The number of children admitted to intensive care in England has risen sharply since 2009, putting additional pressure on already overstretched health services, researchers have warned.
A study of admissions to paediatric intensive care units in England found a nearly 15% increase from 2004 to 2013, with a larger than expected rise against population growth from 2009 onwards. In Wales there was a more than 2% rise over the period studied.
But the authors of the research said it was unclear what is behind the surge in numbers. However, they noted that migration and better survival rates for those born prematurely could be a factor.
The spike seen from 2009 onwards also correlates with cuts to public healthcare spending, the researchers say. “From 2004 to 2009, public healthcare spending in the UK increased by 8.3% per annum; however from 2009 onwards, it grew at just 1.9%,” they write.
Admission rates were higher in areas of England with high numbers of mothers born outside the UK, particularly those from eastern Europe. This includes the South Central region, for example, where there was a 43% rise over the period studied, and London, which saw an increase of nearly 31%.
“We wanted to investigate why there was a rise in admissions and to see if it was due to an increased birth rate or other factors. Following analysis, only a proportion of the rise was due to birth rate; we think the additional increase over what would be expected could possibly be due partly to migration into England, and the problems associated with newly-migrated populations into a new country,” said one of the authors, Prof Elizabeth Draper of the University of Leicester.
She added: “Another factor is that increasing numbers of critically ill children are surviving pre-term birth and other major illness who may not have survived in the past.”
Dr Peter Davis, consultant in paediatric intensive care at Bristol Royal Hospital for Children, said: “What is changing is probably the nature of and type of patients admitted. They tend to have conditions that are more complex and chronic. That won’t change, as parental expectations now are that there should be more done for children than in the past. People are offered all sorts of treatment and packages and surviving longer.”
Writing in the journal Archives of Disease in Childhood, Draper and colleagues said that whatever the reason for the rise, it looks set to continue. “Increasing numbers of critically ill children requiring paediatric intensive care in England and Wales will prove challenging both for [these] services and commissioners, as increased demand potentially outstrips resource,” they conclude.
Researchers at the University of Leicester and the paediatric intensive care unit at Bristol Royal Hospital for Children analysed admissions data from the Paediatric Intensive Care Audit Network along with population data, including births, comparing predicted admission numbers with the actual figures.
The paper found admission rates were slightly higher among boys than girls and were also higher among children of South Asian ethnicity.
The steepest rises were among younger children up to the age of five and those with breathing or cardiovascular problems. Infants under one made up almost half the total annual admissions.
Davis said: “NHS England has a review ongoing at the moment looking at what they are doing in paediatric intensive care and paediatric surgical care. Within that they are looking at issues of where children are cared for.”
“We need to look at investing into making sure that we have we got the right number of beds in the right places to support these children. We know in winter intensive care beds get very tight … The concern within the profession is whether the review will mean more investment or just the same funding distributed differently.”
