Long term conditions in childhood

The focus of this chapter is on common long-term conditions in childhood (0-19 years) with particular attention paid to asthma, epilepsy and diabetes. Long-term conditions affect not just the health of a child but also the quality of life and wellbeing of them and their family, as well as their school attendance, engagement and future prospects. A national survey of school-aged children in 2010 found that one-third (31%) of those with a long-term condition or disability said that their condition was affecting their school attendance (Brooks et al., 2011).

People with long-term conditions, and their carers, are more likely to also suffer from mental health problems, functional impairment and reduced life expectancy. They are also disproportionately greater users of primary and secondary care services and this increases with age (NHS Confederation, 2012).

In general, 1 in 7 young people aged 11-15 years has a long term medical illness (Brooks et al., 2011).

The local picture

The exact numbers of children and young people living in Calderdale with long term conditions including asthma, epilepsy and diabetes are not known as local prevalence data is limited.

In 2015, 1 in 4 (23%) Calderdale school pupils in Years 7 and 10 reported having one or more common illnesses PDFKey findings from the 2015 Secondary School electronic Health Needs Assessment (eHNA) [PDF 494KB]. This represents a reduction on the 2013 figure.

In 2014, around one in seven pupils in Years 7, 10 and 12 reported that they had asthma, around 1% reported having diabetes, and a further 1% reported having epilepsy. However, the school survey from which these figures are drawn does not include pupils in special schools, which children with more complex disabilities, and potentially one of these condition as a co-morbidity, might attend. A review of General Practitioner (GP) prescribing data suggests that 70 (around 0.2%) under 18s received insulin in 2012/13, suggestive of Type I diabetes, while 134 (around 0.3%) received anti-epileptic drugs (though some such drugs may be used in conditions other than epilepsy).

Emergency admissions for long-terms conditions in under 19s in Calderdale CCG area are summarised below (see National Child and Maternal Health Intelligence Network (CHIMAT): Improving services toolkits - information tools , 2013/14).

Table 1: Emergency hospital admissions, 0-19 year olds

  Admission rate per 100,000, 2013/14 Compared to all Clinical Commissioning Groups in the North of England Compared to England
Asthma 247.4 Similar Significantly worse
Diabetes 66.9 Similar Similar
Epilepsy 83.1 Similar Similar

Figure 1: Trends in under 19s asthma admissions 2010/11 to 2013/14

Trends in under 19s asthma admissions 2010/11 to 2013/14

Figure 2: Trends in under 19s emergency epilepsy admissions 2010/11 to 2013/14

Trends in under 19s epilepsy admissions 2010/11 to 2013/14

Figure 3: Trends in under 19s emergency diabetes admissions 2010/11 to 2013/14

Trends in under 19s emergency diabetes admissions 2010/11 to 2013/14

Locally, 7% of secondary school pupils surveyed in 2014 worry about missing school because of poor health and 4% worry about not being able to do the job they want because of it.

Current provision

In 2015, a school nurse role was commissioned which focuses on supporting children and young people with common long term conditions in the school setting.  The service aims to reduce hospital admissions for LTCs and improve school attainment due to better care and improved understanding in school settings.

User views

The views of children and young people with long term conditions have not recently been collected.

In 2016/17 we will be able to feedback specifically regarding the School Nursing Service role in managing long term conditions, at this present time it is too early to understand impact.

Unmet needs

Data relating to hospital admissions indicates that Calderdale has higher than average hospital admissions for respiratory problems for children and young people.  The reasons for this are unclear and require further analysis.

Projected future need

In recent years the number of people with asthma has risen. 1 in 11 people in the UK has asthma, including 1.1 million children, and their chance of good outcomes have plateaued and on some measures declined (Asthma UK). The majority of deaths from asthma are entirely preventable.

Nationally, Type 2 diabetes, which is associated with excess weight, is increasingly found in children and young people. Local prevalence of childhood overweight and obesity are in line with national trends, thus type 2 diabetes in children may become a local concern.

Key considerations linked to the known evidence base (what works?)

There is significant evidence regarding what works with regards to asthma, diabetes and epilepsy care, please see the following links for further information from National Institute for Health and Care Excellence (NICE):

Since September 2014 schools are required to have in place a Medical Conditions Policy for children with asthma which includes the child having an individualised health plan if it's felt to be appropriate.

Schools are now legally allowed to keep an emergency spare reliever inhaler and can purchase these from pharmacists without prescription. The Department of Health has produced a comprehensive guide on how schools can implement this change in the law, see Emergency asthma inhalers for use in schools .

References and further information

References

  • Brooks, F., et al., HBSC England National Report. Findings from the 2010 HBSC study for England. 2011: Hatfield;
  • Calderdale Council: electronic Health Needs Assessment (eHNA) survey: key findings , for primary, secondary and post 16 ages;
  • NHS Confederation, Investing in emotional and psychological wellbeing for patients with long-term conditions. 2012, NHS Confederation's Mental Health Network: London;
  • Linda Haines, Kay Chong Wan, Richard Lynn, Timothy G. Barrett and Julian P.H. Shield, Rising Incidence of Type 2 Diabetes in Children in the U.K. 2007;
  • B Purcell et al,  Epilepsy Prevalence and Prescribing Patterns in England and Wales Office for National Statistics, Institute of Neurology, University College London. 2002

Further information

More information on children and young people can be found within the Further resources .

Specific information on the long term conditions considered here is available from:

Further information on indicators of child health can be found in:

Author

Donna Green, Children and Young People's Programme Manager, Public Health, Calderdale Council;
Edited by Naomi Marquis, Public Health Intelligence Officer, Public Health, Calderdale Council.

February 2016.