Imperial College London

Number of children attending A&E and urgent appointments risen over last decade

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A child holds a stethoscope to a toy teddy bear

The number of children, especially babies, attending Accident and Emergency and urgent hospital appointments has risen significantly over last decade.

This is the finding of the largest ever study of children’s healthcare use, published in the journal BMJ Open, which tracked 1.4 million children in England and Wales across 10 years between 2007 and 2017. The study included 7.6 million GP consultations, and 3.9 million hospital visits, including emergency department visits and outpatient attendances and admissions.

The analysis, by researchers from Imperial College London, revealed Accident and Emergency visits for children under one rose by nearly 4 per cent per year between 2007 and 2017, resulting in an extra 100,000 visits among under-ones between 2007 and 2017. Accident and Emergency visits for children between ages of one and 15 had risen at a slightly lower rate of 1.6 per cent per year. 

Our findings suggest large year on year rising demand for NHS health care, particularly from families with children under five Professor Sonia Saxena Study author

The study, funded by the National Institute of Health Research (NIHR) NW London Applied Research Collaboration and the Imperial NIHR Biomedical Research Centre, also tracked the number of GP appointments over the ten-year study period. This revealed 760,000 fewer GP consultations per year between 2007 – 2017 for children between ages 1-15 (a drop of 1 per cent a year), while children under one had 76,000 extra visits per year between 2007 and 2017 (a rise of 1 per cent). 

The team say the findings suggest increasing unmet need for better access and provision of specialist and community- based support for families, especially those with young children, as under-ones have required both an increase in emergency and GP appointments.

Preserving children's care during pandemic

Professor Sonia Saxena, lead author of the research and head of Imperial’s Child Health Unit, said: 'Our findings suggest large year on year rising demand for NHS health care, particularly from families with children under five, over the past decade since National Health Service primary care reforms. GP consultation rates have fallen for all children, except for infants, while children's use of hospital urgent and outpatient care has risen in all ages, especially infants.

Research to understand drivers and identify solutions to rising health service use is urgently needed Judith Ruzangi Study author

'These trends raise a concern, particularly amidst the current COVID pandemic, about preserving access and quality of routine NHS care for children, whilst NHS efforts are diverted to adult population prone to COVID risk. It is crucial to ensure child health is not compromised and consequently manifests with potential future measles outbreaks, long term conditions such as asthma deteriorating and poor mental health among children.'

The NW London ARC Child Population Health study team used data from the Clinical Practice Research Datalink to study children's primary care consultations and use of hospital care, including emergency department (ED) visits, emergency and elective admissions to hospital and outpatient visits to specialists. Using these data they were able to track the same children over the course of the ten year period.

A&E conditions could have been treated by GP

The team say upward trends in planned and urgent healthcare use by children have major resource and cost implications for the NHS and recommend the reasons behind these changes warrant further research.

Judith Ruzangi, first author of the research, from Imperial's School of Public Health, said: 'Our research suggests use of hospital emergency care has risen among children, particularly under ones. Yet previous research shows up to 80 per cent of children who attend Accident and Emergency have conditions that could have potentially be treated at their GP. These changes may signify the need for better access to primary care and provision of specialist and community-based support for families with young children. Research to understand drivers and identify solutions to rising health service use is urgently needed.'

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'Trends in healthcare use in children aged less than 15 years: a population based cohort study in England from 2007 to 2017' is published in BMJ Open

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Kate Wighton

Kate Wighton
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