A COPD Health Inequalities Improvement Programme addressing variation in access, quality of care and health outcomes for Hastings place.
Project overview, including who was involved in the project
The Hastings COPD Health Inequalities Improvement Programme is designed to reduce the significant respiratory health inequalities in this area, by improving the quality of care for residents with COPD. Hastings is one of the most deprived coastal local authority areas in the South East. Using NHS Confederation’s five‑step approach to tackle health inequalities, the collaborative working programme brought together health system stakeholders, including primary, community and secondary care, voluntary sector community, Local Authority & Integrated Care Board (ICB) commissioners, and public health teams, together with the NHS Confederation and Sanofi. This collaboration generated a robust population health analysis, identified pathway improvements, and co‑developed targeted interventions to address health inequalities.Hastings has COPD prevalence (3.2%) far above national levels, with high rates of emergency admissions and potential underdiagnosis, within some practices. Pathway mapping highlighted fragmentation across the COPD pathway, inconsistent provision of structured annual reviews for treatment optimisation, access to specialist services and pulmonary rehabilitation. The programme therefore focuses on strengthening the integrated neighbourhood model, improving communication across organisational boundaries, increasing primary prevention, enhancing education and training, and stratifying high‑risk patients for a proactive review (OPTIMISE) and improving access to specialist care.
Pilot interventions include clinical training, enhanced reviews of high-risk patients, additional patient peer support groups, enhanced community respiratory drop‑in clinics, increased pulmonary rehabilitation access, and multidisciplinary team (MDT) working between primary, community and secondary care. The programme is aligned to NHS 2025/26 priorities: reducing demand, tackling inequalities, and advancing secondary prevention, providing evidence for future sustainability, and scalable adoption across the Sussex ICB footprint.
Project outcomes/impact
The programme has delivered substantial progress in understanding and addressing COPD inequalities in Hastings. Population health analysis has quantified the scale of the challenge, risk‑stratified the registered COPD population and addressed practice‑level variation in diagnosis, management and non‑elective admission rates versus Sussex and England. This has enabled targeted identification of high‑risk groups, including smokers, people with repeated oral steroid use, unvaccinated patients and those in the most deprived areas.Integrated working has strengthened collaboration between primary care, community RESPS teams, secondary care, local authorities and voluntary sector partners. Early wins include the launch of new patient support groups with high attendance, demonstrating unmet community need; development of an enhanced service specification for OPTIMISE to enable structured reviews of uncontrolled COPD; educational sessions to reduce clinical variation; and expanded community respiratory input, including drop‑in clinics for Hastings’ most vulnerable residents, improving access to pulmonary rehabilitation (PR).
A new MDT pathway for complex or uncontrolled COPD patients is being finalised to ensure timely specialist advice. These interventions will support earlier access to appropriate COPD care, tailored to individual needs, and improve health outcomes. Early qualitative feedback suggests better patient engagement and improved alignment across the pathway.
The programme is now assembling evaluation metrics to assess pathway impact, inform a future business case and support wider adoption. Its collaborative, neighbourhood‑driven model shows how integrated respiratory care can be implemented in deprived communities to reduce inequalities and improve outcomes.
If you were to run the project again, what would you do differently?
It is challenging to evaluate/understand longer term impact from short term projects such as this (6 months in duration). On reflection, it would have been good to build in capacity to revisit programme outcomes/ evaluation metrics, 3-5 years down the line to determine whether there has been any longer-term change, however clearly this is not always an option.Advice you would have for others undertaking the same type of project.
It is important to recognise and build in your plans, the importance of stakeholder engagement to fully understand the challenges across the whole respiratory pathway.One must not under-estimate the challenges to delivering change in an already stretched system e.g. primary care capacity, the current NHS reorganisation, post COVID legacy of elective care waiting times and recent industrial action. We have sought to mitigate these challenges through a combination of maximising capacity for smaller, single-handed practices through the primary care network (PCN) structure. We have also utilised the voluntary, community and social enterprise (VCSE) to offer peer support and community wellbeing centres who specialise in supporting some of the most vulnerable members of the Hastings community.