Hospital admissions among adolescents with local authority care experience or special educational needs in England: a population-based cohort study using linked administrative data from health, education and social care services

Background

We aimed to quantify planned and unplanned hospital admissions during adolescence for pupils with special educational needs (SEN) and/or experience of care under local authority supervision.

Methods

We analysed linked hospital, education and social care records with whole nation coverage of England (ECHILD). The cohort comprised pupils who started secondary school between 2007/8 and 2011/12 (aged 11 years), with follow-up until March 2020 (until 18-23 years old). Hospital admission rates were examined by gender and age across distinct groups with varying levels of statutory support during school: i) no support, ii) school-based SEN support only, iii) an Education and Health Care Plan (EHCP) only, iv) care-experienced only, v) SEN support and care-experienced, and vi) EHCP and care-experienced. Rate ratios were estimated for each group relative to no support using negative binomial regression models.

Results

The cohort included 2,807,230 pupils; 64% (1,791,190) received no support, 31% (876,400) SEN support only, 3% (84,410) EHCP only, 1% (29,330) SEN support and care-experience, with the remaining groups accounting for <1%. Unplanned admissions were higher in all groups with support than peers with no support, and highest in care-experienced girls who had an EHCP (21.9 (95%CI; 21.4-22.4) per 100 person-years). Almost half of all unplanned admissions were mental health-related. Pregnancy-related admission rates were highest in care-experienced girls (14 per 100 person-years).

Conclusions

We found evidence of high levels of unplanned admissions coupled with low levels of planned care use for pupils with multiple needs, indicating a need for preventative care.

KEY MESSAGES

• What is already known on this topic – previous research indicates a higher burden of physical and mental health needs among children and young people who are care-experienced and/or have additional educational needs. Although these young people are known to services, there are concerns about the accessibility and effectiveness of their care, which may be fragmented across sectors and between child and adult services.

• What this study adds – this research takes a multi-sectoral approach to quantify planned and unplanned hospital admissions during adolescence for children in England who are care-experienced and/or have additional educational needs. The study identified high levels of unplanned hospital use coupled with low levels of planned use for adolescents with multiple needs, thus indicating a need for earlier and preventative care.

• How this study might affect research, practice or policy – this research provides evidence of the multifaceted service needs of young people spanning physical, mental and reproductive health, and education and care systems, and highlights the potential benefits of greater co-ordination of early and effective care across services.