Local asthma impact projectThe newsletter for the North West about Asthma UK’s investment in asthma – Issue 1 Sept 09p2 Liverpool PCT update p3 Knowsley PCT update p4 Oldham PCT update

Asthma UK invests more than £100k to tackle high hospital admissions in the North WestAsthma UK is investing over £100,000 in the North West of England with the aim of reducing the high numbers of emergency admissions for asthma in the region.

In 2006/7 there were 11,969 emergency hospital admissions for asthma in the North West yet around 75% could have been avoided if people had a better understanding of their asthma, knew more about their medicines and how to use them, and had the right support from their family doctor or asthma nurse. In fact, just by having a simple personal asthma action plan a person with asthma would be four times less likely to have an emergency hospital admission for the condition.

Asthma UK launched a report Wish you were here? (see right) that highlighted the differences in the numbers of emergency hospital admissions for people with asthma across England. The report revealed that the North West had the highest overall hospital admissions for asthma in England and that admissions among children with asthma were eight times higher in Liverpool than in Richmond & Twickenham in the London region.

Asthma UK has targeted its resources to support those Primary Care Trusts (PCTs) with the highest hospital admissions for asthma to develop and implement an action plan with the overall long-term aim of reducing hospital admissions for people with asthma and their cost to the NHS.

From the £100,000 funding, Liverpool, Knowsley and Oldham PCTs will each receive £20,000 and a further £40,000 is being dedicated towards supporting these and other asthma projects in the North West.

‘Working in the North West, it has become clear that there are lots of pockets of good practice in terms of asthma care and it was decided that we now had an opportunity to start to share this best practice through a quarterly

newsletter,’ says Fran Alecock, Asthma UK’s Local Asthma Impact Project Manager. ‘The aim of this newsletter is to not only share progress on the work of Liverpool, Knowsley and Oldham PCTs but also to share any other work that is taking place in the North West that is helping to improve the lives of people with asthma. And so if you have any examples of asthma care that you would like to share with other health professionals please contact me.’

Contact detailsWe are currently developing a dedicated page on Asthma UK’s website (asthma.org.uk) where you will be able to find all of the background and progress reports from each PCT along with other examples of best practice that are taking place in the North West.

In the meantime if you would like more information on the work in the three PCTs or other work that Asthma UK is doing in the North West please contact:

Frances AlecockProject Manager, Local Asthma Impact ProjectAsthma UKEmail: franalecock@asthma.org.uk

Further Asthma UK funded work in the North WestOpportunities to develop a regional presence are starting to expand outside of the areas that we initially decided to fund. For example:

• This autumn Asthma UK is piloting ten Alert to Asthma awareness sessions for early years and primary school staff in the North West. • We also piloted six asthma awareness sessions this summer aimed at a variety of Black and minority ethnic (BME) communities.• Developing relationships with NHS North West.• Sit on a variety of strategic respiratory groups. • Supporting PCTs in the North West with free resources and advice. • One of our Kick Asthma activity holidays for young people with asthma was held in Cumbria for the first time.

Kick Asthma holidays allow children and young people with asthma to take part in activities they may not normally be allowed to do in a safe environment

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Highlights and progress so far

Liverpool Primary Care TrustThe work in Liverpool aims to improve health outcomes of people with asthma by taking a whole systems approach, supporting healthcare professionals caring for people with asthma and engaging a range of stakeholders as well as supporting and empowering people with asthma themselves.

The project is city-wide and has been carefully planned to raise awareness, control and self management of asthma, and promote an integrated best practice approach to achieve improved health outcomes for people with asthma in Liverpool, particularly targeting areas of high deprivation.

It crosses primary, secondary and tertiary care, and unites with social care, education, the voluntary sector, community outreach programmes and other agencies that impact on health in Liverpool.

Areas that the PCT has identified as priorities include:

• development and implementation of asthma care pathways

• asthma education for all healthcare professionals

• establish health outcomes for asthma (post exacerbation)

• an improvement in care of asthma in walk in centres and GP practices

• establish links to school nursing for paediatric asthma

• establish educational frameworks for academic study.

• A stakeholder strategy meeting was arranged to provide an interactive forum for networking and communication opportunities where all parties could view and discuss their engagement with the project. Twenty eight people attended, ranging from PCT personnel working around the city, clinicians from primary, secondary and tertiary care sectors, and representatives from Liverpool City Council and local BME communities.

• All four Practice Based Consortia (PBCs) in Liverpool have now added asthma to their Service Change Plans for the year 2009/10.

• Community Pharmacy – an education and training event for community pharmacists around Medicines Use Reviews (MURs) has been facilitated by the PCT. The aim is then for this educational event to lead into a pilot audit with the primary intention of setting PCT standard for the use of MURs. This will then be followed by an asthma health promotion campaign in pharmacies.

• Two separate adult asthma education days have already taken place so far this year. This rolling programme will continue in 2009 targeted at the PBCs identified to have the greatest educational requirements and where asthma admissions are higher. The ongoing asthma education programmes have now been embedded in the educational plan for Liverpool PCT with secured funding.

Work in Liverpool includes supporting healthcare professionals who care for people with asthma

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Work in Knowsley is focusing on children and young people, including developing asthma policies for schools

Knowsley Primary Care TrustNHS Knowsley are focusing on improving services for children and young people with asthma. This follows The Commissioning Strategic Plan (CSP) and Knowsley Joint Strategic Needs Assessment, which highlighted paediatric asthma as an issue in Knowsley. The CSP indicated that, along with the funding received from Asthma UK, there will be a further £12,000 per year over the next five years available to fund this initiative. Therefore, including the money from Asthma UK, Knowsley will be investing 80K into asthma over the next five years.

The overall objectives of the initiatives addressing this priority area are to improve paediatric asthma care in Knowsley and reduce emergency hospital admissions.

This wider project will:

• drill further into the data which points to an alarming increase in asthma attendances at local acute trust

• identify clinical leaders for asthma in each of the Practice Based Commissioning groups

• agree evidence based asthma guidance, (linking in with the North Mersey Clinical Reference Group, and its review of Map of Medicine for paediatric asthma)

• implement a schedule of asthma management training for practice nurses, via funding from Asthma UK, and introduce practice based review clinics

• educate GPs on evidence based asthma management, via Respiratory Community of Practice initiative

• educate other stakeholders and parents or children, via Asthma UK and development of social marketing strategy

• move acute care out to the community

• develop skills of walk in centre staff

• work with schools in Knowsley to develop asthma policies.

Highlights and progress so far

• A multi disciplinary steering group has been established to direct and carry out the work.

• The Commissioning Strategic Plan has indicated a commitment of £12,000 per year for the next five years, for paediatric asthma services.

• A sub-group, with input from Liverpool (Alder Hey) has been agreed to work on the practice nurse training.

• An audit of practice and school nurses has been undertaken to identify training needs and issues around paediatric asthma.

• The launch of the Knowsley Asthma Pathway is planned for September, with an associated training package for Practice Nurses.

• It has been suggested that a ‘listening’ event is organised to gain feedback from people with asthma on their use of services, particularly those who have repeat hospital admissions (focus on the zero days length of stay). This will be based on a recent successful event held for people with diabetes where over 150 patients and 50 healthcare profesionals attended.

Asthma impact p4Local asthma impact project North West p4

Highlights and progress so far

Oldham Primary Care TrustOldham PCT are developing and implementing paediatric asthma standards for local asthma services and providing training and education for healthcare professionals. This is along with the long-term aim of piloting a specialist nurse-led asthma clinic dedicated to children and young people bringing together a range of healthcare and education professionals to provide a service with a strong health promotion and prevention element.

The Steering Group, which includes a parent representative, has identified the following priority areas:

• training and education programme for healthcare professionals with a specific focus on paediatric asthma

• current discharge mechanisms and referral management pathways are in need of scrutiny, evaluation and potential redesign

• obtaining and analysing data on admissions and attendances for children with asthma

• develop flow chart for primary care, asthma care pathways that are adaptable and incorporating Healthy Future proposals and transferable across all health and social care disciplines

• develop an asthma clinic as a pilot clinic, drawing upon asthma leads from each service. The longterm aim is that, once a Band 6 Paediatric Nurse is skilled and competent and has completed the Respiratory Diploma, the Children’s Community Nursing Team (CCNT) will be in a position to offer a dedicated respiratory clinic and follow up.

• Considerable work has been undertaken to review current asthma practice across the Oldham borough. The Children’s Community Nursing team is currently exploring how CWA are offered follow up interventions after being discharged from hospital with a focus on encouraging a system for all discharges to be referred to this team.

• Training and Education is a key factor in their plans. GP practices were offered support (ie funding for peripatetic support) and the training was delivered in June. The training was developed by the Oldham PCT Training and Education Team.

• A public health initiative, called Planet Asthma, to raise awareness of asthma among school children through creative sessions has been agreed. The training for the programme took place in June, with delivery of the sessions taking place in September.

• Paediatric staff at the Royal Oldham Hospital are undertaking an asthma audit.

• The Children’s Community Nursing team (CCNT) are pursuing how ward discharges are offered follow up interventions.

• The steering group has agreed to develop a DVD aimed at parents and carers of children with asthma to be produced in different languages and will look at the main areas such as asthma management, inhaler technique, signs and symptoms and triggers.

• The Children’s Community Nursing Team (CCNT) will be in a position to offer a dedicated respiratory clinic and follow up as soon as the Paediatric Nurse has completed the respiratory diploma and is skilled and competent.

Work in Oldham includes training for healthcare professionals and creative sessions for children

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Other examples of best practice:

Asthma UK has also made contact with several other PCTs in the North West that are doing lots of impressive work around asthma and in improving asthma services. They include: • Manchester PCT • Heywood, Middleton & Rochdale PCT • Halton & St Helens PCT

More details on these and other examples of good practice will be shared in the next edition of the newsletter.

In addition to all of the work that Asthma UK are funding, we are also keen to build relationships with other PCTs and networks across the North West so that we can support and share best practice around asthma care.

Some of the local network and groups that Asthma UK are represented on include:

• Bury PCT Paediatric Respiratory Working Group (PRWG) This group, which was set up in response to the high hospital admissions for asthma in children, and which falls under the plans of the Child and Maternity Local Implementation Team, acts as a multidisciplinary forum advising commissioners and providers on all aspects of paediatric respiratory services.

• Central Lancashire PCT – Strategic Respiratory Planning Group This group have been monitoring the Quality and Outcomes Framework (QoF) and hospital admission data (including data on asthma) and are discussing how they can address asthma care. Some suggestions have included evaluating practice nurse qualifications, training and competencies and producing a baseline review on what is happening in practices. This group are also considering establishing a sub group to look at paediatric asthma.

• Wirral PCT - Children and Young People Emergency and Urgent Care – Rapid Improvement Programme This group is a partnership between NHS Institute for Innovation & Improvement and Wirral Paediatric Clinical Network. The group is working on developing and implementing a common wheezy child pathway across the whole system.

• Central and Eastern Cheshire Asthma UK is also funding a paediatric community matron in the NW to complete the asthma diploma and one of Asthma UK’s specialist nurses is acting as a mentor to support the community matron through her studies and practice.

• Specialised Commissioning Task and Finish groups (Respiratory Services and Allergy Services) Asthma UK sits on the Specialised Respiratory Services Task and Finish Group and the North West Allergy and Immunology Task and Finish Group which are developing a North West approach to the delivery of specialised services.

• Public Health Networks Asthma UK is a member of the Cheshire and Merseyside Partnerships for Health Public Health Network (ChaMPs) and the Greater Manchester Public Health Network. Asthma UK is also represented on the Paediatric Respiratory and Allergy Network Group (PRANG) which has a membership of respiratory and allergy nurses from across the North West and is an excellent forum for sharing best practice.

NHS North West

Asthma UK is starting to build relationships with NHS North West (the Strategic Health Authority) and will be running a workshop at an NHS North West event on 28 October.

Further work in the North West