Evaluation of pushing out of children from all English state schools: Administrative data cohort study of children receiving social care and their peers

Background: Pushing out (off-rolling) occurs where pupils are illegally excluded from school. Those receiving children's social care (CSC) services (children in need (CiN), on child protection plans (CPPs) or looked after (CLA)) are thought to be at increased risk, but limited evidence inhibits understanding of this phenomenon. The extent of pushing out can be inferred from non-enrolment in administrative data. Objective: To estimate proportions of children not enrolled across secondary school (aged 11–16, up to year 11) and to explore the association between CSC history and non-enrolment in year 10/11. Participants and setting: >1 M pupils in year 7 (aged 11/12) in English state schools, 2011/12 and 2012/13. Methods: We estimated the proportion of children not enrolled across years 8 to 11, disaggregated by CSC history. We assessed with regression modelling the association between CSC history and non-enrolment in years 10/11. Results: Of children without CSC history, 3.8% had ≥1 year not enrolled by year 11. This was higher in those with a history CiN (8.1%), CPP (9.4%) or CLA (10.4%) status. The odds of non-enrolment in years 10/11 were higher among those with CLA history vs non-exposed peers (OR 4.76, 95% CI 4.49–5.05) as well as in those with CPP history (3.60, 3.39–3.81) and CiN history (2.53, 2.49–2.58). History of special educational needs further increased non-enrolment odds, including after confounder adjustment. Conclusions: Findings imply that children with CSC history are more likely to be pushed out from school than children without, especially those with special educational needs

Inequalities in the care experiences of patients with cancer: analysis of data from the National Cancer Patient Experience Survey 2011-2012.

Objectives To explore inequalities in the care experiences of care by patients clinical or trust-level factors for patients with cancer. Design Secondary analysis of data from the National Cancer Patient Experience Survey 2011–2012. Setting and participants Adult patients with a primary diagnosis of cancer who attended an acute or specialist National Health Service (NHS) trust in England. Outcome measure OR of a patient rating their overall care positively, adjusting for other patient, clinical and trust-level factors. Methods Using cross-sectional data from 71 793 patients with cancer who completed the National Cancer Patient Experience Survey 2011–2012, we examined associations between patient, clinical and trust-level factors and a summary measure of patient experience, namely overall rating of care. Multivariate logistic regression was used to investigate variation by sociodemographic characteristics adjusting for other patient, clinical and trust-level factors. Results Female, non-white and younger patients were less likely to rate their overall care as excellent or very good. Patients with long-standing conditions, particularly those with learning disabilities or mental health conditions, also reported poorer overall care. This variation persisted when other patient, clinical and trust-level factors were controlled for, indicating that there are real differences in experiences among patients with cancer by sociodemographic characteristics. Conclusions There is evidence of inequalities in the experiences of patients with cancer in the UK by sociodemographic characteristics such as gender, age, ethnicity and disability. Quality cancer care services must strive to meet the needs of a diverse patient population equally; this study identifies patient groups for whom it appears cancer care services are in greatest need of improvement

Explaining local variation in referrals from health services to children's social care in England 2013-16: a study using 'children in need' administrative data

BACKGROUND: Referral rates from Health service to Children's Social Care (CSC) services vary across England. In 2019, the National Audit Office (re)iterated the urgent need to understand the drivers of such variation. METHODS: Using administrative data (Children in Need Census, 2013-16), we calculated annual referral rates from Health to CSC services (Health referral rate) by Local Authority (LA) areas. We used multilevel linear regression to investigate the relationship between age-adjusted Health referral rates and local need (demand factors) and local practice/systems (supply factors). We present a tool to compare unadjusted and adjusted LA rates. RESULTS: There was high LA variation in Health referral rates, particularly for infants (mean = 29.0/1000 children < 1 y; range = 6.5-101.8; sd = 12.4). LA variation persisted after age-adjustment. Child poverty (local need) and overall referral rate (local practice/systems) explained 60% of variation in age-adjusted Health referral rates. Overall referral rate was the strongest predictor. Adjusted referral rates were substantially different from unadjusted rates. After adjustment, 57.7% of LAs had higher/lower Health referral rates than expected. CONCLUSIONS: While higher levels of local need are associated with higher Health referrals, some areas have high Health referrals irrespective of local need. Our tool demonstrates the benefits of using adjusted rates to compare LAs

Reductions in hospital care among clinically vulnerable children aged 0-4 years during the COVID-19 pandemic

OBJECTIVE: To quantify reductions in hospital care for clinically vulnerable children during the COVID-19 pandemic. DESIGN: Birth cohort. SETTING: National Health Service hospitals in England. STUDY POPULATION: All children aged <5 years with a birth recorded in hospital administrative data (January 2010-March 2021). MAIN EXPOSURE: Clinical vulnerability defined by a chronic health condition, preterm birth (<37 weeks' gestation) or low birth weight (<2500 g). MAIN OUTCOMES: Reductions in care defined by predicted hospital contact rates for 2020, estimated from 2015 to 2019, minus observed rates per 1000 child years during the first year of the pandemic (March 2020-2021). RESULTS: Of 3 813 465 children, 17.7% (one in six) were clinically vulnerable (9.5% born preterm or low birth weight, 10.3% had a chronic condition). Reductions in hospital care during the pandemic were much higher for clinically vulnerable children than peers: respectively, outpatient attendances (314 vs 73 per 1000 child years), planned admissions (55 vs 10) and unplanned admissions (105 vs 79). Clinically vulnerable children accounted for 50.1% of the reduction in outpatient attendances, 55.0% in planned admissions and 32.8% in unplanned hospital admissions. During the pandemic, weekly rates of planned care returned to prepandemic levels for infants with chronic conditions but not older children. Reductions in care differed by ethnic group and level of deprivation. Virtual outpatient attendances increased from 3.2% to 24.8% during the pandemic. CONCLUSION: One in six clinically vulnerable children accounted for one-third to one half of the reduction in hospital care during the pandemic

Hospital admissions for stress-related presentations among school-aged adolescents during term time versus holidays in England: weekly time series and retrospective cross-sectional analysis

BACKGROUND: Schools are a potential stressor for adolescents and may contribute to emergency hospital admissions. AIMS: We describe rates of stress-related presentations (SRPs) among school-aged adolescents (11-17 years) during school terms and holidays, and explore differences by age and gender. METHOD: Using national administrative hospital data, we defined an SRP as an emergency hospital admission with a primary diagnosis related to pain, psychosomatic symptoms (e.g. fatigue) or mental health problems, or with self-harm indicated in any diagnostic position. We estimated incidence rate ratios for weekly SRPs in term time versus holidays from 2014-2015 to 2017-2018, using negative binomial regression models, stratified by age and gender. We estimated the cumulative incidence of any SRP between 11 and 17 years by analysing prior hospital admission histories of adolescents with an SRP in 2017-2018. RESULTS: Over the 4-year study period, 305 491 SRPs in 171 013 school-aged adolescents accounted for 31% of emergency admissions for this group. SRPs were predominantly for mental health problems or self-harm (38%), or pain (35%). Weekly admission rates for SRPs were higher in term time than holidays for all ages (age-specific incidence rate ratios were 1.15-1.49 for girls and 1.08-1.60 for boys). Rates were highest for girls aged 14 and 15 years. The estimated cumulative incidence of any SRP between 11 and 17 years was 7.9% for girls and 4.1% for boys. CONCLUSIONS: Hospital admissions for SRPs are common among adolescents, affecting around two girls and one boy in every classroom. Higher rates in term time than holidays suggest that school factors may contribute

Changes in adolescents' planned hospital care during the COVID-19 pandemic: analysis of linked administrative data

OBJECTIVE: To describe changes in planned hospital care during the pandemic for vulnerable adolescents receiving children's social care (CSC) services or special educational needs (SEN) support, relative to their peers. DESIGN: Observational cohort in the Education and Child Health Insights from Linked Data database (linked de-identified administrative health, education and social care records of all children in England). STUDY POPULATION: All secondary school pupils in years 7-11 in academic year 2019/2020 (N=3 030 235). MAIN EXPOSURE: Receiving SEN support or CSC services. MAIN OUTCOMES: Changes in outpatient attendances and planned hospital admissions during the first 9 months of the pandemic (23 March-31 December 2020), estimated by comparing predicted with observed numbers and rates per 1000 child-years. RESULTS: A fifth of pupils (20.5%) received some form of statutory support: 14.2% received SEN support only, 3.6% received CSC services only and 2.7% received both. Decreases in planned hospital care were greater for these vulnerable adolescents than their peers: -290 vs -225 per 1000 child-years for outpatient attendances and -36 vs -16 per 1000 child-years for planned admissions. Overall, 21% of adolescents who were vulnerable disproportionately bore 25% of the decrease in outpatient attendances and 37% of the decrease in planned hospital admissions. Vulnerable adolescents were less likely than their peers to have face-to-face outpatient care. CONCLUSION: These findings indicate that socially vulnerable groups of children have high health needs, which may need to be prioritised to ensure equitable provision, including for catch-up of planned care postpandemic

Factors associated with re-entry to out-of-home care among children in England

Exiting and re-entering out-of-home care (OHC) is considered a disruption to permanence which may have long-lasting, negative consequences for children due to a lack of stability and continuity. Each year approximately one-third of children in OHC in England exit, but information is lacking on rates of re-entries and associated factors. Using national administrative data, we calculated rates of re-entry among children exiting OHC from 2007 to 2012, identified key child and care factors associated with re-entry using Cox proportional hazards modelling, and developed a simple probability calculator to estimate which groups of children are most likely to re-enter OHC within three months. Between 2007 and 2012 re-entries to OHC in England decreased (from 23.3% to 14.4% within one year of exit, p<0.001), possibly due to concurrent changes in the way children exited OHC. Overall, more than one-third of children exiting OHC in 2008 re-entered within five years (35.3%, N=4076), but rates of re-entry varied by child and care characteristics including age, ethnicity, mode of exit, and placement stability. Based on these associated factors, we developed a calculator that can estimate the likelihood of rapid re-entry to OHC for a group of children and could be used by social care practitioners or service planners. Our findings provide insight into which groups of children are most likely to re-enter OHC, who may benefit from additional support or ongoing monitoring

Ethnic variation in cancer patients’ ratings of information provision, communication and overall care

© 2016 The Author(s). Published by Taylor & Francis.ABSTRACT: Objective. Ethnic inequalities in cancer patient experience exist but variation within broad ethnic categories is under-explored. This study aimed to describe variation by ethnic sub-category in experiences of information provision and communication (key domains of patient experience) using National Cancer Patient Experience Survey (NCPES) data. Design. The NCPES 2012–2013 contained responses from 68,737 cancer patients treated at 155 NHS Trusts in England. Multivariate logistic regression was used to investigate associations between ethnicity and patients’ ratings of overall care, information provision and communication. Results. Variation by and within broad ethnic categories was evident. Non-White patients (particularly Asian patients (ORadj:0.78; 95%CI:0.67-0.90, p=0.001)) were less likely than White patients to receive an understandable explanation of treatment side effects. Among Asian patients, those of Bangladeshi ethnicity were least likely to receive an understandable explanation. Conclusions. Effective communication and information provision are important to ensure patients are well informed, receive the best possible care and have a positive patient experience. However, ethnic inequalities exist in cancer patients’ experiences of information provision and communication with variation evident both between and within broad ethnic categories. Further work to understand the causes of this variation is required to address ethnic inequalities at practice and policy level

Educational outcomes of children in contact with social care in England: a systematic review

Background: In England, the state intervenes in the lives of children through Children’s Social Care (CSC) services with the aim of supporting and maintaining their welfare. It is known from government cross-sectional data that children who experience these CSC interventions (such as state care) have consistently poorer educational outcomes than the general population. However, these data are limited in providing crude estimates of association and in ignoring longitudinal histories. This systematic review aimed to appraise the extant research evidence from longitudinal studies and answer the question: how do educational outcomes differ between children in contact with CSC and the general population in the UK? Methods: According to a pre-defined protocol, we searched 16 health, social care, education and legal databases for population-level quantitative studies conducted on UK children with exposure to CSC, a general population comparison group and an educational outcome. We also conducted snowball searches and searches of Google Scholar and grey literature. Data on whether each study met inclusion criteria were extracted, and findings of included studies were synthesised narratively. Risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: In total, 5482 sources were screened which resulted in seven studies being included in the narrative synthesis. Only three were published in peer-reviewed journals. All but one used administrative education data and five used administrative data from CSC services. In all studies, exposure to CSC interventions was measured crudely, ignoring heterogeneity in the experiences of children. All agreed that children in contact with CSC services perform worse than their peers on all outcomes (variously: exam results, absences, exclusions, school moves, being missing from school, higher education aspirations and quality of school). Conclusions: Despite employing a search across 16 databases supplemented with additional searches of other online sources, we found only seven studies that met our inclusion criteria. This review throws into sharp relief the urgent need to conduct more population-level research into the educational prospects of children in contact with CSC services