[ADD ORGANISATIONS NAME]
Business Case for a [RESPIRATORY SPECIALIST]
Physiotherapist
[ADD AUTHORS NAMES, JOB TITLES AND DATE]
Contents
1 Introduction
2 Background information
3 Local issues
4 Proposal
5 Cost analysis
6 Benefits and outcomes
1
1 Introduction
This business case highlights the necessity for a [CLINICAL SPECIALIST] in
respiratory physiotherapy. The requirement is driven by the need for [XX N.H.S
Trust (ADD OTHERS IF ADDITIONAL ORGANISATIONS INVOLVED)] to
respond to the current and future changing needs of its population. The proposal
covers the following areas:





Background information
Local issues
Proposal
Cost analysis
Benefits and outcomes
The cost for implementing a [CLINICAL SPECIALIST IN RESPIRATORY
PHYSIOTHERAPY ROLE] is [£XX (SEE COSTS SECTION AND ADD TOTAL)].
These costs will be recovered by the resultant impact on reducing admissions,
reducing Length of Stay (LOS) and readmission rates and a reduction in the
social care costs. Strong evidence is offered to support this business case both
in terms of local demographic need alongside clinical evidence supporting the
impact of such a post and the proposed service provision.
2. Background Information
Respiratory disease is the third most common cause of chronic ill health in the
UK causing patients to experience escalating disability and limitations to their
quality of life. The resultant impact is that respiratory patients are heavy users of
healthcare and social care resources ([1].
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity
and mortality placing large demands on both hospitals and General Practice (GP)
services. The period prevalence of COPD in the United Kingdom is around 11%,
with approximately 900,000 diagnosed COPD patients in England and Wales [2].
COPD is the only disease in the Department of Health (DH) top five killer
diseases, which is still increasing (163% in the last twenty years).
It has been estimated that inpatient costs for COPD exacerbations account for
70% of the total health costs for the COPD patient population. COPD accounted
for 107,352 admissions to hospital in England and Wales and a total of 1051,567
inpatient days in 1999-2000, costing the N.H.S over £818 million in 1999. An
estimated 100,000 hospital admissions were recorded for COPD in England in
the year 2000, equating to around 1m bed days [3]
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Whilst there is currently no curative treatment for COPD, it is possible for the
patients in our local population to improve symptom management, function and
quality of life if given the appropriate therapy support. The introduction of a
specialist physiotherapist for this population group would enable patients to
better manage their condition themselves. This would in turn reduce acute
admission rates, reduce LOS and for those who do require admission and
significantly reduce re-admission rates.
In the United States there are well-established pulmonary rehabilitation
programmes available, based on a wealth of evidence based research [4]. Over
the last few years more centres in Britain have developed pulmonary
rehabilitation services and British standards for pulmonary rehabilitation are now
available [5]. In Wales Llandough Hospital and to a limited extent Singleton
Hospital and Wrexham Maelor Hospital provide this service with beneficial
effects. The Llandough pulmonary rehabilitation programme currently saves
Cardiff and Vale N.H.S trust £150 per patient who completes the course [1] and
data suggests that pulmonary rehabilitation is effective at reducing hospital days
associated with exacerbation [6,7]
2. Local Issues
NB ALL BELOW DATA CAN BE ACCESSED FROM LOCAL PUBLIC HEALTH
SPECIALISTS
.
[XX NHS TRUST] serves a population of [XX] of whom XX% will require
treatment for respiratory disease. This represents a total of XX people who will
require support from XX N.H.S trust.
Our multidisciplinary team serves the population of XX of whom a potential XX
will require treatment for respiratory disorders. To serve the population there are
XX medical beds and XX [ADD ANY OTHER BEDS, SERVICES LOCALLY.]
Despite the above services there is no formalised provision for specialist
respiratory physiotherapy support. [IF HAVE LIMITED SPECIALIST
RESPIRATORY SUPPORT STATE WHAT HAVE AND THE LIMITATIONS.]
The acute [COPD] admissions for XX N.H.S. Trust have increased from XX in
2002-2003 to XX in 2004-2005. [ADD DATA FROM ANY OTHER RELEVANT
ORGANISATION LOCALLY].
Patients in XX N.H.S Trust have higher LOS than others in areas matched for
similar socio-demographics, and longer than the national average of XX. [DATA
AVAILABLE FROM DH WEBSITE]. The average length of stay for the Trust is
XX days. We are therefore not meeting national performance targets in terms of
respiratory admissions and length of stay, but are also falling further behind
comparable trusts. NB CHECK ABOVE STATEMENTS IS THE CASE IF NOT
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OFFER COMPARATIVE DATA. The input of a specialist
physiotherapy could significantly help to reverse this trend.
respiratory
There is no (STATE IF LIMITED RATHER THAN NONE) specialist
physiotherapy provision for the education and treatment of patients with chronic
respiratory disease. If these patients were properly served, hospital admissions
would be avoided and LOS and readmission rates reduced. Patients would be
facilitated to maintain an independent lifestyle at home dramatically increasing
the quality of life. Resource gains can thus be realised through the prevention of
hospital admissions and readmissions, and a reduction in the cost of providing
long-term care and support in the community.
The current staffing levels prevent us from providing the necessary clinical
interventions, rehabilitation and education for patients. In addition there is no
specialist respiratory physiotherapist providing continuing professional
development to more junior members of staff enabling them to deliver more
effective clinical interventions. A physiotherapist who has specialist knowledge of
respiratory conditions would fulfil this commitment to the population we serve.
This service would also compliment the current respiratory services we offer
[ADD SPECIFIC SERVICES AS APPROPIATE] at [XX N.H.S. Trust.] [ADD
OTHER ORGANISATIONS AS APPROPIATE]
3. Proposal
This business case makes the case for funding a specialist physiotherapist to
undertake pulmonary rehabilitation and [XX] [ADD OTHER SERVICES /
INTERVENTIONS AS APPROPATE] so that we may address the needs of the
population we serve.
The proposal is set out as follows:
Overview:
[CHANGE AS REQUIRED TO REFLECT LOCAL NEEDS – BELOW IS
OFFERED AS WORKING EXAMPLE]

The post holder would be based at [XX] organisation and would manage
physiotherapy intervention for patients requiring non-invasive ventilation in
the Acute Medical Admissions Unit (AMAU), thereby preventing
progression to more invasive ventilation and other complications which
increase LOS and reduce outcomes.

The post holder would work cross sites and across organisational
boundaries and will produce and deliver a training package to educate
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colleagues to support the provision of pulmonary rehabilitation across the
trust.

The post holder would link with community services to enable smooth
discharge planning and would provide expert support for clinicians working
in the community with patients who have respiratory disorders.

The post holder would lead the physiotherapy intervention as part of a
pulmonary rehabilitation programme across [XX NHS Trust], thereby
enabling the population of [XX] to maintain their health, well being and
lifestyle choices for longer.

The post holder will develop the physiotherapy educational framework for
the respiratory team and will expand our links with the University of [XX
ADD ANY LOCAL LINKS WHICH WILL ENHANCE OUTCOMES]

The post holder will evaluate their input and provide key outcome data
including the impact on admission rates, LOS and readmission rates.
Quality of life and functional level outcomes will also be collected.
Range and Scope
[CHANGE AS REQUIRED TO REFLECT LOCAL NEEDS – BELOW IS
OFFERED AS WORKING EXAMPLE]
Clinical
 Lead pulmonary rehabilitation services across the trust / community
 Provide support and education to service users and their carers
 Support the NIV therapy to [XX] Hospital
 Develop the respiratory service into the community setting
 Co-ordinate and participate in health promotion across the local population
 Develop physiotherapy led clinics based at the cardio-respiratory centre at
[XX ]Hospital
 Set standards and revise policies for the physiotherapy respiratory service
based on best practice and clinical outcomes
 Work as part of a respiratory multidisciplinary team and participate in
networks
 Participate in research
 Produce clear outcome data
Educational /developmental role

Lead the education of physiotherapy colleagues to ensure respiratory
competencies are maintained for on call purposes and pulmonary
rehabilitation
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



Coordinate and lead in the education of junior and rotational staff from
physiotherapy and other professionals in respiratory issues
Coordinate the education of physiotherapy students within a respiratory
module.
Ensure best practice and new research findings are consistently and
appropriately implemented and maintained.
Ensure staff understand and use outcome measurements as part of daily
practice
5 Costs
The proposal includes all related costs including salary, on-costs, equipment,
administration support and travel and study leave expenses. A break down of the
costs is:







Employment of a physiotherapist who is a [CLINICAL SPECIALIST] in
respiratory disorder –[£XX NB AGENDA FOR CHANGE SALARY]
On costs – [£XX]
Equipment [£XX – LIST ITEMS AND INDIVIDUAL COSTS]
Venue costs for running Pulmonary Rehabilitation [£XX – ONLY ADD IF
NECESSARY BUT CONSDIER FUTURE EXPANSION MAY ADD
COSTS]
Administration costs [£XX – ONLY ADD IF REQUIRED AND CANNOT BE
COVERED BY CURRENT ESTABLISHEMENT – WILL NEED TO DO
DISCHARGE REPORTS AND COMMUNICATION WITH GPS AND
COMMUNITY STAFF IN TIMELY AND EFFECTIVE MANNER]
Travel expenses approx [£XX – QUANTIFY]
Study leave expenses [£XX]
Total Cost [£XX] per annum (NB ADD INFLATION LIFT FOR FOLLOWING
YEARS / CONSIDER ONGOING FUNDING REQUIREMENTS)
6 Benefits and Outcomes
A physiotherapy respiratory specialist post is fundamental to the delivery of high
quality, efficient and effective care for the local population with respiratory
disease. The initial costs of implementing this post will be recovered by the
resultant reduction in acute admissions and a reduction in LOS and readmission
rates. In addition, the functional and quality of patients lives will be optimised. In
summary the key benefits and outcomes are:

Dramatic improvement in specialised acute care for respiratory patients
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






Reduction in acute admissions reducing the costs for the health economy
and enhancing the patient experience
Reduction in the length of stay in hospital for patients who are admitted
thus preventing bed blockages, clinical and social complications and
reducing the costs for the health economy and enhancing the patient
experience
Enablement of patients to maintain a healthier lifestyles and greater
independence, thus reducing the reliance on social care services. This will
offer additional costs saving across the health economy
Ensuring the education of patients and staff with continual service and
professional development, thus preventing the risk of inappropriate care
and the consequences both for patients and the costs to the health
economy
Reduction in health inequalities and improved health standards across the
community and the Trust
Develop of multidisciplinary team working in the approach to respiratory
care offering seamless high quality care to patients. This will ensure a
robust approach to the whole patient pathway ensuring patient are clearly
maintained and monitored through out their whole illness
Improve recruitment and retention of permanent staff thus lowering the
cost of locum services to the trust. The Locum costs for 2003-2004 have
been an average of [£XX] and for 2004-2005 an average of £XX] [ADD
ANY OTHER LOCUM / RECUITMENT AND RETENTION ISSUES
LOCALLY AS APPROPIATE].
Reference List
1. Griffiths T L, Phillips C J, Davies S, Burr M L, Campbell I A. Cost effectiveness of
an outpatient multidisciplinary pulmonary rehabilitation programme. Thorax 2001;
56: 779-784.
2. National Collaborating Centre for Chronic Conditions. Chronic obstructive
pulmonary disease. National clinical guideline on management of chronic
obstructive pulmonary disease in adults in primary and secondary care. Thorax
2004; 59: 1-232.
3. National Respiratory Training Centre. National Respiratory Training Centre
Impact of Respiratory Conditions: a guide for Primary Care Organisations.
2002. Warwick, NRTC.
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4. Lacasse Y, Maltais F, Goldstein R S. Pulmonary rehabilitation: an integral part of
the long-term management of COPD. Swiss.Med.Wkly. 2004; 134: 601-605.
5. Morgan M D, Calverley P M, Clark C, Davidson A C, Garrod R, Goldman J,
Griffiths T L, Roberts E, Sawicka E, Wallace L, White R. British Thoracic Society
Statement on Pulmonary Rehabilitation. Thorax 2001; 56: 827-834.
6. Foglio K, Bianchi L, Bruletti G, Battista L, Pagani M, Ambrosino N. Long-term
effectiveness of pulmonary rehabilitation in patients with chronic airway
obstruction. European Respiratory Journal 1999; 13: 125-132.
7. Man W D, Polkey M I, Donaldson N, Gray B J, Moxham J. Community pulmonary
rehabilitation after hospitalisation for acute exacerbations of chronic obstructive
pulmonary disease: randomised controlled study. BMJ 2004; 329: 1209.
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