JSNA topic report: children and young people
7. Hospital attendances and admissions
Accident & Emergency (A&E) attendances
A&E attendances in children aged under 5 years in Buckinghamshire are significantly below the England and South-East average but pre- COVID-19 pandemic were showing a significantly increasing trend from 2015/16 to 2019/20.
Figure 6: A&E attendances 2011/12 to 2020/21
|Year||DQ1 (least deprived)||DQ2||DQ3||DQ4||DQ5 (most deprived)||Buckinghamshire UA||England|
Compared to statistical neighbours, the rate of A&E attendances in 0 to 4 year olds in 2019/20 is significantly below Surrey and Hertfordshire and significantly higher than Windsor and Maidenhead and West Berkshire (Figure 7).
A&E attendances in children and young people aged 5 to 14 years and 15 to 24 years were also significantly below the England average but with significantly decreasing trends in the 5 years before the COVID-19 pandemic (2015/16 to 2019/20).
The highest rates of A&E attendances were in the most deprived quintile for all three age groups.
All Community Boards within Buckinghamshire saw a decrease in A&E attendances for all age groups in the 3 year period including the COVID-19 pandemic year (2018/19 to 2020/21). Pre- Covid-19 pandemic (2017/18 to 2019/20) there were significantly increasing trends in most community boards for under 5s but in all CYP age groups for Aylesbury and Wendover.
The emergency admission rate for under 5s and children aged 5 to 14 years in Buckinghamshire, before the COVID-19 pandemic, was significantly higher than the England and South-East average. This trend had been significantly increasing over the 5 years from 2015/16 (under 5s 177.6 per 1,000 population; 5-14 years 41.0 per 1,000) to 2019/20 (222.7 per 1,000;51.2 per 1,000).
The rate for under 5s was highest in the most deprived areas are shown in Figure 8b. Data for 2020/21 is showing a significant drop in attendances in line with the first year of the COVID-19 pandemic.
The high and increasing rates of emergency admissions in the under 5s is largely driven by high rates of lower respiratory tract infections but also high rates (smaller numbers) for gastroenteritis in Buckinghamshire compared to England.
Compared to statistical neighbours (view the Children's Services Statistical Neighbour Benchmarking Tool on GOV.UK) in 2019/20 the rate of emergency admissions in under 5s in Buckinghamshire was significantly higher than all areas (Figure 9) with most other areas significantly below the national average. Most are showing significantly increasing trends over the previous 5 years.
All Community Boards saw a decrease in emergency admissions in the under 5s in the 3 year period (2018/19 to 2020/21 combined) as it includes the COVID-19 pandemic year (which saw large decreases in admissions). In the 5-14 years olds, all Community Boards except for Wing & Ivinghoe saw a decrease in emergency admissions, and in the 15 to 24 year olds all except Chesham & Villages and Wendover saw decreases.
The rate of hospital admissions for self-harm in Buckinghamshire in children and young people aged 10 to 24 years (399.9 per 100,000 population) is similar to the national average (421.9 per 100,000) and significantly below the South East rate (505.6 per 100,000).
Over the 5 years in Buckinghamshire, from 2016/17 to 2020/21, the trend has shown an increase but this change is not significantly different.
For self-harm admissions there has been no significant difference in trends over the last 5 years in Buckinghamshire. This is similar to England, however, in the South East there is nationally and a significantly increasing trend.
However, in Buckinghamshire there has been a significant increase in admissions from 2019/20 to 2020/21, an increase from 265 to 360 admissions, whereas the rates nationally and in the SE have shown small decreases. The increase seen in Buckinghamshire is magnified by a decreasing trend seen between 2018/19 and 2019/20.
Figure 10: Self harm admissions (10-24 years) trend 2011/12 to 2020/21 Table Chart
|Year||Buckinghamshire||England||South East region|
In the pre-COVID-19 pandemic period (2014-16 to 2017-19), only Haddenham and Waddesdon Community Board was seeing an increasing trend in admissions for self-harm in the 10-24 year olds.
However, when the COVID-19 pandemic year is included (2018/19 to 2020/21 combined) only South West Chilterns saw a significant decrease in admission rates from the previous 3-year period.
The community boards with significantly higher (compared to Buckinghamshire average) rates of self-harm admissions in 2018/19 to 2020/21 were Amersham (678.3 per 100,000; 74 admissions) and Beeches (580.6 per 100,000 population; 64 admissions).
Eating disorders (under 25s)
Numbers of admissions for eating disorders are small and therefore it is helpful to look at the trend over several years. In the pre-COVID-19 pandemic period (2011/12 to 2019/20) in Buckinghamshire, and in England as a whole, there had been a significantly increasing trend in admissions for eating disorders in children and young people aged under 25 years.
There were also increases for both Buckinghamshire and England between 2019/20 and 2020/21. The admissions rates in Buckinghamshire have been higher than England since 2014/15.
Figure 11: Admissions for eating disorders, under 25 years
Source: Hospital Episode Statistics, Buckinghamshire Public Health Intelligence Team.
Referrals for eating disorders
Waiting time data from NHS England shows there has not been much change in the number of urgent cases for children and young people in Buckinghamshire with eating disorders starting treatment over the last four years.
For routine cases, the numbers starting treatment have been increasing (from 93 in 2018/19 to 165 in 2021/22) over the COVID-19 pandemic years and coinciding with this the proportion starting treatment within 4 weeks has reduced (33% in 2021/22 compared to 80.6% in 2018/19).