The Covid-19 pandemic saw the demand for specialist clinics to treat patients with lung problems suddenly grow exponentially. This has had a huge impact on respiratory care, with now more than two thirds (71%) of respiratory departments in the UK reporting they do not have enough medical staff to manage their workload.

However, the sector was already close to breaking point before the pandemic began. In 2018, the Taskforce for Lung Health published its five-year plan to improve lung health in England. The report revealed that staff shortages in pulmonary rehabilitation, nursing, primary care, secondary care, and radiology were among the areas identified as needing urgent reform to support the one in five people diagnosed with lung disease in their lifetime.

Today, professional bodies sitting on the Taskforce for Lung Health have come together to highlight the lack of progress in improving respiratory care. For this reason, they are calling for an urgent review into the current workforce shortages and the potential long-term impact of Covid-19 on what is a historically understaffed sector.

At least one third of people with lung conditions had their treatment cancelled

Professor Jon Bennett, Chair of the British Thoracic Society warns: “Without extra resources and staff, the respiratory workforce cannot adequately deliver routine and specialist clinics for the many people with lung problems while at the same time being expected to treat acute and post-Covid-19 patients, and run Long-Covid clinics. This means patients with lung disease are being deprived of access to the specialist expertise they need.

“The UK needs a larger and better funded respiratory workforce including consultants, nurses, physiotherapists, physiologists and all other essential, skilled professionals, to cope with the ever-increasing demand for care.”

The NHS is currently facing a huge backlog of patients in all areas of care as a result of the pandemic, which is putting increasing pressure on an already physically and mentally exhausted workforce. This is particularly visible in respiratory care, with many services offering pulmonary rehabilitation postponing or stopping their treatment programmes altogether. A recent survey found that at least one third of people with lung conditions had their treatment cancelled.

The Taskforce argues that this backlog (compounded by the rising number of Long Covid patients needing care), cannot be addressed without a commitment towards improving the numbers of trained, skilled respiratory professionals at all levels.

The CSP say 2,300 physiotherapy posts will be required to address Covid recovery

In 2018, the Chartered Society of Physiotherapy (CSP) estimated that an additional 1,000 staff members were needed to meet the growing demand for pulmonary rehabilitation. Now, the CSP estimate that the Covid-19 patients who were in hospital in the first wave alone will require almost two million hours of rehab. To account for this, the CSP say 2,300 new physiotherapy posts will be required to address the community rehab needs of Covid recovery within one year.

Rachel Newton, Head of Policy at the Chartered Society of Physiotherapy, said: "We are facing a serious and immediate shortage of physiotherapists and physiotherapy support workers in the UK. Although the registered workforce has been expanding for some time, it has simply not kept up with current demand and this is now even greater due to Covid-19. 

"Physiotherapy staff play a crucial role in treating these patients in intensive care and also prove rehabilitation for those suffering from Long Covid in the community. This is extra pressure on an already stretched workforce that provides life-saving and life-prolonging rehabilitation for patients with all kinds of lung conditions – conditions that for millions have got progressively worse due the pandemic.”

Tens of thousands of people waiting for a lung disease diagnosis

Delays in diagnosis have also worsened with the pandemic. A patient survey by Asthma UK and the British Lung Foundation found that one in three people waited more than six months for a diagnosis before the pandemic, and one in six waited longer than a year. Estimates suggest that now, over a year into the pandemic, the backlog of people waiting for a lung disease diagnosis is in the tens of thousands.

Radiologists play a vital role in diagnosing and managing lung disease by carrying out imaging and interpreting scans. However, the latest census by the Royal College of Radiologists showed that workforce shortages have deteriorated over the last few years with one in five trusts or health boards reporting missing a consultant and a quarter of chest/lung radiologists due to retire within five years.

Dr Graham Robinson, President of the British Society of Thoracic Imaging said: “Imaging, particularly CT scanning of the lungs, is vital for many respiratory diagnoses. It should also be more available direct from primary care. Pre-existing backlogs in CT scanning and reporting have been magnified during Covid-19. The UK also has less CT scanners per head of population than the majority of our European neighbours. This, and the shortage of specialist thoracic radiologists, risks delays in diagnosis.

“NHS England are separately encouraging all the lung cancer screening pilots (lung health checks) to restart at full capacity, but as yet there remains no signed off national program, which will again only magnify staff and scanner shortages.”

Half of specialist respiratory nurses could retire within the next six years

Delays to diagnosis in primary care have also been heavily impacted by the pandemic, with diagnostic spirometry training coming to a complete halt due to a lack of funding and staff shortages.

The nursing sector are also understandably concerned about respiratory staffing levels, with experts estimating that half of specialist respiratory nurses could retire within the next six years. Wendy Preston, Head of Nursing Practice at the Royal College of Nursing & Consultant Respiratory Nurse, says it is therefore vital that workforce is prioritised in order to “attract to next generation of nurses and retain existing expertise.”

It seems across all areas of respiratory care, there is a desperate plea to increase the workforce and get staffing levels up to a level that can cope with the backlog of patients suffering with lung conditions, as well as those suffering with acute and Long-Covid.

Alison Cook, Chair of the Taskforce for Lung Health, said, “The Taskforce for Lung Health has come together in a rallying cry to stress the fact that the future of respiratory treatment and care is at risk if nothing is done, now. For too long, we have seen a lack of progress in filling the vacant respiratory posts in our hospitals, GP practices and communities.

“It is no secret that outcomes for patients with lung conditions have not improved for over a decade, and that we urgently need to see a workforce equipped to support the millions of people in need. We must now see an immediate review into the current shortages in the respiratory workforce, and the potential long-term impact of Covid-19 on staffing levels across the sector. The wellbeing of people living with lung disease depends on it”.