Elective care respiratory programme

Elective pathways for sleep, breathlessness and chronic cough are under sustained pressure. Many services face long referral to treatment times, rising demand and variation in how care is delivered. These challenges do not sit in isolation. They affect the flow, quality and equity of respiratory care more broadly.

NHS England has commissioned Health Innovation Oxford and Thames Valley to lead a national programme focused on improving these targeted elective pathways. Our role is to coordinate delivery across England and support NHS teams to implement recognised best practice in a way that works in real services.

The programme supports providers to reduce referral to treatment times, address unwarranted variation and strengthen multidisciplinary working across primary and secondary care.

Lead delivery partners

Health Innovation Oxford and Thames Valley (HIOTV): Implementation of Optimal Sleep Pathway
Health Innovation Yorkshire and Humber (HIYH): Scaling breathlessness pathways in primary and secondary care
Imperial College Health Partners (ICHP): Optimising chronic cough management across the patient pathway
Primary Care Respiratory Society (PCRS) and the national CLEAR programme: Neighbourhood extension

Clinical champions

Each workstream is supported by one or more clinical champions/leads:

Dr Alanna Hare and Gavin Phillips: Implementation of optimal sleep pathway
Dr Helen Ward: Scaling breathlessness pathways in primary and secondary care
Dr Sean Parker & Mrs Claire Slinger: Optimising chronic cough management across the patient pathway
Claire Brewster: Neighbourhood extension

This page brings together the practical resources, pathway models and learning developed through the programme so you can apply them within your own organisation or system.

How the programme supports you

The programme uses a system-led, cohort-based model. Selected trusts are taking part in mutually supportive action learning sets and are receiving tailored support. Learning is also being shared nationally so that all providers can benefit.

All resources developed through the programme are published here for any trust or system to use.

You can access:

Best practice pathways and guidelines
Business case templates
Models of care
Case studies
Referral and diagnostic optimisation tools
Patient advice and guidance materials
Self care videos

You do not need to start from scratch. You can use tested models and adapt them to your context.

How the programme is structured

The programme has two connected parts -both align with the national goal to reduce referral to treatment times, waiting lists, variation and inequity in respiratory care.

How the programme is structured

Neighbourhood delivery supporting the left shift model within elective care pathways

Best practice development and deployment within secondary care

Neighbourhood left shift

This workstream focuses on extending sleep, breathlessness and chronic cough pathways into community settings. The aim is to support earlier intervention, clearer referral routes and stronger multi-disciplinary working.

This workstream aims to produce a national model that:

Strengthens multi-disciplinary, diagnostic and referral optimisation capability.
Forms a blueprint, including a workforce model, which may be adapted and scaled.
Reflects best practice and may be applied sustainably
Will be supported by national webinars and training events

Best practice development and deployment

This workstream supports the development and adoption of recognised best practice in:

Sleep
Breathlessness
Chronic cough

We are working with a cohort of 27 vanguard trusts who identified challenges in these elective pathways through an expression of interest process.

Support includes action learning sets, shared improvement tools and tailored site level input. The focus is on practical implementation that reduces referral to treatment times and improves pathway flow.

Best practice pathways for targeted elective respiratory care