NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement, as a commissioning body, supports local systems to implement evidence-based interventions, such as standardised information and wheeze management plans, for the parents/carers of pre-school children. This will be undertaken in conjunction with the British Paediatric Respiratory Society.
NHS England and NHS Improvement are happy to accept the recommendations made in the report. We welcome your recommendations as they align well with our commitments laid out in the Long-Term Plan for improving outcomes for Children and Young People (CYP) with asthma.
Following your recommendations, we have developed our work with the British Paediatric Society to ensure systems are provided with standardised templates to support the delivery of high standards of care for CYP with asthma.
We have also worked with the authors of the National Review of Asthma Deaths to incorporate their recommendations into the National Bundle of Care for CYP with Asthma.
We continue to collaborate with Royal Colleges and Professional Bodies to develop training competencies for all healthcare staff who care for CYP with asthma and are developing an implementation strategy for the future sustainability of the competencies and associated training.
ACTION: NHS England and NHS Improvement have developed standards of care detailed within the Bundle which have been co-written and endorsed by a number of key stakeholders, including the BPRS.
NHS England and NHS Improvement will supply systems with a standardised:
- Preschool wheeze decision aid
- Personalised Asthma Action Plan template
- Template for asthma reviews
Following the recommendations of the HSIB investigation, NHS England and NHS Improvement will use a CYP Asthma dashboard to produce performance reports for the regions. This will be done in conjunction with formal reporting through the CYP Regional Leads to monitor how well ICS’s are performing in relation to the standards of care set out in the bundle. Where a performance need is identified NHS England and NHS Improvement will support ICS’s to develop strategies to address this.
TIMELINE: Phase One of the National Bundle of Care for CYP with Asthma will be published in quarter two 21/22.
NHS England and NHS Improvement will gather information on system wide asthma outcomes from publication.
Phase Two of the bundle will be published in April 2022.
The programme is a three-year programme running until 2023 at which point the bundle will be thoroughly embedded in systems and formal evaluation of the bundle will commence.
Response received on 30 July 2021.
NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement reviews the recommendations arising from the National Review of Asthma Deaths to prioritise and ensure the implementation of recommendations that are outstanding.
NHS England and NHS Improvement have reviewed the recommendations arising from NRAD.
The authors of the NRAD have collaborated with the programme at NHS England and NHS Improvement to produce the National Bundle of Care. Their recommendations have been considered and built upon throughout the document. NHS England and NHS Improvement have outlined how ICS’s can deliver on the NRAD recommendations and provided them with enabling tools, funding and governance to ensure their future sustainability.
Response received on 30 July 2021.
NHS Digital
HSIB recommends that NHS Digital reviews the supporting information for triaging the breathless child up to 16 years of age, to determine whether there are features of life-threatening breathing difficulty.
Thank you for the opportunity to be involved in this investigation and for raising this safety recommendation with NHS Digital.
NHS Pathways (on behalf of NHS Digital) is a telephone and digital triage Clinical Decision Support System (CDSS) that has been in use since 2005 within the Urgent and Emergency care setting. It is used in all NHS 111 services and half of English ambulance services. This triage system supports the remote assessment of over 19 million calls per annum. Calls using NHS Pathways are managed by non-clinical specially trained ‘Health Advisors’ who refer the patient into suitable services based on the patient’s health needs at the time of the call. The Health Advisors are supported by clinicians who can provide advice and guidance or who can take over the call if the situation requires it.
NHS Pathways continuously reviews and refines the pathways and questions to ensure it is up to date and learning from feedback. NHS Pathways has undertaken a review of the question relating to breathlessness in children under 16 years old and agreed to make changes to the supporting information for those aged 5-11 years old, to include chest recession (an indrawing of the chest which may indicate breathing difficulties). Chest recession is already included in the supporting information for children under 5 and it was not considered appropriate to make this change in 12-16 years old (as per national guidance). Changes made were in line with guidance from National Institute for Health and Care Excellence and have been approved by The Royal College of Paediatrics and Child Health. The changes were made to Release 26.2.0 of NHS Pathways which was deployed on 21st April 2021.
ACTIONS: Review of question relating to breathlessness for children under 16 years old, specifically to consider adding a prompt for chest recession in the supporting information.
TIMELINE: Complete. Review undertaken and changes made to supporting information of breathlessness question in those aged 5-11 years old to include chest recession.
Changes effective in NHS Pathways Release 26.2.0 which was deployed on 21st April 2021.
Response received on 26 July 2021.
NHS England and NHS Improvement
HSIB recommends that NHS England and NHS Improvement supports clinical experts to work with professional bodies to develop training competencies for healthcare professionals with responsibility for caring for children with suspected or confirmed asthma.
A 5-level tiered framework for anyone involved in the care of CYP with asthma has been developed by NHSE/I and a number of key stakeholders. These have been approved by professional bodies, Royal Colleges and relevant Arm’s Length Bodies.
NHS England and NHS Improvement will enlist the support of a professional body as a host organisation of the framework.
NHS England and NHS Improvement will ensure that the framework is easily accessible to all, including those working outside of healthcare.
To ensure that standards of training meet the expectations of the framework, NHS England and NHS Improvement will cross-check existing education materials and training courses and assign them accordingly to the relevant tier of the framework. The host organisation that will ultimately hold the framework will formally accredit those courses that meet the capability standards.
Response received on 30 July 2021.
NHS England and NHS Improvement |
NHSX
HSIB recommends that NHS England and NHS Improvement and NHSX identify and integrate data items into information technology systems to develop a greater understanding of the risk factors present in the community.
NHS England and NHS Improvement are happy to accept the recommendations made in the report. We welcome your recommendations as they align well with our commitments laid out in the Long-Term Plan for improving outcomes for Children and Young People (CYP) with asthma.
Following your recommendations, we are now working with NHSX to facilitate better use of data systems to build a picture of the CYP asthma landscape and identify risk factors for CYP with asthma.
ACTIONS: NHS England and NHS Improvement and NHSX, are now working together to facilitate better use of current data systems to improve the National, Regional and Local landscape of CYP asthma.
The CYP Transformation Team at NHS England and NHS Improvement are currently developing a CYP Asthma Dashboard. Phase One of the proposed asthma dataset will utilise available data from a range of healthcare settings - primary care (TPP and EMIS), 111, EC (ECDS) and secondary care (SUS) to provide an overview of the asthma patient population including risk factors.
The Phase Two dataset will incorporate the currently unavailable datasets, open prescribing data and primary care data. This will enable the link of phase 1 datasets and support identification of patients who are under prescribed (inhalers), over prescribing (use) of inhalers and/or oral Corticosteroids which indicate poor control of asthma and increased risk of exacerbation.
TIMELINE: Phase one of the CYP asthma dashboard will be available within quarter two, alongside Phase One of the National Bundle of Care for CYP with Asthma.
Phase Two of the bundle will be published in April 2022.
The programme is a three-year programme running until 2023 at which point the bundle will be thoroughly embedded in systems and formal evaluation of the bundle will commence.
Response received on 30 July 2021.
NHSX
HSIB recommends that NHSX, supported by NHS England and NHS Improvement, implements a discovery programme into the roadmap for the digital personal child health record focused on developing support, self-reporting and alerting for asthma self-care.
NHSX is aware that provision of data capture, and self care tools, for young people with asthma is a recognised priority.
NHSX would propose that scope could include:
- An Asthma dashboards to support data-sharing to improve outcomes and commissioning.
- A user centred design approach to explore and understand user needs.
For example, there could be an opportunity to incorporate Asthma Action Plans, symptom diaries, medication reminders, functionality to record peak flow results as well tailored educational information and weather and pollen counts.
At the current time specific resources have not been identified to support digital work to support the above. As an early part of the discovery the team will liaise with the NHSX Shared Care Records programme to establish any opportunities for collaboration and alignment. NHSX will table proposals to address these requirements to the NHS England and NHS Improvement CYP Transformation board for prioritisation and provision of appropriate resourcing to begin this work.
Response received on 23 August 2021.
Public Health England
HSIB recommends that Public Health England develops resources for young people and their parents/carers to raise awareness and enable them to self-manage asthma more effectively.
As part of the modernisation of the Healthy Child Programme and our work with NHS England and NHS Improvement and the Department of Health and Social Care we will work with stakeholders including young people to develop appropriate resources to raise awareness of asthma. We will work with public health nurses and the wider children’s workforce to support a public health approach to asthma and supporting families.
ACTIONS: Review the Healthy child programme intervention schedule to ensure this includes asthma and interventions to support parents & young people. TIMELINE: October 2021.
ACTIONS: Engage with partners including the Department of Health and Social Care and NHS England and NHS Improvement to work with parents & young people co-produce to awareness materials which can be accessed through public health nurses. TIMELINE: January 2022.
Response received on 11 May 2021.