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The Nightmare before Christmas


A burnt-out and under-funded respiratory workforce can only watch nervously as winter approaches.

At the British Thoracic Society (BTS) 2022 Winter Meeting, respiratory experts from around the UK are discussing their apprehension of the looming pressure on the health system as we enter the winter months.

The inability of the UK health system to manage winter-related illness is not new. Of particular concern is the negative impact colder temperatures pose to the capacity of specialist respiratory resource available. This winter, respiratory clinicians are facing rises in influenza, asthma, pneumonia and COVID-19, increasing hospitalisations and a reduction in the availability of Intensive Care beds.

At this year’s Winter Meeting - the first in-person conference since 2019, BTS has seen a strong desire for respiratory professionals to reflect together on their experiences of the COVID-19 pandemic. A clear consensus is emerging that although our respiratory services overall performed admirably over the last three years, continuing to stretch teams to breaking point will deprive patients access to the expert care they need.

BTS continues to highlight the risks of the chronic understaffing and under-resourcing of respiratory departments. Published in 2020, the Society ran a survey which found many respiratory teams across the UK were additionally required to look after up to 40 extra patients outside of respiratory wards to manage illnesses exacerbated by winter. Respiratory specialists are also supporting general medicine more frequently which, although a testament to the highly skilled and dedicated respiratory workforce, risks respiratory patients not getting the specialist care they need and increases staff fatigue. With many respiratory illnesses so closely linked to health inequality, any shortfalls particularly affect the most vulnerable communities.

Dr Paul Walker, Chair of the BTS Board of Trustees said:

“If you have a lung condition and are treated by a respiratory specialist you are more likely to have the correct diagnosis, receive the best treatments and consequently have fewer symptoms and a better quality of life. Sadly, we have a major shortage of respiratory specialists across all professional groups as we showed in our recent report ‘A Respiratory Workforce for the Future’. For too long many respiratory services have operated through the goodwill of staff but, in light of increasing pressures, including the impact of COVID on respiratory teams, it is clear that this is not sustainable. Our frustration is that adequate staffing would allow us to address the seasonal nature of respiratory care which contributes so much to NHS winter pressure.” 

Optimal patient care is delivered by the right person in the right place at the right time. To achieve better lung health for all, issues that hinder the integration of services, the attraction and retention of respiratory professionals, and focus on illness prevention must be addressed.

The Society will continue to work hard to advocate on behalf of the respiratory workforce for prioritisation of these areas. For our health system to simply maintain the current trajectory will risk both patient and professional safety throughout the coming winter and beyond.