The Healthcare Safety Investigation Branch (HSIB) – an independent investigatory body funded by the Department of Health and Social Care (DH) – published a report today (May 5), listing its recommendations to improve the management of chronic asthma in children aged 16 or under.

The report primarily focuses on the learnings from a case of a child who experienced a “near-fatal asthma attack” when he was five.

Too young to give “informed consent” 

In the case of the five-year-old child, HSIB heard during the investigation that he was too young to “provide informed consent” and was therefore not eligible for medicines use reviews (MURs) or the new medicines service (NMS).

Medicines adherence was an issue, in that the child was not being given the corticosteroid medication he had been prescribed “in line with the prescriber’s instructions”, according to the HSIB report.

“The community pharmacist told the investigation that had the child been eligible for an MUR, the irregularities in collecting medicines may well have been identified, with appropriate feedback provided to the prescriber,” HSIB wrote in the report.

The pharmacy was also not monitoring the child’s adherence to medication, due to “minimal information being available to it”.

“The investigation heard that if community pharmacists could edit the summary care record (SCR), they could upload information such as uncollected prescribed medicines,” according to the report.

MURs were decommissioned in April this year and replaced with structured medication reviews (SMRs), which are completed by GP or primary care network pharmacists.

The HSIB said that, following its investigation, NHS England and NHS Improvement (NHSE&I) “plans to make clarifications that children should be considered eligible for SMRs and the NMS, even if too young to consent themselves”.

NMS service specification to be amended

HSIB said that NHSE&I will amend the NMS’s service specification and accompanying guidance and toolkit “to reinforce that ‘the service can be offered to younger children involving their guardians as well as to older patients involving their carers where appropriate’”.

Pharmacists should continue to follow the latest guidance before the updates are issued, NHSE&I told C+D today.

Commenting on the HSIB report, an NHSE&I 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”.

A Pharmaceutical Services Negotiating Committee spokesperson told C+D today that any change to the NMS service specification will be negotiated with NHSE&I and the DH.

*This article was updated after publication following extra information from PSNC

Pharmacy teams are aptly placed to support correct inhaler technique and to identify any issues with compliance or adherence. Read C+D’s clinical article on the importance of “going back to basics” with good inhaler technique in younger patients.