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Long-term conditions in children

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Introduction

Long term conditions in children can manifest in a variety of ways, but this section will focus primarily on childhood diabetes (type 1), asthma and epilepsy. Providing effective care for these conditions will lead to better patient care and a reduction in preventable emergency admission, which are costly and expose patients to otherwise avoidable clinical risks such as healthcare associated infections. The importance of reducing emergency admissions is recognised by the inclusion of an indicator measuring this patient outcome in the quality premium, the better care fund and it is one of the outcome measures against which Clinical Commissioning Groups (CCGs) are required to set ambitions1.

    • Type 1 diabetes is an autoimmune condition resulting in 'insulin dependence' as the person's pancreas fails to produce any insulin to control blood glucose levels, and therefore requires insulin injections for life. The majority of children have type 1 diabetes, though a minority does have type 2 diabetes. 23,000 children and young people have diabetes in England, around 209 per 100,000 children aged 0-172.
    • Asthma is a long term condition which causes breathlessness, wheezing and coughing. The severity of the symptoms varies from person to person from mild to severe. Triggers include smoking, pollen, damp housing, cold air and exercise. For children diagnosed with asthma, the condition may disappear or improve during the teenage years, although it can return later in life. Moderate or severe childhood asthma is more likely to persist or return later on. The Health Survey for England 2010 reports that 17% of boys and 12% of girls suffer from lifetime diagnosed asthma. 11% of boys and 8% of girls suffer with current asthma, that is, symptoms in the last 12 months or symptoms controlled by medication for asthma in the last 12 months.
    • Epilepsy is a condition diagnosed in those who have had more than one epileptic seizure. An epileptic seizure is when a sudden burst of electrical energy in the brain causes a temporary sensory overload in the brain. Approximately 63,400 children (1 in 220) aged 18 and under in the UK have a diagnosis of epilepsy along with a current prescription of anti-epileptic drugs3.

Facts, figures and trends

    • The estimated number of children aged 0-17 with type 1 diabetes in Blackpool is 544.
    • 47% of children with type 1 diabetes in Blackpool are overweight or obese, this compares with 44% nationally5.
    • There are an estimated 2,300 children aged 0-15 with doctor-diagnosed asthma in Blackpool6.
    • Blackpool has an estimated 139 children aged 0-18 with diagnosed epilepsy7.

The Royal College of Paediatrics and Child Health undertook a survey in 2009 to identify the total number of children and young people, aged less than 18 years, with diabetes. The Diabetes Community Health Profile for Children and Young People provides a snapshot of the number of children and young people being treated for diabetes at Blackpool's hospital.

Nationally, asthma, diabetes and epilepsy account for approximately 94% of emergency hospital admissions for children (under 19 years) with long-term conditions. Figure 1 shows the overall trend in admissions for asthma, diabetes and epilepsy in young people aged under 19 in Blackpool compared to England, figure 2 compares Blackpool with all other CCGs in the country. 

Figure 1: Trend in unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s, directly standardised rate (DSR) per 100,000 registered patients

Figure 1: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s, directly standardised rate (DSR) per 100,000 registered patients
Source: HSCIC Indicator Portal, CCG Outcomes Indicator Set

Figure 2: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s, directly standardised rate (DSR) per 100,000 registered patients - Blackpool compared to CCGs in England: 2013/14

Figure 2: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s, directly standardised rate (DSR) per 100,000 registered patients
Source: PHE, Children and Young People's Health Benchmarking Tool
 
    • There were 178 unplanned hospital admissions for asthma, diabetes and epilepsy in under 19s in Blackpool in 2014/15
    • This is a rate of 518 per 100,000 population, significantly higher than the national rate of 311 per 100,000
    • Contrary to the trend nationally, Blackpool has shown an increase in admissions for asthma, diabetes and epilepsy since 2010/11
    • Blackpool ranks 12th highest out of 209 CCGs in the country for unplanned hospital admissions for asthma, diabetes and epilepsy in under 19s

When looking at the admissions by specific cause, asthma accounts for more than half (55%) of the unplanned admissions for these three conditions, epilepsy for 26% and diabetes for 19%. Figure 3 shows admission rates in 2013/14 for each specific condition were all significantly higher in Blackpool when compared to the national average.

Figure 3: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s by specific condition, directly standardised rate (DSR) per 100,000 registered patients: 2013/14

Figure 3: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s by specific condition
Source: PHE, National Child and Maternal Health Intelligence Network, Disease Management Information Tool

The National Child and Maternal Health Intelligence Network Disease Management Information Toolkit provides more detailed information about emergency hospital admissions for children with asthma, diabetes or epilepsy and subsequent time spent in hospital. Figures 4-6 show trends in emergency admissions, average length of stay and average bed days for the three conditions comparing Blackpool to England.

    • The average length of stay in hospital for asthma in 2013/14 was 1.2 days, the same as the national average.
    • Hospital length of stay for both diabetes and epilepsy in Blackpool were below national averages; 1.5 days for diabetes and 0.8 days for epilepsy.
    • Although admissions for epilepsy have been significantly higher than average, the number of bed days and average length of stay have been consistently lower than the national trend.
    • For all three conditions, there seems to be scope for increasing compliance with medication and for the avoidance of asthma triggers such as cigarette smoke or damp housing.

Figure 4: Asthma emergency admissions in under 19s, Blackpool compared to England

LTC-in-children-Asthma-Fig4
Source: PHE, National Child and Maternal Health Intelligence Network, Disease Management Information Tool

Figure 5: Diabetes emergency admissions in under 19s, Blackpool compared to England

LTC-in-children-Diabetes-Fig5
Source: PHE, National Child and Maternal Health Intelligence Network, Disease Management Information Tool

Figure 6: Epilepsy emergency admissions in under 19s, Blackpool compared to England

LTC-in-children-Epilepsy-Fig6
Source: PHE, National Child and Maternal Health Intelligence Network, Disease Management Information Tool

Risks

    • Children in higher levels of deprivation are more likely to develop a long term condition
    • Children and young people who have a long-term condition can be at risk of missing out on educational opportunities due to prolonged absences from school, from ill health or multiple appointments
    • Asthma is more common in males in childhood8
    • The incidence of epilepsy is high among very young children aged under 53
    • There is a significant relationship between deprivation and child emergency hospital admissions for both asthma and epilepsy across England: as deprivation increases, admission rates increase9
    • There are increased risks for asthma, asthma development, wheezing and respiratory infections for people living in damp houses10 and Blackpool has high levels of substandard housing in poor repair. (LInk to housing JSNA section)
    • Concerning trends have been identified in prevalence of obesity in children with Type1 diabetes as they reach adolescence5
    • Blackpool has significantly higher proportions of children who are overweight or obese than the national average

National and local strategies

The ChiMat Improving Services Toolkit: children with long-term conditions is aimed at commissioners and service managers who are aiming to redesign services for children with long-term conditions. It provides evidence and data which can be used to help develop strategies and business cases.

NICE guidance on Diabetes covers the diagnosis and management of type 1 and type 2 diabetes in children and young people aged under 18.

NICE guidance on Asthma covers the diagnosis and treatment of asthma in adults, young people and children aged 12 months and older.

NICE guidance on Epilepsy covers the diagnosis and management of the epilepsies in children and young people aged up to 18 years.

Services

The Paediatric Epilepsy Team at Blackpool Victoria Hospital works with children and young people who have epilepsy, and their families to make sure that they can stay safe and healthy. They visit children and young people at home and also keep in touch over the phone.

The Paediatric Diabetes Team at Blackpool Victoria Hospital looks after all children and young people who have been diagnosed with diabetes. They support, encourage and teach these children and young people and their families about how to look after themselves and their diabetes.

Recommendations for consideration

    • Establishing further information about the prevalence of children with disabilities, complex health needs and long term conditions.
    • Ensuring that parents and carers are able to access services for their children.
    • Support families and children with long term conditions so that they are able to enjoy and to achieve fully in their lives and to make a positive contribution.
    • Improved data and intelligence for key long term conditions; asthma, diabetes, epilepsy, neurological and congenital conditions to support delivery of high quality services

 


[1] NHS Outcomes Framework - Domain 2: Enhancing quality of life for people with long-term conditions. Improvement area - Reducing time spent in hospital by people with long-term conditions

[2] RCPCH (2009). Growing up with Diabetes: children and young people with diabetes

[3] Joint Epilepsy Council of the UK and Ireland, Epilepsy prevalence, incidence and other statistics, September 2011

[4] Modelled estimate based on PHE Children and Young People Diabetes Profile prevalence rates

[5] RCPCH (2015) National Paediatric Diabetes Audit Report 2013-14

[6] Modelled estimate based on Health Survey for England 2010, Chapter 4 Respiratory symptoms and asthma in children

[7] Modelled estimate based on Joint Epilepsy Council prevalence rates

[8] HSCIC, Health Survey for England - 2010, Respiratory health

[9] PHE, ChiMat briefing, Children with long-term conditions in the North West: Emergency hospital admissions for asthma, diabetes and epilepsy 2008/09 (March 2011)

[10] Fisk W.J., Eliseeva E.A., Mendell M.J. (2010): Association of residential dampness and mold with respiratory tract infections and bronchitis: a meta analysis. Environmental Health 9:72