Reaching 50 accredited pulmonary rehabilitation services is a significant milestone for PRSAS and an opportunity to reflect on the programme's journey over the past eight years. Maria Buxton, initially starting out as the programme first quality leads, and now the programmes clinical lead; has been involved since PRSAS was first established. 

Looking back, Maria reflects not only on how the programme has grown, but also on the collective effort that has transformed PR accreditation into a recognised driver of quality improvement across pulmonary rehabilitation services. 

"When we first started, there was quite a lot of learning involved for us as lead assessors as well," Maria recalls. "Obviously, you need to start somewhere." At the outset, the accreditation standards had been developed, but the team was still establishing leadership structures, assessment processes and a shared understanding of what constituted robust evidence. Every assessment became an opportunity to learn, refine and improve. 

One of the biggest changes Maria has seen is the increased clarity and consistency of the accreditation process. "We've got better at understanding what is acceptable evidence and what maybe needs to be improved upon," she explains. "As we've evolved, we've tried to share that learning as much as we can amongst our assessors so that we get consistent assessments, but also with the services themselves." 

That learning has shaped the programme's recent review of its standards and guidance. "We've had the opportunity to review the standards again for the first time ever in PRSAS and put that learning into practice," says Maria. "I think that's made us focus more on the guidance for services so that they understand what we're looking for." As a result, services are increasingly submitting evidence that aligns with requirements, helping them navigate the process with greater confidence.  

Perhaps most importantly, Maria believes services now recognise accreditation as much more than a quality mark. "Services are seeing the benefits of pulmonary rehabilitation accreditation in how they evaluate themselves, identify their weaknesses and strengths, focus on those gaps in quality and drive forward improvement," she says. "It's been a real pleasure to be part of that."  

Relationships with services have also evolved considerably. In the programme's early days, interaction outside of formal assessments was limited. Recognising this, PRSAS introduced educational webinars and opportunities for services to engage directly with the accreditation team.

"I think that's created a firmer bond between us and the services," Maria says. "They can ask questions and ask for support, and we'll try and share examples." The popularity of these sessions has demonstrated a strong appetite for collaboration and helped establish the support that can be offered by PRSAS.  

The programme's reputation has continued to grow nationally through engagement with respiratory networks, NHS stakeholders and services. Maria is particularly proud of the progress made in Wales. "We've had great Welsh engagement, and we've had our first Welsh accredited service," she says. "That took quite some time, but it's been really great to see." 

As with any long-running programme, challenges have accompanied the successes. Unsurprisingly, COVID-19 remains one of the most significant.
"The big thing was COVID," Maria reflects. "It hit everyone and wiped us all out in pulmonary rehab." Services were forced to focus on recovery and rebuilding at a time when accreditation understandably became a secondary priority. Even now, many services continue to face significant pressures.

"Accreditation absolutely requires a lot of work and I don't think there's any hiding from that," she says. "A lot of services are relatively small within large organisations, and they often struggle to find the dedicated time and support locally." 

"I think it's trying to get the message across that deferral isn't a failure," she explains. "In fact, it's just a delayed success path. It's part of a journey. Services will get there with support and a bit more guidance."  

Another key factor behind the programme's success has been its assessor community. With a recent surge in submissions, assessors have faced growing workloads while balancing accreditation activity alongside their clinical roles. "We couldn't have got where we are without all the assessors working incredibly hard," Maria says. "They've been very loyal and we want to acknowledge that and applaud it." 

She also highlights the value of becoming an assessor. "It's an absolute win-win. If you want to get your service through accreditation, there's nothing better than being an assessor yourself. You'll always be paired with somebody experienced and you'll gain an insider's view of the whole process."  

Maria was also keen to recognise the contribution of the PRSAS leadership and operational teams, particularly current quality lead, Enya, whose work continues to strengthen the programme. Equally, she stressed the importance of the operational team who support services throughout their accreditation journey.

Looking ahead, Maria believes the next phase of PRSAS will focus on demonstrating the measurable impact of accreditation and ensuring that quality improvement is embedded across all pulmonary rehabilitation services. "What we need to do now is get a platform where we can shout about why accreditation is worth it and what it brings to services," she says. 

Her vision for the future extends beyond accreditation numbers alone. "I'm hoping that as accreditation becomes part of the landscape, what that will do is drive up the quality of pulmonary rehabilitation across the whole country," Maria says. "It would be great to see consistently high outcomes across the UK and no postcode lottery anymore." 
Reflecting on the achievement of 50 accredited services, Maria sees more than a numerical milestone. She sees evidence of a growing community united by a shared commitment to quality improvement.

"It has been a real pleasure to be part of that," she reflects. And with services, assessors, stakeholders and the operational team continuing to work together, the next 50 accredited services promise to be just as impactful as the first.