To ask the Minister of Health what steps his Department is taking to ensure quality respiratory care provision for people living in rural communities.

The Health and Social Care Board (HSCB) commissions respiratory care in both acute and community settings across the whole of Northern Ireland as part of the overall Service and Budget Agreements (SBAs) with each of the Health and Social Care Trusts.

The SBAs do not include commissioning of respiratory services particularly for people living in rural communities, but do include the provision of services by community respiratory teams who help support people with respiratory illness in the community or primary care settings closer to the patient’s home rather than a need to attend for outpatient/treatment in a hospital setting.

In 2016 the Regulation and Quality Improvement Authority carried out a review of Community Respiratory Services. The review recognised the very committed community respiratory services workforce, who provide a patient-centred service for those with long-term respiratory conditions but highlighted the need for equal service provision for every patient across Northern Ireland and for stronger integration across primary, community and acute services.

A Community Respiratory Services Review by the Regional Respiratory Forum NI in 2019 included a scoping exercise of community services. Whilst there was a degree in variation across HSC Trusts, all Trusts provided services for patients with Chronic Obstructive Pulmonary Disease (COPD) with 4 out of 5 Trusts providing Bronchiectasis, Interstitial Lung Disease (ILD), Pulmonary Rehabilitation, and Oxygen Services. Some Trusts work closely with their palliative care teams and district nurses in caring for end stage respiratory patients.

The review set out a number of recommendations prioritising the following 5 developments:

Increase capacity and resources for pulmonary rehabilitation in community settings especially in HSC Trusts with waiting lists

Increase capacity of community services for patients with bronchiectasis to improve quality of care, patient experience and outcomes in HSC Trust that are currently unable to meet recommended standards of care.

Resource and implement the ILD network service model proposed in 2016 to support full implementation of NICE technology assessments of antifibrotic medication.

Review staffing requirements in all HSC Trusts for home oxygen services to take account of growing population need.

Resource all HSC Trusts for consultant and specialist nurse long term ventilation leadership to improve care of this rapidly growing patient cohort.

Whilst the Covid-19 Pandemic has impacted on the ability to progress the recommendations, the HSCB is preparing a more strategic approach to planning of respiratory care in Northern Ireland. It will be necessary to develop new services over time and this would include ensuring that the needs of rural populations are assessed and met.