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Why does this matter?

The COVID-19 pandemic disrupted NHS services. Planned hospital care, such as outpatient appointments and planned admissions, was reduced while health services responded to COVID-19. Some children and young people may have been more affected than others, particularly those already receiving support from children's social care or special educational needs services. Understanding these differences is important because children receiving these services already experience poorer health outcomes than their peers. Disruption to healthcare could add to these existing inequalities.

What did we want to find out?

We wanted to understand how planned hospital care changed for adolescents during the first nine months of the COVID-19 pandemic, particularly for young people receiving children's social care services or special educational needs support.

What we did

We used ECHILD to look at data for all secondary school pupils in England. The data brought together information about education, children's social care and hospital care, allowing us to study healthcare use alongside information about children's circumstances. We focused on young people aged 11–16 years. We compared planned hospital admissions and outpatient care before the pandemic with care during the first nine months of the pandemic. We also looked at whether outpatient appointments were delivered face to face or remotely.

What we found

Planned hospital care decreased substantially during the first nine months of the pandemic. The decrease was greater among adolescents receiving statutory children's social care services or special educational needs support than among their peers. Before the pandemic, these young people already had higher rates of planned hospital care. Adolescents receiving these services were also less likely than their peers to have outpatient care delivered face to face during the pandemic.

The study therefore found a double disadvantage: young people with existing vulnerabilities had greater healthcare needs before the pandemic, but experienced disproportionately large reductions in planned hospital care during the pandemic.

What this means, and what's next

These findings suggest that the disruption to planned hospital care during the pandemic may have widened existing inequalities for vulnerable adolescents. Recovery of NHS services should therefore consider the needs of children and young people receiving statutory services or support.

Introduction: 

We aimed to describe changes in planned hospital care during the pandemic for vulnerable adolescents receiving children's social care (CSC) services or special educational needs (SEN) support, relative to their peers.

Methods: 

We used ECHILD to create a cohort of all secondary school pupils in years 7-11 in academic year 2019/2020 (N=3 030 235). We evaluated changes in outpatient attendances and planned hospital admissions during the first 9 months of the pandemic, estimated by comparing predicted with observed numbers and rates per 1000 child-years. We compared children who received SEN support or CSC services with those who did not.

ECHILD data used:

HES: APC data from 2019-2020

CSC 2019/2020

NPD: Spring Census 2019/20

Results:

A fifth of pupils (20.5%) received some form of statutory support: 14.2% received SEN support only, 3.6% received CSC services only and 2.7% received both. Decreases in planned hospital care were greater for these vulnerable adolescents than their peers: -290 vs -225 per 1000 child-years for outpatient attendances and -36 vs -16 per 1000 child-years for planned admissions. Overall, 21% of adolescents who were vulnerable disproportionately bore 25% of the decrease in outpatient attendances and 37% of the decrease in planned hospital admissions. Vulnerable adolescents were less likely than their peers to have face-to-face outpatient care.

Conclusions: These findings indicate that socially vulnerable groups of children have high health needs, which may need to be prioritised to ensure equitable provision, including for catch-up of planned care postpandemic.

‍ Published paper

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