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Michelle Dunning and Keir Lewis with participants, Rebekah Mills Bennett,  Carol-Anne Davies, Lisa Butler, Trystan Sion, Claire Hurlin, Vicky Stevenson, Kerrie Phipps, Liam Knox and Kylie Smith 

Hywel Dda University Health Board and Industry partners, Comcen and Polycom

This Bevan Exemplar project used technology to enable people with long-term lung conditions in rural areas to take part in an exercise and education programme.


Pulmonary rehabilitation is a programme of exercise and education for COPD (Chronic Obstructive Pulmonary Disease) patients, which traditionally takes place twice a week over a seven-week period. For individuals with a chronic lung condition, Pulmonary Rehabilitation should be an integral part of their care and the Welsh Government has an expectation that all eligible patients are offered rehabilitation.

While pulmonary rehabilitation offers proven health benefits for those living with long-term lung disease, no such service currently exists in rural parts of West Wales. The Pulmonary Rehabilitation service in Hywel Dda does not extend to Ceredigion and the service in Carmarthenshire now has an 8-12 month waiting list due to loss of key staff and increasing demand. This has resulted in Hywel Dda having the lowest referrals of eligible patients in Wales for their pulmonary rehabilitation services at 31% (COPD Primary Care National COPD Audit 2016).

The Virtual Pulmonary Rehabilitation (VIPAR) project aligns with the prudent model of health by ensuring there is consistency across the Health Board and in different parts of Wales, and making the best use of resources by using technology to roll out the service to rural areas.


This project aims to provide a more efficient and equal pulmonary rehabilitation service, by delivering this to rural areas through video conferencing.

VIPAR tackles the issue of rural access by using video conferencing, in partnership with technology partners Comcen and Polycom, so that patients in places like Tregaron can participate in real-time in the rehab session led from Glangwlli General Hospital.

“VIPAR has transformed my life.”

Granville, patient


There were challenges to solve throughout the whole project, which ranged from procurement issues, to missing equipment and difficulties in securing funding. The project lead overcame each one by not giving up!


VIPAR has saved driving time and miles travelled for all patients, as well as providing improved health outcomes.

The COPD Assessment Test (CAT) showed a decrease in symptoms for patients in both hub and spoke sites, and post-intervention hospital anxiety and depression scores have also decreased. Many patients have also been able to take up former hobbies or lifestyle habits, such as horse riding and shopping, as a result of their renewed health and strength. Those taking part have also reported higher self-confidence and welcomed being part of a support network as a result of the programme. Patients were unfazed by the use of new technology and enjoyed watching their counterparts exercising in different parts of Wales, with one even joking: “We treated it like a competition!”

The project was able to clearly demonstrate (via 3 programmes) that virtual pulmonary rehabilitation:

  • is feasible and safe
  • is popular with staff and patients
  • appears at least as effective as standard pulmonary rehabilitation in the short-term
  • saves money and reduces environmental impact.

Next steps:

The future plan for the project is to secure funding to continue running virtual pulmonary rehabilitation through the spoke sites, and to add up to another three spoke sites linking simultaneously to the hub site, creating a Virtual Pulmonary Rehabilitation (VIPAR) network.

“It has been an amazing experience. As an Exemplar I have gained confidence and feel empowered to bring about innovation in service delivery to benefit our population.”

Michelle Dunning, Senior Primary Care Locality Development Manager (North Ceredigion)

This project won the ‘Improving Health and Wellbeing and Reducing Inequalities’ award at the NHS Wales Awards 2018. They were also awarded ‘MediWales Innovation NHS Wales Collaboration with Industry’ Award 2018. It is a double award winner!