Summary
The Oxford and Wessex AHSNs are leading on two national programmes which are benefiting thousands of asthma patients. The two neighbouring AHSNs are taking an increasingly joined up approach in supporting system-wide collaboration and innovation in all asthma pathways. These initiatives, commissioned by the NHS in line with national priorities, are leading to improvements in outcomes and quality of life for many people. More appropriate diagnosis, management and referral of patients needing further specialist input is helping to reduce asthma attacks, asthma-related hospital admissions and the use of steroids, known to have long-term side-effects.
What is the challenge?
Improving outcomes in respiratory disease is identified as a clinical priority in the NHS Long Term Plan. More than five million people in the UK have asthma with the NHS spending over £1bn per year on asthma, the vast majority of it on medication. Asthma can be difficult to diagnose and misdiagnosis can be common. Severe asthma, a specific type of asthma which is difficult to control even with optimised inhaled asthma medication, is known to affect approximately 200,000 people in the UK. Many of these patients live with poor asthma control typified by emergency trips to hospital, intensive care and regular doses of strong oral corticosteroids which are known to have serious side-effects. Asthma biologics can have a life-changing impact on some patients with severe asthma. They work in a targeted way by disrupting pathways causing airways inflammation, helping to manage symptoms, reduce relapses and scale back reliance on steroids. The National Institute for Health and Care Excellence (NICE) estimates that more than 54,000 patients in England currently suffering with severe asthma would benefit from an asthma biologic medicine – but only around one in five currently do so.
What did we do?
The NHS Accelerated Access Collaborative (AAC) works with AHSNs and other partners to speed up the spread and adoption of proven technological innovations and treatments which are approved by NICE but are not yet integrated into everyday practice. The AAC Rapid Uptake Products programme identified wider access to asthma biologic medicines and expansion of FeNO (Fractional exhaled Nitric Oxide) testing – devices which measure nitric oxide in exhaled breath which support asthma diagnosis – as two key priorities in improving asthma care. In 2021 the Oxford AHSN took the national lead for asthma biologics with Wessex AHSN leading nationally on the FeNO programme. The AHSNs supported system-wide collaboration and innovation on a national, regional and local level to integrate these innovations into everyday practice. This included:
- providing clinical leadership
- developing supporting materials for those involved in delivering asthma care
- creating patient resources (many of them in seven languages in addition to English)
- sharing best practice
- supporting engagement activity.
The AHSNs have taken a flexible approach, adapting to meet the needs of clinical teams, focusing on pathways rather than products and collaborating with industry partners. Online toolkits were developed to provide a single repository for colleagues looking to drive implementation.
What has been achieved?
When looking at the impacts and metrics that the programmes are tracking a number of positive benefits to patients, systems and the workforce have been recognised.
FeNO testing programme:
- More than 100,000 patients benefiting nationwide following use of FeNO device
- More than 2,000 hours of staff training
- More than 3,000 views of patient video
- More than 8,000 monthly web page views.
Asthma biologics programme:
- More than 2,000 new patients initiated on life-changing asthma biologics
- More patients self-administering biologic medication for their asthma
- Fewer patients receiving high dose (3g or more) oral steroids each month
- More than 8,000 users of the asthma biologics online toolkit
- More than 1,000 healthcare professionals attending educational webinars
- Consensus pathway launched at NHS ConfedExpo, June 2022 – first-of-its-kind guidance document for clinicians, commissioners and all involved in asthma care, a best practice blueprint across the entire patient journey.
What people said
“I have seen how biologics can transform the lives of people with severe asthma and this pathway is an important step in optimising access for people who will benefit from them.”
Professor Andrew Menzies-Gow, National Director for Respiratory Services, NHS England/Improvement
“By continuing to work together, we will ensure that more people with severe asthma are able to access high quality care and benefit from life-changing treatment.”
Professor Gary Ford, Chief Executive, Oxford AHSN, and Chair of the national AHSN Network
“I hope the consensus pathway will shape discussions and guide the development of asthma pathways at a local and regional level.”
Dr Hitasha Rupani, Pathway Lead and Clinical Champion for asthma biologics programme and Respiratory Consultant at University Hospital Southampton
“The freedom I got from biologic therapies both physically and mentally was amazing.”
Jo Beecroft, severe asthma patient
“Patient Involvement in the biologics and FeNO programmes has been so valuable. Our patient involvement partners have been key members of the national working groups, ensuring that real-life patient experience and recommendations informed all developments.”
Nathalie Carter, Patient and Public Involvement Manager – Innovation, Research and Life Sciences Group, NHS England
What next?
Through 2022/23 the Oxford and Wessex AHSNs will continue to work across the AHSN Network with NHS and industry partners to grow, expand and widen the impact of these two initiatives to transform asthma pathways and benefit even more patients. These programmes are contributing to reducing underlying health inequalities in access to treatment.