‘Worrying’ inequalities gap highlighted in children’s emergency healthcare

School-aged children from the poorest areas are two and a half times more likely to be admitted to hospital in an emergency for asthma than their counterparts in the richest areas, and this gap has grown substantially in a decade, new research reveals today.

The findings, published in a new study by the Nuffield Trust, draws on in-depth analysis of hundreds of thousands of patient records to explore how children and young people across different levels of deprivation have been using emergency hospital care between 2005/06 and 2015/16.

As well as looking at the overall picture for children and young people aged 0-24, the study examines emergency care for those with conditions like asthma and diabetes, where admissions can often be avoided with better care and support outside of hospital emergency care departments.

Authors argue that the most vulnerable children are being let down by health services and policymakers must focus on narrowing what they term a ‘worrying’ inequalities gap.

Key findings include:

  • The most deprived 0-24 year olds were 58% more likely to go to A&E than the least deprived groups, with the most deprived teenagers experiencing A&E attendance rates that were almost 70% higher than the least deprived.
  • The most deprived groups were 55% more likely to experience an unplanned hospital admission than the least deprived, despite the gap between the two groups having narrowed.
  • As well as the inevitable human cost, these inequalities also have a significant financial cost: If unplanned admissions for all groups were brought down to the level of the least deprived, this would have led to a decrease of around 244,690 paediatric hospital emergency admissions in 2015/16, a potential saving of £245 million per year.
  • In 2005/6 school aged children in the most deprived areas had about double the emergency admission rate for asthma compared to the least deprived. By 2015/16 this had grown to around two and a half times. Closing the gap could save the NHS £8.5m per year.
  • Unplanned admissions for diabetes have been stable or decreased for younger children. But when children transition into adult services, there has been a striking growth for all 20-24 year olds and the most deprived 20-24 year olds were almost twice as likely to experience an unplanned admission in 2015/16 as the least deprived.
  • Across the ten most common conditions leading to an unplanned hospital admission, the rates were consistently highest amongst children and young people from the most deprived areas.

Responding to the review, Professor Russell Viner, Officer for Health Promotion for the Royal College of Paediatrics and Child Health (RCPCH) said:

“This report highlights the devastating impact poverty can have on child health, especially in relation to emergency admissions for asthma and diabetes. However poverty has an impact on a range of other issues such as education, housing and continuity of healthcare. In fact, in a survey of paediatricians earlier this year, two-thirds said housing problems or homelessness was a concern and 40% said they had difficulty discharging a child in the six months prior to completing the survey because of concerns about housing or food insecurity.

“We know that children who do not have permanent housing can get lost in the healthcare system, making it difficult for children to regularly attend doctor appointments and services to manage their care. This can mean long-term health conditions become poorly controlled and as a result, children find themselves in emergency departments and being admitted to hospital. This isn’t good for children or their families and adds to the increasing pressure building up on the health service.

“We agree with the authors of this report when they say the most vulnerable children are being let down by health services and we back their calls for policymakers to focus on narrowing the inequalities gap. They can do this by reversing cuts to universal credit which actually leave the majority of families claiming this benefit worse off, and by the restoration of national targets to reduce child poverty, backed by a national child poverty strategy.

“Nearly four million children in the UK live in poverty with projections suggesting this could rise to 5 million by the end of the decade. So it is vital Government gets a grip on this desperate issue to prevent this startling gap widening.”