As a part of our pulmonary rehabilitation awareness week celebration, we spoke with Nikki from West Essex Pulmonary Rehabilitation Service to discuss how she used their service’s involvement in the Pulmonary Rehabilitation Services Accreditation Scheme (PRSAS) to help maintain quality standards, support decision-making, and advocate for appropriate facilities.
Delivering pulmonary rehabilitation (PR) across large and geographically dispersed areas presents unique challenges, particularly when suitable venues and resources are limited.
As Nikki explained, accreditation has acted as a constant reference point:
“If it wasn’t for accreditation, we would have been in the community hospital still… with a room that was too small.”
The Essex service covers three distinct areas: Harlow, Epping, and Uttlesford, which are geographically far apart and operate largely independently.
One of the biggest challenges has been securing suitable venues that meet the needs of PR delivery. In Uttlesford in particular, PR had not been running since COVID-19, and the service needed to be re-established.
Several barriers impacted service delivery:
- Lack of appropriate venues that met space and safety requirements
- Pressure to use free or existing spaces that were not fit for purpose
- Patients unwilling or unable to travel across large distances
- Ongoing financial pressures affecting decision-making
- Limited understanding of PR requirements among stakeholders
At one point, the team were expected to use a community hospital space that could only accommodate a small number of patients and did not meet accreditation standards.
This had a direct impact on care delivery. Nikki described how services previously operated in a restricted, chair-based format that did not fully promote independence or functional exercise.
PRSAS provided a clear framework for what high-quality PR should look like, giving the team confidence to challenge unsuitable options and advocate for better provision.
Nikki emphasised the importance of aiming for high standards: “I want to work for gold standard care and that’s what accreditation is.”
The team used accreditation standards to:
- Justify the need for adequate space (e.g. for walk tests and functional exercise)
- Challenge decisions based purely on cost or convenience
- Support communication with managers, commissioners, and PCNs
- Reinforce the clinical importance of delivering evidence-based PR
In some instances, this meant directly referencing guidelines and accreditation standards in discussions and correspondence to explain why certain venues were unsuitable.
After exploring multiple unsuitable venues, the team eventually identified a community hall that met most of their needs.
This new venue provided:
- Sufficient space for exercise and walking tests
- Greater availability of sessions
- Lower cost compared to previous options
- Improved accessibility for patients
The space also enabled the team to deliver more functional, patient-centred rehabilitation, including walking circuits and step-based exercises.
Not all sites have ideal facilities, and the team has had to be flexible and creative in adapting spaces.
Examples include:
- Using corridors or adjoining areas to conduct walking tests
- Adjusting layouts to maximise available space
- Repurposing equipment storage solutions
- Using alternative areas for private conversations when needed
This pragmatic approach has allowed the service to continue delivering PR while still working towards accreditation standards.
Support from PRSAS played a crucial role in helping the service navigate complex challenges, particularly when engaging with stakeholders who had limited understanding of pulmonary rehabilitation.
For Nikki, having access to expert, external support made a significant difference: “Having that backup from someone that is skilled in pulmonary rehabilitation accreditation and understands it… was massive.”
The PRSAS team provided practical and direct support throughout the process. This included attending meetings alongside the service to help explain accreditation standards and reinforce the clinical rationale behind key decisions.
This external perspective helped shift conversations. Rather than the service being seen as resistant, PRSAS brought an independent, expert voice to discussions:
“They understood it better… to back me up with those things.”
Regular contact also gave Nikki the confidence to continue advocating for high standards: “We were meeting and touching base to any issues I had… I just felt somebody supported me, somebody fully understood it.
A key reflection from this experience is the importance of engaging with PRSAS early. While support was invaluable, Nikki noted that accessing it sooner would have made the process easier; “On reflection on myself, I wish I’d done it a lot sooner.”
PRSAS is not only a framework for accreditation, but also a source of practical support, guidance, and advocacy. Services can benefit from:
- Expert input to support decision-making
- Attendance at meetings to strengthen discussions with stakeholders
- Ongoing advice when navigating challenges
- A shared understanding of what high-quality PR looks like
Nikki’s advice to other services is clear:
“Don’t be hesitant in making contact… take the support that you need”
If your team could benefit from support from PRSAS, please feel free to contact us at pulmrehab@rcp.ac.uk .