Blog series – Asthma outcomes: National policy perspective | Professor Mike Morgan
Professor Mike Morgan is an Honorary Professor at the University of Leicester and was formerly the National Clinical Director for Respiratory Services in England. He gave us his view on the recent policy changes around asthma care in the UK, and how things need to change in the future.
When it comes to asthma mortality, everyone is aware just how difficult it is to make meaningful comparisons between countries. We have a responsibility to examine our own data closely before we compare it to other countries.
Is there an epidemic of asthma in the UK?
We are told there are about 1200 asthma deaths in England and Wales per year. However, two thirds of those are over the age of 75 and the growth rate has been in the very elderly patients who have been coded as dying from asthma. I find it difficult to believe that there is an epidemic of asthma in the over 90s that we have failed to recognize so these figures deserve close scrutiny.
Between 2001 and 2010, we saw a significant drop in deaths from asthma in the under 65s. In fact, we halved asthma deaths in this age group in England and Wales in the first decade of the millennium. Those patients under 65 are also more likely to have had a more accurate death certification of asthma. However, we haven’t improved these figures since 2010.
It is probably about 250 people a year who die from asthma. Tragically, when it does happen, and it happens often in young people, the chances to save lives are missed. There are preventable factors in deaths. These preventable factors can be systemic, patient, or health professional factors. These preventable factors aren’t new to us. This was most recently demonstrated in the National Review of Asthma Deaths, but there have been previous reviews which have said the same thing.
Changes in national policy
As a result of this review, there have been a substantial number of policy introductions in England:
- NICE Guidelines: to make asthma diagnosis more objective
- QOF changes: to stimulate quality improvement
- The Respiratory Programme in the long-term plan
- National and local commissioning incentives through Right Care, CQUINs etc
- Specialised commissioning for people with severe asthma
- A National Asthma Audit
The future of asthma care in the UK
Asthma deaths are still occurring. What’s missing?
The notion that asthma is a chronic disease
Asthma patients are not unsuspectingly ambushed by asthma attacks. That language persuades people not to think of it as a chronic disease that requires ongoing management
No integrated care structure for asthma
We have specialists in hospital for asthma, but we have most of the patients in community care. We need an integrated specialist care structure to provide a population approach to asthma. This way we can ensure there is proper oversight of asthma care for the benefit of patients. Hopefully, commissioning reform towards Integrated Care Structures will help steer things in the right direction.