The number of infants admitted to hospital for emergency care for conditions such as asthma, bronchitis and jaundice has risen sharply in the past decade.
More young children are also ending up spending time in hospital being treated for tonsillitis, breathing problems, drug poisonings and infections, new NHS figures show.
Experts behind the report into children’s care are demanding that the NHS overhauls services inside and outside hospital to provide better care and avoid young people adding to the pressures on hospitals by spending time unnecessarily as an inpatient.
They have raised concerns about a number of weaknesses they have identified in NHS care of children and young people, including a lack of knowledge among GPs, poor mental health services and paediatricians spending too little time helping patients in community-based settings. Problems with the quality of care children receive helps explain why some need to be admitted in the first place and, in some cases, have to be readmitted soon after their hospital stay.
“We have identified a number of areas of concern, which highlight potential inadequacies in the level of care and support this group is receiving outside the emergency hospital setting”, said co-authors Ellis Keeble and Lucia Kossarova, who work at the Nuffield Trust thinktank.
They undertook the research, alongside the Health Foundation thinktank, by examining official NHS hospital episodes statistics records for admissions to hospital in England by newborns up to those aged 24 between 2006-07 and 2015-16.
Emergency hospital admissions for all under-25s grew during the decade from 990,903 in 2006-07 to 1,124,863 in 2015-16 – a rise of 14%. However, that was lower than the 20% increase in emergency admissions among the population as a whole over that time.
But they learned that there had been a 30% jump in the number of infants having to be admitted and a 28% rise among those aged one to four. The “concerning” spikes in those younger age groups raised inevitable questions about the availability and quality of maternity and community services, the researchers said.
“The number of infants, children and young people using emergency departments continues to increase – with 30% more emergency admissions for under ones and 28% more for one- to four-year-olds than 10 years ago. This is placing huge pressure on a service already under strain,” said Dr John Criddle, a spokesman for the Royal College of Paediatrics and Child Health.
The number of admissions among infants for jaundice more than doubled from 8,186 to 16,491 per year and cases of acute bronchitis rose 88% from 21,235 to 39,122.
Spells in hospital for “other perinatal conditions”, which includes digestive problems and feeding trouble in babies, also increased sharply, from 14,293 to 24,848. Upper respiratory infections except asthma rose from 17,357 to 20,940; viral infections rose by 116% from 12,730 to 16,826.
Tens of thousands of emergency admissions a year in the nought to 24-year-old range as a whole – each of which costs the NHS about £400 a night – could be avoided with better management and treatment, the report concludes. Four-fifths of the 37,549 admissions seen in 2015-16 for acute and chronic tonsilitis could have been prevented, as could “a proportion” of the 27,727 inpatient stays for epilepsy and 27,325 admissions for asthma, the authors said.
Emergency readmissions rose 12% over the decade, including 17% among 15- to 19-year-olds. “Perhaps most worryingly, compared to other conditions the analysis revealed a larger rise in emergency readmissions following emergency admission for acute and chronic tonsilitis (27%) and poisoning by other medications and drugs (25%) for children and young people”.
Dr Bob Klaber, a paediatrician at St Mary’s hospital in London, said: “There is no one medical explanation for why 30% more young children are now being admitted to hospital than before. So there must be something about how we are supporting these families and a lack of support for mums with newborns who are socially isolated.
“From my experience, the fragmentation of our health and social care system, including antenatal support and help in the child’s first five years of life, has made things really difficult for parents with new babies and young children, and so too often our hospitals become the default place for them to attend.”
A lack of focus on developing joined-up preventative care plans may help explain the growth in admissions for asthma and it could be that the NHS has made the eligibility criteria for children having their tonsils removed too tight so that some with recurrent tonsil problems end up needing hospital care, according to Klaber.
He urged paediatricians to work more closely with GPs, health visitors, school nurses and other primary care health professionals in their area so they can help them identify and manage illness in children.
Klaber said a scheme in which children’s doctors from St Mary’s did that with seven “hubs” showed that approach worked. “As well as extremely positive patient and staff experience, our published evaluation of the first full hub showed that 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice,” he said.
“In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions to hospital and a 22% decrease in A&E attenders.”
Rise in hospital admissions for infants triggers call for NHS overhaul
Hiç yorum yok:
Yorum Gönder