Ageing Well - Health

Respiratory Disease


Respiratory disease is the third biggest cause of death in England after cancer and cardiovascular disease.  Hospital admissions for respiratory disease have been rising over the last few years and at a higher rate than other admissions. 

Examples of respiratory disease include Chronic Obstructive Pulmonary Disease (COPD), Asthma, Influenza and Pneumonia along with other respiratory infections.

Respiratory diseases have a major role to play in increasing winter pressures on NHS trusts – admissions double in winter.  There are clear social gradients with respiratory disease.  Incidence and mortality rates are higher in more deprived areas.  This is linked to increased smoking rates, poor housing, exposure to poor air quality and occupational hazards. 

Improvements to respiratory health can come from reducing smoking, increasing vaccination rates and improving diagnostic rates.


Main Issues

Hartlepool’s under 75 mortality rate from respiratory disease is at a four year high of 49.6 per 100,000 people. This is the 4th highest level in the north East, and higher than both the regional and England average.


Hartlepool’s rate had been declining for 3 years before the 2015-17 figures saw an increase of 3.2 per 100,000. The rate has declined by 27.7% from the start of the reporting period in 2001/03, but since reaching its lowest point in 2009/11, the rate has increased by 19.5% in 2015/17. Compared to the England average, the gap between England and Hartlepool initially declined year on year for eight years, down to a low of 7.3 per 100,000 in 2009/11, but has since increased back up to 15.3 per 100,000. Looked at separately, the trends for males and females have followed differing patterns recently.

Male under 75 mortality from respiratory disease increased rapidly in 2010/12 and 2011/13, 15.8% and 11.4% respectively, before stabilising to stay within 3.4% of the preceding year.


The female rate increased from 38.0 per 100,000 in 2008/10 to 45.3 per 100,000 in 2011/13 due to relatively large jumps in 2009/11 and 2011/13 of 5.2 per 100,000 and 5.8 per 100,000 respectively. This led to a rate of 45.3 per 100,000 in 2011/13, an increase of 29.4% on the 2008/10 rate. This was followed by a three year reduction, down to 36.3 per 100,000 in 2014/16, however the rate had again increased in 2015/17.


For under 75 mortality from respiratory disease that is considered preventable, Hartlepool has been on an upward trend for six years.


While Hartlepool’s rate is considerable lower than the 40.1 per 100,000 population in 2001/03, 27.7% lower in 2015/17, the rate of 29.0 per 100,000 in 2015/17 is a significant increase on the 2009/11 figure of 17.1 pew 100,000. The 2015/17 rate is 69.6%, more than two thirds, larger than the 2009/11 rate. During this same period the England rate increased by 9.9%.

Looking at chronic obstructive pulmonary disease Chronic Obstructive Pulmonary Disease (COPD) individually, Hartlepool’s rate of emergency hospital admissions for COPD in 2017/18 of 805 per 100,000 population is the 2nd highest in the north east and the 8th highest in England.


Hartlepool’s rate has been statistically worse than the England average throughout the eight year reporting period, but has fluctuated up and down across these years.


Comparatively the England rate has remained quite stable, moving only 7.2% from its lowest level to its highest level in this period. The Hartlepool rate shifts by 35.7% from its lowest to highest point. The mortality rate from COPD in Hartlepool has increased 26.9% in five years, and after a single year where the rate was statistically similar to England.



Current Services

It is recognised that the current design, capacity and capability of current services is insufficient to cope with the projected increase in the number of people with COPD, from a registered prevalence of 2.7% in 2010 to 4.5% in 2020 in Hartlepool. The CCG are working with primary care, secondary and community care to ensure patients are supported and empowered to manage their respiratory disease.

Locally, there is low awareness of lung health and COPD in sub-groups that are at high risk (for example current and ex-smokers and women). Incidence and mortality rates for those with a respiratory disease are higher in disadvantaged groups and areas of social deprivation.

There is inequitable access to high quality spirometry across primary and community care and by March 2021, any health professional performing and interpreting spirometry will be required to obtain an ARTP qualification. The CCG are developing how spirometry services will be commissioned, working closely with the Primary Care Networks.

We have a high number of emergency admissions for respiratory conditions, implying a level of unmet need and increased requirements for support and education of this patient group. The Hospital at Home service provides a home support service to ensure that wherever possible, patient’s symptoms are managed in their own homes thus reducing the need for a hospital stay


Future Intentions

Our intention for the future is to improve services and outcomes for respiratory disease. We will achieve this by taking an integrated approach to delivery which involves communities, voluntary organisations and the health and care system. We will focus on prevention, early detection and diagnosis and optimal treatment options, concentrating interventions initially on populations at greater risk.

The NHS Long Term Plan outlines a number of key milestones for respiratory care:

  • Early and accurate diagnosis: to increase early and accurate diagnosis for people with respiratory disease. 
  • Medicines management: to promote appropriate prescribing of respiratory medication and inhaler use to promote better compliance and prevent avoidable acute admissions and deaths from poor self-management.
  • Flexible learning: to develop an accredited education programme for individuals diagnosed with common respiratory diseases such as COPD, asthma and bronchiectasis. Patients will be empowered to effectively self-manage offering innovative support such as digital solutions and enhanced group structured education programmes
  • Expansion of pulmonary rehabilitation: to increase the number of patients who would benefit from Pulmonary Rehabilitation and are referred to and complete a good quality programme.
  • Community-acquired pneumonia: to reduce avoidable admissions and bed days for patients with community acquired pneumonia, achieved through implementation of risk stratification tools and ambulatory care services such as nurse-led supported discharge services.
  • Breathlessness models: A model of care for breathlessness management is designed for patients who have either cardiac or pulmonary disease and have symptoms of breathlessness in common, to include the diagnostic pathway and joint rehabilitation models.
  • Effective care will be wrapped around patients in the community to reduce emergency admissions and support patients to be discharged following admission as quickly and safely as possible.