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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 admissions, 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 the NHS and 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. In 2019, there were an estimated 36,000 children and young people aged under 19 in the UK with diabetes, up from 31,500 in 2015. The majority (90%) of children have type 1 diabetes2.
    • 1,560 children and young people under 18 in the UK were living with type 2 diabetes in 2019/203.
    • 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 UK has one of the highest prevalence, emergency admissions  and death rates for childhood asthma in Europe. Around 1 in 11 children and young people in the UK are estimated to be living with asthma, and around 1 million children are receiving treatment for the condition.
    • 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 drugs4.

Facts, figures and trends

    • The estimated number of children aged 0-17 with type 1 diabetes in Blackpool is 665.
    • There are an estimated 2,650 children and young people aged under 18 living with doctor-diagnosed asthma in Blackpool6.
    • Blackpool has an estimated 121 children aged under 18 with diagnosed epilepsy7.

Nationally, asthma, diabetes and epilepsy account for approximately 94% of emergency hospital admissions for children (under 19 years) with long-term conditions. Between 2008/09 and 2019/20 national rates for 0-19 emergency admissions remained generally stable, with the exception of asthma admissions for 0-4 year olds (thought to be mainly due to improved coding by clinicians8). 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

CCG ADE trend
Source: NHS Digital, CCG Outcomes Indicator Set (CCGOIS Indicator 2.7)

Figure 2: Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s, directly standardised rate (DSR) per 100,000 registered patients - NHS Blackpool CCG compared to CCGs in England: 2019/20

CCG ADE comparison
Source: NHS Digital, CCG Outcomes Indicator Set (CCGOIS Indicator 2.7)
 
    • There were approximately 150 unplanned hospital admissions for asthma, diabetes and epilepsy in under 19s in NHS Blackpool CCG in 2019/20
    • This is a rate of 417 per 100,000 population, 30% lower than the 2015/16 peak of 595 but significantly higher than the national rate of 267 per 100,000
    • Blackpool ranks 11th highest out of 191 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 (60%) of the unplanned admissions for these three conditions, epilepsy for 30% and diabetes for 10%. Figure 3 shows admission rates in 2019/20 for asthma and epilepsy were both significantly higher in Blackpool compared to the national average, whilst admission rates for diabetes were similar to the national average.

Figure 3: Unplanned hospitalisations for asthma, diabetes and epilepsy in under 19s by specific condition, crude rate per 100,000 registered patients: NHS Blackpool CCG and England, 2019/20

CCG ADE breakdown
Source: NHS Digital, Hospital Episode Statistics, 2021

Figure 4 shows the trend for asthma, diabetes and epilepsy emergency admission rates for the NHS CCG Blackpool and England. Admission rates for asthma have fallen for the last three years, from a high of 406 per 100,000 in 2016/17. Rates for both diabetes and epilepsy fluctuated between 2013/14 and 2019/20 (being sensitive to relatively small numbers), though emergency admissions for all three conditions show a reduction between 2018/19 and 2019/20.

Figure 4: Unplanned hospitalisations for asthma, diabetes and epilepsy in under 19s by specific condition, crude rate per 100,000 registered patients: NHS Blackpool CCG and England, 2013/14 to 2019/20CCG ADE All 3 trends
 Source: NHS Digital, Hospital Episode Statistics, 2021

Whilst NHS Blackpool CCG admission rates for epilepsy among children aged 10 to 18 in 2019/20 are similar to the national average, admissions for children aged 0 to 9 have been significantly higher than the England average since 2017/18, with a rate of 188.1 per 100,000, compared to 95.1 per 100,000 across England. This is the 5th highest rate among CCGs in the country.

For asthma this patterns reverses: NHS Blackpool CCG 2019/20 admission rates for children aged 0 to 9 years are similar to the national average having been significantly higher between 2016/17 and 2018/19.  However, admissions for those aged 10 to 18 are significantly higher at 275.4 per 100,000 compared to 119 per 100,000 across England. This is the second highest rate in England. 

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
    • In early childhood, asthma is more common in boys than in girls9
    • There is a significant relationship between deprivation and child emergency hospital admissions for both asthma and epilepsy across England: as deprivation increases, admission rates increase
    • 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.
    • Concerning trends have been identified in prevalence of obesity in children with Type1 diabetes as they reach adolescence
    • Blackpool has significantly higher proportions of children who are overweight or obese than the national average

National and local strategies

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 range of epilepsy in children and young people aged up to 18 years.

The Royal College of Paediatrics and Child Health (RCPCH) report State of Child Health in the UK (2020) provides evidence about long-term conditions affecting children and young people across the UK.

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] Royal College of Paediatrics and Child Health (2020) State of Child Health. London: RCPCH. [Available at: stateofchildhealth.rcpch.ac.uk]

[3] NHS Digital National Diabetes Audit: Young People with Type 2 Diabetes, 2019-20

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

[5] Modelled estimate based on RCPCH National Paediatric Diabetes Audit 2019/20 prevalence estimates.

[6] Modelled estimate based on RCPCH State of Child Health (2020) and Asthma UK national prevalence data.

[7] Modelled estimate based on Joint Epilepsy Council (2011) and Epilepsy Action prevalence estimates.

[8] Nuffield Trust (2021) Emergency admissions for children with chronic conditions.

[9] NICE (2021) What is the prevalence of asthma?

[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