Specialised commissioning

Children’s asthma services need to be commissioned in a seamless integrated fashion across the entire pathway from prevention and self-management to in hospital and out of hospital care. This section provides information, advice and resources to support those commissioning children’s asthma services.


NHS England commissions severe and difficult-to-control asthma services from five highly specialist respiratory centres for adults. NHS England has produced a manual of prescribed services defining ‘difficult’ asthma as:

  • An event of acute severe asthma which is life threatening, requiring invasive ventilation within the last 10 years
  • Requirement for maintenance oral steroids for at least six months at a dose equal to or above 7.5 mg prednisolone per day or a daily dose equivalent of this calculated over 12 months
  • Two hospitalisations within the last 12 months in patients taking and adherent to high dose inhaled steroids (greater than or equal to 1000mcg of beclomethasone or equivalent)
  • Fixed airflow obstruction, with a post bronchodilator FEV1 less than 70% of predicted normal
  • Referred as an adolescent transition patient from a paediatric severe asthma service.

Allergy services

NHS England also commissions highly specialised allergy services from 18 centres across the country.  All other allergy services are commissioned by CCGs.

Useful tools

  Service specification for paediatric allergy services developed by NHS England

 Schemes guide for prescribed specialised services for April 2016 to March 2017

 NHS England Key sepcialised commissioning documents

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