by Dr Stephen Goldring, Consultant Paediatrician, Director of Clinical Studies, The Hillingdon Hospitals NHS Foundation Trust
Our first tentative meetings to establish the NWL asthma network were back in Autumn 2019, with a group of enthusiasts thinking about how to get everyone together and get started.
We entered the embryonic, ‘forming’ stage, and had a fantastic meeting in January ’20 – great attendance, with representation from schools, public health, hospitals, community and even two GPs. Yes – a meeting where humans actually met, chatted, and had coffee – how quaint! As covid hit, our network embryo went back into the deep freeze. We variously were seconded, worked nights, covered for our trainees who went to the front line and dealt with the uncertainties of Covid.
Then somewhere around May, we realised there was an opportunity. The great ‘control-Alt-Delete’ that is covid, has enabled amazing digital meetings and set new priorities. There is a new sense of purpose for change. We met in July, and then Aug, on-line, naturally. In some ways these meetings are more democratic – virtually raising your hand to speak, adding comments in the chat. It’s different but effective and has multiplied the connections we have made between professionals. We developed an ‘asthma conversation’ for school nurses, to help them with calls to vulnerable children at home. This helped me understand how school nurses can see the big picture for a child, their safeguarding risks, their family support, and that in this case, asking every last question relating to asthma risk is not the right approach. We are all learning to understand risk assessment done virtually.
We now meet monthly as a network and have weekly asthma ‘big rooms’ in place for inner and outer London. These are an amazing place for local change – getting to the heart of how you make local change. I am indebted to Claire Galvin, Head of Strategy and transformation for CYP for NWL transformation board for all her motivation and support, and Lucy Colleer, for project management support. And also Ahmed Abdi at London NWL through Mitch Blair, for kick-starting our meetings, and setting up the digital platform. I realise that it is virtually impossible to make change without that wider system support.
Our priorities include
– ‘Asthma and allergy friendly schools’ for NWL, and Alison Summerfield and Jacqui Reilly are leading on a fantastic project to make this happen borough-wide.
– We are working with Yasmin Razak, a dynamic GP from inner London on ‘virtual group clinics’ which is an incredible use of virtual platforms to link professionals together and use peer support for CYP with asthma.
– Developing the WSIC asthma radar for focused high-risk reviews – we have a list of all the ‘high-risk patients and intend to ensure they are all reviewed.
– Understanding training requirements and competencies across the network to inform our training approach
One of the main challenges remains how inequitable services are distributed. Why do some boroughs still not have asthma nurse specialists? Gap analysis in progress.
Its frustrating, challenging and exciting, in equal measures. We remain in the ‘forming’ stage but have made great progress.