Survey reveals ‘silent scandal’ of missing lung tests across England

Patients in some of the most deprived areas of England, where respiratory conditions including chronic lung disease (COPD) and asthma are most prevalent, have limited or no access to vital diagnostic tests to confirm their diagnosis, according to a new survey.

The BMJ requested information on access to spirometry – a lung function test recommended by NICE for diagnosing COPD– from England’s 42 integrated care boards (ICBs). The BMJ also looked at information the boards had put into the public domain around access to spirometry from general practice and corroborated some ICBs’ depiction of availability of diagnostics in their regions by speaking with local GPs. 

a person with a light in their head

Of the 25 ICBs that responded, the BMJ found that provision was patchy and the full picture unclear in West Yorkshire, and that spirometry was no longer commissioned in Hampshire and the Isle of Wight.

Humber and North Yorkshire ICB said that it ‘did not commission spirometry as a local enhanced service’ and did not have a clear picture of provision in its region. Derby and Derbyshire ICB also could not give a picture of availability in its area, but a Derbyshire-based GP said she had no access to services to which to refer her patients.

In Devon, spirometry is not available for some patients, while in Cornwall, a region with high levels of deprivation and long waiting lists for lung diagnosis, the ICB does not commission spirometry and could not give a clear picture of provision, although it says there is some coverage by community diagnostic centres (CDCs).

The BMJ also found disparities of access to diagnostic services between more and less deprived areas within ICBs, including in London.

Lung conditions are the third biggest killer in the UK. The government’s Major Conditions Strategy highlighted the need for early and accurate diagnoses of lung conditions, and one of the aims of NHS England’s Core20PLUS5 initiative is to ‘narrow health inequalities’ in chronic respiratory disease.

Last month, a report by the charity Asthma + Lung UK warned that without timely and accurate diagnosis, people with lung conditions do not get treatment for their symptoms, suffer acute and long term deterioration, and die early.

Image: julien Tromeur

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