Improving outcomes for children and young people with asthma depends on what happens after the immediate crisis, as well as during it. Through the Innovation for Health Inequalities Programme (InHIP), partners in Tameside have been working to redesign the paediatric asthma pathway to ensure children are identified earlier, followed up consistently and supported with the education they need to manage their condition.In this Q&A, Dr Robert Block, Consultant Paediatrician, CYP Asthma Lead and Joint Named Doctor for Safeguarding at Tameside and Glossop IC NHS Trust, shares why change was needed, what has improved so far and what matters most for long-term impact.

Why did the way children entered the asthma pathway need to change?
There was no single, consistent way for children to enter the asthma pathway; it depended entirely on how and where they first presented, whether that was general practice, A&E or hospital admission. While we are generally very good at treating acute asthma attacks, both locally and nationally, the bigger challenge has been chronic management. Children were not always being identified early enough, followed up consistently, or supported with the education needed to manage asthma day to day. Tightening the entry point was essential to make sure children received the right assessment, treatment and follow-up from the very start.

Where was variation across the system causing the biggest problems?
The greatest variation was in urgent and emergency care settings. Children would often be treated for an acute episode and discharged without a clear follow-up plan, then return repeatedly with further attacks. Without proper follow-up and chronic management, these children were at increased risk of more severe and potentially life-threatening exacerbations. The redesigned pathway focuses on reducing this variation by standardising expectations across A&E, hospital, primary care and community services.

How did data help highlight where children were being missed?
We used a combination of national asthma audit data, local admission figures and prescribing patterns from primary care. One of the most striking findings was that Tameside has historically had one of the highest rates of asthma admissions for under 19s in the country. A significant number of admitted children were experiencing severe exacerbations requiring intravenous treatment. This data clearly showed that the system was not preventing asthma attacks early enough and reinforced the need for whole-system change.

Why is standardising assessment and education so important?
Education is the most important part of asthma management. Inhaler technique checks, written asthma action plans, severity scoring and clear documentation are fundamental. If a child does not take their inhaler in the right way, it simply will not work. Evidence consistently shows that good education and correct inhaler technique have a greater impact on outcomes than many advanced treatments. Standardising these elements gives families the best possible chance to manage asthma safely and confidently at home.

What improvements have you seen in handover and continuity of care?
One of the biggest improvements has come from clearer discharge summaries and clinic letters, particularly through better training and support for junior doctors. When primary care teams receive clear, detailed information, they are much better placed to continue care appropriately. Alongside this, the development of asthma hubs and greater engagement from GP practices with a specialist interest in asthma has helped strengthen continuity once children return to the community.

How is access to the GM Care Record helping support the transformed asthma pathway?
Access to the GM Care Record has been a significant step forward in supporting the transformed asthma pathway. It allows us to review a child’s medication pickups and assess adherence, check the accuracy of GP prescribing, and understand how often and where a child is accessing care for asthma whether that’s routine reviews or acute exacerbations. We can also see the number and frequency of SABA and oral steroid prescriptions, as well as whether a child has presented elsewhere with an acute asthma attack. Having this information available before we see the child in clinic or review them on the ward gives us a far more complete picture and supports safer, more proactive decision making.

Are there early signs that the redesigned pathway is working?
Although the programme is still relatively early, we are starting to see encouraging signs. Repeat attendances within 30 days of discharge have fallen, and clinicians are reporting improvements in asthma control test scores, FeNO levels and adherence to preventer medication. These early indicators suggest that clearer entry points, better follow-up and improved education are beginning to reduce avoidable harm.

What are the key priorities for the next phase of the pathway?
Future priorities include expanding asthma hubs across all neighbourhoods, introducing a common referral form for childhood asthma, improving the consistency of managing probable asthma in younger children, and strengthening the role of community pharmacies. Ensuring inhaler technique is checked and information remains consistent wherever medications are supplied is a major opportunity to further reduce variation and improve outcomes.

What message would you share with other systems looking to improve paediatric asthma care?
The message is simple but powerful: children do best when they receive the right medicine, in the right way, at the right time. Clear, concise and consistent education, delivered uniformly across primary, secondary and emergency care, is the foundation of effective asthma management. When families understand asthma and feel confident using treatment correctly, outcomes improve across the whole system.