Redesigning services to improve outcomes for children with asthma requires strong system leadership, clear data and close collaboration with frontline teams. Through the Innovation for Health Inequalities Programme (InHIP), partners in Tameside have taken a system-wide approach to tackling variation, reducing inequalities and improving care for children and young people with asthma.

In this Q&A, Philippa Robinson, Commissioner at NHS Greater Manchester Integrated Care Board Tameside, shares why childhood asthma became a priority, how data has shaped commissioning decisions, and what other systems can learn from Tameside’s approach.

Why was childhood asthma identified as a commissioning priority in Tameside?

Asthma was identified as a priority because of the high number of children affected locally and the clear inequalities in outcomes across different communities. Using the Core20PLUS5 framework helped focus attention on asthma as a condition where we could make a meaningful difference. Data showed high admission and attendance rates, alongside variation in diagnosis, management and follow-up, which made it clear that a system-wide redesign was needed.

What were the main gaps in the asthma pathway before it was redesigned?

One of the biggest challenges was variation across practices and services. With around 40 GP practices involved, children were experiencing very different pathways depending on where they lived and where they first accessed care. There were differences in how asthma was diagnosed, how consistently children were placed on asthma registers, and how well follow-up and smoking cessation support were embedded. These gaps made it harder to deliver equitable care.

How has data been used to guide commissioning decisions?

Data has been central to shaping decisions. Admission rates, repeat attendances, the number of children on asthma registers, prescribing patterns and suspected asthma diagnoses have all been important indicators. We are also looking closely at how FeNO is being used across the system. While six months is a relatively short time to measure impact, early signs suggest greater consistency in assessment and increased use of FeNO compared to before the programme began.

Why is collaboration with frontline teams so important in commissioning work?

Engaging clinicians and frontline professionals has been essential. Input from colleagues across primary care, secondary care, pharmacy and community services helped shape a pathway that works in practice, not just on paper. Listening to people delivering care day to day allowed us to understand where the real challenges were and co-design solutions that felt realistic and achievable.

How has smoking cessation been embedded within the asthma pathway?

Smoking cessation has been a key part of the pathway redesign because of its impact on childhood asthma outcomes. Working closely with public health colleagues has helped embed smoking cessation referrals and brief advice across the system. Training professionals to have these conversations and making referral routes clearer has helped ensure families receive consistent messages and support.

How has the pathway been shaped to meet the needs of children with SEND?

It was important that resources worked for all children, including those with special educational needs and disabilities. The commissioning team worked with the SEND Youth Council and parent forums to adapt asthma resources so they were accessible, appropriate and easy to understand. This co-production approach helped ensure materials reflected real experiences and needs.

What will success look like over the next 12 to 24 months?

Success will be reflected in improved data across the system, including reduced admissions and attendances, increased and appropriate use of FeNO, and better identification of children on asthma registers, as well as increasing referrals for support to stop smoking and ultimately helping some parent/carers or young people to quit smoking and vaping. We also want to see continued improvements in consistency and equity, with children receiving the same standard of care regardless of where they enter the system.

What advice would you give to other systems looking to redesign their asthma pathway?

I would recommend bringing together a broad group of stakeholders from across the whole system and using the national bundle of care to map where you are and identify gaps. Listening to clinicians, understanding local data and developing shared solutions is crucial. Having a clear, shared vision and strong collaboration makes a real difference to delivering sustainable change.