As part of Greater Manchester’s Innovation for Health Inequalities Programme (InHIP), specialist clinicians are working to transform asthma care for children and young people across Tameside. We sat down with Amy Brooke, Paediatric Respiratory Nurse Specialist at Tameside and Glossop Intergrated Care NHS Fonundation Trust, to talk about what “good” looks like, how care is changing, and the early signs of impact

What does excellent paediatric asthma care look and feel like?

For me, excellent paediatric asthma care starts with a simple but vital belief: asthma attacks are not normal. They are dangerous, and it should never be accepted that a child attends A&E multiple times a year with no meaningful follow-up.

When a child keeps presenting, it’s usually a sign that something deeper hasn’t been addressed. That might be environmental issues like damp or mould, gaps in health literacy, problems with medication, or wider social pressures affecting the family. True excellence means taking the time to unpick all of this – not just treating the acute episode and sending the child home.

Historically in Tameside, we’ve been very good at stabilising children when they arrive acutely unwell. Where we’ve wanted to improve is what happens next. Calm, structured follow-up, an accurate diagnosis, and a personalised plan that families actually understand and feel confident using day to day – that’s what excellent care really looks like.

How has InHIP supported earlier intervention and prevention?

Before InHIP, capacity was a real challenge. It was difficult to proactively review children who attended A&E repeatedly but didn’t always end up admitted. These children can easily fall under the radar – yet they’re often the ones most at risk.

Through InHIP, we’ve been able to identify children who’ve attended A&E more than once in a year and bring them in for review much earlier. This allows us to step in before things escalate into more severe exacerbations or hospital admissions.

That early intervention has been transformational. It improves outcomes for individual children and families, but it also reduces pressure on the wider system by preventing avoidable emergencies.

What improvements have been made to the hospital-to-home pathway?

One ongoing challenge is variation in engagement across GP practices. Where engagement is lower, families can experience gaps in follow-up and continuity of care.

However, the additional clinical capacity created through InHIP has allowed us to produce clearer, more detailed management plans and discharge communications. Our letters to primary care are deliberately thorough – they set out responsibilities clearly, explain the rationale behind decisions, and offer guidance on monitoring and when to re-refer.

Even where confidence with asthma management is limited, these letters help build reassurance and consistency. Alongside this, access to better diagnostic equipment in the community has strengthened the pathway and reduced uncertainty for families.

How have community-based diagnostics changed asthma care?

Access to community-based diagnostics – particularly FeNO testing – has made a huge difference. Previously, children often faced long waits for spirometry or allergy testing, which delayed diagnosis and appropriate treatment.

With updated guidelines and improved access to diagnostic tools, we can now make decisions more quickly and with greater confidence. Fewer children sit in a grey area of uncertainty, and families are able to move forward with clarity about their child’s condition and treatment plan.

How do you help families better understand and manage asthma?

Many families don’t initially understand asthma as a long-term inflammatory condition. Children may appear well between flare-ups, which can make ongoing treatment feel unnecessary or confusing.

I spend a lot of time explaining the difference between preventer and reliever inhalers, addressing over-reliance on blue inhalers, and helping families understand that inflammation can be present even when symptoms aren’t obvious.

One of the most helpful questions I ask is, “Can you tell me what asthma is?” It often reveals gaps in understanding and opens up a supportive conversation. When families really understand what’s happening in their child’s airways, they’re far more empowered to manage the condition confidently.

How do you approach sensitive conversations about smoking and vaping?

We ask every family whether anyone in the household smokes or vapes. It’s essential to name both, because many people don’t see vaping as a trigger unless it’s explicitly mentioned.

These conversations can feel uncomfortable, but they’re too important to avoid. I approach them without judgement, offering brief advice, clear information about respiratory health, and signposting to local support services.

The focus is always on support, not blame. Even small changes can have a big impact on a child’s asthma control.

What adaptations support children with SEND?

It’s vital that asthma care is genuinely accessible for children with SEND. One example that really stands out involved co-creating a simple visual cue card for a non-verbal child. This allowed her to communicate how she was feeling and signal when she needed help at school.

The traffic-light format aligns with asthma action plans but is far more usable for children with significant communication needs. We’ve also involved children and families in reviewing our existing resources, so future materials are shaped by lived experience rather than assumptions.

Where do inequalities persist – and how is InHIP helping?

Asthma-related inequalities often align with areas of higher deprivation, where admission rates are higher and access to routine reviews can be more limited. Engaging both families and GP practices in these areas remains challenging.

By identifying children through A&E attendances, we’re still able to reach those most at risk. Even when engagement elsewhere is limited, families receive a holistic review, and tailored advice is sent back to primary care so no child leaves without support.

What early evidence shows this approach is working?

We’re already seeing encouraging signs. Earlier intervention has reduced the number of referrals reaching my caseload, allowing me to focus on children who need specialist input most.

Hospital admissions and high-dependency care have fallen, easing pressure on inpatient services – particularly during winter. Waiting lists have reduced, and 90-day readmission rates have dropped significantly. Together, this shows better outcomes for families and more sustainable use of NHS resources.

Amy’s message to the wider system

Clinicians need a strong voice in pathway design. We have to invest in prevention, health literacy and neighbourhood-based approaches if we want to move away from crisis-driven care.

This model is working. With sustained funding and longer-term data, I believe the full impact of this preventative approach will be even clearer.