Asthma is a common medical condition in children in the UK, but the care they receive does not always reflect they care they deserve. Health inequalities impact children and young people’s outcomes: the asthma death rate is higher for children living in urban areas than rural areas and is four times higher for children living in the most deprived neighbourhoods of England compared to the least deprived. This same cohort is also more likely to face an emergency respiratory admission.
The new NICE/BTS/SIGN asthma guidelines state that asthma in children should be diagnosed with FeNO as the first line test, but access remains limited despite efforts to expand FeNO under the Accelerated Access Collaborative. The second line test is spirometry – this means that spirometry is essential in the diagnosis of asthma in children and as such needs to be commissioned alongside FeNO.
What the data shows
Only a third of the ICSs that responded to our survey are commissioning spirometry for children, one of the objective tests that can be used for diagnosing asthma. Of those who do commission spirometry, the majority of Integrated Care Systems [9/12] say that there is not enough testing capacity to meet the demand of new referrals.
Significantly, none of the survey respondents could say what their paediatric spirometry referral and testing rates in their local systems were.
The three most deprived ICSs have a childhood respiratory hospital admission rate 74% higher than that of the three least deprived ICSs while the childhood asthma hospital admission rate is 2.5x higher. All of the ICSs within the North East and North West have childhood respiratory hospital admission rates within the highest 10 and all the ICSs within the North West have childhood asthma hospital admission rates within the highest 10.
What is Asthma + Lung UK calling for?
- Prioritise the diagnosis of respiratory patients by providing a spirometry recovery fund of £40 million over the next two years, with more funding to those ICSs experiencing higher levels of deprivation. This could also provide some of the money required to increase the number of staff in primary care who can perform and interpret spirometry specifically for children.
- Comprehensive, nationwide implementation and resourcing of the new asthma guidelines, including providing the appropriate training to healthcare professionals to deliver them.
- Improve data collection and analysis across the care pathway to bring together primary and secondary data. Make high quality data publicly available to help ICSs target care where it is needed and ensure accountability.
Further information provided by the ICSs
Across South Birmingham, South Docs Services member practices have spirometry and FeNO testing for paediatrics. There may be some paediatric spirometry at practice level in other areas.
Each area bar one can refer to secondary care paediatric services for diagnostics. There is one Place where this is also not available. Liverpool Place refer to Alder Hey. St Helens has a respiratory hub. Warrington has a respiratory hub currently working with 1 PCN. Cheshire East have recently trained 2 members of staff who will be offering tests in 1 PCN.
We have mitigated some of the issues with the lack of CYP asthma inclusion in the original CDC plans by exploring virtual spirometry diagnostics with a digital partnership grant. More recently, we have been successful in receiving funding for specific CYP asthma CDC development.
Children would only be sent for spirometry in a secondary care setting via referral to outpatients.
Children can be sent for spirometry in a secondary care setting only if the test is associated with a secondary care pathway.
- Bury: PCN model via GP Fed. All referrals into central hub and Fed manage/fill the clinics which run from 3 sites providing a 7-day service. Age 5+.
- Manchester: No primary care commissioned offer. Working towards PCN model in negotiations with primary care providers.
- Oldham: Mix of GP practice & PCN models. Local Quality Assurance process in place.13/33 practices only for CYP.
- Salford: PCN model with 1 hub in each of 5 PCNs.
- Tameside: GP practice model via locally commissioned service. CYP funded separately however service not age restricted.
Plan to include CYP in CDC and funding bid to be submitted to support the development of this pathway. Children can be sent for spirometry in a secondary care setting but they would need to be referred to their local paediatric asthma clinic/service initially. Ad hoc funding is used e.g. NHSE spirometry monies for spirometers and training.
Some paediatric specialist services in secondary care have been used. The plan is for these to be used only for escalation once the revised commissioning and clinical pathways are in place.
Not commissioned currently. Similar to adults we have identified non-recurrent funds for 24/25. Will be commissioned as part of the RDH service 25/26 onwards and merging with adult service. As such, the service will be provided across all 5 boroughs in NCL. We are currently setting up capacity to be able to test CYP in the designated Respiratory Diagnostic Hublets. In this financial year, we will test a high-risk cohort of CYP patients identified with relevant clinical search criteria. In the next financial year we will open up for routine referrals as well.
We have a CYP service as a pilot running from CDC sites.
Spirometry commissioning varies depending on locality/place. Not all localities/places have commissioned services. We are currently working on closing inequity.
Children can be sent for spirometry in a secondary care setting in some places.
The ICS has a CYP clinical lead.
Note: review dates refer to the page content rather than the data visualisations