Richard Iles, consultant paediatrican at Evelina London’s Children’s Hospital, writes about improving the consistency of asthma care and improving the outcomes for children and young people in the capital
London has one of the highest rates of children with asthma in Western Europe. 12 children die and 4,000 are admitted to hospital for asthma each year. There is much to do to reduce this number which requires whole system change and an improvement in the consistency of care provided to children and young people living with asthma in the capital.
There are pockets of excellent asthma care provision but current practice and outcomes are highly variable between practices, A&Es and ward to ward. Additionally, we have all experienced the variability in opinion between clinicians, even within units, as asthma action plans are not routinely used or referenced. Consequently we give differing information and levels of care to our patients.
Improvement to the consistency of care is possible. This was achieved in Finland after a national improvement plan was introduced that re-educated and changed key elements of the workforce. What followed was interesting. Initially, there was a rise in asthma diagnosis and cost of treatment, however two to three years later there has been a drastic reduction in asthma morbidity, hospital admissions and impressively the number of deaths.
Improvements are underway across London too. The National Paediatric Asthma Collaborative (NPAC), which was formed from the Children and Young People’s Strategic Clinical Networks (SCN) across England to progress the improvements set out in the 2014 National Review of Asthma Deaths report has achieved a number of successes.
A number of these successes have been included in the Healthy London Partnership toolkit. The toolkit has been developed to support healthcare professionals, schools, parents, carers, children and young people implement the London asthma standards.
These include E-learning resources for clinicians, children and their families. The resources, from HEE and EESCN, are designed to support education and training that will improve diagnosis and management, particularly in primary, secondary and community care.
We have seen tremendous enthusiasm and commitment from across the asthma community including primary and secondary care, to develop a number of useful tool that help commissioners and clinicians understand what good asthma services look like. These include working documents from a variety of clinical environments.
Last summer Healthy London Partnership undertook an asthma audit with community pharmacies to raise awareness of asthma. The audit collected very interesting community level data. It showed that of children with asthma in London:
- 23% live with a person who smokes
- 64% Didn’t have a flu jab last year
- 25% Had to make an emergency request for an inhaler in the last 12 months
- 48% Do have an asthma action plan or wheeze plan
More information on the audit can be seen on the pharmacy section on the London Asthma Toolkit.
Pharmacists can play a key role in monitoring the use of inhalers in the community with a red flag approach and promoting best practice in inhaler technique. This is a model that could be easily replicated across England.
The improvement landscape has changed somewhat since we began the collaborative, and whilst most of the Strategic Clinical Network areas are no longer supporting a children’s programme we are confident that this will change in time. In the meantime, we will look for new delivery partners and direction for those who are still involved in this space.
I am supporting the HLP #AskAboutAsthma campaign which is seeking to raise awareness of the simple measures that can be taken to manage asthma. It aims to ensure that existing London asthma standards are met across London and that no more children die from preventable asthma attacks.