Analysis

How have the demands on emergency care for young people changed in England over ten years?

A study carried out by the Nuffield Trust and the Health Foundation has analysed whether the demand for emergency care of children and young people has changed over the past decade. 

A study carried out by the Nuffield Trust and the Health Foundation has analysed whether the demand for emergency care of children and young people has changed over the past decade

A ten-year study has highlighted some eye-opening statistics concerning children and emergency care: significantly more children are now being admitted for jaundice, acute bronchitis, acute and chronic tonsillitis, and viral infections.

There is some good news though there are considerably fewer emergency admissions linked to both asthma and fractures of the upper limb than there were a decade ago.

The figures come from a joint study by the think tanks the Nuffield Trust and the Health Foundation, which analysed hundreds of thousands of hospital episode statistics across England from 2006-7 to

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A study carried out by the Nuffield Trust and the Health Foundation has analysed whether the demand for emergency care of children and young people has changed over the past decade 


Figures have shown how the demand from children and young people
for emergency hospital care has changed. Picture: Getty Images

A ten-year study has highlighted some eye-opening statistics concerning children and emergency care: significantly more children are now being admitted for jaundice, acute bronchitis, acute and chronic tonsillitis, and viral infections.

There is some good news though – there are considerably fewer emergency admissions linked to both asthma and fractures of the upper limb than there were a decade ago.

The figures come from a joint study by the think tanks the Nuffield Trust and the Health Foundation, which analysed hundreds of thousands of hospital episode statistics across England from 2006-7 to 2015-16.

They wanted to know how demand from children and young people for emergency hospital care has changed.

Indicators

The analysts used six age bands, starting with the under-ones and going up to 20-24 year olds, and looked at admission and readmission numbers as indicators of activity and care quality respectively.

1,124,863

emergency hospital admissions in England among under-25s in 2015-16, a rise of 14% since 2006-7

They found that the numbers of babies and young children admitted to hospital have grown by almost one third over ten years (or 23% when adjusted for population increases). Young children (one to four year-olds) experienced one quarter more emergency admissions over the decade (or 11% when adjusted for population growth).

Statistical increases

There have been decreases in emergency admissions among young people aged over 15, however. The figures should be seen in context: among the general population the increase in emergency admissions is 20% over the decade, compared with 14% for children and young people.

Some very common admissions – linked to asthma, epilepsy and acute tonsillitis – could have been prevented through better management in primary care, the analysts argue. Their summary report states says there is ‘room for improvement in treating and managing potentially preventable conditions; in particular better access to staff with appropriate paediatric expertise in the community.’

30%

increase in emergency admissions of babies under one year old between 2006-7 and 2015-16

They say that some ‘promising’ new models of care are being developed, including nurse-led children’s walk-in centres, paediatric hotlines, and child health GP hubs. But these are not widespread enough. ‘If the NHS does not have adequate resources or sufficient alternatives to emergency hospital care, it may become difficult for the service to address these concerns and improve quality of care for children and young people.’

The RCN’s professional lead for children and young people, Fiona Smith, agreed. She said: ‘Parents naturally want to access the best care for their children, yet many urgent care centres still do not have nurses with the specific skills to treat children and young people.’

She added: ‘Only a third of GPs have child-specific training. We need to ensure that parents have good access to nurses and other health professionals with the right knowledge.’

Bob Klaber, a paediatrician at St Mary’s Hospital in London, argues that paediatricians need to work more closely with health visitors, school nurses, GPs and other primary care professionals to help them identify and manage childhood illnesses in primary care settings. Dr Klaber explained: ‘Too often our hospitals become the default place for patients to attend.’

Top reasons for admission

The analysts have compiled a list of the ten most common reasons for children and young people to be admitted to hospital via an emergency department. Top of the pile for 2015-16 are viral infections (91,386 admissions) and acute bronchitis (67,954).

Viral infection numbers have more than doubled since 2006-7, while acute bronchitis admission numbers have risen by 88%. These increases are chiefly among the under-nines. Among infants, emergency admissions for jaundice more than doubled to 16,491 over the decade, while numbers for ‘other perinatal conditions’ – which include digestive system disorders and feeding problems – rose by almost 75%. 

The analysts are calling for studies to investigate the causes, but believe the trend may be the result of infants with complex disabilities surviving longer, therefore needing more intensive support. Perhaps mothers and babies are being discharged too early after births, resulting in subsequent emergency admissions, they suggest.

The number of children and young people being readmitted to hospital after emergency admissions has risen, especially for chronic tonsillitis and for poisoning by other medication and drugs. In 2006-7 around one in ten children who had experienced an emergency admission were readmitted to hospital within 30 days. By 2015-16 this was 12 per cent higher. The increases were 27% and 25% for acute tonsillitis and poisoning by other medications and drugs respectively.

 

Encouragingly, the think tanks’ figures show that there were 8,724 fewer emergency admissions for fractures of the upper limb in 2015-16 compared to 2006-7.

Robert Cole, a matron responsible for acute services for children, including emergency care, at Lewisham Hospital in London, said: ‘Parents and children are more safety conscious now. Children are more likely to wear seat belts in cars and helmets for cycling. Playgrounds have softer surfaces instead of concrete.

91,386

admissions via an emergency department of children and young people with viral infections in 2015-16

'Parks and visitor attractions don’t want bad publicity and to be seen as be unsafe, so they do more to prevent accidents. Perhaps risk-taking behaviour is less common among children – they are more likely to be playing electronic games now.’

Although admissions relating to asthma remain common, the numbers were significantly lower in 2015-16 than in 2006-7: 27,325 compared to 32,514.

Nurse Monica Fletcher, chair of the European Lung Foundation and chief executive of the Education for Health charity, said: ‘Although the report is concerning I’m pleased to see the figures have gone down in children with asthma. At Education for Health we have been working for years to promote within our training programme the importance of nurses working together with parents and children to develop self-management plans so they know how to recognise deterioration in symptoms and how to take action – sooner rather than later.

'This message may finally be getting through. It may also be the case that parents feel more confident in contacting their practice nurse rather than going to the emergency department.’

The analyst's view

More must be done to improve the quality of primary care services to cut the number of emergency admissions among children, Eilis Keeble, a co-analyst on the study, said.

‘High numbers of emergency admissions for some conditions such as asthma, epilepsy and chronic tonsillitis say more about the quality of care outside the emergency setting. Early intervention with planned or preventive care could help prevent some of these admissions. For example, there are routine care interventions, such as condition management and regular medication assessments that can be put in place.’

She added: ‘If we get healthcare right for children first time, it’s not only good for them but perhaps there will also be less pressure on the NHS and social care in the future.’


Further information

Quality watch: Independent scrutiny into how the quality of health and social care is changing over time


Christian Duffin is a freelance writer

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