To consider the submitted report on the above.

The Director of Women and Children’s Improvement - Su Smart and Children’s Commissioning Manager NHS Devon – Georgina Minifie presented the submitted report on Long Term Conditions for Children and Young People Plan and responded to questions.  The key themes were:

·                Asthma admissions were high, with Devon the fifth worst Integrated Care Board (ICB) area in England for children at high/very high asthma risk.

·                A fuel poverty pilot in two Primary Care Network (PCNs) showed improvements in inhaler use and risk reduction.

·                Major improvements had been made in diabetes care due to hybrid closed-loop technology, with a rise in uptake from 40% to 73%.  A transition pilot in Torbay had successfully re?engaged 32% of patients.

·                Gaps remained in asthma care with not enough cases diagnosed or with action plans.

·                There were multi?agency challenges with housing, damp/mould, and other environmental factors impacting on asthma.

Members also received feedback from a young person and their experiences.

Members asked the following questions:

·                Asthma attacks and deaths were often avoidable, what was being done to improve asthma care?

·                Why was Torbay?specific data hard to provide?  Could data be broken down further than “Devon averages”?

·                What was the role of schools, school nursing, housing, and wider services in preventing asthma episodes?

·                Were 65% of children truly in high/very high-risk categories, and why was this so high?

·                What was the cost of the diabetes transition pilot, and was it sustainable after NHS England pilot funding ends?

·                How many children get home visits from health visitors?

·                What power do health professionals have to require landlords to fix damp and mould?

·                What was the difference between Type 1 and Type 2 diabetes in children?

·                Could obesity-related diabetes be considered neglect?

·                Why were some children and young people not given diabetes training?

·                What training exists for teachers and youth workers?

·                65% of asthma?risk sits in primary care — what work was ongoing with GPs?

·                Were children being directly educated about asthma management?

·                What was the fuel poverty trial measuring, did this include heating or temperature?  What were its triggers, and how would the findings be used?

·                Why were Devon’s admissions higher, despite lower accident and emergency attendances?

·                How were long?term conditions managed if diagnosed late (e.g. age 16–17)?

The following responses were received:

·                Asthma care improvements included ensuring annual reviews, follow?up after hospital attendance, correct medication, and personal asthma plans including school copies.

·                National minimum standards were used as framework.

·                Data was often aggregated at Devon ICB level.  PCN - and hospital-level data was available and used internally.  It was acknowledged that Devon averages could mask Torbay trends.

·                There was a role for the wider system for example Housing/Health Group to address damp, mould, and environmental triggers.  Work with education to create “asthma-friendly schools”.  Environmental Health were involved in dealing with hazardous housing conditions.

·                The Diabetes transition pilot was funded by NHS England and there were outcomes presented through a business case which had now been adopted permanently in Torbay and South Devon.

·                Regarding enforcement of damp and mould, health visitors could report concerns.  The Legal powers differ between private landlords and social housing.  Awaab’s Law strengthens requirements for timely landlord action.

·                The difference between the types of Diabetes were Type 1: autoimmune, not lifestyle-related and Type 2: linked to childhood obesity, was increasing globally was reversible with lifestyle changes.

·                Very rare cases of obesity-related harm could reach child protection thresholds.

·                School staff receive diabetes training from local teams.  Training outside education (e.g. youth workers) was limited and identified as a gap.

·                GPs were responsible for most asthma monitoring including annual checks.  It was recognised that education for children could reduce admissions with work ongoing through schools and family hubs.

·                The fuel poverty trial looked at triggers including indoor/outdoor air pollution and home energy efficiency.  This was carried out by Exeter Community Energy and the report had not yet been published.

·                Torbay allows direct short-stay paediatric referrals from GPs, which reduces Emergency Department attendances but increases admissions.

·                For young people receiving a late diagnosis e.g. 16–17 year olds transition planning begins immediately upon diagnosis.

Resolved (unanimously):

1.       that NHS Devon be recommended to put in place training for wider partners and those who have contact with young people for diabetes care;

2.       that the results of the fuel poverty pilot be presented to a future meeting of the Children and Young Peoples Overview and Scrutiny Sub-Board; and

3.       that NHS Devon be requested to bring an annual update on long term conditions for children and young people to the Children and Young Peoples Overview and Scrutiny Sub-Board.