The Archives of Disease in Childhood has reported a 28% rise in emergency admissions of children under 15 to English hospitals over the past decade. However, the majority of the increase in hospital admissions for children is in relation to those with relatively minor conditions, such as gastroenteritis.
The report attributes the increase primarily due to out-of-hours admissions, and notes that it coincided with the decision in 2004 to allow GPs to opt out of providing acute care in the evening and weekends leading to the development and promotion of various out of hours services.
Is this a good or a bad thing?
On the one hand, increased hospital admissions for children potentially reflect better public awareness of symptoms of concern and hospitals being proactive at investigating children who show these signs.
On the other hand, the increase could be said to be due to either a lack of non A&E out of hours resources or poor quality of service. We have dealt with a number of cases of out of hours services taking a long time to respond or attendance and advice being cursory, resulting in concerned parents going to A&E. Arguably in some cases poor out of hours services are the direct cause of increased hospital admissions. Should that be the case then this potentially means that children with serious conditions who need urgent or time consuming attention may be overlooked or backlogged due to the number of non urgent admissions. Is there a risk that non emergency conditions are impacting on the care provided to those who are urgent cases?
Philippa Luscombe, partner in the clinical negligence team at Penningtons, comments: “We deal with a number of cases where children with signs indicative of potentially serious conditions needing urgent treatment – such as meningitis, kidney infections and testicular torsion - are sent away with a non specific diagnosis of ‘infection’ or similar. The impact of the delay in receiving the right diagnosis and treatment can be significant – in some cases fatal . Is this due to the sheer volume of children being assessed and the fact that in most cases there is a non serious cause, leading to the serious ones being overlooked?”
There are currently significant concerns about the new 111 service and whether it is capable of quickly and accurately assessing and directing patients. Should the system work well then potentially it will ensure that children with minor ailments can have prompt diagnosis and treatment outside the A&E system and those urgent cases can be directed to the best and most prompt care.
The NHS 2012/13 Outcomes Framework cites a reduction in unplanned hospital admissions for children as a health improvement target, so hopefully action will be taken to reverse current trends.