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Assessing the impact of respiratory conditions on the NHS

Assessing the impact of respiratory conditions on the NHS

Managing respiratory infections affects everyone who relies on healthcare systems. Acute respiratory infections, including respiratory syncytial virus (RSV), influenza, invasive group A streptococcus (iGAS) pneumonia and COVID-19 (SARS-CoV-2), 1-4 impact patients, the community, healthcare staff and systems. 

RSV is an extremely common infection that usually affects 80% of children by the age of two.1 In at-risk populations, RSV can lead to pneumonia or even death.1 In babies, RSV is the leading cause of bronchiolitis.1 The true number of RSV infections may be even higher than estimates, as the majority of adults with RSV do not receive a microbiological diagnosis.1

Other infections also impact the planning and delivery of health services, such as the strain caused by seasonal influenza2 and the ongoing influence of COVID-19, which still produces more than 2600 admissions and 260 deaths per week.3

Sudden increases in the incidence of a pathogen can add unexpected strain on health services. One example is a surge in the rate of iGAS infections in the 2022/2023 season, which resulted in an increase in child mortality, with 28 deaths across the UK in children from iGAS complications.5

To add to the burden of these conditions, the COVID-19 pandemic had a myriad of effects on all aspects of care, with the large-scale conversion of inpatient beds into critical care beds and widespread cancelling of elective procedures.6

How respiratory conditions impact patients, staff and the NHS

Patients experience considerable personal burden from respiratory infections.

RSV has wide-ranging effects on both the elderly,7 and also on young children, for whom it can account for more than 80 deaths per RSV season.8

Influenza has impacts beyond immediate health, leading to reduced productivity, lost wages, and reduced quality of life.2 Sickness from influenza results in the loss of up to 4.8 million work days per year.2

NHS staff have to manage the burden of respiratory infections on the background of an ever-increasing workload, with demand for healthcare now reaching or exceeding pre-pandemic levels.6

This need is reflected in an increase in emergency attendances by 2.6 million between 2010 and 2024.6 This upward trend is mirrored in primary care, with a 15.4% rise in GP appointments from 2010 to 2015.6

NHS staff recognise the impact that respiratory infections can have, with influenza perceived to have a moderate to severe impact on the ability to provide routine services.2

As with patients, acute respiratory infections can affect staff, with flu season leading to increased staff absences and even negative effects on staff psychological well-being.2

Acute respiratory infections (ARI) are one of the most common reasons for attendance at A&E, putting significant pressure on healthcare systems.9 Admissions for ARI appear to be growing at up to 13% per year.9

Unplanned care is expensive. An attendance at an Accident and Emergency department can cost up to £445, with ambulance dispatch and transport adding an extra £417.6 Primary care costs can also soon add up, with a single 10-minute face-to-face GP consultation costing £56.6

ARI can also lead to further healthcare costs, with 125,478 GP episodes of otitis media, and 416,133 prescriptions for antibiotics attributable to RSV.8  Direct medical costs attributed to ARI are estimated to run at £86 million per year.10

Influenza has wide-ranging effects, with an annual loss to the economy of £644 million, equivalent to 0.04% of GDP.2 Covid-19 had a seismic effect on the economy, with public health measures including social distancing, travel restrictions and closure of non-essential shops driving a 19.8% fall in GDP between April and June 2020.11

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How respiratory conditions affect healthcare provision

In the community, respiratory infection can cause significant disruption through primary symptoms (such as bronchiolitis and bronchitis with RSV) and exacerbations of pre-existing diseases, such as COPD and other cardiorespiratory conditions.7

Several factors can affect the spread of respiratory infections. Despite being unwell, up to 50% of adults with influenza still attend work.2

Primary care often takes the brunt of managing increasing respiratory infections, with RSV leading to an estimated 487,247 GP attendance episodes per season.7 These patients can lead to significant resource utilisation, with those who go on to need treatment for ARI receiving an average of 2.5 prescriptions each.10

In secondary care, the greatest direct costs for ARI relate to hospital admission.10 RSV alone accounts for an estimated 17,799 hospitalisations per season, with 8,482 deaths.7 Influenza can cause system-wide impacts, leading to increased waiting times and pressure on other services.2

How the traditional model of care could evolve

Early intervention in acute respiratory infection is key. NHS England highlights earlier intervention as one of the most important strategies for managing ARI.9 By diagnosing conditions sooner in the disease course, specific therapies may be initiated.12

To be effective, early intervention needs a prompt and accurate diagnosis, however diagnosis of ARI can be challenging to make based on symptoms alone.13

A report from the Academy of Medical Sciences called for the availability of testing for Covid-19, RSV and influenza as a core component of managing infections among children and vulnerable adults.14 This is supported by NHS England, who include point of care testing (POCT) as part of their ARI management strategy.9

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How respiratory testing can impact care provision

POCT may allow for clinicians to optimise their management of respiratory infections, including timely commencement of antiviral therapy.14

The Academy of Medical Sciences advocates for the routine use of testing to support diagnosis, treatment decisions and, importantly, to reduce transmission.14

The rollout of testing is supported across hospitals, primary care settings, care homes and the community, with resources dedicated to facilitating this.14

One example of where this could improve care is the treatment of influenza. The ideal time to commence antiviral treatment in influenza is within 48 hours of symptom onset. However, this requires rapid diagnosis, which is impractical without investment in rapid testing.14

The evidence for point-of-care testing

Point-of-care-tests (POCTs) are diagnostic tests performed in close proximity to patients with fast turnaround time (usually within 30 min or less), which support clinical decision making during or close to the time of consultation.15

A flu pilot was run across three primary care networks, covering a total of 16 GP surgeries.16

The pilot aimed to demonstrate whether using rapid diagnostics to diagnose Flu A/B and SARS CoV 2, alongside digital reporting in the community, could improve patient outcomes, reduce the need for hospitalisations, and therefore reduce the secondary care burden.16

In total, 250 at-risk patients were tested across all sites, with a 12.4% positivity rate (31 cases) for flu A; 1.2% positivity rate for flu B (3 cases) and 10.4% positivity rate for SARS CoV 2 (26 cases) using a rapid point of care testing system.16

Of the patients who tested positive for flu, 23 were prescribed antivirals and six were prescribed antibiotics.16

The authors concluded that a community test-and-treat pathway improves patient care by providing an early diagnosis, thus helping to prevent deterioration through appropriate treatment in primary care, and potentially reducing the burden on secondary care.16

 

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Helping you transform what’s possible in respiratory testing

Respiratory infections place a considerable burden on patients, staff and healthcare systems, through increased attendances, admissions, associated conditions and prescriptions.1,2,7,9,10

Rapid POC testing can support the early diagnosis of acute respiratory infections, potentially allowing for earlier and appropriate interventions, thereby helping reduce the burden on secondary care.16

Roche has a diagnostic respiratory portfolio that is built on foundations of quality and efficiency. With almost 30 years of world-leading experience in respiratory research, they are dedicated to improving patient outcomes.

Roche point-of-care testing allows patients to go from test to treatment in one visit, using one sample, in 20 minutes or less. Roche technology delivers results you can trust, with gold-standard PCR technology, to provide care when and where it is needed.

 

Learn more about the Roche respiratory solution at:

Respiratory solutions Roche

Learn more about Roche respiratory solutions.

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References

1. House of Lords Library. Respiratory syncytial virus and its impact on the NHS. Available at: https://lordslibrary.parliament.uk/respiratory-syncytial-virus-and-its-impact-on-the-nhs. Accessed: November 2024.

2. Romanelli RJ, et al. Rand Health Q. 2023;10(4):2.

3. UK Health Security Agency. Covid-19. Available at: https://ukhsa-dashboard.data.gov.uk/respiratory-viruses/covid-19. Accessed November 2024.

4. Group A Strep - What you need to know. UK Health Security Agency. Available at: https://ukhsa.blog.gov.uk/2022/12/05/group-a-strep-what-you-need-to-know. Accessed: November 2024.

5. 4 Nations rapid review of iGAS deaths in children. Public Health Wales. Available at: https://phw.nhs.wales/fournationsigasreport. Accessed: November 2024.

6. The King’s Fund. NHS facts and figures. Available at: https://www.kingsfund.org.uk/insight-and-analysis/data-and-charts/key-facts-figures-nhs. Accessed November 2024.

7. Fleming et al. BMC Infectious Diseases. 2015;15:443.

8. Taylor S, et al. BMJ Open 2016;6:e009337.

9. NHS England. Combined adult and paediatric acute respiratory infection (ARI) hubs. Available at: https://www.england.nhs.uk/long-read/combined-adult-and-paediatric-acute-respiratory-infection-ari-hubs. Accessed: November 2024.

10. Meier GC, et al. PLoS ONE. 202;15(8):e0236472.

11. How the COVID-19 pandemic shocked the UK economy. Office for National Statistics. Available at: https://www.ons.gov.uk/economy/grossdomesticproductgdp/articles/gdpandeventsinhistoryhowthecovid19pandemicshockedtheukeconomy/2022-05-24 . Accessed: November 2024.

12. British National Formulary. Respiratory syncytial virus: Management in children. Available at: https://bnf.nice.org.uk/treatment-summaries/respiratory-syncytial-virus. Accessed November 2024.

13. Dietz et al. BMC Medicine. 2024;22:143.

14. Academy of Medical Sciences. COVID-19: Preparing for the future, Looking ahead to winter 2021/22 and beyond. 2021.

15. Matthes A, et al. BMC Primary Care. 2023;24:96.

16. Community pathway to rapidly test and treat flu. Available at:

https://diagnostics.roche.com/content/dam/diagnostics/gb/infectious-diseases/community-pathway-to-rapidly-test-and-treat-flu-casestudy.pdf. Accessed: November 2024.