Healthcare utilisation among children in contact with social services in England
“This evidence gives policymakers a clearer picture: CSC referrals are not just administrative milestones, but real opportunities to reshape health trajectories. They are windows to provide more planned support, reduce reliance on emergency care, and support families.”
This study was led by Dr Eliazar Luna (UCL) and was funded by the Economic and Social Research Council (ESRC) through the ADR England Community Catalyst: Children at Risk of Poor Outcomes. It was completed in 2026.
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We wanted to find out how children's use of hospital services changes around the time they first become involved with children's social care (CSC), and whether this involvement shifts children towards more planned, rather than emergency, care.
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Children's use of hospital services rose sharply around the time of their referral to CSC. Afterwards, planned care (such as outpatient appointments) immediately rose, while the increasing trend of unplanned, emergency care slowed or reversed. Mental health was the most common reason for hospital contact among children involved with CSC.
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Referral to children's social care may be a moment when previously unmet health needs are identified and addressed in a more coordinated way. This could be an important opportunity for health and social care services to work together to support children and families.
Find out more
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Why does this matter?
Every year, hundreds of thousands of children in England become involved with children's social care (CSC) – as a Child in Need, on a Child Protection Plan, or as a Child Looked After. We know these children tend to have poorer health than other children, but until now we knew little about how their use of hospital services changes around the time they first come into contact with CSC.
What did we want to find out?
We wanted to see how often children visited hospital for planned appointments and for emergency care in the two years before and the two years after their first involvement with CSC, and how this compared with similar children who had no CSC involvement.
What we did
We used ECHILD data linking hospital records with children's social care records, for over 1.3 million children in England who were first referred to CSC between 2009 and 2018. We compared their patterns of hospital use, before and after referral, with matched children who had no CSC involvement.
What we found
Overall use: Children involved with CSC had roughly double the number of hospital contacts of similar children with no CSC involvement, both before and after referral. Children Looked After had the highest overall levels of hospital use.
A peak around referral: Hospital contacts, including A&E visits, admissions and outpatient appointments, rose sharply in the months around referral to CSC, for all groups of children.
A shift towards planned care: After referral, children's use of planned care (outpatient appointments and planned admissions) increased further, while the previous upward trend in unplanned, emergency care slowed or went into reverse.
Mental health: Mental health was the most common reason for hospital contact among children involved with CSC (this was not seen among children with no CSC involvement).
What this means, and what's next
Referral to children's social care may mark an important turning point, where children's health needs can be recognised and managed through planned care, rather than being dealt with as emergencies. This suggests that closer working between health and social care services around the time of referral could help identify and meet children's health needs earlier. More research is needed to understand what drives this shift, and how families as a whole are affected.
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Introduction:
Children in contact with children's social care (CSC) services have high levels of hospital utilisation, but patterns of use before and after referral remain insufficiently understood. We aimed to evaluate healthcare utilisation in the two years before and after first CSC referral among Children in Need (CiN), Children on a Child Protection Plan (CPP) and Children Looked After (CLA).
Methods:
We used a national linked dataset of hospital and social care records for children first involved with CSC in England between April 2009 and March 2018, aged 2–17 years. Using an interrupted time series design, we compared monthly rates of planned (outpatient, planned admissions) and unplanned (A&E, unplanned admissions) hospital contacts before and after referral, with 1:1 age-sex matched children with no recorded CSC involvement. We fitted negative binomial regression models, adjusted for age, sex, ethnicity and area-level deprivation.
ECHILD data used:
HES: Admitted Patient Care, Outpatients, and Accident & Emergency (2007/08 to 2019/20)
NPD: Children in Need Census; Children Looked After Return (2009/10 to 2017/18)
Results:
We analysed over 12 million hospital contacts for 1,014,330 Children in Need, 204,240 Children on a Child Protection Plan and 177,640 Children Looked After. Children Looked After had the highest average number of contacts (11.8 per child over 4 years), followed by Children in Need (8.8) and Children on a Protection Plan (8.4). All CSC groups had around twice the hospital contacts of matched peers. Healthcare use increased sharply prior to referral, peaking around the time of referral. After referral, planned care increased and unplanned care decreased, with pre-referral upward trends slowing or reversing. The most common reason for hospital contact was mental health–related.
Conclusions: At a population level, referral to children's social care marks a pivotal point in children's healthcare utilisation, with a shift from unplanned to planned care. This may reflect more structured engagement with health services and more coordinated support for children and families, offering a potential window for earlier, better-coordinated intervention.
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Related outputs from the ADR England Community Catalyst for Children at Risk of Poor Outcomes.