Time to take action on asthma - Asthma UK | Homepage to take action on asthma 3 All governments across the UK have developed standards Who took part in our survey? which acknowledge

3

Time to take action on asthma

2� Time�to�take�action�on�asthma

Foreword: Poor asthma care costs lives and money

Asthma is the one of the most common long-term conditions in the UK,1 affecting almost 1.1 million children and 4.3 million adults – that’s 1 in 11 people.2 Every 10 seconds someone is having a potentially life threatening asthma attack,3 while more than 70 children are admitted to hospital because of their asthma every day.4 As a result, asthma has a significant impact on school absences and lost working days across the UK.5, 6 Every year, asthma costs the NHS more than £1.1 billion in hospital admissions, drugs, and over 3.7 million GP visits.7, 1*

* GPvisitscalculatedbymultiplyingthe2012/13QualityandOutcomesFrameworkAsthma09UKaveragepercentageuptake(includingexceptions)by5.4million.† Onaverage,calculatedfrom2002-2012.‡ Calculatedbydividingcostofaveragehospitaladmissionbycostofaverageasthmareview.

Yetdespitethis,inMay2014thefirsteverNational Review of Asthma Deathsfoundthattwo-thirdsofasthmadeathscouldbepreventedwithbetterroutinecare.Shockingpatientsafetyconcernswerealsoidentifiedinthecasesofthosewhodied,withprescribingerrorsfoundinalmosthalfofalldeathsfromasthmainprimarycare.8Thisissimplyunacceptablewhen,everyday,threefamilieslosesomeonetoasthmaand,everyyear,asthmakillsenoughchildrentofillaclassroom.9

Asthmaattackscanbepreventedifwesimplygetthebasicsright.AstheBritish Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN) British Guideline on the Management of Asthma recommends,10thismeansprovidinganannualreviewinprimarycare,wherepeoplewithasthmareceiveawrittenasthmaactionplanandhavetheirmedication,symptomsandinhalertechniqueassessedbytrainedstaff.Whenasthmaattacksdooccur,riskoffurtherlife-threateningattackscanbereducedbyeffectiveandtimelytreatmentinhospitalandafollow-upappointmentatadoctor’ssurgerywithintwoworkingdaysofdischarge.

However,thebasicssimplyaren’tbeingdelivered.Despiteaplethoraofclinicalguidelines,frameworksandstandards,over1,200peoplediefromasthmaeveryyear.9†Morethan80%ofpeoplewithasthmaaren’treceivingtherightbasiccare.11

Publicmoneyisspentonover65,000emergencyasthmaadmissionseveryyear,1275%ofwhicharepreventable.13Onaverage,eachemergencyasthmaadmissioncoststhehealthservice23timesthecostofanannualasthmareview.13,‡Caringforpeoplewhoexperienceanasthmaattackcostsover3.5timesmorethanforthosewhoseasthmaiswellmanaged.14,15

Itisunacceptablethathealthservicemoneyisspentoncarewhichdoesnotfullymeettheclinicalguideline,butitisunforgivablethattheUKhasoneoftheworstasthmamortalityratesinWesternEurope.16Untilweimplementallofthebasicelementsofasthmacareandimproveoutcomes,ourchildrenarefourtimesmorelikelytodiefromasthmathanchildreninGermany,Spain,Italy,Austria,Finland,PortugalorSweden.

Complacency in asthma care must end: we have to get the basics right. Action must be taken now to implement asthma standards across the UK to prevent asthma deaths and cut hospitalisations.

On average, an emergency admission for asthma costs 23 times more than an annual asthma review

Two-thirds of asthma deaths could be prevented with better routine care

5.4 million people in the UK are currently receiving treatment for asthma –

that’s 1 in 11 people

Time�to�take�action�on�asthma� 3

AllgovernmentsacrosstheUKhavedevelopedstandardswhichacknowledgetheurgentneedtoimproveasthmaoutcomesandprovideguidanceonhowtoachievethis.17,18,19,20 Allofthesestandardsarebasedonthelatestbestpractice,outlinedintheBTS/SIGN Guideline,andAsthmaUKrecognisestheworktakingplaceacrossEngland,NorthernIreland,ScotlandandWalestodelivergoodasthmacare.

However,asDrKevinStewartfromtheRoyalCollegeofPhysicians(RCP)statedinresponsetotheNational Review of Asthma Deaths,moreneedstobedone:

“It’s time to end our complacency about asthma, which can, and does, kill. We haven’t paid enough attention to the importance of good routine asthma care by clinicians with the right training and experience. Too often we have also been slow to detect signs of poor asthma control and slow to act when these have been present.”21

Tohelphealthservicesdetectsignsofpoorasthmacareandencouragethemtoactbyimplementingthestandards,AsthmaUKconductedasurveyofmorethan6,500peopleacrosstheUKtofindouthowthestandardofasthmacaretheyreceivecomparestowhattheyshouldexpect,asrecommendedbytheBTS/SIGN Guideline.ThisfollowsonfromtheAsthmaUK2013surveywhichalsolookedatstandardsofasthmacareinEngland,NorthernIreland,ScotlandandWales.11

Thisreportpresentsanoverviewofthe2014surveyfindingsonthequalityofcareacrosstheUK.Aspartofthisreport,AsthmaUKhasalsoproducedsomevitaltoolstohelphealthmanagersandcommissionersimproveasthmacarelocally:

• Local data breakdownsofthesurveyresults.

• Local breakdowns of net cost savingswhichcanbeachievedbyimplementingthestandards.

• AnAsthma Improvement Hub,whichbringstogetherservice improvement toolsandbest practice examplesofworkthathaveimprovedasthmaoutcomesinbothchildren’sandadults’carearoundtheUK.

• Downloadable asthma action plansforbothadultsandchildren

To access these resources, please visit www.asthma.org.uk/takeaction.

AsthmaUKurgescommissionersandhealthmanagerstousetheseresourcestoassessthequalityandimprovethestandardofasthmacareintheirarea,toensurethatallpeoplewithasthmareceivethebasicelementsofcare,includinganasthmaactionplan.

“It’s time to end our complacency about asthma”

Notes:

20 people (0.3%) gave an invalid postcode. These people are not included in the England, Scotland, Wales and Northern Ireland analyses.

Population source: ONS Mid-year population estimates for the UK mid-2013

Who took part in our survey?

6,538peopletookthesurveybetween23June2014and26August2014.Overtwo-thirdsofpeoplewhotookthesurveywereaged18-59(64%).Thesurveycouldbecompletedbyaparentonachild’sbehalf,and18%ofresponseswereforpeopleaged17orunder.18-59yearoldsareslightlyoverrepresentedwhileotheragegroupsareslightlyunderrepresented.TheproportionofpeoplewhorespondedfromeachcountryreflectstheUK’spopulationasawhole.

17 or under 18-59 60+

1,18918%

4,16464%

1,18518%

What did we do?

ThesurveyaskedaboutthebasicelementsofclinicalasthmacareasoutlinedintheBTS/SIGN Guideline:diagnosis,annualreviews,writtenasthmaactionplans,accuratetreatmentfollowingadmission,andappropriatedischargefromhospital.

Accordingtopeople’sanswers,theircarewasratedasgreen(excellent),amber(satisfactory)orred(poor).Forcaretorateasexcellent(green)peoplehadtoreportreceivingcarethatincludedallofthebasicelementsofcareoutlinedintheBTS/SIGN Guideline.Satisfactorycare(amber)requiredmorethanhalfofthebasicelementstobeincluded.Poorcare(red)meanthalforlessofthebasicelementswereincluded.

Additionalquestionswereaskedtoassessasthmacontrol(ameasureofhowwellsymptomsarekeptundercontrol),followingthestructureofthethreeRCPquestionsoutlinedintheBTS/SIGN Guideline.QuestionswerealsoaskedtoassesssatisfactionusingtheNHSEnglandFriendsandFamilyTestquestions.22

EnglandParticipants

5,418 (83%)Population53.9 million (84%)

ScotlandParticipants

627 (10%)Population5.3 million (8%)

WalesParticipants

333 (5%)Population3.1 million (5%)

Northern Ireland

Population1.8 million (3%)

Participants

140 (2%)


§Sample size may vary due to missing data.

**Rounding means percentages may not add up to 100.††Rates calculated by 10,000 population.§§NICE 75% savings rate applied to mid-2013 ONS UK population.

Only a fifth of people with asthma are receiving all of the basic elements of clinical asthma careFindings on overall quality of care

TheNational Review of Asthma Deathsfoundwide-rangingandwidespreadissueswiththequalityofasthmacarereceivedamongstthosewhodied.

The2014AsthmaUKsurveyresultssuggestthatoverallasthmacarecontinuestofallshortoftheclinicalguideline:onlyafifthofpeoplewithasthmaintheUKarereceivingcarethatfullymeetstheBTS/SIGN Guideline.TheresultsshowtherehasbeenlimitedimprovementacrosstheUKoverthelastyear:therehasbeena5%increaseintheproportionofpeoplereceivingcarewhichincludesallofthebasicelementsofclinicalasthmacare,anda2%decreaseintheproportionofpeoplereceivingpoorcare.

TheresultsshowthattheproportionofpeoplewhoreceivecarewhichfullymeetstheBTS/SIGN GuidelineisstillverylowinallpartsoftheUK.Sincelastyear’ssurvey,therehasbeenalimitedimprovementinWales,ScotlandandEngland.

TheresultssuggestthatmorepeoplearereceivinggoodcareinNorthernIrelandthanlastyear,alikelyresultofthecontinuedimplementationoftheService Framework for Respiratory Health and Wellbeing,whichwaspublishedin2009.ThesurveyresultssuggestthatNorthernIrelandhasthehighestproportionofpeoplereceivingcarewhichfullymeetstheBTS/SIGN Guideline.

ThefindingsindicatethatpeoplewithasthmainNorthernIrelandarealmosttwiceaslikelytoreceivecarewhichfullymeetstheBTS/SIGN GuidelineaspeopleinWalesorEngland.TheresultsalsosuggestthatoverathirdofpeoplewithasthmainEnglandandalmosttwo-fifthsofpeoplewithasthmainWalesreceivepoorcareincomparisontolessthanaquarterinNorthernIreland.Thisisreflectedinthenationaloutcomesforasthma,whereemergencyadmissionratesinNorthernIrelandhavefallenfromsomeofthehighestintheUKin1993tothelowestintheUKby2011/2012.12,††

Four out of five children are still not receiving all elements of basic clinical asthma care

TheresultsshowthattheproportionofchildrenreceivingcarewhichfullymeetstheBTS/SIGN Guidelinehasonlyincreasedby3%sincelastyear(from16%),meaningthatfouroutoffivechildrenarestillnotreceivingallelementsofbasicclinicalasthmacare.

Implications of improvement

Bydeliveringcarewhichincludesallofthebasicelementsofasthmacare–inlinewiththeBTS/SIGN Guideline–commissionersandmanagerscanprovidepeoplewiththetools,knowledgeandskillstobeabletomanagetheirasthmamoreeffectively,reducingtheirchanceofanasthmaattackandimprovingtheirqualityoflife.Byimplementinggoodstandardsofcare,theNationalInstituteforHealthandCareExcellence(NICE)estimatesthatemergencyasthmaadmissionscanbereducedbybetween50and75%,deliveringnetsavingsofupto£28.6millioneveryyearacrosstheUK.13§§

2,162(33%)

3,122(48%)

1,228(19%) 350

(29%)

608(51%)

230(19%)

Actual quality of care

Overall total: Children and young people 6,512§ (100%) (17 and under) total: 1,188 (100%)**

2013total 4,967

14%

51%

35%

2014total 5,394

18%

48%

34%

2014total 332

14%

47%

39%

2013total 248

12%

48%

40%

2014total 625

24%

47%

29%

2013total 503

20%

50%

30%

2014total 140

35%

41%

24%

2013total 101

31%

37%

33%

2014total 6,512

19%

48%

33%

2013total 5,878

14%

50%

35%

ENGLAND WALES SCOTLANDNORTHERN IRELAND UK

Variations in care

Actual quality of care received by country**

Poor Satisfactory Excellent


Stories from people with asthma

AlexHardiment

I should never have lost my daughter to asthma”

“MydaughterAlexdiedofanasthmaattackinAprilofthisyear.Shewasjust15.Alexhadherwholelifeaheadofher—Ididn’tthinkforonesecondthatasthmawouldclaimherlife.Shetookmedicationasdirected—includingonthedayshedied—butwhatI’vecometorealiseisthatAlexdidn’thaveanasthmaactionplan,andneitherwerewetoldoftheseriousnessofhercondition.Iknownowthatthingscouldhavebeenverydifferent,hadAlexbeenseenregularlybyanasthmanurseandgivendifferentmedication.Forsuchacommoncondition,thissimplyshouldn’thappen.Ishouldneverhavelostmydaughtertoasthma.Wefeelthatwewereverybadlyletdownbythehealthcareprofessionalswesaw.

Louise (Alex’s mum) from Scunthorpe

My sister Ellen died after an asthma attack”

“Iwasonly8whenmysisterEllendiedafteranasthmaattack,whichleftthewholefamilydevastated.Wedidn’tmonitorEllen’speakflowveryoften,didn’thaveregularasthmareviewswithaGPanddidn’tuseanasthmaactionplan.Hertriggerswerepollen,aswellasexerciseandemotionaltriggerssuchasfear.IfeelthattheGPcouldhavetalkedmoretoourparentsaboutEllen’sasthmaandhermedicinessoweweremoreaware.

Rebecca (Ellen’s sister) from Swansea

Two-thirds of asthma deaths could be prevented with better routine care


Almost all people who were admitted to hospital for asthma, or sought help for an attack, did not have control over their asthma symptomsFindings on asthma control

TheNational Review of Asthma Deathsalsolookedatasthmacontrollevels–ameasureofhowwellsymptomsarekeptundercontrolandtheextenttowhichtheyimpactondailylife.

Poorlevelsofasthmacontrolareassociatedwithaworsequalityoflife,andmayputpeopleatgreaterriskofhavingalife-threateningasthmaattack.23Peoplewithasthmatendtounderestimatetheirlevelofasthmacontrol.Evidencesuggeststhatonlyaroundaquarterofpeoplehavecompletecontroloftheirasthmasymptoms.24

WeaskedeveryonewhotookthesurveytoanswerthethreeRCPquestionswhichshouldbeaskedbyhealthcareprofessionalstoassesssomeone’slevelofasthmacontrol:

• Inthelastmonth/weekhaveyouhaddifficultysleepingduetoyourasthma(includingcoughsymptoms)?

• Haveyouhadyourusualasthmasymptoms(forexample,cough,wheeze,chesttightness,shortnessofbreath)duringtheday?

• Hasyourasthmainterferedwithyourusualdailyactivities(forexample,school,work,housework)?

Ifsomeoneanswered“no”toallthreequestions,theirasthmawasassessedtobecontrolled.Iftheyanswered“yes”toatleastonequestion,theirasthmawasdefinedasuncontrolled.

What did we find?

Ourresultsshowthatmorethanthree-quartersofpeoplewereassessedashavinguncontrolledasthma.

Asthma control§ Peoplewithasthmawhotookthesurvey(%)Total:6,529(100%)

Almostallofthepeoplewhowereadmittedtohospital,orwhosoughthelpforanattack,haduncontrolledasthma.

Asthma control of people who were admitted to hospital*** Numberofpeopleadmittedtohospitalfortheirasthma(%)Total:663(100%)

Asthma control of people who sought help for an asthma attack Peoplewhosoughthelpforanasthmaattack(%)Total:1,193(100%)

OurresultsalsosuggestthatpeoplewhoreceiveexcellentcareinlinewiththeBTS/SIGN Guidelinearemorelikelytohavecontrolovertheirasthmathanthosewhoreceivecarewhichdoesnotincludeallofthebasicelementsofclinicalasthmacare.


Improvingcontrolcangreatlyimprovethequalityoflifeofpeoplewithasthmabyreducingtheimpactofasthmaontheirdailylife.Itmayalsoimproveoutcomesbyreducingtheirriskofhavingalife-threateningasthmaattack.

Areductioninasthmaattackswouldalsoreduceemergencyadmissionstoachievecostsavings.Forexample,ifthe408adultsand187childrenwithuncontrolledasthmawhohadbeenadmittedtohospitalinoursurveyhadbeenabletocontroltheirsymptomsbetter,preventingtheiradmission,around£743couldhavebeensavedforeachadmissionaccordingtoNICE’sestimates.13

Uncontrolled5,120 (78%)

Controlled1,409(22%)

Uncontrolled595(90%)

Controlled68(10%)

Uncontrolled1,064(89%)

Controlled129(11%)

§Sample size may vary due to missing data.

***Rounding means percentages may not add up to 100.


What can be done to improve outcomes for people with asthma?

Two in five people diagnosed with asthma in the last five years could not recall being asked the key questions at diagnosis

Diagnosis: what should be happening?

TheNational Review of Asthma Deathsidentifiedavoidablefactorsrelatedtotherecognitionofriskinthecasesofthosewhodied–forexampleincorrectdiagnosis–inaroundhalfofpeopleofallagesandalmost80%ofchildrenbeingtreatedinprimarycare.

Thereisnoonetestfordiagnosingasthma.However,theBTS/SIGN Guidelinesetsoutaprocessthathealthcareprofessionalsshouldfollowtoensurethatappropriatetreatmentisgiveninatimelymannerwitharecordofhow,whenandonwhatbasisthediagnosiswasmade.Keyquestionsshouldbeaskedrelatedtosymptoms,personalandfamilymedicalhistoryandresponsetoanytreatment.

Itisalsoimportantthatquestionsaboutoccupationalasthmaareaskedatdiagnosisastheonsetofadultasthmaisassociatedwithasmanyas18differentprofessions.Adiverserangeofoccupationsincludinghairdressing,printingandcleaninghavebeenlinkedtoasthma,whilefarmersarearoundfourtimesmorelikelytodevelopadultasthmathanofficeworkers.25

What did we find?

Ofthepeopleinthesurveydiagnosedwithasthmainthelastfiveyears,twoinfivecouldnotrecallbeingaskedthekeyquestionssetoutintheBTS/SIGN Guidelineatdiagnosis.Thisisthesameresultaslastyear’ssurvey.Onlyaquarterofadultsrecallbeingaskedquestionstofindoutiftheirasthmacouldbecausedbytheirjob.Thismeansthatover700ofthepeoplewhoansweredthisquestionmaynotbeawarethattheirjobcouldbeaffectingtheirasthma.


Performingaccurateandtimelydiagnosismeansthatpeoplewithasthmaaremorelikelytoreceiveappropriatetreatmentwhichhelpsthemcontroltheirsymptoms,improvingtheirqualityoflife.

Not sure 149 (9%)No 576 (33%)

Yes 1,020 (58%)

People�asked�key�questions�at�diagnosis

Total: 1,745 (100%)

Not sure 189 (19%)

No 561 (56%)

Yes 255 (25%)

People�asked�about�their�occupation

Total: 1,005 (100%)


Just under a quarter of people had not had a review of their asthma in the last year

Justunderaquarterofpeopletoldustheyhadnothadtheirinhalertechniquechecked,orhadanasthmareview,inthelastyear.Shockingly,lessthanathirdsaidtheyhaveawrittenasthmaactionplanandonlyaquarteraregettingallthreekeyaspectsofroutineasthmacare.

Althoughthisisaslightimprovement–one-fifthofpeoplereceivedallthreekeyaspectsofroutinecareinlastyear’ssurvey–thisisstillunacceptable.AcrosstheUKalmostthree-quartersofpeoplethatreportedseekinghelpfromadoctorornurseforaproblemwiththeirasthmainthelastyeardidnothaveawrittenasthmaactionplan.Iftheyhadbeengivenaplantheymaynothaveneededhelp.

Afreewrittenasthmaactionplantemplate,Your Asthma Action Plan,canbedownloadedfrom:www.asthma.org.uk/takeaction.

Routine management of asthma: what should be happening?

TheNational Review of Asthma Deathsfoundthattwo-thirdsofdeathscouldbepreventedwithbetterroutinecare.Thisincludesthreekeyaspects:anannualreview(whichincludesareviewofmedications),awrittenasthmaactionplanandacheckofinhalertechnique.However,thelatestQualityandOutcomesFramework(QOF)resultsshowsthatoveronemillionpeopleintheUKaremissingoutontheirannualreview,withthenumberofreviewsprovidedinScotland10%lowerthaninNorthernIreland.1Ifpeoplemissoutontheirreview,theymayalsobemissingoutontheseotheressentialaspectsofroutinecare.

Peoplewithasthmashouldbegivenself-managementtoolsattheirannualreviewsotheycanmanagetheirsymptomseffectivelytoreducethechanceofhavingalife-threateningasthmaattack.Peoplewithoutawrittenasthmaactionplanarefourtimesmorelikelytobeadmittedtohospitalfortheirasthma.26Uptoathirdofpeoplemakemistakeswithinhalersthatcanmeantheirtreatmentislesseffective.27

TheNational Review of Asthma Deathsalsoidentifiedthatprescribingerrorswerepresentinalmosthalfofthedeathsinvestigated.Qualityannualreviews–whichincludeareviewofmedications–couldpreventfuturedeaths.

Key aspects of routine care†††

Action�plan

Total: 6,534 (100%)

Inhaler�technique

Total: 6,532 (100%)

Annual�review

Total: 6,534 (100%)

All�three

Total: 6,533 (100%)

Yes 1,648 (25%)

No 4,885 (75%)

Yes 5,014 (77%)

No 1,520 (23%)

Yes 1,972 (30%)

No 4,562 (70%) No

1,464 (22%)

Yes 5,068 (78%)

Up to a third of people make mistakes with inhalers that can mean their treatment is less effective

Research shows that people without a written asthma action plan are four times more likely to be admitted to

hospital for their asthma

Our survey suggests that seven out of ten people with asthma do not have a written asthma action plan

†††Totals may be different due to missing data.


Three out of five children do not have a written asthma action plan

Almostthree-quartersofchildrenhadtheirinhalertechniquechecked,whileeightoutoftenhadareviewoftheirasthmainthelastyear.However,thesurveyresultssuggestthatthreeinfivechildrendonothaveawrittenasthmaactionplan.Morethantwo-thirdsofchildrenarenotgettingallthreeessentialaspectsofroutinecare,showinglittleimprovementsincelastyear(72%).Thesurveyfindingsshowthatahigherproportionofchildrenhaveactionplans(39%)comparedtoadults(30%),andthatmorechildrenreceivedallthreekeyaspectsofroutinecarethanadults(withadifferenceof7%).

AsthmaUK’sfreeMy Asthma Action Planhasbeendesignedspecificallyforchildrenwithasthma,andcanbedownloadedhere:www.asthma.org.uk/takeaction.

Variations in care

TheresultsshowthatthereisvariationintheproportionofpeoplewithawrittenasthmaactionplanindifferentpartsoftheUK.SevenoutoftenpeoplewithasthmainEngland,andthree-fifthsinScotland,donothaveawrittenasthmaactionplan.However,ourresultssuggestthatmorethanthree-quartersofpeoplewithasthmainWalesdonothaveawrittenasthmaactionplan.

AmuchhigherproportionofpeoplehaveawrittenasthmaactionplaninNorthernIrelandthantherestoftheUK(63%)–alikelyresultofthefactthatactionplansareincentivisedinNorthernIrelandthroughuseofaDirectedEnhancedService(DES).Improvementsinactionplanprovisionhavebeenmadesincelastyear–a6%increaseacrosstheUKoverall.

Asthma action plans

Received an asthma action plan (%)

Did not receive an asthma action plan (%)

ENGLA

ND

1,559�(29%) 3,854�(71%)

2014

2013 1,109�(22%) 3,858�(78%)

2014

2013

WAL

ES

74�(22%) 259�(78%)

48�(19%) 200�(81%)

2014

2013SC

OTL

AND 246�(39%) 381�(61%)

163�(32%) 340�(68%)

2014

2013

NORT

HER

N IRE

LAND

88�(63%) 52�(37%)

61�(60%) 40�(40%)

2014

2013

UK

1,972�(30%) 4,562�(70%)

1,398�(24%) 4,480�(76%)

Key aspects of routine care – children

Action�plan

Total: 1,188 (100%)

Inhaler�technique

Total: 1,188 (100%)

Annual�review

Total: 1,188 (100%)

All�three

Total: 1,188 (100%)

Yes 381 (32%)

No 807 (68%)

Yes 949 (80%)

No 239 (20%)

Yes 461 (39%)

No 727 (61%)

No 292 (25%)

Yes 896 (75%)

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Routinemanagementcanreducetheriskoflife-threateningasthmaattacks,prescribingerrorsandpoorasthmacontrol:astheNational Review of Asthma Deathsfound,two-thirdsofasthmadeathscouldbepreventedwithbetterroutinecare.

NICEalsoestimatesthatsubstantialefficienciescanbeachievedacrosshealthsystemsbyimprovingroutineasthmacare.Althoughsomecostswouldbeincurredwiththedeliveryofadditionalasthmareviewsforpeoplewhocurrentlydon’treceivethem,eachreviewonlycostsanaverageofaround£32.17.Theaveragecostofanadmissionforasthmais£743.Itismoreefficienttopreventexpensiveadmissionsbydeliveringlessexpensive,qualityreviewswhichincorporateallthreekeyaspectsofroutinemanagement.13

Byimplementingallthreeessentialaspectsofroutinecare,savingswouldberealisedinsecondarycareviaareductioninemergencyadmissions.However,primarycarecouldalsobenefitbyidentifyinginappropriateprescribingduringreviews,andbyareductioninunscheduledvisits.

Average cost of asthma review = £32Average cost of emergency admission for asthma = £743

It is more efficient to prevent expensive admissions by delivering less expensive, quality reviews which incorporate all three aspects of routine management.


My last asthma review was two years ago”

“Iwasn’tfeelingwellsoIphonedtheGPsurgerytoaskforanemergencyappointmentbutIcouldn’tgetone.FortunatelymyneighbourfoundmewhileIwashavingtheasthmaattackanddrovemetohospital.Mylastasthmareviewwastwoyearsago.WhenIaskedtheGPifasthmareviewswereacommonthinghereplied,‘No,they’reonlyreallyforchildrenwhohavejustbeendiagnosed’.Idon’thaveanasthmaactionplanandIhaveneverbeenshowninhalertechnique–IthinkdoctorsassumethatbecauseI’vehadasthmaallmylifeIknowhowtousethem.

Hollie, from Aberdeen

HollieShirley

Time�to�take�action�on�asthma� 11Time�to�take�action�on�asthma� 11

Only half of the people admitted to hospital for their asthma spoke to a specialist about their care before they were discharged

Asthma care when symptoms get worse: what should be happening?

TheNational Review of Asthma Deathsemphasisedtheimportanceofgettingcarerightwhensomeone’ssymptomsgetworseandtheyseekmedicalhelp.

Topreventsymptomsfromdeteriorating,andtoavoidtheneedforadmissionorcomplextreatment,peoplewithasthmashouldhavetheirlevelofasthmacontrolandsymptomseverityassessedwhentheyseekhelp.Iftheirsymptomsaresevereorlife-threatening,theyshouldalsobegivensteroidswithinonehourofarrivalatA&E.

Whenpeopleareadmittedtohospitalfortheirasthma,theyshouldhaveastructuredreviewwithamemberofthespecialistrespiratoryteambeforedischargetoensuretheyhavetherighttreatment,haveawrittenasthmaactionplanandcanusetheirinhalercorrectlytohelpreducethechanceofhavinganotherattack.

Followinganytreatmentathospitalforasthma–whetherafterA&Edischargeorfollowingadmission–peoplewithasthmashouldhaveafollow-upappointmentattheirdoctor’ssurgerywithintwoworkingdaystohelppreventfurtherasthmaattacks.Pastattackscanbeariskfactorforfutureattacks,28andtheNational Review of Asthma Deathsshowedthatovertwo-thirdsofpeoplehospitalisedinthemonthbeforetheydieddidnotgetproperlycheckedupafterwards.

What did we find?

Aroundtwo-thirdsofthepeoplewhotookthesurveysoughthelpfortheirasthma,ahigherpercentagethanlastyear(57%).Approximatelyfouroutoffiveofthesepeoplehadnotreceivedalltheelementsofbasicasthmacare.Overaquartershouldhavereceivedbettercarewhentheysoughthelp–animprovementof8%fromlastyear.

Onlyhalfofthepeopleadmittedtohospitalfortheirasthmawereseenbyaspecialistbeforetheyleft–asmallimprovementsincelastyear(48%).Onlyaroundaquarterhadafollow-upappointmentattheirdoctor’ssurgerywithintwodaysofdischarge.Disappointingly,theseresultsareexactlythesameaslastyear.


Whenpeoplearetreatedappropriatelyandpromptlywhentheirasthmasymptomsgetworse,theyarelesslikelytoneedtostayinhospital,orrequiremorecomplextreatment.Iftheyarealsoseenbyaspecialistandfollowed-upaftertheyhavebeendischarged,theymaybelesslikelytohaveanotherattack.

NICEestimatesthattheremaybesomecostsassociatedwithimplementingthebasicstandardsofcarewhensomeoneseekshelpfortheirasthma.Forexample,ifmorepeoplereceivetherightcareinA&E,servicesmayadministermoredrugs.Servicesmayalsoseeanincreaseinthenumberofpeoplerequiringfollow-upsinprimarycaretwoworkingdaysafterdischargefromhospital.

However,theseadditionalcostsarenotsubstantial:therelevantdrugsonlycostapproximately£3.03perdoseandanaveragefollow-upreviewcostsaround£32.17.Thenetsavingswhichcouldbeachievedthrougha50-75%reductioninadmissionsfarexceedanyinvestmentmadeindeliveringthebasicelementsofclinicalcarewhensomeoneseekshelpfortheirsymptoms.13

People who sought help for symptoms that had their asthma control assessed. Total: 3,695

Yes:3,076(83%)

No:503(14%)

Notsure:116(3%)

People who sought help for symptoms that had the severity of their symptoms assessed. Total: 1,190

Yes:822(69%)

No:315(26%)

Notsure:53(4%)

People who were treated at or admitted to hospital that had a follow-up appointment at their doctor’s surgery within two working days. Total: 1,373

Yes:335(24%)

No:996(73%)

Notsure:42(3%)

People who were admitted to hospital that had a review on discharge. Total: 660

Yes:330(50%)

Notsure:27(4%)

No:303(46%)


Only around half of the people who took the survey would recommend the care they receive to a friend or family member


*Rounding means percentages may not add up to 100.§Sample size may vary due to missing data.

Thesurveyalsoaskedsomequestionstomeasurepeople’sperceptionofcareusingthequestionsfromtheNHSEnglandFriendsandFamilyTest.

Aroundhalfofthepeoplewhotookthesurveywouldrecommendtheirasthmacaretoafriendorfamilymemberwhorequiredsimilartreatment.ThiscomparespoorlytoNHSEnglandFriendsandFamilyTestresultsforA&Ewhichshowthat87%ofpeoplearelikelytorecommendtheircare.29

Perceived quality of careChildren and young people total: 1,188*

Poor Satisfactory Excellent

Theresultssuggestthat16%ofadultsbelievetheyarereceivingpoorcarehoweverathird,accordingtoresponsestothequestions,areactuallyreceivingpoorcare.Similarly,16%ofchildren–ortheirparents–thinkthelevelofcaretheyreceiveispoorwhile,inreality,30%arereceivingpoorcare.Thisdiscrepancybetweenperceivedqualityofcareandactualqualityofcareisveryworrying.

196(16%)

630(53%)

362(30%)

1,046(16%)

3,595(55%)

1,887(29%)

Overall total: 6,528§

Wealsoaskedpeopleiftheypersonallythoughttheircarewassatisfactory,excellentorpoor.

How likely are people with asthma to recommend their care to friends and family?*Total: 6,525

Extremelylikely Likely Neitherlikelynorunlikely Unlikely Extremelyunlikely Don’tknow

1,351(21%)

2,033(31%)

818(13%)

468(7%)

361(6%)

1,494(23%)

I find using a written asthma action plan very reassuring”

“IhavehadasthmasincechildhoodandthecareIhavereceivedhasbeenabsolutelyexcellent.IgetinvitedtoattendannualasthmareviewsbymyGPandduringthesewediscussmysymptomsandwhatmedicationIamon.Onetime,ItoldmyGPthatIwasusingmyrelieverinhalermuchmorefrequentlythanusual.Shetookmypeakflowreadingandsubsequentlychangedmytreatmenttoastrongerdose.IhavenodoubtthathadshenotbeenasresponsivemyconditionmighthaveworsenedandImighthaveneededhospitaltreatment.Ihavehadsupportfromaspecialistasthmanursewithusingmyinhalercorrectly,whichhasbeenarealhelp.Ifindusingawrittenasthmaactionplanveryreassuring,notjustformebutalsoforsaymyhusbandtouseintheeventofmehavinganasthmaattacktoknowwhattodo.

Andrea from County Tyrone

AndreaLewis


Service improvement examples

Willowbank Surgery, Armagh

The practice developed a series of tools to identify and support those at greater risk.

TheWillowbankSurgeryinArmaghwasalreadyreviewingmorethan85%ofasthmapatientseachyear,butdecidedtofocusspecificattentiononpatientswithpastasthmaattacks–knowntobeariskfactorforfutureattacks.Theythereforesetupanenhancedservice,usingasimplescoringsystemdesignedtoidentifythesepatients.Patientsarescoredaccordingtowhethertheypresentedtothesurgeryandrequiredsteroids;requiredanebuliser;presentedtooutofhoursoremergencycare,orrequiredadmission.Thescoreiscalculatedannuallybyretrospectivelyreviewingthepreviousyear’sdataforeachpatient,andanalysisoverthelastthreeyearshasshownthat,onaverage,15%ofpatientshavesomedegreeofexacerbationeveryyear.

Thepracticedevelopedaseriesoftoolstooptimisecare,includingatoolforconductingareviewfollowinganasthmaattack,whichidentifiesdeficienciesinmanagement.Apriorityaccessnumberhasbeenintroducedforpatientswhohaveexperiencedanasthmaattack,toaddressdelaysinpresentationforareview.Additionally,theenhancedserviceprovidesaconvenientwaytoidentifypatientswhoareabletosafelystepdownmedication.

Thepracticecontinuestoreviewinexcessof80%ofpatientswithasthmabutnowplacesparticularfocusonthosewhohaveanasthmaattackscore.Lastyear,97%ofthesepatientswerereviewedandmostasthmaattacksarenowmanagedinprimarycaresettings.Thishasresultedinemergencydepartmentattendancesfallingfrom10in2011to3in2014.

NHS Tower Hamlets CCG, London

Significant changes in the quality and number of reviews are expected to result in a rise in the number of people with an asthma action plan.

Anannualreviewisanessentialcomponentofgoodasthmacare.NHSTowerHamletsCCGdecidedtolookathoweffectivelytheyaredeliveringannualreviewsinlightofhighadmissionsratesdespitetheirhighspendonrespiratorydiseasemedication,includingsignificantprescribingofinhalers.ThisworkisalsobeingcarriedoutinresponsetothefindingsoftheNational Review of Asthma Deaths(NRAD).

In2014/15theyarerollingouteducationalsupporttoenableGPsandpracticenursestodeliverimprovedasthmareviews.Providingeachpracticewithawealthofresourcesincludingchecklists,reviewtemplatesandpatientinvitationletters–accompaniedbyin-persontraining–hasseenaveryhighlevelofengagementfrompractices.

Aswellasprovidingthispackageofsupport,theCCGisincentivisingpracticestodelivertheenhancedannualreviewsto10%oftheiradultasthmapopulationandensure:

• eachpracticehasasthmachampionsidentified

• thechampionsreadandsubmitaminireflectionontheNRADexecutivesummary

• apracticenurseand/oranasthmachampionundertakestheNICErecommendedBMJ‘PatientwithAsthma’setofe-learningmodules

• atleasttwomembersofeachpracticeclinicalteamattendtheasthmain-houseorganisedtrainingandsubmitaminireflection

• practicessubmitevidenceofdisseminationoflearningtootherpracticemembers

Significantchangesinthequalityandnumberofreviewsbytheendofthefinancialyear2015areexpectedtoresultinariseinthenumberofpeoplewithanasthmaactionplan;anincreaseintheuseofappropriatelyprescribedinhaledcorticosteroidinhalers;anappropriatereductioninthenumberofprescribedrelieverinhalersand–mostimportantly–fewerhospitaladmissionsforasthma.

Asthma UK’s Asthma Improvement Hub brings together more service improvement tools and best practice examples of work that have improved outcomes for people with asthma. To access the hub please vist www.asthma.org.uk/takeaction.

Two-thirds of asthma deaths could be prevented with

better routine care


Asthma accountability

England

Thisyear’ssurveyresultsindicatethatClinicalCommissioningGroups(CCGs)andAreaHealthTeamscontinuetofallshortindeliveringcarewhichfullymeetstheBTS/SIGN Guideline.ThreeyearsonsincetheOutcomes Framework for COPD and Asthma in Englandwaspublished,almosttwoyearsonsincetheNICE Quality Standard for Asthmawaspublished,30andsixmonthsonfromtheNational Review of Asthma Deathshighlightedshockingfailuresincare,morethanfouroutoffivepeopleinEnglandarestillnotreceivingcarewhichfullymeetstheBTS/SIGN Guideline.

Therehasbeenaslightimprovementinthebasicelementsneededforclinicalasthmacareof4%sincelastyearanda7%increaseinthenumberofpeoplewhohaveawrittenasthmaactionplan.However,theoverallproportionsremainlow.ThesurveyresultssuggestthatEnglandperformsworsethanbothScotlandandNorthernIrelandoverall.LessthanathirdofpeoplewhotookoursurveyinEnglandhaveawrittenasthmaactionplan,despitetheSecretaryofStateforHealthcommittingtoeverypersonwithasthmahavingacareplanby2015.31

Regionally,theNorthWestLondonAreaTeamperformsmostpoorly,withonly10%ofpeoplewithasthmareceivingcarewhichfullymeetstheBTS/SIGN Guideline,closelyfollowedbySouthLondonAreaTeamandCheshire,WarringtonandWirralAreaTeamat12%.WestYorkshireAreaTeamperformsbestinoursurvey,withalmostathirdofpeoplereceivingexcellentcare.

Overall,thesurveyresultsarereflectedinNHSOutcomesFrameworkIndicatorsnumbers,32andtheCCGOutcomesIndicatorSet.33Forexample,reductionsinasthmamortalityrateshavestalledinrecentyearsand,moreworryingly,sawarecentincrease.AccordingtotheChildandMaternal(CHiMat)HealthIntelligenceNetworkatPublicHealthEngland,asthmahospitaladmissionsforunder-19sacrossEnglandhaveinfactincreasedby15%since2011.34ThisisofparticularconcernwhenreducingchildasthmahospitalisationratesisoneoftheprioritiessetbytheSecretaryofStateforHealth.31

Byimprovingoutcomesforpeoplewithasthma,commissionerswillimprovetheoverallqualityoflifeforpeoplewithasthmainEngland.However,CCGswillalsohavetheopportunitytoachieveannualnetsavingsofupto£24.1million,13††††andtocapitaliseonadditionalfinancialincentives.ToensurethatCCGsareprovidingwrittenasthmaactionplansandreviewsusingastandardisedtemplateNHSEnglandmustaddressbothactionplansandreviewsinfutureincentives,rewardsandsanctions.

Overall,CCGsmustdomoretoprovideserviceswhichimproveasthmaoutcomesbyensuringthatallpeoplewithasthmareceivethecareoutlinedintheNICE Quality Standard for Asthma.Toachievethis,aNationalClinicalAuditshouldbecommissionedtobenchmarkandimproveperformanceonanationalscalewhileaudits,incentivesandevidence-basedbestpracticemustbeadoptedlocallythroughouttheentirepatientpathway.AsthmaUKpresentsawealthofinformationonhowtoimplementthestandardsandimprovethequalityoflifeforpeoplewithasthmaattheendofthisreport.

Scotland

Theyear’ssurveyfindingsindicatethatHealthBoardsstillhavealongwaytogoindeliveringserviceswhichcomplywiththeAsthma Priorities Document,publishedin2013.AlmosttwoyearssincetheAsthmaPrioritieswereagreed,andsixmonthsaftertheNational Review of Asthma Deathshighlightedshockingfailuresincare,theresultssuggestthatmorethanthree-quartersofpeoplewithasthmainScotlandarestillnotreceivingcarewhichmeetstheBTS/SIGN Guideline.

Ourfindingsshowtherehasbeena4%increaseinthenumberofpeoplereceivingcarewhichfullymeetstheBTS/ SIGN Guidelinesincelastyear’ssurvey,andactionplanprovisioninScotlandishigherthaninbothWalesandEngland.However,theresultsimplythatthree-fifthsofpeoplearestillnotreceivinganactionplanandmoreneedstobedonetoensurethattheAsthmaPrioritiesaredelivered.

Bothchildren’sandadults’servicesmustbeincentivisedbyManagedClinicalNetworks(MCNs)toachievethePrioritiestoimproveoutcomesforpeoplewithasthma.Evidence-basedserviceimprovementprojectsshouldbeidentifiedandadoptedbyHealthBoardsinordertodriveupstandardsintheirlocalarea.AsthmaUKpresentsawealthofinformationonhowthiscanbedoneattheendofthisreport.

FollowingthepublicationoftheNational Review of Asthma DeathstheMinisterforPublicHealthinScotlandmadesomesignificantpledgestoimplementserviceimprovement,andmomentumisgrowingforthePrioritiestobeimplementedtoimproveoutcomesforpeoplewithasthma.Anactionplantemplateshouldbedevelopedandincentivised,Scotlandwide,toensurethattheasthmaprioritiesaretakenforwardandimplemented.

Indoingso,HealthBoardswillimprovethequalityoflifeforpeoplewithasthma,reducecostlyadmissions,andalignwithmanyofNHSScotland’sstrategicprioritiesasoutlinedintheNationalAdvisoryGroupworkplanandtheScottishGovernment’s2020 Vision.35AccordingtoNICEestimates,£2.37millionnetsavingscouldbeachievedeveryyearbyimplementinggoodstandardsofcareacrossScotland.13‡‡‡‡

††††NICE 75% savings rate applied to mid-2013 ONS England population. ‡‡‡‡NICE 75% savings rate applied to mid-2013 ONS Scotland population.

Timeline showing publication of UK asthma frameworks, standards and plans

2009Northern Ireland:

ServiceFrameworkfor

RespiratoryHealthandWellbeingpublished

England: AnOutcomesStrategyfor

ChronicObstructivePulmonaryDisease

(COPD)andAsthmainEngland

published

2010 2011


Wales

Together for Health – A Respiratory Health Delivery Plan (The Plan)waspublishedinApril2014followingalongcampaign,andourfindingsindicatehowtimelythisinitiativeisforimprovingoutcomesforpeoplewithasthma.ThesurveyresultssuggestthatmorethansixoutofsevenpeoplewithasthmainWalesarenotreceivingcarewhichfullymeetstheBTS/SIGN Guideline–thehighestproportionacrosstheUK.

ThesurveyresultsarealsoreflectedinnationalindicatorsasbothasthmaadmissionandmortalityratesinWaleshaverisensince2011.ThisisnotsurprisingwhenourresultssuggestthatlessthanaquarterofpeoplewithasthmainWalesarereceivinganasthmaactionplan.

LocalHealthBoardsmustseizetheopportunitypresentedbyThe PlantoachievetheoutcomeindicatorssetoutbytheWelshGovernment,andimprovethequalityoflifeofpeoplewithasthma.Healthmanagerscanachievethisbydrawingonoursurvey’slocalfindingsandusingexistingevidence-basedbestpracticeexamplesfromacrossWales,andtherestoftheUK,whereframeworks,standardsandprioritiesarealreadywellestablished.Aswithasthmareviews,writtenasthmaactionplansshouldbeincentivisedthroughrewardinitiativeslikeQOF.AccordingtoNICEestimates,£1.38millionnetsavingscouldbeachievedeveryyearbyimplementinggoodstandardsofcareacrossWales.13§§§§AsthmaUKpresentsawealthofinformationonhowtoimprovelocaloutcomesattheendofthisreport.

Thepublicationofaseparatechildrenandyoungpeople’ssectionisessentialtoaddressspecificoutcomemeasuresforchildren,andtheirtransitionintoadultasthmacare.ThissectionwillbevitalforLocalHealthBoards,incoordinationwiththeirlocalRespiratoryPlanningandDeliveryGroups,toformulatelocaldeliveryplanswhichwillimproveasthmaoutcomesforthewholepopulation.TheseplanswillallowLocalHealthBoardstoalignwithbroaderWelshGovernmentpriorities,includingDoing Well, Doing Better,36andHigh Impact Service Changes.37

Northern Ireland

NorthernIrelandwasthefirstpartoftheUKtoproduceaService Framework for Respiratory Health and Wellbeing(ServiceFramework),withspecificasthmastandardsthatcoveredadults,childrenandyoungpeople.Sincethiswaspublishedin2009,advancesinauditandserviceimprovementhavebeenmadeandtheseachievementshavebeenreflectedinthesurveyresults.Despitethechallengingeconomicenvironment,theresultssuggestthatNorthernIrelanddeliverscarewhichfullymeetstheBTS/SIGN Guidelinetomorethanathirdofpeoplewithasthma,a4%increasesincelastyear.ThesefiguresplaceNorthernIrelandtopintheUKinoursurveyoverall,aheadofScotland,EnglandandWales.Ourresultssuggestthatalmosttwo-thirdsofpeopleinNorthernIrelandwithasthmahaveanactionplan–morethandoubletheproportionsinWalesandEngland.

Thesesurveyresultsarealsoechoedinnationaloutcomes,whereNorthernIrelandhasovertakentherestoftheUKinthelast20yearsinreducingemergencyadmissionsforasthma:by2011/2012,theasthmaemergencyadmissionratewaseightper10,000population,whiletherestoftheUKwastenormore.12TheProgress ReportonthedeliveryoftheService Frameworkhasalsoindicatedthatoutcomesforpeoplewithasthmaareimprovingoverallinlinewithexpectations.38However,althoughthisisverypositive,therearestillareasofconcernincludingA&Ecare,OutofHourscareandfollow-upafteradmissions,andmortalityratesforasthmahavefailedtodecreaseoverthelastfiveyears.Itisimportantthattheachievementstodatedonotleadtocomplacencyinasthmacare,andoutcomescontinuetoimproveforpeoplewithasthma.

Anewdraftoftheframeworkhasbeenproposedandthiswillbecomplementedbyarecommendedservicespecificationbasedonbestpractice.IntegratedCarePartnerships(ICPs),alongsideLocalCommissioningGroups,primarycareorganisationsandthePublicHealthAgencynowhaveacrucialopportunitytoapplyarenewedenergyandfocustowardsimprovingoutcomesforallpeoplewithasthma,inlinewithbroaderstrategiessuchasTransforming Your Care,39andtheQuality Strategy 2020.40ByimplementingthenewService Frameworkacrossallservices,ICPscanimproveoutcomesforthetwo-thirdsofpeoplewithasthmawhoarestillreceivingcarewhichdoesnotfullymeettheBTS/SIGN Guideline.AccordingtoNICEestimates,upto£800,000netsavingscanbeachievedeveryyearbyimplementinggoodstandardsofcareacrossNorthernIreland.13*****

AuditsandserviceimprovementprojectsshouldbeadoptedinlinewithbestpracticefromacrosstheUKtoidentifyinnovativeyetevidence-basedwaysofdeliveringgoodasthmacareforbothchildrenandadults,inlinewiththeService Framework.Nationally,thedevelopmentofanewQOFindicatortoincentiviseasthmaactionplanscouldincreasetheiruseacrossthecountry.

TofindouthowaspecificareaisperformingincomparisontotherestoftheUK,pleasevisit:www.asthma.org.uk/takeaction.

§§§§NICE 75% savings rate applied to mid-2013 ONS Wales population. *****NICE 75% savings rate applied to mid-2013 ONS Northern Ireland population.

2012Scotland:

AsthmaPrioritiesDocumentpublished

England: NICEQualityStandardfor

Asthmapublished

2013Wales:

RespiratoryDeliveryPlan

published(Adultsonly:Childrenand

YoungPeople’ssectionpublished

separately)

2014


How can we improve asthma outcomes?

AsthmaUKiscallingonallCCGs,HealthBoards,ICPsandLocalHealthBoardstoensureeverypersonwithasthmahasawrittenasthmaactionplan,anddelivercarewhichfullymeetstheBTS/SIGN Guidelinetoimproveoutcomesforpeoplewithasthma.

Tosupportcommissionersandhealthmanagerstoachievethis,AsthmaUKhasproducedarangeofresourcesincluding:

• Local data breakdownsofthesurveyresults.

• Local breakdowns of net cost savingswhichcanbeachievedbyimplementingthestandards.

• AnAsthma Improvement Hub,whichbringstogetherservice improvement toolsandbest practiceexamplesofworkthathaveimprovedasthmaoutcomesinbothchildren’sandadults’carearoundtheUK.

• Downloadable asthma action plansforbothadultsandchildren

To access these resources, please visit www.asthma.org.uk/takeaction.

AsthmaUKhasafreeHealthcare Professionals’ Communitywithover2,000members.WekeepmembersupdatedwiththelatestnewsinasthmaandprovideaccesstoresourcessuchasYour Asthma Action Plan and our Asthma Control TestTM.OurAsthma Care Toolkitcontainsarangeoftoolstohelphealthcareprofessionalsimproveasthmacareintheirorganisation.Moreinformationcanbefoundatwww.asthma.org.uk/healthcare-professionals.

AsthmaUKhasalsodevelopedtheTriple A Testtohelppeoplewithasthmaunderstandtheirriskofanattack–www.asthma.org.uk/triplea


1. Health and Social Care Information Centre (2014) Quality Outcomes Framework data 2013/14, Information Services Division Scotland (2014) Quality Outcomes Framework data 2013/14, Welsh Government (2014) Quality Outcomes Framework data 2013/14, Department of Health, Social Services, and Public Safety (2014) Quality Outcomes Framework data 2013/14

2. Health Survey for England (2001); The Scottish Health Survey (2003); Welsh Health Survey (2005/2006); Northern Ireland Health and Wellbeing Survey (2005/2006). Population estimates from Office for National Statistics, General Register Office for Scotland, Northern Ireland Statistics & Research Agency

3. From http://www.asthma.org.uk/asthma-facts-and-statistics [accessed 4 September 2014]

4. Department of Health (2012) Hospital Episode Statistics; Information Services Division, NHS Scotland (2013) Scottish Morbidity Record; Health Services Wales (2013); Department of Health, Social Services & Public Safety Northern Ireland (2013) Hospital Inpatients System

5. Blainey, D., et al. (1990) “The cost of acute asthma-how much is preventable?” Health Trends. 22.4: 151-3

6. Office for National Statistics (2014) Sickness Absence in the Labour Market

7. NHS England (2013) Programme Budgeting Data 2012/13

8. Royal College of Physicians (2014) Why Asthma Still Kills: The National Review of Asthma Deaths

9. Office for National Statistics; General Register Office for Scotland; Northern Ireland Statistics & Research Agency

10. British Thoracic Society/Scottish Intercollegiate Guideline Network (2014) British Guideline on the Management of Asthma

11. Asthma UK (2013) Compare Your Care: how asthma care in the UK matches up to standards. All references to last year’s results are taken from this report.

12. Department of Health, Hospital Episode Statistics; Information Services Division, NHS Scotland, Scottish Morbidity Record; Health Services Wales; Department of Health, Social Services & Public Safety Northern Ireland Hospital Inpatients System

13. National Institute for Health and Care Excellence (2013) Implementation Programme: NICE support for commissioners and others using the quality standard for asthma. Average emergency admission and average asthma review costs based on supplementary information for 2013/14 provided by NICE on 17 September 2014.

14. National Asthma Campaign (2001) Out in the Open: a true picture of asthma in the United Kingdom today. Asthma J 6 (suppl)

15. Hoskins G., McCowan C., Neville R.G. et al.(2000) Risk factors and costs associated with an asthma attack. Thorax 55:19–24 (unpublished data)

16. Wolfe, I., Thompson, M., Gill, P. et al. (2013) Health Services for children in Western Europe. The Lancet. 381(9873):1224-34

17. Department of Health, Social Services & Public Safety Northern Ireland (2009) Service Framework for Respiratory Health and Wellbeing

18. SIGN (2013) SIGN/BTS British Guideline on the Management of Asthma, Asthma Priorities: influencing the agenda

19. National Institute for Health and Clinical Excellence (2013) Quality Standard for Asthma

20. Welsh Government (2014) Together for Health – A Respiratory Health Delivery Plan

21. Royal College of Physicians (2014) Commentary: Why complacency in asthma must end. From https://www.rcplondon.ac.uk/commentary/why-complacency-asthma-must-end [accessed 16 September 2014]

22. NHS England (2014) FAQs for the Friends and Family Test. From http://www.england.nhs.uk/wp-content/uploads/2014/07/fft-imp-guid-faqs-14.pdf [accessed 8 September 2014)

23. Global Initiative for Asthma (2014) Global Strategy for Asthma Management and Prevention

24. Fettiplace, J., Jogee, S., Rajakumaraswamy, N. (2013) M6 level of asthma control in primary care in the UK as determined by the RCP 3 questions. Thorax. 68(3): A197

25. Ghosh, R.E., et al. (2013) Asthma and occupation in the 1958 birth cohort. Thorax. 68:365-371

26. Adams, R. J., et al. (2000) “Factors associated with hospital admissions and repeat emergency department visits for adults with asthma.” Thorax. 55.7: 566-73

27. Lavorini, F., et al. (2008) “Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD.” Respir. Med. 102.4: 593-604

28. Bateman E.D. et al. (2004) Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control study. Am J Respir. Crit. Care Med.170(8):836-44

29. NHS England (2014) Friends and Family Test Data 2013/14

30. Department of Health (2011) An outcomes strategy for people with chronic obstructive pulmonary disease (COPD) and asthma in England

31. Department of Health (2013) The Mandate: A mandate from the Government to the NHS Commissioning Board: April 2013 to March 2015

32. Health and Social Care Information Centre (2012) Indicator Portal. From https://indicators.ic.nhs.uk/webview/ [accessed 17 September 2014]

References


References33. NHS England (2013) CCG Outcomes Indicator 2014/15- At

a Glance. From http://www.england.nhs.uk/wp-content/uploads/2013/12/ccg-ois-1415-at-a-glance.pdf [accessed 18 September 2014)

34. Asthma UK (2014) Asthma UK warns of alarming increase in hospital admissions for children. From http://www.asthma.org.uk/Sites/healthcare-professionals/news/hcp-asthma-uk-warns-of-alarming-increase-in-hospital-admissions-for-children [accessed 17 September 2014]

35. Scottish Government (2011) A ‘2020’ Vision

36. NHS Wales and the Welsh Assembly Government (2010) Doing Well, Doing Better

37. Welsh Assembly Government (2011) High Impact Service Changes

38. Gingles, J. (2013) Service Framework Progress Report

39. Department of Health, Social Services and Public Safety (2011) Transforming Your Care: A Review of Health and Social Care in Northern Ireland

40. Department of Health, Social Services and Public Safety (2011) Quality 2020

©2014AsthmaUK,registeredcharitynumberinEnglandandWales802364andScotlandSC039322

Every ten seconds someone in the UK has a potentially life-threatening asthma attack and three people die every day. Tragically many of these deaths could be prevented, whilst others still suffer with asthma so severe current treatments don’t work. This has to change. That’s why Asthma UK exists.

We work to stop asthma attacks and, ultimately, cure asthma by funding world leading research and scientists, campaigning to improve the quality of care and supporting people with asthma to reduce their risk of a potentially life threatening asthma attack.

Stop asthma attacks. Cure asthma.

TofindoutmoreaboutAsthmaUK’swork,orgetinvolvedwiththeHealthcareProfessionals’Communityvisitwww.asthma.org.ukorcalluson0800 121 62 44.

Asthma UK Adviceline: 0800 121 62 44

Email us: [email protected]

Visit our website: www.asthma.org.uk Find us on facebook:

www.facebook.com/asthmauk

Follow us: @asthmauk

Documents

Time to take action on asthma - Asthma UK | Homepage to take action on asthma 3 All governments across the UK have developed standards Who took part in our survey? which acknowledge