26 February 2020

Stopping the monster days

We recently heard about the progress of one of our early triple aim projects that we supported across Tower Hamlets Together, bringing together a range of stakeholders and partners and supporting three projects.

Tower Hamlets Together is a group of health and social care organisations working closer together to improve the health and wellbeing of people living in Tower Hamlets and the following piece is written by Rita Araujo and below is a presentation the project team has put together to summarise their work so far. Enjoy…

In 2017, a local young person, Nasar Ahmed, sadly died in school from a severe asthma attack triggered by anaphylaxis. Prior to this, we knew respiratory conditions were the leading cause of admissions locally for children. However, the death brought into sharp focus the need for better partnership working. We did this through Tower Hamlets Together resulting in the: Take a breather– Stopping the monster days Programme. When I say partnership, I am serious! We had nearly 300 people from all parts of the system actively involved in this programme. We started with children, young people and their carers.

Many young people said “We just want to be able to breathe” – and that became the name of the programme: “Take a Breather”. We also wanted to make sure we co-designed with even young children. A child aged 5, helped us realise that we all  have a part to play in “stopping the monster days” in children’s lives – see his quote and picture below.

To date these are the outcomes/outputs we have achieved in partnership:

  • Increased confidence and understanding of children and families
  • Increased knowledge and confidence reported by 757 system wide professionals
  • 25% increase on asthma prevalence – children who were being treated as having asthma but who had no formal diagnosis
  • Over 1000 children reviewed – who attended AE twice or more or/and had an admission with wheeze/asthma
  • Identification in clinics (via Asthma Control Test scores) of 503 children at higher risk of asthma attack
  • 189 children reviewed in group consultations in schools – 65% had wrong spacer; 60% no Asthma Action Plan
    • 46 children at higher risk of asthma attack in schools – 71% had not been seen by GP in last year; 74% wrong spacer; 57% had no asthma annual review in last year; 98% had no contact with AE/admission in last year
  • Improved ACT – 92% of high risk children who were followed up
  • Education programme on air quality co-designed with health professionals
  • Co-designed materials for families and children on air quality with professionals, families and children (the implementation phase of this is coming this year so keep tuned!)
  • Reduced unplanned admissions by 22%
  • Reduced cost of acute care by £142,000 as a minimum (excluding preventive work done in schools and not including all the fantastic improvements seen in primary care)

Lastly, the feedback from families, children and young people was overwhelmingly positive but who better than the children and young people to tell you this themselves? Please see video: https://vimeo.com/386820362

To achieve the above we focused on delivering our driver diagram (see simplified version below). The interventions/projects went through a number of PDSA cycles. It is clear where we piloted interventions for the first time nationally, and projects that we tried but realised they didn’t work locally (it’s ok to fail!).

I am very happy to report that this work has influenced other colleagues to use QI methodologies in system wide programmes. I also had the privilege of initiating the North East London (NEL) CYP Asthma Network where we have agreed on a standardised Asthma Action plan, worked hard to achieve better IT integration with schools and the sharing of business cases has resulted on increasing the workforce across NEL from 1 to 8 permanent Asthma Nurses. We have also set up Pan London Asthma Nursing Forum.

Our next steps includes celebrating the work at the LGC Awards https://awards.lgcplus.com/ in March 2020 (we have been nominated for Public Health Programme of the year!) as well as presenting this wonderful work at local, national and international conferences.


This work is now up for a local government award. 

Well done to all those involved, it’s a brilliant piece of work and shows the true potential of our Triple Aim ambition.

Stop the monster days (powerpoint) 

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