Recovery JSNA: Children and young people
The coronavirus pandemic has disrupted the life of every child, young person and family in the country. Although medical literature shows that children are minimally susceptible to 2019-Corona Virus disease (COVID-19), they have undoubtedly been among those hit the hardest by the psychosocial impact of this pandemic. Being quarantined in homes and institutions may impose greater psychological burden than the physical sufferings caused by the virus. School closure, lack of outdoor activity, abnormal dietary and sleeping habits are likely to have disrupted children's usual lifestyle and can potentially promote poor health.
While it is easy to identify the negative impacts of the pandemic response on children this section of the JSNA looks at the wider impacts in particular:
Admission and attendance at hospital
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Background
Child poverty
The coronavirus pandemic has disrupted the life of every child and their family in the country. Families with children have been among the hardest hit, with job losses and increased costs of living from children being off school causing many families to struggle financially.
Even before the pandemic hit, there were 4.2 million children living in poverty in the UK.
Growing up in poverty restricts a young person’s life chances, affecting their well-being, educational attainment and future life chances. The coronavirus crisis has no doubt exacerbated these impacts of child poverty.
Government, schools and local communities have had to be agile to try and respond to the ever changing needs of children and families through the pandemic. The crisis has shone a light on and exacerbated issues known to underpin child poverty such as financial instability for families; food insecurity; challenges accessing learning; access to suitable accommodation and highlighted new emerging issues such as the digital divide.
Index of Deprivation Affecting Children Indicator (IDACI)
The IDACI is part of the Index of Multiple Deprivation.
It indicates around 10% of children age 0-15 in Wiltshire are living in income deprived families. This lower than that seen in England and the South West.
Free School Meals uptake
Within Wiltshire in 2018 around 8% of Primary school and 6% of Secondary school pupils in state funded schools claimed the free school meals that they were eligible for.
This is a substantially lower proportion of children than in the South West or England.
Free School Meals eligiblity
The number of pupils eligible for Free School Meals has increased during 2020, and this was already increasing prior to the pandemic. In Wiltshire, Free School Meals eligibility increased from 9.3% in Spring term of 2018/19, to 10.9% in 2019/20. This has now increased to 12.3% in Autumn term of 2020/21, showing a higher increase than seen previously.
Source: Free school meals: Autumn term, GOV.uk, extracted 02/07/2021
Clinically Extremely Vulnerable Children
In April 2020 NHS England developed a methodology for identifying patients who were clinically extremely vulnerable should they catch COVID-19.
There are 4 main groups of patients:
– Transplant patients
– Specific Cancer patients
– Rare Disease patients at higher risk of infections
– GP Managed (Elderly, COPD, Diabetic, CVD & Other)
In Wiltshire there were 345 children age 0-17 that were classed as clinically extremely vulnerable.
These patients were asked to shield during the 1st and 3rd National Lockdowns to protect them being infected.
Children in care
In 2020 there were 460 children in Care in Wiltshire. This is around 40 per 10,000 children. This is a substantially lower rate of children than in the South West or England.
Within Wiltshire the trend has been broadly flat while in England and the South West there appears to be a slow increase in the rate.
Teenage mothers
In 2019-20 there were 25 deliveries to mothers aged 12-17 in Wiltshire. This is around 0.5% of all deliveries in Wiltshire. This is a broadly similar to percentage in the South West or England.
2019-20 saw the number of deliveries in those aged 12-17 more than double from the low seen in 2018-19 and maybe an exception in the otherwise rapidly decreasing trend.
Immunisation Cover Statistics
While infant immunisations have continued through primary care, uptake was reportedly down, with early data suggesting that measles, mumps and rubella (MMR) vaccinations in England fell by nearly 20% during early lockdown compared with previous years.
School-aged programmes were ceased as per national guidance, again prompting concern, particularly for children in marginalised groups with historically low vaccine uptake.
An example of successful innovation in this arena is the Derbyshire Community Health Services’ drive-through human papillomavirus (HPV) immunisation clinics, set up to replace school-based clinics from May 2020.
Trend in Population Coverage – Dtap / IPV / Hib at 1 yrs
Around 97% of infants in Wiltshire received their first immunisation by their 1st birthday.
This is higher than the average in England and the South West.
Wiltshire has seen an increasing trend for the last few years while England and the South West saw decreasing trends with the exception of 2019-20.
Trend in Population Coverage – HIB & MEN-C Booster at 2 yrs
Around 95% of infants in Wiltshire received their HIB & MEN-C Booster by their 2nd birthday.
This is higher than the average in England and the South West.
Wiltshire has seen an increasing trend for the last few years while England has seen a decreasing trend and the South West has remained constant.
Trend in Population Coverage – MMR 2 Doses at 5 yrs
Around 92% of children in Wiltshire received 2 doses of the MMR vaccine by their 5th birthday.
This is higher than the average in England and slightly higher than the South West.
Wiltshire has seen an increasing trend for the last 3 years while England has seen a decreasing trend and the South West has been increasing gradually.
Initial 2020-21 (Q1 & Q2) Population Coverage Statistics
Around 92% of children in Wiltshire received 2 doses of the MMR vaccine by their 5th birthday.
This is higher than the average in England and slightly higher than the South West.
Wiltshire has seen an increasing trend for the last 3 years while England has seen a decreasing trend and the South West has been increasing gradually.
Population Coverage – Child Flu Vaccination
In 2020-21 the Childhood Flu vaccination programme was extended to cover pupils in Year 7 of high School.
In Wiltshire just over 32,000 children (70.5%) of eligible children were vaccinated. This is slightly higher than 2019-20 (69.3%).
Uptake in Wiltshire is generally higher than that seen in England or the South West.
Admissions and attendance at hospital
While representative data on the scale and impact of diversion of care for children is lacking, there is some evidence about children presenting late for acute illnesses. In a recent survey of UK A&E paediatricians, a third reported witnessing delayed presentations, particularly for new diagnoses of diabetes mellitus, diabetic ketoacidosis and sepsis, and 18% reported delays.
Trend in attendances at accident and emergency
There were just under 30,000 attendances at A&E for children aged 0-17 in Wiltshire in 2018-19. That gives a rate per 100,000 population of around 280 which is lower than the rate in England and the South West.
Wiltshire has seen a reducing trend in the last few years while the trend in England and the South West has been slowly increasing.
Trend in emergency admissions
There were just over 6,800 emergency admissions for children aged 0-17 in Wiltshire in 2018-19. That gives a rate per 100,000 population of around 65 which is lower than the rate in England and the South West.
Wiltshire saw a reduction in the rates of admissions in 2015-16 which has been sustained as the rate has remained broadly similar since then.
Trend in admissions for asthma
In 2018-19 there were 110 admissions for Asthma in Wiltshire Children, 75 in those under 10 and 35 in those aged 10-17. The admission rate in both age groups is lower than the England and South West average. In the younger cohort in Wiltshire rates had been decreasing but increased in the last year, while in the older cohort rates were increasing but decreased in the last couple of years.
Provisional 2020-21 asthma admissions
In 2019-20 there were an average of around 8.5 admissions per month with a primary diagnosis of Asthma. In the first 10 months of 2020-21 the average has fallen to around 6 per month.
Source: Local Hospital Episode Statistics (HES) data, extracted 14th May 2021 .
Childhood mortality
In England and Wales in 2020 there were a total of 20 deaths registered with COVID-19 as the cause or a complicating factor in the death in people aged under 20. This is around 0.5% of the total number of deaths in this age group.
Trend in childhood mortality rate (Age 1-17)
In 2017-19 there were 33 childhood deaths, giving a rate of around 11 per 100,000 population. This is similar to the England average and higher than the South West.
Wiltshire has seen a reducing trend but there was a sharp increase in 2017-19. The trend in England and the South West has been slowly decreasing.
Provisional data for 2018-20 shows 36 childhood deaths giving a rate of around 12 per 100,000 population.
Childhood mental health and self harm
Children are generally more resilient to change than adults tend to perceive. Studies with children and their parents suggest there have been increases in young people’s levels of anxiety, in emotional, behaviour and attention difficulties among primary aged children and in attention difficulties among secondary aged children. While these rises were reported by parents, adolescents in the same study themselves reported no statistically significant changes in emotional, behavioural and attention difficulties.
In terms of children’s well-being, studies have highlighted feelings of loneliness and lower wellbeing scores. A poll conducted for Barnardo’s by YouGOV reported a rise in issues related to mental health and wellbeing for at least one in three of the participating 4,000 children and young people. Over two-thirds said that not seeing their friends was one of the three hardest things about lockdown.
The emerging data shows a picture which can be related to adverse childhood experiences and elevated risk of toxic stress.
Children with probable mental health condition
NHS Digital commissioned a survey in Children and Young People exploring the mental health of children and young people in July 2020, during the pandemic and changes since 2017.
Rates of probable mental disorders have increased since 2017, as has the likelihood of a probable mental disorder with a noticeable difference in gender for this 17 to 22 years young women have seen the biggest increase in the likelihood of a probably mental health disorder.
Trend in admissions for mental health conditions (Age 1-17)
In 2019-20 there were 90 admissions to hospital for mental health conditions for children and young people aged 0-17.
The rate of these admission has fallen slightly in Wiltshire in the last couple of years while in England and the South West the rates have been rising.
Trend in percentage of school age children with social, emotional or mental health needs
In 2020 just over 1,800 pupils in school in Wiltshire had social, emotional or mental health need, this is around 2.5% of the school age population. This is lower than the South West but broadly similar to the England average.
The 2020 numbers represents an increase of over a quarter on the number of pupils in 2015 (1,400) as the school age population has remained broadly similar this explains the growth in the percentage.
Provisional 2020-21 admission for mental health conditions
In 2019-20 the average number of admissions for Mental Health conditions was around 6 per month in those aged 0-17.
In the first 10 months of 2020-21 the average number of admissions for mental health conditions has increased to over 8 per month. There is a noticeable increase in admissions in August & September when in 2019-20 these were the lowest months for admissions.
Source: Local Hospital Episode Statistics (HES) data, extracted 14th May 2021
Trend in admissions for self harm (Age 10-24)
In 2019-20 there were 520 admissions to hospital for self harm in children and young people aged 10-24.
The rate of these admission in Wiltshire continues to increase slightly which mirrors the South West average. In England the rate is substantially lower and has remained broadly similar for the last 5 years.
Provisional 2020-21 admission for self harm
In 2019-20 the average number of admissions per month in those aged 10-24 for self harm was around 43. In the first 10 months of 2020-21 the monthly average number of admissions as increased to around 50.
Both October and November 2021 stand-out as the months with over 70 admissions in both months, while in 2019-20 these months were closer to the average for the year.
Source: Local Hospital Episode Statistics (HES) data, extracted 14th May 2021
Early maternal health and wellbeing
The birth of a child is a critical and potentially stressful experience for women, entailing several changes both at the individual and interpersonal level. This event can lead to different forms of distress, ranging in intensity and duration. Many studies highlight medical, psychological, and social variables as risk factors potentially influencing the onset or aggravation of perinatal maternal conditions. The COVID-19 pandemic and the measures adopted by government to prevent the spread of infection may negatively affect mothers-to-be and new mothers a high frequency of maternal mental health problems have been reported potentially increasing the likelihood of anxiety, depressive or post-traumatic symptoms to develop with likely limitations on the access to professional services to support them.
Surveys have shown that some parents struggled enormously and described feeling abandoned or falling through the cracks, while others thrived. Some services were badly affected, others stepped up and did more than ever. Many families with lower incomes, from Black, Asian and minority ethnic communities and young parents have been hit harder by the COVID-19 pandemic. This is likely to impact inequalities in the early experiences and life chances of children. For those parents who have experienced overwhelming stress, with little social support/ support from family, friends and/or local services, the pandemic may cast a long shadow both in terms of their child’s early development and their own health and wellbeing. This, however, is not inevitable with the right support in place.
The first 2 years of a child’s life, from pregnancy to age two, lay the foundations for a happy and healthy life. The support and wellbeing of babies during this time is strongly linked to better outcomes later in life, including educational achievement, progress at work and physical and mental health. For generations, no other group of parents has had to navigate pregnancy, birth and beyond under such extraordinary circumstances.
Source: The Babies in Lockdown Report, bestbeginnings.org.uk, 2020 .
Impact on schools
As part of the pandemic response schools were closed to pupils, except for vulnerable children and key worker children, during the first and third national lockdowns. For those not attending, schools were asked to provide remote learning for children and national assessments were cancelled.
The closure of schools has impacted on the learning of children, and assessments at the start of school in September suggest some children have maintained learning but other have fallen behind. The Government is providing additional funding to support schools and pupils catch up. Surveys of schools suggest:
– Progress most disrupted for Year 1 pupils.
– Mathematics was the most affected subject.
– More pronounced drop for disadvantaged pupils.
– Sharp drops in attainment for Year 1 children with SEND in writing and maths.
– Younger children have recovered more slowly, as have disadvantaged and SEND pupils.
– Year 6 most resilient cohort.
In addition the closure of schools impacted on the collection of the National Childhood Measurement Programme (NCMP) which has resulted in few pupils being measured in schools particularly those in Reception in Wiltshire.
Children achieving a good level of development at the end of Reception
Children age 4 start school in their reception year. At the end of this year a teacher assessment of the pupils who have a good level of development is recorded to support learning in future years of primary school.
In Wiltshire just over 70% of pupils achieved a good level of development which is broadly similar to the South West and England.
Children with free school meal status achieving a good level of development at the end of Reception
In comparison to the 70% of all children that achieved a good level of development in Wiltshire, less than 50% of children with free school meal status achieved this. This is also lower than South West (53%) and England (56.5%).
Children achieving at least the expected level in communication and language skills
For children to have achieved at least the expected level means that they achieved ‘expected’ or ‘exceeded’ levels of development within all three communication and language early learning goals (listening and attention, understanding, speaking).
72% of children eligible for free school meals achieved the expected level of communication and language skills in Wiltshire, in comparison to 87% of children not eligible.
KS2 meeting the expected standard in reading, writing and maths
In Year 6 at the completion of primary school pupils would sit national tests to measure if they meet the expected standard in Reading, Writing and Maths.
The percentage of pupils meeting the standard in all 3 subjects has been increasing. Wiltshire is broadly similar to the South West and England.
Average 8 attainment score
Attainment 8 measures the achievement of a secondary school pupil at the end of Key Stage 4 across 8 qualifications including English, Math, Sciences and Humanities.
The average score in Wiltshire is broadly similar to that in the South West and England. Scores in 2019-20 will be based on teacher assessment following the cancellation of national assessments.
Overweight - Reception
The NCMP measures the height and weight of children in Reception and Year 6.
In 2018-19 around 500 children in Reception were overweight, this is around 21% of pupils measured. This is an increase on previous years but Wiltshire remains well below the England and South West averages.
The number of pupils measured was also lower which may impact the overall picture.
Overweight - Year 6
The NCMP measures the height and weight of children in Reception and Year 6.
In 2018-19 around 1,500 children in Year 6 were overweight, this is around 32% of pupils measured. This is an increase on previous years but Wiltshire remains well below the England average but is now similar to the South West average.
The number of pupils measured was broadly similar to previous years.