NHS Wales Respiratory Toolkit

A Case Study

The bespoke NHS Wales Respiratory Toolkit, today used by tens of thousands of healthcare professionals and people living with respiratory conditions across Wales, has resulted in nationwide improvements in patient wellbeing.

The outcomes from this case study:

Improved patient wellbeing and reduced healthcare utilisation

Among all users of the respiratory apps, 36% reduce their visits to the GP, and 19% reduce their admissions to A&E when they regularly use their app for more than six months.

Near-perfect coverage

Where the Respiratory Self-Management apps have been implemented, including on a National basis, we see coverage of 99% of GP practices who have patients using the apps.

No geographical variation in patient uptake

There is no geographical variation in coverage (North, South, East and West), nor variation in Deprivation Index based on GP postcode.

Patients feel empowered to manage their condition

Of those patients, 90% surveyed said that the apps help them with self-management of their condition.
Healthcare professionals are using the toolkit to support their practice

For the associated Respiratory toolkit that supports healthcare professionals in practice, we see similar coverage across Primary care services (95% GP Practices with healthcare professionals on the system).

Background to the project

During a previous project, ICST’s model for implementation proved highly effective, seeing a nine-fold increase in engagement and accreditation in those healthboards in NHS Wales who used the ICST model, when compared to healthboards who chose to use the more traditional approaches.

Following this success, the NHS Wales respiratory team identified other areas in which they wanted to focus on raising the standards across Wales, including:

  • Ensuring that every asthma diagnosis was accurate and evidenced by objective testing in practice
  • Ensuring that everyone living with asthma was offered basic, high value care, according to a national standard
  • Ensuring that everyone living with COPD was offered basic, high value care, according to a national standard
  • Ensure that everyone living with Asthma and COPD in Wales were equipped with the skills to manage their condition, and prevent unnecessary admissions to hospital

The bespoke NHS Wales Respiratory Toolkit was developed and implemented, today used by tens of thousands of healthcare professionals and people living with respiratory conditions across Wales.

The journey of success

Fail to prepare, prepare to fail

The early stages of the implementation process ensures that the product is prepared for the new environment, and that the environment is prepared to receive this product.

Customising the innovation for the audience

Although ICST’s toolkits are ‘ready to go’ for a general audience, there is a process to optimise the innovation for the environment in which it is being implemented. For example in NHS Wales, the patient apps needed to be bilingual in English and Welsh, to meet the Welsh language standards.
Establishing the teams
Identification of those who would be involved in the development of the innovations (the innovation team), the team who would oversee the governance of the process and content (the governance team) and the team that would oversee the implementation of the innovation into the system (the implementation team).
Alignment and awareness campaign
As part of ICST’s implementation methodology, the active alignment of key stakeholders, or people with influence in the system, is key to ensure that there are no barriers to implementation. In doing so, ICST supported NHS Wales to run awareness campaigns prior to the launch of the NHS Wales Respiratory Toolkit.
Testing the toolkit
A representative sample of users (both healthcare professionals and people living with respiratory conditions) were recruited to test the toolkit and make sure it was real-world compliant. The feedback from this process highlighted a few areas of improvement that we addressed before proceeding with the formal launch. 

Ongoing implementation success

Continuous optimisation of the toolkit
Throughout the implementation, ICST monitors the uptake and engagement of the innovation, as well as survey data and feedback from the audience. The findings from this help inform further development work, ensuring that the innovations continue to be optimised for the audience. One such finding, suggested that 70% of users of the respiratory apps felt that the app supported them in their self-management. Following some development work to optimise the user experience of the app, the audience was re-surveyed. This increased to 90% of those surveyed saying the app helps them manage their own condition.
…we continue to strive for 100%.
Active implementation work
During active implementation, ICST leads the implementation team towards implementation success, monitoring a whole range of proven implementation factors (we call them Enablers), to ensure that the value is realised for this implementation project.

Barriers overcome:

Geographical barriers
Traditionally, there is variation in access to healthcare across Wales, and therefore we engaged as much as possible with key players to establish the innovation in North, South, East and West Wales.
For this reason, there is no geographical variation in app provision.
Language barriers
Partnering with NHS Wales meant that our patient-facing innovations had to be bilingual, to ensure that our apps were delivering safe, high quality information in both English and Welsh, and a positive patient experience.
All our apps were developed to accommodate this functionality, and therefore this was incorporated into our development process.
A global pandemic
Active implementation of the NHS Wales Respiratory toolkit had begun 6-months before the start of the COVID-19 pandemic, but progress was halted when the pandemic hit.
Shortly into the pandemic, the apps became an essential part of the COVID response, offering support and guidance to some of the most vulnerable people living in the communities.

"Healthhub apps are both revolutionary and innovative, allowing us to co-produce healthcare by working together with patients to create better health outcomes."


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“The plans have led the way in embedding quality improvement in respiratory care, focusing on self- management and digital solutions to modernise treatment pathways”


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“It really helps me to manage my symptoms, keeps track of my medication and helps me establish if I’m unwell due to my Asthma. It gives me a confidence boost; I wouldn’t know what to do without it. I tell everyone – Download the app, it’s amazing!”


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“This app has a number of good points making it essential if you have copd at any stage. There is an information and tip section with short videos explaining how up you can be better. You can input symptoms if you are ill and get advice. Plus, lots more. And it’s free.”


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For more information, check out the Respiratory Toolkit product page.