Your healthcare closer to home Services provided by Central London Community Healthcare NHS Trust www.clch.nhs.uk Barnet Home Oxygen Assessment Review Service Bunmi Adebajo Clinical & Operational Service Lead Clinical Specialist Respiratory Physiotherapist Central London Healthcare NHS Trust 1
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Your healthcare closer to home
Services provided by Central London Community Healthcare NHS Trust
www.clch.nhs.uk
Barnet Home Oxygen
Assessment Review Service
Bunmi Adebajo
Clinical & Operational Service Lead
Clinical Specialist Respiratory Physiotherapist
Central London Healthcare NHS Trust
1
NHS England Oxygen provision context
In 2012, the DoH & NHS re-ordered the prescription
of oxygen to only be undertaken by suitably qualified
and trained healthcare professionals.
Currently within the NHS in England & Wales,
specifically designated HOSAR services are
commissioned by local CCGs to provide clinical care
and support to their local oxygen user population.
NHS England Oxygen provision context
• The terms of the 2012 home oxygen supply
(HOS) contract requires that prescribers
select suitable equipment for prescription.
• Restriction of GP and all non designated
HOSAR service personnel to ordering only
temporary or emergency supply (HOOF A)
which does not include ambulatory (HOOF
B) devices applies.
3
HOS-AR Services
Why are Home Oxygen Assessment and Reviews services required?
Long-term oxygen therapy in appropriate individuals can
improve survival rates by around 40%.
At the same time 30% of people on home oxygen therapy
currently derive no clinical benefit from it.
In a recent study, at least 15,000 people were found to have no
recorded oxygen usage in a six-month period, at a cost nationally of
£13m per annum.
The total annual cost of the service in England is approximately
£120m. The introduction of HOSAR services has been shown to reduce
annual spend by up to 20%. If the scale of savings were replicated
across England, it is estimated that they could amount to between £10-
20m of savings a year. 4
Barnet HOS-ARHome oxygen assessment review service
The overarching aim of the Barnet HOS-AR is to ensure that home
oxygen is appropriately prescribed to those people who clinically
need it.
The high-level objectives of the HOS-AR are:
• To provide a systematic and integrated Service
• To provide easy access to assessment and follow up procedures delivered by
appropriately qualified and trained healthcare professionals.
• To reduce/eliminate waste and poor quality care, and strengthen affordability and value,
by targeting the service on those who will benefit from home oxygen
• To ensure a higher standard of clinical treatment and improved outcomes, through more
effective and speedier diagnosis
• To ensure that users of the Service have a positive experience of care
Barnet HOS-AR Service
6
Barnet HOS-AR
Four principal stages underpin the service operational delivery
namely:
• Stage 0 Identification and referral of persons for home
oxygen assessment
• Stage 1 Home Oxygen Assessment undertaken
– (a) Assessment for long-term oxygen therapy
– (b) Assessment for ambulatory oxygen
• Stage 2 Follow up home visits for further assessment &
review
• Stage 3 Withdrawal of oxygen therapy (were indicated)
7
National guidance for home oxygen
The Outcomes Strategy for COPD and Asthma and the subsequent NHS
Companion Document to the Strategy recommend :
Routine pulse oximetry in people with COPD whose FEV1 is lower than
50% predicted to identify those who may need long-term home oxygen
therapy and, for those identified, ensure referral for structured assessment
of need by a home oxygen assessment and review service
The NICE Clinical Guideline for COPD recommends home oxygen
assessment and review assessment for the need for oxygen therapy in :
Patients with very severe airflow obstruction (FEV1 < 30% predicted)
Patients with cyanosis
Patients with polycythaemia
Patients with peripheral oedema
Patients with a raised jugular venous pressure
Patients with oxygen saturations ≤ 92% breathing air.
8
National guidance for home oxygen
The NICE Quality Standard for COPD also highlights the
importance home oxygen assessment and review for:
People with COPD potentially requiring long-term oxygen
therapy are assessed in accordance with NICE guidance by a
specialist oxygen service.
People with COPD receiving long-term oxygen therapy are
reviewed in accordance with NICE guidance, at least annually,
by a specialist oxygen service as part of the integrated clinical
management of their COPD
9
Screening
In considering the need for oxygen therapy, the
first step is pulse oximetry, to determine whether
the individual is hypoxaemic. Pulse oximetry should
be routinely available in general practice
Such a modest investment would enable general
practice to screen patients. People who are shown to
be hypoxaemic i.e. where SpO2 is less than or equal
to 92%, whose condition is stable, should be
referred to the HOS-AR Service to have a full
assessment carried out.
. 10
Screening
Where the person’s diagnosis is unclear or when significant
co-morbidity might contribute to breathlessness or
hypoxaemia, e.g. heart failure, they should be referred to an
appropriate specialist physician
Any person with COPD who is hypoxaemia needs a confirmed
and quality-assured diagnosis
People with potential hypercapnia respiratory failure should be
also reviewed by a physician.
People whose oxygen saturation levels are satisfactory
(above 95%) do not need to be seen by a HOS-AR service 11
• Known clinical diagnosis
• Optimisation of other therapeutic measures
• Known Chronic Hypoxaemia > 92%
• SpO2 at rest or exercise de-saturation of
> 4%, tested through pulse oximetry
Referral Criteria considerations
Referral sources
• The Barnet HOSAR service can receive referrals from a