An innovative six-month pilot has launched at the Royal Oldham Hospital (ROH), with the aim of transforming services for children and young people living with asthma and related conditions as well as reduce avoidable harms caused by smoking or second-hand smoke inside the home.

Introduced in February this year, the pilot takes a whole-household approach to asthma intervention, working with ROH Children’s and Paediatric Observation and Assessment Unit to help identify children and young people admitted to hospital with asthma or respiratory illnesses, who smoke or live in a household that smokes.

According to data captured as part of the Asthma friendly schools’ pilot, conducted by NHS England, the UK has one of the highest prevalence, emergency admission and death rates for childhood asthma in Europe. In Greater Manchester, 6,482 children and young people (0-19 years) attended A&E due to asthma and 1,346 were admitted to hospital between January 2022 and January 2023 alone.

As part of the pilot, patients are offered Fractional Exhaled Nitric Oxide (FeNO) testing on the ward to monitor inflammation of the lungs, and offered advice and nicotine replacement therapy as well as support helping them to be smoke-free and ultimately become healthier as a result.

Continued support is provided for the patient, with a repeat FeNO test offered in a community-based setting as part of a follow-up asthma consultation. If the child or young person’s asthma is determined to be uncontrolled, they will be referred onto the Asthma Biologics pathway to assess whether they are eligible for biologic therapy medication.

The work sets the blueprint for joined up services designed around the needs of the family by supporting children and young patients, as well as their parents and households to become smoke-free. As an in-patient and post-discharge, both children, young patients and their families have access to local smoking cessation services, as well as nicotine replacement therapy and ongoing support through Greater Manchester’s Smoke-free App. The app offers families access to stop smoking expert support, as well as tips and advice for tackling milestones on their journey to become smoke-free.

Innovation for Healthcare Inequalities Programme (InHIP)

This pilot taking place at the Royal Oldham Hospital (ROH) is part of the wider Innovation for Healthcare Inequalities Programme (InHIP) which is a unique collaboration between the Accelerated Access Collaborative (AAC), NHS England’s National Healthcare Inequalities Improvement Programme and the Academic Health Science Network (AHSN) and delivered in partnership with Greater Manchester Integrated Care System (ICSs).

The programme aims to address local healthcare inequalities experienced by deprived and other under-served populations. ​Project teams from across the country are working together with their local communities to identify, address and minimise healthcare inequalities through projects to improve access to the latest health technologies and medicines.

These technologies and medicines are focused on five clinical areas of priority that closely align with the national Core20PLUS5 approach to reducing healthcare inequalities, which includes maternity, mental health, respiratory, cancer diagnosis and cardiovascular disease. ​

Health Innovation Manchester has worked collaboratively with key stakeholders across NHS Greater Manchester (NHS GM), including The Royal Oldham Hospital, ABL Health and Your Health Oldham and the Make Smoking History Team to identify key focus points within the local health and care system, proposing that one of the greatest healthcare inequality challenges in Greater Manchester is paediatric asthma and effects of second-hand smoke on asthma.

Dr Tracey Vell MBE, Medical Director at Health Innovation Manchester, said: “This is a perfect example of making every contact in the NHS count and whilst we have citizens engaging with the health service, we must tackle the wider determinants of health and prevent future ill health. In Greater Manchester we must start with those identified to be in the most need. Often citizens present only with their children, and we take every opportunity to offer health advice.”

Dr Prakash Kamath, Divisional Clinical Director at Bury Care Organisation, Northern Care Alliance, said:“Northwest England has twice the prevalence of Asthma compared to rest of England and Greater Manchester, especially the conurbations of Oldham and Rochdale, which stands at three times the national average. This project aims to address the key preventable factors for improving respiratory health in children and working towards not only immediate high-quality care but also creating a future wherein children in Oldham have similar outcomes to the rest of England. One of those factors is childhood smoking; first hand, second hand or beyond – providing education and ongoing support will be key in tackling this local health inequality.”

Sarah Price, Head of Population & Inequalities at NHS GM IC, said: “This work sets the blueprint for effective, joined up services designed around the needs of the family by supporting children and young patients, as well as their parents and households to become smoke-free. Tobacco smoke is a significant trigger for exacerbation of asthma, in both children and adults. It’s also the single biggest cause of preventable illness and premature death in the world, and one of the greatest drivers of health inequalities. Across Greater Manchester, there are stark differences in smoking prevalence between boroughs, linked to differences between more affluent and poorer areas as well as other contributing factors. By working to make every contact count, we can better tailor services to meet community needs and prioritise resources to have the greatest impact in tackling inequalities.”

Raz Mohammed, Head of Communities at ABL Health, said: “At ABL Health (Your Health Oldham), we fully support the Innovation for Healthcare Inequalities Programme (InHIP) and the focus on increasing treatment rates for children admitted to pediatric wards with asthma, particularly in households where smoking is prevalent. This project offers the chance to leverage innovation and tackle healthcare inequalities in this clinical area. We are delighted to be supporting families of children that suffer from asthma to stop smoking and co-producing educational resources with children and adults. Through the co-production sessions and development of resources, we strive to empower children, young people, and parents to make informed decisions about their respiratory health. By doing so, we aim to promote the overarching goals of InHIP and foster positive health outcomes for all.”

Ricky Barber, Children’s Unit Manager at The Royal Oldham Hospital said: “It has been a great privilege to take part in this pilot project that will offer children, young people and their family smoking cessation support and advice. We have a dedicated nurse who has been pivotal in ensuring that children and their families are identified where smoking is found to be a factor affecting their respiratory health. We are then able to provide them with the care and support needed to guide their smoke-free journey. Smoking amongst young people is prominent health inequality within the Oldham area, whether it be through first-hand or second-hand smoke. If not tackled, it can be a potential trigger for the exacerbation of asthma, or respiratory illness.”

Louise Ross, Business Development Manager, the Smoke Free App: “We are excited to have this opportunity to support families to stop smoking for the health of their children. Respiratory illness is made much worse by smoking, and our advisors know how to give that extra support to help people to go smoke free for life.”