Background In 2012 changes in the home oxygen service (HOS) contract offered patients the potential to benefit from new technology designed to assist ambulatory oxygen (AO) use, such as liquid oxygen (LOX) and refillable cylinders (Homefill). Prior to the change in contract only three services were thought to be commissioned in London (serving approximately 10,000 HOS users, costing £10.5m), with many areas attempting to meet increasing demand with no increase in resources.
To determine the service provision, commissioning arrangement and assessment protocols for AO across London
Establish an AO network across London
Methods A telephone audit was carried out in January-March 2013 with all known oxygen assessment centres in London. Two clinicians used an agreed proforma, with email follow-up. The interview included questions regarding; commissioning/funding; location; access to service, referrals and pathway; assessment protocol; disciplines/grades; and integration with respiratory services.
Results 34 interviews were performed across the 32 London boroughs. Key findings are:
Access: Two boroughs had no service, some had multiple.
Who: In 20 teams nursing staff assessed; 15 teams, physiotherapists; and 7 teams, respiratory physiologists.
Where: 16 assessed in the hospital, 9 in the community and 7 in both.
How: The majority (94%) performed the 6MWT, however teams that assessed in the home did not use validated reproducible exercise tests.
Equipment for assessment: The majority had standard cylinders (88%); 53% had lightweight and conservers; and other devices were rarely (3–13%) available.
Size: 16 services (47%) carried out less than 5 assessments per month.
Funding: 47% have some arrangements in place, 29% had no funding or no service provided and 24% unclear.
Integration: 67% were part of an integrated service, 18% stand alone, 12% unclear and 6% had no service.
Conclusions Service provision for AO across London is varied, with no standardised referral pathway, assessment protocol and often limited range of equipment available for assessment. This raises concerns over access to services, clinical assessment skills/competencies and unsuitable prescriptions. Approximately half of the services have no or unclear funding arrangements and although the majority of services (67%) are integrated within a wider COPD/IRS there was no established network and many clinicians felt isolated.