Whole System Asthma Plan Development & Implementation

1. Whole System Asthma Plan Development & ImplementationDesigning and delivering system-wide asthma improvements inNorth Central London Barnet, Camden, Enfield, Haringey & Islington

2. Scale of the challenge in London 12 London children die every year from asthma  

3. NCL Vision for Asthma To support children, young people and their families with asthma to receive the appropriate treatment, at the right time and right place and enable them to remain as well as possible NCL Asthma Vision

4. Why we need a system response

5. Development and delivery

6. Overarching Outcomes • 1. Young People & Families informed and empowered to manage the condition more effectively into adulthood • 2. Enable healthy environments, which support children and young people with asthma to remain as well as possible • 3. Enable all children to have access to a full education and activities, unhindered by asthma • 4. All children have access to high quality asthma care • 5. Earlier identification of children at risk of life threatening asthma attack or those with poor control. What we want to achieve for children, young people and families in North Central London Outcomes developed through a whole-system logic model workshop across NCL. System representation from health, children’s social care, housing, air quality and public health

7. Plan Development Whilst common strategic outcomes and objectives have been developed and agreed at an NCL level, it is recognised that local systems are best placed to understand the needs of their populations and the landscape of local responsibilities, decision making and delivery mechanisms in place to improve outcomes. To reflect this, the approach to developing the plan has been based on local borough-based workshops to map, design and develop the asthma plan. This process, which has been replicated across all five NCL boroughs, has in itself been incredibly helpful for local systems, enabling a greater understanding of the relationships across the local system and has generated further insight into how organisations can work more effectively together

8. Delivering Together across NCL • To date, the elements of our strategic work to improve asthma outcomes in north central London that have emerged as best done at the NCL level include:- • A shared approach to training and development of key staff groups in relation to asthma • A networked learning approach across the system to support continuous improvement in outcomes for children and young people with asthma • A consistent approach to engaging with and communicating to children, young people and families in relation to asthma awareness and education • A system-wide asthma dashboard to monitor progress towards our shared outcomes across the partnership • An NCL-wide understanding about the links with asthma and the wider social and environmental triggers, such as air pollution, smoking, poor housing.

9. Engagement with CYP These strategic outcomes and associated objectives have been shared and tested with a number of key stakeholder groups across North Central London including local authority services and teams (including public health, housing, air quality, school health and wellbeing teams), tertiary, secondary, primary and community services, all of whom have supported our aspirations and approach. We are also passionate about ensuring the plan is meaningful to and informed by the children, young people and families we serve. Across February and March we commenced engagement work with children, young people and families through workshops and questionnaires to ensure their views are at the heart of our plan and inform the way it is delivered. “Self-check in, because sometimes young people feel really confronted by people at reception, sometimes they prompt and they don’t know what to say.” “I would feel that if we had better healthcare in schools that exceed first aid” “It would also help if doctors could tell us about our medications and our conditions more directly rather than telling our parents”

10. Engagement with CYP Q: How does it feel having asthma? A: “Um…it feels a little bit scary” Q: Do you know how to use your inhaler properly? A: “Yes, it says on the side a bit and my mummy helps me” Q: How do you feel about cars outside school? A: “I just think it would be better if cars weren’t invented yet” Q: Does it make you happier to know that lots of people are working together to help you remain well? A: “Aha, because if there wasn’t it wouldn’t be good because it might mean I have to skip school”

11. Engagement with families Q: Have you ever had to attend an ED for your child's asthma? A: “We have and that was quite a scary experience” Q: Do you worry about your child's asthma? A: “I worry about the fact that you can go downhill so quickly. I still don’t think people take it seriously because she dances and runs about. It’s only every now and then that it’s uncontrolled and they can see” Q: What’s can asthma education bring to schools? A: “Earlier support in schools: having a conversation so that people know what it is and it’s not a stigma” Q: What do you value about current asthma services? A: “I value that every year we go and have an asthma review with a professional, that I’m not floundering around in the dark and that I’m getting the reassurance I need that we are managing it as well as we can”

12. Engagement with the wider system

13. NCL Paediatric Asthma Network The NCL Paediatric Asthma Network will oversee the development and delivery of the strategic elements of the asthma plan on behalf of the CYP Programme Board, via an agreed programme of work. In addition the Network will also provide support and oversight of the local delivery plans. There was consensus across all local borough-led workshops that there were areas which would benefit from an NCL approach, enabling more effective use of resources, consistency of support, reducing variation and ultimately improving outcomes. In addition, locally determined plans are in development and will be supported and overseen by the network, themselves having local governance arrangements in place. Over 50 individuals, representing the full range of partners who can impact on the wider determinants of health, are part of our network including: • General Practice • Secondary Care • Public Health • Teaching • Safeguarding • School Nursing • Housing • Energy Advice • Smoking Cessation • Environmental Health • Early Help • Patient representative • Commissioning • Pharmacy

14. Strategic Workplan

15. Baseline analysis

16. Draft Dashboard DUMMY DATA

17. Critical steps for us: • Draw together a system and recognise the role that each plays in supporting CYP with asthma • Agree togetheryour outcomes and objectives • Seek a mandate from a partnership body (or bodies) • Design the workplan that will deliver your objectives • Local vs Strategic - Be clear about what is delivered where (local vs strategic) • Confirm governance and agree the delivery chain

18. Questions?