Debbie Watson and Dr Rebecca Fletcher: “Tackling the inequalities that children and young people with asthma are facing in Greater Manchester”

Debbie Watson (left) and Dr Rebecca Fletcher (right).

Health Innovation Manchester and NHS Greater Manchester (NHS GM), alongside expertise from Secondary Care and other community organisations across Greater Manchester, has worked with communities to identify, address and minimise healthcare inequalities through the Innovation in Healthcare Inequalities Programme (InHIP), helping to improve access to the latest health technologies and medicines.

In this blog Debbie Watson, Director of Population Health at Tameside Metropolitan Borough Council and Chair of GM Public Health Leadership Network and lead Director of Population Health for Making Smoking History in GM, and Dr Rebecca Fletcher, Interim Director of Public Health at Oldham Council, and joint-lead Director of Public Health for Making Smoking History in GM, share their thoughts on the work being carried out across Greater Manchester through the Making Smoking History service, and in Oldham through the InHIP pilot.

The work being delivered in Oldham as part of this is helping to support children, young people and families living with asthma and related conditions caused by smoking or second-hand smoke inside the home.

Asthma is the most common long-term medical condition in children in the UK, with around one in 11 children and young people living with asthma, with Greater Manchester having the highest rates of paediatric asthma hospital admissions in the North-West region and a higher rate of smoking (14.9%), compared to the rest of England (12.1%).

The goal of the pilot currently being delivered in Oldham is to reduce admission and re-admission rates of children admitted with respiratory problems, specifically asthma, at The Royal Oldham Hospital via increased uptake of FeNO testing model on the ward to monitor and diagnose asthma in children.

Debbie Watson and Dr Rebecca Fletcher: Making Smoking History

Since 2017, Greater Manchester has been on a journey to become a smokefree city-region, pioneering many of the recommendations in the Khan Review, including being the first place in the country to pilot ‘Swap to Stop’ – an initiative that encouraged adult smokers in Salford to switch to vaping.

As a result of Greater Manchester’s multi-component approach to making smoking history, smoking rates in Greater Manchester have fallen to an all-time low, with just 14.3% of adults (equivalent to around 316,000 people) in Greater Manchester smoking in 2022. We have also seen significant reductions in smoking in pregnancy resulting in an additional 4,500 babies being born smokefree.

Additional government funding announced for local stop smoking services, for mass media campaigns and enforcement will support our successful, collaborative and comprehensive approach to Making Smoking History in GM – and the measures set out in the consultation will support delivering a Smokefree 2030 together across our city region – Make Smoking History – Reignite your quitting journey.

The InHIP pilot: Addressing asthma inequalities in Oldham

The goal of the pilot in Oldham was to reduce admission and re-admission rates of children admitted with respiratory problems. This was to be achieved with three key programmes of work:

  • Increase provision of rapid testing to monitor and diagnose asthma in children quickly and effectively
  • Ensure children with severe and uncontrolled asthma are referred appropriately
  • Increase the identification of household members, or children themselves, that smoke and provide smoking cessation support to them

The third of these programmes of work focuses on preventing a key trigger for asthma attacks, and poorly controlled asthma. We also know that people living with smokers are more likely to smoke and so taking a whole household approach is important to really make a difference in the lives of our residents. We want to ensure that the next generations grow up as non-smokers.

Debbie Watson also shares a personal story from her childhood, after living as part of a smoking household in the late 1960’s and early 1970’s – something that many children across Greater Manchester will have also experienced at some point in their lives. Debbie explains:

“As children born in late 60s and early 70s my younger sister and I were both brought up in a household where both of our parents smoked – in fact most people smoked where we lived.  We were diagnosed with asthma at a young age.  I have and am still experiencing first-hand the impact of second-hand smoke back then, on my health and wellbeing – over the years I’ve missed school and work, have suffered sleep disturbance, tiredness during the day, and poor concentration.  We know some people in GM, including those in deprived areas, are more likely to be addicted to tobacco and find it harder to stop.

“This is likely due to several factors, including social, housing and income pressures that can make it harder to quit, as well as unequal access to stop smoking support. Both Rebecca and I work in the two areas (Tameside and Oldham) with the highest number of under-19 asthma related hospital admissions in the country – the sharing of learning and adoption of this pilot across Greater Manchester will be an important step to reduce the prevalence and severity of asthma in our children and young people.”

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