The Archives of Disease in Childhood has reported a 28% increase in emergency admissions of children under 15 to English hospitals over the past decade. Since 2003 there has been a continuous year-on-year rise in admissions of children suffering from minor conditions, such as respiratory tract infections and gastroenteritis. At the same time, admission rates for chronic conditions have actually fallen by 5.6%. When you consider that many minor conditions could be better managed in the community - and that admitting children with minor ailments could unnecessarily expose them to more serious risks such as hospital-acquired-infections like MRSA - this increase seems both strange and unnecessary.
Who is to blame?
The study doesn’t provide a single definitive reason for this rise, but 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. Only 10% of GPs now perform this service, and the onus has shifted to the (defunct as of today) NHS Primary Care Trusts, who contracted services out to several different providers. These reforms were undertaken in the name of efficiency, but have seemingly had a detrimental effect on patient care. Other suggested causes include an incentive to admit early in order to meet the government’s 4 hour A&E waiting time target, and an increasing reluctance on behalf of parents to tolerate uncertainty when it comes to their child’s health.
The authors of the report conclude that this continuing increase is indicative not of a single problem that can be easily fixed, but a systematic failure across the NHS, from GPs, out-of-hours care providers and NHS Direct to A&E departments and paediatricians. These concerns are shared by the President of the Royal College of Paediatrics and Child Health, Dr Hilary Cass, who commented: “These latest statistics further serve to highlight that the way hospital services are currently arranged means we're in danger of not providing children with the highest possible standard of healthcare when they fall ill. The health service is coming under increasing pressure and demand, so it's more important than ever that we look to settings outside of the hospital to address this.”
One could argue that being cautious and admitting children to hospital early is no bad thing; however, if paediatric resources for chronic conditions are depleted by an upsurge in potentially unnecessary admissions for minor ailments, there is a real risk of failings in chronic care which, in turn, will lead to avoidable injuries being inflicted on children. Negligent hospital treatment accounts for a significant proportion of clinical negligence claims and, if no action is taken, this will only increase. The report recommends further study of the root causes of the problem, and an evidence-based, wholesale restructuring of the way acute paediatric care is delivered.
In tandem with the substantial changes that are currently being recommended within the NHS, the structure of paediatric healthcare provision will also need attention if we want to reduce the possibility of children becoming victims of negligent medical treatment. 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.