Introduction

This quality standard covers the management of atopic eczema in children from birth up to the age of 12 years. For more information see the scope.

Why this quality standard is needed

Atopic eczema (atopic dermatitis) is a chronic, inflammatory, itchy skin condition that usually develops in early childhood. It is typically an episodic disease of exacerbation consisting of flares, which may occur 2 or 3 times per month, and remissions, but in some children it is continuous. Atopic eczema often has a genetic component that leads to the breakdown of the skin barrier. This makes the skin susceptible to trigger factors, including irritants and allergens, which can make the eczema worse.

In many children atopic eczema clears or improves during childhood, whereas in others it persists into adulthood. Some children who have atopic eczema will go on to develop asthma and/or allergic rhinitis; this sequence of events is sometimes referred to as the 'atopic march'. Although atopic eczema is not always recognised as a serious medical condition by healthcare professionals, it can have a significant negative impact on quality of life for children and their parents or carers.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measureable quality improvements within a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following outcomes framework published by the Department of Health:

Tables 1 and 2 shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:

Table 1 NHS Outcomes Framework 2013/14

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

ii Children and young people

Improvement areas

Reducing deaths in babies and young children

1.6 i Infant mortality*

4 Ensuring that people have a positive experience of care

Overarching indicator

4a Patient experience of primary care

i GP services

ii GP Out of hours services

4b Patient experience of hospital care

Improvement areas

Improving children and young people's experience of healthcare

4.8 An indicator is under development

Alignment across the health and social care system

* Indicator shared with Public Health Outcomes Framework.

Table 2 Public health outcomes framework for England, 2013-2016

Domain

Objectives and indicators

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities

Indicators

4.1 Infant mortality*

Alignment across the health and social care system

* Indicator shared with NHS Outcomes Framework.

Coordinated services

The quality standard for atopic eczema in children specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole atopic eczema in children care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to children with atopic eczema.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality service for children with atopic eczema are listed in Related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare practitioners involved in assessing, caring for and treating atopic eczema in children should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard.