ICS respiratory review successes - public health

While many Integrated Care Boards described discrete local projects, others focussed on the processes and platforms that are helping them to deliver public health interventions.  

Buckinghamshire, Oxfordshire + Berkshire West

Cold and unsafe homes referral pathway – enabling home improvements and grants for those whose poor/cold housing is impacting their health condition.

Devon

PCN Respiratory Champions. During 23/24 NHSE funded 23 PCN Respiratory Champions across Devon. Projects undertaken by the Respiratory Champions included: COPD and Asthma Diagnosis and Management; Treating Tobacco dependency; Breathlessness; Respiratory infections and antibiotics; Optimising Pulmonary Rehabilitation capacity  and Leadership skills.

Nurses undertaking the Respiratory Champions roles reported that in addition to increasing their Respiratory Disease expertise and knowledge, they improved their quality improvement skills and improved communication about Respiratory Disease within the PCNs.
Although the Respiratory Champion roles are no longer funded, the Respiratory Champions across Devon have remained in contact and continue to promote Respiratory projects within Primary Care.

Dorset

Most impactful intervention: The development of the Dorset Insight and Intelligence service PHM database enabling us to see granular data of processes and outcomes across the ICS. We have managed to reduce SABA overuse significantly. We are planning to use it to address asthma exacerbation rates and smoking and PR in COPD.

Frimley

Mouldy housing.

Hampshire + Isle of Wight

Warm homes on prescription. Portsmouth County Council and the NHS ran a successful pilot in Autumn 2023 which is being expanded for winter 2024. The project identified people aged 65 and over living with a respiratory condition, who were living in cold homes. This was achieved by combining NHS and low Energy Performance Certificate (EPC) rating data from the local authority. People were sent a text offering them advice on increasing the warmth of their home, including where to get help on energy use, bills and what financial support was available.

Clean air champion programmes. We have delivered a range of Clean Air Trainings across Hampshire and Isle of Wight integrated care system, focused on some of our urban areas in Southampton, Portsmouth and Eastleigh. Southampton City Council commissioned Global Action Plan to provide Clean Air Training in Southampton to clinicians. The Environment Centre also commissioned and offered clean air training in Eastleigh Borough Council. Portsmouth City Council also delivered Clean Air Training. All trainings aimed to educate clinicians to become clean air champions who are then able to provide personalised advice to people to help them reduce their exposure to air pollution and thereby protect their health including promoting clean walking routes. Global Action Plan developed resources for clinicians who attended the Clean Air Champion trainings which were shared across the Integrated Care System for further use.

Asthma friendly schools. Support for children’s spirometry in primary care. The Integrated Care System is part of the Asthma Friendly Schools programme. The Asthma Friendly Schools programme sets out clear, effective partnership arrangements between health, education and local authorities for managing children and young people with asthma at primary and secondary schools. Becoming an Asthma Friendly School means that schools will have the following in place:

• Register of all children and young people with asthma.
• Management plan for each child (or a school wide emergency asthma plan)
• Named individual responsible for asthma in each school.
• Policy for inhaler techniques and care of the children and young people with asthma.
• Policy regarding emergency treatment.
• System for identifying children who are missing school because of their asthma or who are not partaking in sports or other activities due to poor control.

This guide enables schools to manage children and young people with asthma effectively in the pre-school, early years, primary and secondary school setting. It includes templates and checklists to practically support schools to become asthma friendly. Progress against the programme is monitored through the Hampshire and Isle of Wight Children and Young Person’s Asthma Network.

CORE20PLUS5 supporting uptake of COVID-19 vaccinations in deprived areas using a vaccination bus. Hampshire and Isle of Wight Integrated Care System had the highest uptake in the spring 2024 COVID-19 vaccine programme of anywhere in the South East. More than 180,000 eligible people had the vaccine, the third highest number of vaccines delivered nationally. Our uptake level was over 65 per cent which was the highest in the South East Region and fifth highest for population uptake in the country. We promoted and delivered the vaccines through a Hampshire roving vaccination and health vehicle. Specific initiatives to reduce health inequalities in vaccine uptake included specialist clinics in GP practices, pop-up services, supporting people who are homeless, and ethnic minority community champions.

North West London

The London Asthma Decision Support tool (LADS) - a collaboration between North West London ICS, South East London ICS, Imperial College Health Partners, Imperial College London, and Vizify - was highly commended in the Data-Driven Transformation Award at the 2023 HSJ Awards. The LADS tool brings together air pollution, demographic and social deprivation data with routinely collected NHS data for the first time ever. Linking data in this way not only allows clinical teams to intervene much earlier in the patient pathway and improve outcomes, but also to focus on identifying and investigating areas of health inequity across the capital. This tool is built on the whole systems integrated care (WSIC) platform and maximised the capabilities of the linked, longitudinal data to take a population health management approach.

Somerset

We have targets on smoking cessation.

South Yorkshire

Most impactful intervention: Movement towards a proactive population health management and multi-morbidity approach to identify patients greatest needs and then supporting patients with evidence-based care and support. Starting to use segmentation and risk stratification approaches.

Asthma friendly schools. Symptom based going home plans for children’s asthma implemented across all trusts. Housing and children's asthma.   

Surrey Heartlands

Most impactful intervention: CYP Asthma Team established - their work includes: providing updates and teaching for primary and secondary care, improving communication between primary and secondary care, developing discharge pathways to improve a safer discharge process, promoting asthma friendly schools, liaising with housing services to decrease incidence of damp and mould in homes, working with Surrey Air Alliance to increase awareness of pollution and asthma, and working with prescribing leads to find ways to decrease SABA prescribing in CYP asthma. Evidence of impact of the role-modelling clinics for CYP asthma, undertaken by the team, can be seen in reduction of the number of CYP at high risk of asthma attack/death (reducing by more than 40% in one practice, and c. 60% in another).

Inpatient Tobacco Dependency Programme pathways are established in all acute inpatient and maternity settings, and inpatient mental health settings.