Before the coronavirus (Covid-19) pandemic, the NHS Long Term Plan set out aims to improve the health and wellbeing of children and young people. However, while they are unlikely to become seriously unwell with Covid-19, the wider determinants of children and young people’s health have been impacted by measures brought in to limit the spread of the virus, such as national lockdowns and school closures.
Services for children and young people were significantly disrupted by the pandemic, with appointments cancelled, staff redeployed to adult services, and a rapid switch to virtual consultations. Particular concern has been raised about the impact of the pandemic on children and young people’s mental health, with services reporting that they are struggling to meet demand.
This month, we’ve updated our indicators on quality of care for children and young people before and during the pandemic. Starting with care during pregnancy, which impacts child health outcomes, they span measures from early childhood such as breastfeeding and vaccination coverage, to measures focusing on teenagers and young adults, such as smoking and teenage pregnancy.
Only some of the indicators have available data covering the impact of the pandemic. They highlight a worrying deterioration in waiting times for children and young people with an eating disorder, alongside a huge increase in the number starting treatment for eating disorders. More encouragingly, some indicators remain at levels seen before the pandemic, such as access to antenatal services. Childhood vaccination coverage was maintained, however in 2020/21 for the third consecutive year none of the routine vaccinations met the World Health Organization’s target.
A summary of our indicators is shown below. Click on the links for more detailed content and analysis.
Access to antenatal services
- The percentage of women who attend an antenatal booking appointment at 10 weeks gestation or less has increased over time, from 48% in April 2015 to 64% in March 2021.
Smoking in pregnancy
- Between 2006/07 and 2020/21, the percentage of women who were known to be smokers at the time of delivery decreased from 15.8% to 9.5%.
Maternal readmissions
- Between 2015/16 and 2016/17, the percentage of mothers who had an unplanned overnight readmission within 42 days of giving birth increased from 2.4% to 3.3% in England and 2.9% to 3.3% in Scotland.
Low birth weight
- In 2017, 6.9% of live births in the UK were babies weighing less than 2,500 grams – a small improvement from 7.5% in 2000. Compared with similar OECD countries, the UK lies around the middle of the range of values.
Stillbirths and neonatal and infant mortality
- Between 1993 and 2005, the rate of stillbirths fluctuated around 5.7 stillbirths per 1,000 live births and stillbirths, but then began to fall steadily. In 2019, the stillbirth rate fell to 3.8 stillbirths per 1,000 live births and stillbirths.
- In England, the neonatal and infant mortality rates fell between 1993 and 2013, but have since increased slightly. In 2019, there were 2.9 neonatal deaths per 1,000 live births and 4 infant deaths per 1,000 live births.
Breastfeeding
- In England, the percentage of babies that had a first feed status recorded with a first feed of maternal or donor breast milk decreased slightly from 74% in 2017/18 to 72% in 2019/20, then stayed constant in 2020/21.
Vaccination coverage for children and mothers
- Coverage for all of the childhood vaccinations plateaued between 2011/12 and 2013/14, and has since declined. In 2020/21, for the third consecutive year, none of the routine vaccinations met the World Health Organization’s target of 95% coverage.
- In the 2019/20 school year, coverage of two doses of the HPV vaccine fell to 65%, following school immunisation programmes being paused when schools closed in March 2020 during the national lockdown. This compared to coverage of 84% for two doses in the 2018/19 school year.
- Pertussis vaccination coverage for pregnant women in England is not especially high, reaching 67% in March 2020. However, this is a considerable increase since its introduction in October 2012, when uptake was 44%.
Emergency admissions for children with chronic conditions
- Between 2008/09 and 2019/20, the rate of emergency admissions for asthma in children and young people aged 5 to 19 remained relatively constant, but the rate in children aged 0 to 4 decreased considerably. In 2020/21, emergency admissions for asthma roughly halved in all age groups, alongside an overall decrease in emergency admissions during the Covid-19 pandemic.
- The rates of emergency admissions for Type 1 diabetes decreased for children aged 0 to 14 and remained roughly stable for young people aged 15 to 19 between 2008/09 and 2019/20. However, in young people aged 20 to 24 emergency admissions increased sharply. In 2020/21, emergency admissions remained constant for children aged 0 to 14 but decreased for young people aged 15 to 24.
- Emergency admissions for epilepsy have remained relatively constant over time for children and young people, but fell for all age groups in 2020/21. Children aged 0 to 4 have the highest emergency admission rate for epilepsy, at 83 admissions per 100,000 population in 2020/21 (19% lower than in 2019/20).
Diabetes care
- Between 2015/16 and 2018/19, the percentage of children and young people with Type 1 diabetes receiving all seven recommended annual care processes increased from 36% to 54%.
Hospital admissions as a result of self-harm in children and young people
- Between 2012/13 and 2019/20, rates of hospital admission as a result of self-harm in children and young people (aged 10-24) increased from 508 to 695 admissions per 100,000 females but fluctuated around 200 admissions per 100,000 males.
Waiting times for children and young people with an eating disorder
- Between Q1 2016/17 and Q1 2020/21, the percentage of children and young people with an eating disorder starting urgent treatment within one week of referral increased from 65% to 88%. The percentage of routine cases starting treatment within four weeks of referral increased from 65% in Q1 2016/17 to a high of 90% in Q2 2020/21.
- Since the onset of the Covid-19 pandemic, waiting times have worsened. In Q4 2020/21, 71% of urgent cases started treatment within one week and 73% of routine cases started treatment within four weeks.
- Between Q1 2016/17 and Q1 2020/21, the number of children and young people starting treatment each quarter following an urgent referral fluctuated around 300. In Q2 2020/21, it began to increase sharply and in Q4 2020/21, 719 urgent referrals started treatment, more than double the number in Q4 2019/20.
Obesity
- Between 2006/07 and 2019/20, the gap in obesity prevalence for children aged 4-5 between the most and least deprived areas increased from 4.5 to 6.5 percentage points.
- The gap in obesity prevalence between the most and least deprived areas for children aged 10-11 increased from 8.5 percentage points in 2006/06 to 13.3 percentage points in 2019/20.
Alcohol-related harm and drinking behaviour
- Between 2006 and 2019, there has been a large decrease in the percentage of 8 to 15-year olds who reported that they have had an alcoholic drink. The largest decrease was in 13 to 15-year olds, where the percentage who had drunk alcohol fell from 67% to 35%.
Smoking among young people
- Between 2000 and 2018, the proportion of 15-year-old secondary school pupils who were regular smokers decreased from 23% to 5.3%.
Teenage pregnancy
- Between 1993 and 2018, the under-18 conception rate decreased by 60%, from 42 per 1,000 women to 17 per 1,000 women.
For more information and analysis on care for children and young people, see these Nuffield Trust blogs and reports: