Header image for the current page Using Local Authority levers to effect change

Using Local Authority levers to effect change

The London Borough of Barking and Dagenham has a high rate of standardised hospital admission for Chronic Obstructive Pulmonary Disease (COPD), which is currently more than double the England average.

NHS Arden & GEM Commissioning Support Unit (CSU) was appointed to design and support implementation of a pathway redesign project to improve symptoms, reduce hospital admissions and reduce mortalities. This has required close partnership working with commissioners, clinical providers and local leisure services to deliver a complete integration of public health and traditional healthcare.

The challenge

Barking and Dagenham has the highest rate of standardised hospital admissions for COPD of all the boroughs in outer north east London and the rate is more than double the England average. In parallel with the high rate of hospital admissions there are also very high death rates from COPD.

The project was initially intended to fully develop a Pulmonary Rehabilitation programme which would target patients with COPD and those undergoing lung surgery. Pulmonary Rehabilitation is designed to provide long term support to help patients to improve their quality of life and relieve breathing problems through a varied programme. This typically includes physical exercise, facilitating self-management, breathing exercises, smoking cessation and counselling. An evidence based intervention, Pulmonary Rehabilitation is proven to decrease hospital admissions and has a 64% probability of delivering cost savings.

However, all parties quickly recognised that, to really make a difference for patients, the project needed to go beyond the initial brief and completely redesign COPD pathways in order to provide support to a well-run but overburdened Pulmonary Rehabilitation service.

Our approach

Using its bespoke project management system, NHS Arden & GEM CSU deployed a service redesign lead to plan and oversee the project. The project team is responsible for identifying options to promote self- management, improve patient symptoms, reduce hospital admissions and deliver cost savings, as well as considering potential funding sources for delivery of the redesigned service specification.

"We are delighted to be leading this project for the London Borough of Barking and Dagenham. We specialise in working with multidisciplinary teams and engaging with public, private and voluntary sector partners to achieve a common objective. We’re looking forward to making headway on this exciting opportunity."

Wendy Lane, Director of Transformation, NHS Arden & GEM CSU


To date, the following pathway changes have already been identified:

  • COPD specialist personal trainers have been switched from delivering one to one sessions to delivering ongoing group gym cohort exercise classes to help keep attendees engaged in exercise.
  • The current community provider, together with local voluntary group Breathe Easy, has been tasked with establishing a buddy system which can be run out of local council offices.
  • Smoking cessation services, run by public health, have been redesigned so that workers spend more time in acute settings such as maternity and mental health to support stopping smoking alongside medical interventions.

The project has also secured support from the British Lung Foundation (BLF) to provide a dedicated resource to act as the liaison between the voluntary sector and primary care.

The service specification makes a range of recommendations that, when implemented, will significantly benefit patients. These include an extensive data interrogation exercise to identify a definitive list of current COPD sufferers while monitoring a wide set of metrics to both track patient progress and performance manage individual practices. Dedicated GP staffed community clinics are to be set up and reablement training delivered for hospital discharge staff and social workers. The full service specification and commissioning intentions will be complete by April 2015. NHS Arden & GEM CSU will then deliver a 9 month implementation plan.

The outcomes

The COPD service redesign project is intended to bring the hospital admission rate in line with the London average through implementation of a BLF endorsed and supported Gold Standard Pathway. If this is achieved then potential cost savings could be as high as £800k.

In addition to delivering the project plan, identifying immediate pathway changes and developing the service specification, the team are also currently developing a case for this to become a QIPP scheme.

The team are also working alongside the community provider and Clinical Commissioning Group to identify and apply relevant CQUIN schemes.

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