Hartlepool and Stockton Health: Chronic Respiratory Diseases

Hartlepool and Stockton Health delivered an innovative Respiratory Outreach Project designed to transform asthma care for children and young people who were not accessing traditional primary care services. In response to national and regional data highlighting gaps in asthma reviews and poor control among young patients, the project focused on removing barriers to access and delivering high‑quality, nurse‑led asthma reviews in community‑based settings. 

Working closely with voluntary organisations, schools, family hubs and GP practices, the team brought care closer to home by offering flexible appointments outside school hours, weekend clinics, and sessions held directly in schools. These efforts enabled 111 children from 16 practices to receive comprehensive asthma reviews many of whom had “fallen off the radar” since the pandemic or were living without a Personal Asthma Action Plan. 

The project provided gold‑standard clinical assessments, including FeNO testing, personalised advice, smoking cessation support and education for families and school staff. Importantly, every child received a Personal Asthma Action Plan, and those with clinical concerns saw significant improvements in their Asthma Control Test scores. 

Beyond patient impact, the project successfully enhanced the skills and confidence of participating nurses, inspiring the development of a local network of respiratory champions. Engagement at community events and use of mobile health units further strengthened public awareness of asthma management. 

This pioneering approach demonstrates how accessible, community‑focused care can reduce inequalities, empower families, and lay the groundwork for a sustainable asthma service that supports healthier futures for children and young people.