Chronic obstructive pulmonary disease (COPD): policy context

There is an increasing policy focus on long-term conditions, both in Scotland and in the UK as a whole. COPD is recognised as an important long-term condition, but there is limited policy relating specifically to this disease.

The Scottish policy documents Delivering for Health, 2005 (2005) and the Better Health, Better Care: Action Plan (2007) both recognise the importance of long-term conditions. Policy advocates a generic (rather than disease-specific) approach to managing these conditions, including improving community care and self-management. A Long term Conditions Collaborative Programme has been established by the Scottish Government to support this agenda, including support for the HEAT target around COPD admissions (see below). The Scottish Government's palliative care action plan (Living and Dying Well) is also relevant to the care of people with advanced COPD.

The Scottish Government publishes HEAT (Health improvement, Efficiency/governance, Access, Treatment) targets against which health boards are performance managed. One of the targets in the Treatment section of the 2010/11 HEAT is 'To achieve agreed reductions in the rates of hospital admissions and bed days of patients with primary diagnosis of COPD, asthma, diabetes or CHD, from 2006/7 to 2010/11'.

Audit Scotland published a report entitled 'Managing Long Term Conditions' in August 2007. COPD and epilepsy were used as examples of long-term conditions and the report contains some useful analyses in relation to these conditions. It suggests that increased community care for COPD may reduce numbers of admissions, outpatient appointments and GP consultations (based on the experience of Scottish health boards), but the report suggested that the cost implications appear to be much less understood. The Royal College of Physicians published a UK wide COPD audit in December 2008 (the National COPD Resources and Outcomes Project - NCROP), which covered the organisation and delivery of care.

COPD is one of the conditions included in the Quality and Outcomes Framework (QOF) of the new General Medical Services contract. This provides incentives to deliver high quality care.

In England, an expert group was convened in 2006 to produce a National Strategy for COPD. The consultation on this strategy closes in April 2010.

Clinical guidance regarding the management of COPD (CG12) was produced by NICE (the National Institute for Health and Clinical Excellence) in 2004 and more recently by the Global Initiative for Chronic Obstructive Lung Disease (GOLD), with an update in 2009.

Internationally, the World Health Organization has produced a 'Strategy for the prevention and control of chronic respiratory diseases'  (113Kb) and established the WHO Global Alliance against Respiratory Diseases (GARD).