Catching Our Breath: NRAP Report Is A Call for Action for Industry Partners

The 2025 National Respiratory Audit Programme (NRAP) State of the Nation Report, aptly titled Catching Our Breath, delivers a sobering and urgent assessment of respiratory care in England and Wales.

While acknowledging some improvements, the report reveals profound inequities, service fragmentation and systemic pressures that continue to cost lives and strain NHS capacity. It also sets out clear priorities for change across the full respiratory pathway.

For those of us working in the pharma, medtech and device industries, the findings are both a challenge and a call to action.

Respiratory disease remains one of the biggest burdens on the NHS, accounting for 6.5 million hospital bed days annually and nearly 20 per cent of emergency admissions. Yet the service remains one of the most variable and under-supported areas in healthcare.

But within this challenge lies opportunity. If we are serious about embedding ourselves in NHS pathways, not just pitching products, we must respond to what this report reveals.

As I argue in my upcoming book Embedded, the key to long term access is not selling features but solving problems the system already recognises.

Read my blog: Upstream care: The future of NHS success and how industry can play its part – here.

NRAP Audit Headline Findings

NRAP’s audit draws on data from primary, community and secondary care services covering asthma, COPD, pulmonary rehabilitation, oxygen therapy and adult and paediatric emergency admissions. Three key themes emerge:

1. Unequal access and variation

• Patients face a postcode lottery. From spirometry access to pulmonary rehab and oxygen therapy, where you live continues to determine the care you receive.
• Black patients are more likely to be admitted for asthma and COPD and experience worse outcomes, yet they are less likely to receive timely diagnostic assessment.

2. Systemic failures in diagnosis

• Only 35 per cent of patients admitted with COPD in 2023 had a recorded diagnostic spirometry test result.
• In primary care, spirometry remains under-delivered and inconsistently interpreted. This leads to delayed diagnosis, avoidable exacerbations and higher hospital admissions.

3. Underuse of proven interventions

• Fewer than 50 per cent of eligible patients are being referred to pulmonary rehabilitation following COPD admission.
• The uptake of supported self-management tools and personalised action plans remains patchy and untracked.
• Oxygen therapy assessments are not routinely reviewed, with safety audits revealing major gaps.

Priority Actions for NHS Leaders, Providers and Partners

The report outlines several priority actions for NHS leaders, providers and system partners. Notably:

1. Fix the spirometry gap.
2. Integrate services around the patient.
3. Embed data, audit, and equity in quality improvement.

Collaboration opportunities for pharma, medtech and device companies

To help the NHS breathe easier, industry partners must step up. Not as vendors but as collaborators. The following five areas offer immediate alignment between system needs and industry capabilities.

• Close the spirometry gap: Partner with ICBs and trusts to co-design and deliver local spirometry clinics aligned with NICE and NRAP standards.
• Support personalised care and action planning: Provide co-branded, culturally adapted asthma and COPD action plans in multiple languages and formats.
• Rebuild pulmonary rehab pathways: Offer training, triage tools or digital enrolment platforms to increase rehab referrals.
• Embed oxygen safety and review protocols: Offer integrated oxygen assessment and monitoring kits that support home use and safety.
• Tackle health inequalities with data and targeting: Work with ICBs to overlay prescribing and rehab access by deprivation, ethnicity and rurality.

Embedding the industry offer through practical solutions

The message from NRAP is not just that respiratory care needs fixing, it’s that the fixes must be practical, equitable and embedded in the day to day reality of NHS services. For industry, that means a mindset shift from vendor to value partner.

In my book, Embedded, I describe the move “from product to pathway” as the critical leap most companies fail to make. It’s not enough to offer a better inhaler, device or app. You have to design or adapt your offer to solve a specific system problem.

Final thought: Catching our breath, together

The NRAP report is a challenge to the whole system but it’s also an invitation. It asks: what would respiratory care look like if it were truly person centred, equitable, data driven and integrated?

For industry partners, this is a moment to lead. Not by pushing products, but by offering practical solutions to the system’s most visible pain points.

Because when we embed ourselves in the problems the NHS already cares about, we don’t just sell, we stay. And when we stay, we help the system – and its patients – finally catch their breath.

Scott McKenzie helps pharmaceutical, medical technology and device firms get their products and services in front of the right NHS decision-makers. In 2023 alone, he helped land 53 new NHS projects and he added a further 28 in 2024. His 12-month coaching and mentorship programme – revamped and expanded for 2025 – offers tools, extensive NHS customer insights and direct decision-maker introductions to get your projects over the line. Scott’s support is grounded in real world experience of what gets approved, funded and sustained across systems, places and provider collaboratives, turning strategy into impact and frustration into progress. Find out more here.