This briefing looks at the relationship between deprivation and the use of emergency hospital care by children and young people in England (between 2005/6 and 2015/16). It aims to describe and highlight areas of inequality and to explore how they have changed over time. As well as looking at the overall patterns of emergency hospital use, we focus in particular on three common conditions – asthma, diabetes and epilepsy – where more timely and effective primary, community or outpatient care could prevent admissions.
We find 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 children from the least deprived areas.
Encouragingly, in many areas the inequality gap is narrowing. This may be due, in part, to certain national policy initiatives and quality improvement work. However, the size and persistence of any gap is a matter of concern. Indeed, there are areas where the most deprived children are experiencing a higher rate of emergency admissions than they were a decade ago and where this inequality gap is growing.
- In 2015/16 the most deprived children and young people overall were 58 per cent more likely to go to A&E than the least deprived. A&E attendances for the most deprived infants and pre-schoolers were over 50 per cent higher than the least deprived. For the most deprived teenagers they were nearly 70 per cent higher.
- While, overall, emergency (or unplanned) hospital admissions have increased slightly (by 9 per cent between 2005/6 and 2015/16), the gap between the most and least deprived groups has narrowed. Nonetheless, the most deprived children are still 55 per cent more likely to experience an unplanned hospital admission than the least deprived.
- Across the 10 most common conditions leading to an unplanned hospital admission, the rates were consistently highest among children and young people from the most deprived areas.
- Looking specifically at asthma, in 2005/6 school-aged children in the most deprived areas had about double the emergency admission rate of the least deprived (248 admissions per 100,000 population compared to 125). By 2015/16 this had grown to around two and a half times the rate of the least deprived (323 admissions per 100,000 population compared to 127).
- Unplanned admissions for diabetes (all types) have been stable or have decreased for younger children (0–14). However, when children transition into adult services, there has been a striking growth for all 20–24-year-olds (between 40 and 90 per cent across the different deprivation groups) and the inequality gap remains significant. The most deprived 20–24-year-olds were almost twice as likely to experience an unplanned admission in 2015/16 as the least deprived.
- Unplanned hospital admissions for epilepsy have reduced over time for all age groups and there has been most progress in reducing unplanned admissions for the most deprived groups.
- Evidence suggests the reasons behind these findings 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 data highlight the importance of national policy initiatives in improving outcomes. For example:
- The reduction in unplanned admissions for children with diabetes in the 0–14 age group coincided with the introduction of the National Paediatric Diabetes Audit and the best practice tariff
- Similarly, the reduction in unplanned admissions overall for epilepsy coincided with initiatives such as Epilepsy 12 (the national clinical audit for paediatric epilepsy) and a new national best practice tariff.
- As well as the inevitable human cost, these inequalities also have a significant financial cost: if unplanned admissions among the whole population were brought down to the level of the least deprived, this would have led to a decrease of around 244,690 paediatric emergency hospital admissions in 2015/16, a potential saving of almost £245 million per year. This translates to a potential saving of £8.5 million for asthma, £3 million for diabetes and £3 million for epilepsy.
- Designing and implementing policies that help reduce deprivation and improve social determinants of health should remain the overall long-term objective for policymakers. In the short term, the inequality of health outcomes we describe in this briefing should be the basis for a renewed emphasis on health care policies that specifically engage and focus on deprived children and young people with ongoing health needs and their families.
Kossarova L, Cheung R, Hargreaves D and Keeble E (2017) Admissions of inequality: emergency hospital use for children and young people. Briefing, Nuffield Trust. www.nuffieldtrust.org.uk/research/admissions-of-inequality-emergency-hospital-use-for-children-and-young-people