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Transforming asthma services in London for children and young people

20th September 2017

Sara Nelson, Children and Young People Programme Lead at Healthy London Partnership, writes about the asthma tools on offer to ensure better outcomes

Asthma affects around 1 in 11 children and young people, that’s over 200,000 in London. As a long standing cardiothoracic nurse and an asthma sufferer myself I am well aware of the impact the condition has on school, sports and social events and how the avoidance of triggers and the important role played by self-management of your condition.

There are a number of actions that we can take as a health and social care system to make improvements in the way that children and young people with asthma are cared for; prevention, early recognition, education, training and self-management. Healthy London Partnership has developed a number of tools to assist organisations with this.

In order to drive up standards we agreed our London ambitions. We then collated all existing policy documents and national standards into one coherent document for both commissioners and providers to work to;  London asthma standards for children and young people. In December last year the London Asthma Toolkit was published to support the implementation of the standards. The toolkit brings a number of resources together in one place to help system wide delivery of best practice.

Prevention

Preventative measures are essential. There is too much pollution in our cities today. Exposure to pollutants can impact on children and young people’s current and future health, as strong evidence suggest it impairs lung growth in children. The recent report Every breath we take (2016) outlined the high cost (up to more than £20 billion every year) to people and our health services resulting from exposure to air pollution.

The London smog of days gone by may be a dim memory for many but the smog has sadly been replaced by less obvious, but equally toxic diesel fumes. Diesel engines are the single biggest source of nitrogen dioxide. We should take action both individually and organisationally to reduce air pollution, as outlined in the London Mayors Air Quality Strategy and in particular through monitoring air quality near schools. The NHS must lead by example and steps to help have been outlined in our recent publication NHS Organisations: Air pollution toolkit.

Early Recognition

We need to ensure that children and young people get diagnosed early, and are provided with the right treatment and management at the right time and in the right place. Generally this care should be provided within the community but when appropriate referral to hospital may be required for specialist advice. Further information on diagnosis is available here.

Education and training

Up to date, evidence based care is essential and staff need to be adequately trained to deliver this. To assist we have trained 75 healthcare professionals in the Education for Health Asthma Diploma as well as providing and promoting access to a number of free eLearning tools;

For healthcare professionals

http://www.e-lfh.org.uk/programmes/asthma/

http://www.severeasthmaonline.co.uk/

https://ukiginhalerstandards.educationforhealth.org/

For schools and non-healthcare professionals 

http://www.supportingchildrenshealth.org/ 

One key element of the asthma programme in London is to integrate care and join services up by encouraging new models of care and different ways of working. A particular focus is on the importance of schools in the delivery of good long term condition care and also the use of pharmacy as an extension to the traditional member of the practice team.

Schools play a major role in ensuring a safe environment for children and young people with asthma and pharmacists are an accessible and expert source of useful help and information for young people with asthma and their families.

Self-Management

Self-management is crucial and our current AskAboutAsthma campaign encourages children and young people and their families to ask for three simple, effective interventions to help them control their asthma:

  • Use a written asthma action plan drawn up between clinician and child or young person. Having a plan means asthma is better controlled; children and young people with a plan are four times less likely to be admitted to hospital for their asthma. Only 28 to 48% of children and young people with asthma in London have an asthma plan.
  • Improve inhaler use. Less than 75% of children and young people have any form of instruction in how to use their inhalers meaning they may not be getting the full benefit of their asthma medication. Inhaler technique can be taught by pharmacists, practice nurses
  • Have an annual asthma review. This ensures those with asthma have effective regular review of their condition and management

Please consider making your own (or organisational) pledge to help improve the care of children and young people with asthma in the capital and let’s make London the healthiest global city.

About the author

Sara Nelson RGN, BSc (Hons) MSc Queens Nurse is a Children and Young People Programme Lead at Healthy London Partnership and Governing Body Nurse, Bromley CCG

www.healthylondon.org/ask-about-asthma

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