This week, the Health Foundation and the Nuffield Trust released a new QualityWatch report on ‘Emergency hospital care for children and young people’, which shows concerning rises in emergency admissions of infants under 1 years of age over the last 10 years.
The research used routinely collected Hospital Episode Statistics from 2006/07 to 2015/16. Data was analysed for children and young people aged 0 to 24 years, including the under 1 year (infant) age bracket.
Emergency admissions of infants rose more than any other age group over the decade. The absolute number of emergency admissions for infants increased by 30% (from c170,000 to c220,000 admissions per year). This compares to the total number of emergency admissions across the population increasing by 20% across the same period, and the number of emergency admissions for all children and young people (0-24 years) increasing by 14%.
After taking population changes since 2006/07 into account, the emergency admission rates for infants showed the largest increase of any age bracket at 23% – from 27,415 emergency admissions per 100,000 population in 2006/07 to 33,684 per 100,000 population in 2015/16. Relative to their population size, infants also had the highest number of A&E attendances at 74,522 per 100,000.
The rate and number of particular conditions are behind the increase in admissions of children and young people, including concerning rises in emergency admissions of infants for jaundice, feeding and respiratory problems.
Emergency admissions of infants for jaundice more than doubled, from 8,186 to 16,491. Emergency admissions for conditions categorised as ‘other perinatal conditions’, including digestive system disorders and feeding problems, increased by 74% – from 14,293 to 24,848.
The authors state that ‘The rise in emergency admissions among infants raises some questions about maternity and community care’. They raise concern about the lack of available support outside the hospital emergency care setting. The report refers to Better Births (the NHS England National Maternity Review) as highlighting the need for improved breastfeeding and follow-up support for new mothers in the community.
The authors note that there are various supply and demand factors that can influence emergency attendance and admissions. These include: demographic changes (births, deaths, migration); people’s behaviour (when and how they seek help); the public health system (rise and fall of different types of prevention work); and the availability, accessibility and quality of care in and outside the hospital. Plus there are broader environmental and socioeconomic factors (e.g. financial difficulties and poverty).
They refer to specific policy changes that may have impacted on emergency attendance and admission data. For example, the introduction of 4-hour A&E waiting times may have influenced decisions to admit individuals to hospital. And the Health and Social Care Act 2012 shift in public health function to local authorities was followed by significant cuts to their budgets.
These findings are of significant relevance to those supporting new parents and their babies in both maternity and community settings. They add to concerns regarding the quality of postnatal care and the cuts to public health services, including health visiting and infant feeding. And most importantly, the findings reflect what we hear from women about not being able to access the support they need, when they need it.
Support postnatally and during early parenthood really matters. The health and wellbeing of babies and parents bears the brunt of poor access to community-based support. But the public purse also feels the pressure. When the consequences are such that the cost of emergency admissions and unnecessary hospital care steals from the budget available for preventative and community services.
I’d love to hear of examples of community or hospital services which have been shown to reduce admissions for infant feeding and related issues. I was impressed to hear about this Rapid Access Clinic at Sheffield Teaching Hospitals service at the UNICEF Baby Friendly conference in 2014. You can see the slides here. Please do share your examples!
Read coverage in the Guardian here.