2 12 Transforming asthma services as part of everyday healthcare in Lambeth and Southwark Dr Azhar Saleem GP lead Integrated Respiratory team Transforming London s health and care together 1
Transforming Asthma services as part of children s everyday healthcare in Lambeth and Southwark Dr Azhar Saleem GP and Respiratory Lead, Lambeth CCG CYPHP Paediatric Asthma Chair 2
Our Vision. All children and young people in Lambeth and Southwark will have safe, effective everyday healthcare as part of a world class health system 3
Population health gain: Focus on everyday healthcare Greatest need is among children and young people who are mostly well or who have simple chronic conditions Common things are common 4
Where could we add most value? Very unhealthy Mostly healthy Very healthy 5
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Programme workstreams Asthma Epilepsy Mental Health Education Primary care Including INREACH to GP practices and joint consultations 7
10 year SDR per 100000 (0-14 years) Percentage wheeze European Asthma outcomes 0.3 30 0.25 25 0.2 20 Mortality 0.15 0.1 15 10 6-7 age group 0.05 5 13-14 age group 0 0 Wolfe, Lancet 2013 8
75% of children and young people died before reaching hospital Only 14% of children and young people had a PAAP 39% of young people were exposed to second hand smoke 72% of young people were failing to take appropriate treatment 9
Asthma in Lambeth and Southwark CYP: 135,000 Asthma: 9,000 Projected: 12,000 Evelina & KCH 10
Asthma in Lambeth and Southwark High rate of A&E attendances for asthma, with over half not requiring follow-up following attendance, suggesting inappropriate Outliers for emergency admissions to hospital for asthma 1.5 times the national average in each borough More bed days per patient than the national average Longer lengths of stay in hospital than the national average Insufficient support locally for children s mental health needs 11
Current provision of care Inpatient Outpatient Consultant Respiratory Paediatrician Clinical Nurse Specialist A&E Primary care 12
Gaps and unmet need PAAP Inhaler technique SABA vs ICS ratio Review after admission Holistic assessment during a time of need including mental health assessment 13
Without standards, there can be no improvement Taiichi Ohno. Founder of the Toyota Production System 14
We are the kings (and queens) of standards 15
Some of the standards 16
Outcomes against standards Inhaler technique: NICE QS 4 LondonSCN 13 PAAP: NICE QS 3 LondonSCN 11,12, 27 Tobacco smoke exposure: LondonSCN 40 Emergency vs Planned care: LondonSCN 24, 26, 32 NICE QS London SCN Asthma standards School days missed: LondonSCN 17,18 Medication misuse: NICE QS 4 LondonSCN 36, 37, 38, Review after admission: NICE QS 10 LondonSCN 16 Annual review: NICE QS 5 LondonSCN 11, 12, 28 17
What will be our value added? Recruitment of 4 WTE Paediatric Asthma CNSs to bolster current capacity of 2 WTE Recruitment of 0.5 WTE pharmacist to tackle medication misuse and inhaler technique A community based role straddling primary and secondary care. With education and liaison across school and local authorities being a central feature of the job. Upskilling of primary care whilst helping them deal with many of the moderate cases of asthma that have more complex needs (eg. Psychosocial issues). 18
Proposed model of care Schools: - Increased support to children with asthma - Identifying worsening of disease earlier CNS CNS Upskilling of CNS in identifying mental health needs CNS Tobacco Dependence: - Monitoring of CO/Cotinine - Family support to stop smoking Pharmacists: Education: - Ensuring - GP and PN inhaler upskilling in technique is GPs primary care central to - INREACH clinics reviews as part of - Identifying and CNS complex actioning management in prescribing the community Enhanced PNs PNs anomalies and adherence issues 19
Legacy We will have succeeded when: Children and young people in Lambeth and Southwark have world class everyday healthcare Children and young people in Lambeth and Southwark become healthier We have produced an evidence-based demonstrably effective and cost-effective model of everyday healthcare; a detailed service specification We have created a sustainable learning healthcare system Through our evaluation, we have contributed to children s health systems research to improve evidence-based practice and policy 20