Data and evidence: Summary

A summary of our work on the future burden of need for paediatric services.

What our members said…

We asked 298 members “In 2040, what do you think will be the biggest health issue affecting children and young people?” The top three responses (from qualitative data) were mental health (43.71%), obesity (31.14%) and climate change (10.78%).

What our dedicated data and evidence work says…

In looking at data and evidence, we concentrated on three broad areas to consider likely future trends:

Global burden of disease and disability

We used data from the Global Burden of Disease (GBD) study (a tool to quantify health loss from hundreds of diseases, injuries, and risk factors) to identify recent and current burden of disease from various causes amongst children and young people across the UK. We then used the data to forecast change in all-cause disability-adjusted life years (DALYS) out to 2040.

For neonates and infants, we see forecast falls for burden from most major causes of disease by 2030 and 2040, continuing the falls seen in the decade to 2017. For children 1-9 years, we forecast rises in burden due to neonatal disorders i.e. consequences of prematurity, epilepsy and other neurological conditions and ADHD, although most of these rises are relatively small. In contrast, there are significant declines in more traditional causes of burden including cancer, congenital causes, injuries, asthma and infections. For adolescents and young adults, we forecast increases in mental health, substance use and neonatal disorders (consequences of prematurity) and falls in burden due to injuries, asthma and most medical causes.

Forecast increases in DALYS from particular causes are likely to indicate a need for additional workforce or a change in training focus. For paediatricians, there will be a need for broader training that includes increased numbers with skills in dealing with mental health problems, broader adolescent health issues as well as the consequences of neonatal survival, such as neuro-disability and epilepsy.

Healthcare activity

The large increases in emergency activity and outpatient attendances documented across the past decade in young children, of the order of 60-80%, have placed great strain on children and young people’s services across the UK, as the children’s workforce and service structure has not increased to match it.

Our most conservative scenario, in which there are no substantial changes in terms of child poverty or health system organisation over the next two decades, predicts increases of 50-145% in emergency department attendances and 20-125% increases in outpatient attendances. An alternative scenario where policy action reduces child poverty significantly over the next two decades has a beneficial impact upon these forecasts, although the forecast impact is less than 5% for all activity. These changes will require significant additional workforce and health services resources. In contrast, integrated care scenarios dramatically reduce projected future activity across all admission types, suggesting markedly lower needs for future additional workforce and capacity. Managing all ambulatory care sensitive conditions outside the hospital system (a high integrated care scenario) could potentially reduce total admissions to at or below 2007 levels by 2040.

If drivers of increased activity are not addressed, there will be further rapid increases in children and young people’s (CYP) emergency and outpatient activity over the next 20 years, requiring significant additional investment in both services and workforce if quality is not to fall. Without concerted action to reduce child poverty, healthcare activity will increase, and outcomes worsen. Contrary to these pessimistic scenarios, our findings suggest that development of integrated care for CYP at scale in England has the potential to dramatically reduce or even reverse these forecast increases, reducing strain in the system whilst improving outcomes for family and young people’s experience of care.

Workforce

Most of our workforce projections cannot be viewed in isolation from projected healthcare activity. However, we note three key findings. Firstly, we have forecast less-than-full-time working in paediatric trainees to increase from 30% in 2019 to over 60% in 2040. We welcome and encourage this flexibility, as discussed in our working lives work. However, this is of major concern with regards to paediatric trainee full-time-equivalent numbers if the current cap on the number of training places available is not reviewed.

Based on recent trends we have forecast that there is a risk of significant decline in the Specialty, Associate Specialist and Staff Grade (SAS) doctor workforce group by 2030. This is an important workforce group who need urgent support to avoid this trend from becoming reality. There are also concerning trends ahead for community paediatricians, who are forecast to decrease from around 18% of workforce to 12% of workforce, based on the last ten years of trends. Elsewhere in the project we have discussed the need for more paediatricians to be working in the community to meet the needs of children and families in the future, and this trend therefore needs some attention.

Top three messages

The pattern of health and disease facing child health professionals in 2040 is likely to consist of higher proportions of mental health, other adolescent health issues, neurodisability and long-term conditions than currently, and this must be reflected in changes in training requirements for paediatricians and other child health professionals

Our forecasts suggest that, if drivers of increased activity are not addressed, there will be further rapid increases in CYP emergency and outpatient activity over the next 20 years, requiring significant additional investment in both services and workforce if quality is not to fall. Without concerted action to reduce child poverty, healthcare activity will increase and outcomes worsen.

Development of integrated care for CYP at scale in England has the potential to dramatically reduce or even reverse these forecast increases, reducing strain in the system whilst improving outcomes for CYP and family and young people’s experience of care.

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