Prevention and Early Identification Strategy

Of the 3.5 million people in England with COPD, only 800,000 have been diagnosed, leaving 2.7 million people who have the disease, without knowing it. Some are yet to have symptoms. A significant challenge, as set out in the `Consultation on a Strategy for Services for Chronic Obstructive Pulmonary Disease in England' and recently published Outcomes Strategy for COPD is how to identify these people and overcome current levels of late diagnosis, moving diagnosis further ‘up-stream’ in an individual’s disease trajectory so that significant improvement in quality of life can be achieved. An additional challenge is that 75% of lung disease is caused by smoking, a notoriously difficult behaviour to shift.

The key to prevention and treatment of COPD in its early stages is behaviour change among those affected or ‘at risk’. The content of this digial platform has a two-pronged goal: to help reduce people’s risk-taking activities and encourage them to take up more health-enhancing behaviours (prevention), and to recognise the symptoms of lung disease and not to ignore them, but to seek a clinical assessment (early identification).

Targeting priority population segments will maximise the effectiveness of identification and behaviour change interventions in COPD and will ensure efficient use of healthcare resources. An England-wide audience segmentation based on life-stage, socio-economic and environmental factors was conducted to identify priority segments. Focus groups and interviews with informants in each segment provided a rich understanding of behaviours, attitudes and motivation.

Which stakeholder(s) is the toolkit designed to support?

• Frontline and allied Health Professionals: those with a direct interface with patients
• Commissioners (Clinical Commissioning Groups): using delegated budgets to commission new services to meet the health needs of the local patient population
• New Public Health Service: Will likely have primary responsibility for commissioning primary preventative initiatives
• Other public bodies: (Unions, trade organisations, employers of ‘at risk’ individuals, HSE) who have their own agendas relevant to priority audiences and may wish to draw on COPD insights and learning to support their efforts
• Third sector: has audience-specific expertise, particularly in delivery of interventions. Many are increasingly moving into a provider role
• Private sector: has a role to play in the service delivery value chain, such as pharmaceutical companies, device manufacturers, community pharmacy, or as a significant R&M employer

The actions that stakeholders need to take should ideally be coordinated in three ways:

• With consistency: At a minimum, approaches, actions and interventions taken by stakeholders should be consistent and operating in line with this programme
• In collaboration: Stakeholder organisations will need to form new partnerships and collaborative models for working together, in line with evolving principles underpinning ‘the big society’ and increased localism, in order to reach ‘at risk’ audiences with the right behavioural interventions for the isolated priority segments of the population
• Using common tools: Stakeholder organisations will need to have access to tools and other materials that will assist them in their efforts to identify and locate audiences, design the right interventions, and implement strategic programmes

Turning Policy into Partnership Lung Health Activation Plan - A plan for local delivery

A wide range of partners from the private sector, third sector and public sector/NHS have worked to develop a strategic approach to prevention and early identification of COPD. This provides a roadmap for healthcare system commissioners, providers and other associated partners. The strategy enables those involved in addressing prevention and early identification of lung disease (with particular emphasis on COPD) to help build a consistent, evidenced and consumer insight-driven response to the challenge that faces us. The approach is both to mitigate risk factors in relevant groups but also to identify those people who currently have the disease but are without a confirmed diagnosis.

Targeting those at risk

The strategy identifies those groups who are most at risk, seeks to understand their current behaviour and motivations, and describes interventions based on the best available evidence. The strategy outlines the role that organisations operating at all levels of the health economy can play and makes recommendations for what they should do to support implementation. The sheer volume of individuals currently affected by lung disease remains unacceptably high and the NHS and partners must respond to this challenge.

The prevention and early identification strategy also seeks to evolve the language which has for so long been associated with low levels of public understanding of the condition. We will seek to encourage the public to understand the importance of good ‘lung health’.

To do this successfully this requires a shift by all stakeholders away from often confusing clinical terms to more simple, ‘translatable’ language that can be communicated successfully outside of clinical circles by those with (or at risk from) the condition.

In much the same way, ‘heart health’ (and conversely ‘heart disease’) has successfully replaced more traditionally complex terminology for a range of heart conditions. Language that the general public can understand and identify with is extremely important. For this reason, throughout the strategy and activation plan, we refer to ‘lung health’ rather than ‘COPD’.

Language – like ideas – is viral. The adoption of common metaphors and descriptors will go a long way to bringing the condition out of the shadows for patients, their carers, family and friends.

The single biggest challenge to addressing earlier identification of people with lung disease is that there is currently no significant understanding of the early symptoms of lung disease. Using the language of ‘lung health’ we will been able to create a narrative that can build understanding.