Rapidly growing waiting times for health services on top of the disproportionate burden on their mental health wrought by the pandemic risks leaving a generation of children and young people behind, new analysis warns today.
Data analysed by QualityWatch, a joint programme between the Nuffield Trust and the Health Foundation, shows that the impact of the pandemic and measures to control it have led to an unprecedented increase in demand for mental health services for children and young people, particularly relating to eating disorders.
While children and young people are 10 times less likely to be hospitalised with Covid-19, there is mounting evidence that the pandemic has had an increasingly heavy toll on young people. Access to mental health and other health services was severely disrupted by the pandemic storing up significant pressure on health services for the future.
Growing problems: What has been the impact of Covid-19 on healthcare for children and young people in England? finds:
- In April to September 2021, there was an 81% increase in referrals for children and young people’s mental health services on the same period in 2019. The increase for adults (19 years and over) in the same period was 11%.
- During this same period, there were over 15,000 urgent or emergency crisis care referrals for children and young people. A 59% increase compared to the same period in 2019.
- One in five children and young people waited more than 12 weeks for a follow-up appointment with mental health services between April 2020 and March 2021, increasing the risk that conditions deteriorate further.
- The number of children and young people (under 19 years) waiting to start treatment for a suspected eating disorder quadrupled from pre-pandemic levels to 2,083 by September 2021.
- During the pandemic, the number of children and young people (under 19 years) attending A&E primarily for an eating disorder doubled, from 107 in October 2019 to 214 in October 2021.
- Children attending A&E with an eating disorder are having to spend longer there than those with many other diagnoses. In October 2021, 65% of children attending A&E with an eating disorder spent over four hours in A&E, compared to the average of 19% for all diagnoses.
Alongside the impact on mental health services, growing waits for planned paediatric care, access to cancer treatment and increases in urgent GP referrals are a clear signal that access to timely care is being severely compromised with younger people suffering as a result:
- By the winter of 2021, urgent referrals from a GP were up to 47% higher than pre-Covid levels but routine referrals were the same or lower than they were previously. This increase may be a sign of deterioration of children's health as they access services at a worse stage of illness.
- The waiting list for planned paediatric hospital care has grown from 245,654 in April 2021 to 300,465 in November 2021 – a 22% increase in just seven months. This compares to a 17% increase for all planned services for all patients, including adults, over the same period.
- In November 2021, nearly 1000 children and young people had been waiting over two years for paediatric hospital services.
- In November 2021, 15.7% of children under 16-years old with suspected cancer waited longer than two weeks to see a consultant following an urgent GP referral (156 children out of 995 seen in total), this is up from 6.0% in November 2019.
The impact of the pandemic and the knock-on effects on health care, social and education services have seen many children and young people have formative years of their development disrupted. Meanwhile failure to diagnose and treat childhood illness, including cancer, and mental health conditions early can have lasting harm on future health.
The researchers urge the government and health services to improve access to health services for children and young people further. There is an urgent need to address the unsustainable demand challenges for mental services as part of recovery from the pandemic.
Jessica Morris, researcher at the Nuffield Trust said:
“In many ways, the wider effects of the pandemic and nationwide lockdowns on children and young people have been greater than the Covid-19 infection itself. Despite being much less at risk of hospitalisation from the virus, the youngest members of our society have not escaped unscathed and we can see a heavy toll on their mental wellbeing and access to health services.
“Healthcare services for children and young people, just as with adult care, are facing an uphill battle to recover from the pandemic, but they rarely get the same level of scrutiny or exposure. With referrals for mental health services jumping to unprecedented levels, understanding the full impact of the pandemic on children's health is critical if we are to support services to improve access and meet the growing health and care needs of our young people."
Tim Gardner, senior policy fellow at the Health Foundation said:
“The analysis is further evidence that the headline numbers of Covid-19 cases, hospital admissions and deaths mask the unequal burdens carried by different generations during this pandemic.
“Covid-19 has had a profound impact on the health of our children and young people, even though they are generally at least risk from the virus itself. The pandemic has driven demand for mental health services to record levels and increased delays in accessing routine hospital treatment, while the disruption to education, employment and social support will have consequences for children's future health prospects.
“As the country emerges from the pandemic, there is an opportunity to ensure no one is left behind. Children and young people must be at the heart of the national recovery effort, including revisiting plans to expand access to mental health services to account for greater need and targeted action to address the backlogs in children's health services.”
Notes to editors
- We have published a data visualisation of the key findings in a mobile-friendly scrolling data story.
- Data sets and quality indicators used in Growing problems include NHS Digital data, GP patient Survey, NHS England and NHS improvement performance statistics, NHS e-referral data, the Emergency Care Data Set and cites BBC freedom of information data.
QualityWatch is a Nuffield Trust and Health Foundation programme providing independent scrutiny into how the quality of health and social care is changing over time. Each year the Nuffield Trust publishes a QualityWatch statement, which specifically draws on a range of indicators and findings on one topic or theme.
About the Nuffield Trust:
The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate.
About the Health Foundation:
The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.