Children’s lives at risk from failures in asthma care, warns safety watchdog

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Children with asthma are at risk of avoidable deaths in England because of poor NHS systems and a failure to appreciate the dangers posed by the condition.

A new investigation by NHS safety watchdog the Healthcare Safety Investigation Branch (HSIB) has revealed a series of risks to children with asthma, as concerns emerge of the impact of the pandemic on asthma patients more generally.

The latest inquiry was sparked by the deaths of three children between 2014 and 2017. All were caused by asthma attacks which were later the subject of warnings by coroners.

In each case HSIB said there were missed opportunities to recognise asthma as a life-threatening condition as well as problems with how the children were managed by doctors working in different parts of the NHS.

It focused its investigation on the treatment of a five-year-old boy who almost died from an asthma attack in July 2019. He needed seven weeks of hospital care, including 13 days in intensive care.

The safety body said it found a “a general lack of understanding about the potential seriousness of asthma” adding: “A combination of paper records and electronic systems, and the limited ability of different electronic systems to share information with one another, resulted in inconsistent and incomplete transfer of information about the child’s condition and treatment.”

It also highlighted a "lack of capacity" in the outpatient clinic at the child's hospital meant he waited "much longer" than necessary between appointments.

It also found the triage algorithm used by NHS 111 for breathless children did not include a key question for parents that can help indicate a life-threatening problem.

More than 1,400 adults and children died in 2018 from asthma attacks in England and Wales, an 8 per cent increase compared to 2017. Across the UK 5.4 million people receive treatment for asthma.

The UK has one of the worst asthma death rates in Europe with the Nuffield Trust think tank warning in 2019 that young adults in the UK were “more likely to die from asthma … than their counterparts in comparator countries.”

A major inquiry into asthma deaths in 2014 made 19 recommendations, 12 of which HSIB said were relevant to the five-year-old’s treatment it examined.

Only one of the 19 recommendations has been implemented.

Dr Jen Townshend, a consultant paediatrician who advised on the HSIB investigation said: “Outcomes for children and young people with asthma in the UK continues to be amongst the worst in the developed world and twice as bad as the next worst country in Europe. As a result, many children are living with intrusive and unnecessary asthma symptoms and sadly every year children and young people continue to die from asthma. In many cases these deaths are preventable.”

Keith Conradi, chief investigator at HSIB said: “On average, three people die from an asthma attack in the UK every day. Our investigation offers an independent view on why there continues to be serious safety risks associated with the diagnosis and management of chronic asthma in children.”

The HSIB report comes as Asthma UK warned an estimated 623,000 people at high risk from the condition may have missed out on annual face to face reviews because of the coronavirus pandemic.

The charity's new report, released to mark World Asthma Day, also suggests that 3.5 million people with asthma have not received all elements of basic asthma care such as an annual review, an inhaler technique check and having a written asthma action plan.

It has called on GPs to prioritise reviews of those with uncontrolled symptoms.

Dr Andy Whittamore, clinical lead at Asthma UK and the British Lung Foundation, said: "It is deeply concerning that so many people including some of the most at risk of an asthma attack are not receiving any basic care which could keep them well and out of hospital.”

An NHS England spokesperson said: “The NHS is already implementing the recommendations of the report with improved asthma care at the heart of the NHS long term plan, which committed to improving asthma outcomes for children and young people.

“The NHS spends around £1 billion a year treating and caring for people with asthma and helping them get back to good health, while national experts are working on developing a new national framework to be implemented across the country to further improve care for children and young people suffering from asthma.”