‘Worrying’ inequality gap highlighted in children’s emergency health care

School-aged children from the poorest areas are two and a half times more likely to be admitted to hospital in an emergency for asthma than their counterparts in the richest areas, and this gap has grown substantially in a decade, new research reveals today.

The findings come in a new study [1] from the Nuffield Trust, which draws on in-depth analysis of hundreds of thousands of patient records to explore how children and young people across different levels of deprivation have been using emergency hospital care between 2005/06 and 2015/16.

As well as looking at the overall picture for children and young people aged 0-24, the briefing examines emergency care for those with conditions like asthma and diabetes, where admissions can often be avoided with better care and support outside of hospital emergency care departments.

The research reveals that while there has been progress in reducing the rate of emergency admissions for the most deprived children, a stubborn gap remains between rich and poor: children and young people from the most deprived areas are consistently more likely both to go to A&E and to need emergency hospital treatment than those from the least deprived areas.

The study suggests the reasons behind this are complex and likely to be down to many different factors – from the relative health of the population to the availability of services outside hospital. However the authors argue that the most vulnerable children are being let down by health services and policymakers must focus on narrowing what they term a ‘worrying’ inequality gap.

Key findings include:

• The most deprived 0-24 year olds were 58% more likely to go to A&E than the least deprived groups, with the most deprived teenagers experiencing A&E attendance rates that were almost 70% higher than the least deprived. [2]
• The most deprived groups were 55% more likely to experience an unplanned hospital admission than the least deprived, despite the gap between the two groups having narrowed. [3]
• As well as the inevitable human cost, these inequalities also have a significant financial cost: If unplanned admissions for all groups were brought down to the level of the least deprived, this would have led to a decrease of around 244,690 paediatric hospital emergency admissions in 2015/16, a potential saving of £245 million per year. [4]
• In 2005/6 school-aged children in the most deprived areas had about double the emergency admission rate for asthma compared to the least deprived. By 2015/16 this had grown to around two and a half times. Closing the gap could save the NHS £8.5m per year. [5]
• Unplanned admissions for diabetes have been stable or decreased for younger children. But when children transition into adult services, there has been a striking growth for all 20-24 year olds and the most deprived 20-24 year olds were almost twice as likely to experience an unplanned admission in 2015/16 as the least deprived. [6]
• Across the ten most common conditions leading to an unplanned hospital admission, the rates were consistently highest amongst children and young people from the most deprived areas. [7]

Commenting on the research, report author and Nuffield Trust visiting researcher Dr Dougal Hargreaves said:

"Receiving emergency hospital treatment is often absolutely essential and emergency care saves lives every day. But the level of variation between rich and poor, and the growing inequality gap in unplanned admissions for asthma is really worrying.

"The frustrating thing is that we know what works: our analysis tracks consistent progress in reducing unplanned admissions for diabetes among children, which has been the focus of significant national policy interventions. Yet these can’t work in isolation. With public health and other public services cut to the bone and child poverty on the rise, it is hard to see the inequality gaps we highlight being eradicated any time soon.”

Nigel Edwards, Chief Executive of the Nuffield Trust said:

“Asthma and diabetes are both conditions that we should be managing outside hospital. It is an indictment of how we are looking after the most vulnerable in our society that deprived children are now more likely to experience unplanned admissions for asthma than their counterparts did ten years ago.”

This analysis forms part of a broader programme of work the Nuffield Trust is undertaking to examine the evidence on child health and well-being.