide a wide range of care including physiotherapy, psychological support and advice on healthy eating and exercise.

She says it has made a huge difference.

“This is the longest I’ve not been in hospital and I’ve not had that feeling of panic,” she says.

“I couldn’t believe having someone hear chatting to me, and knowing she was only a phone call away, would make such a difference to my life.”

It is the name for a group of lung conditions that cause breathing difficulties, including emphysema and chronic bronchitis.

COPD is a common condition that mainly affects middle-aged or older adults who smoke or have smoked.

The breathing problems tend to get gradually worse over time and can limit normal activities, although treatment can help keep the condition under control.

Midlothian has the highest rate of the disease in Scotland, managing about 80 patients at any one time.

The new respiratory team aims to dramatically reduce hospital stays and free up NHS beds for other patients.

Data from NHS Lothian estimates that it has led to 146 fewer admissions in the past year, with 136 patients able to get home from hospital sooner because the right level of care was available in the community.

Claire Yerramasu, advanced physiotherapist and team lead, says the team tries to help patients with acute flare-ups whenever they are unwell at home.

She hopes this will lead to better self-management when the patient is not unwell.

“That in turn helps prevent admissions in the future because if they are treated early, they are less likely to panic, become anxious about symptoms and admit to hospital,” Claire says.

The Scottish government is due to publish its winter resilience plans for the NHS in the coming weeks, with the focus expected to be on avoiding hospital admissions.

Creating “virtual wards” where care is delivered at home is being scaled up as part of both short and long-term solutions to the pressure on hospitals.

It saves money, it frees up beds and is better for patients.

Dr Gourab Chowdray, the clinical lead for COPD at NHS Lothian, says the model is being developed by other health boards.

“We have managed to cut down dramatically the need for COPD patients to come to hospital with their flare-ups and they love it,” he says.

Models like the Community Respiratory Team, or Hospital at Home are proven to work well but recruitment is an ongoing challenge as it is elsewhere in the health service.

Despite a significant increase in the number of allied health professionals working for the NHS in the past five years, there are still significant vacancies. About 9% of physiotherapy posts remain unfilled.

Dorothy Keith has had COPD for 16 years and has been under the care of Midlothian CRT for the past two years.

The 73-year-old is dependent on supplemental oxygen but because of regular contact with the team has been able to manage her condition better, avoiding hospital admissions and able to do more things like attend a family wedding in Stonehaven.

“I think they are wonderful, I’ve never felt so well looked after,” she says.

“I just have to pick up the phone, I don’t like to but I do. I think they are saints.”

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