Title: Understanding the disruption of children and young people's health and healthcare use during and after COVID-19 to inform healthcare and policy responses
Funder: Department of Health and Social Care

Abstract: Research Questions 1. What are the differences between expected and observed NHS activity for children and young people (CYP; 0-24 years) during the first COVID-19 pandemic wave and over the next year, and how does this vary by setting, diagnostic category and patient characteristics 2. For which patient groups is the pandemic period linked with adverse outcomes Background CYP health and wellbeing have been markedly affected by the response to the COVID-19 pandemic despite experiencing few direct effects from infection with SARS-CoV-2. Children s services were markedly disrupted during the pandemic and these disruptions continue, resulting in a mix of health harms and benefits for CYP that are poorly understood. Aims Short-term: To inform planning for winter and future pandemic waves; to use health service use data as a proxy for health outcomes and understand the mix of harms and benefits arising from reduced activity during the first wave Medium term: To use insights from analysis of COVID impact and new metrics to inform healthcare policy, in particular the development of integrated care systems and population health management at STP/ICS level (ie to build back better ). Methods: Mixed-methods: Participatory work with CYP and professionals together with secondary analyses of administrative healthcare datasets. Workpackage (WP) 1: Patient/public involvement and expert consultation work Focus groups and online consultation work with CYP and consultation/consensus exercises with RCPCH subspeciality groups and other relevant stakeholders, including charities. WP2: Analysis of trends in primary care and hospital activity Datasets: Secondary Users Survey (SUS), Hospital Episode Statistics (HES), Clinical Practice Research Database (CPRD), ONS Mortality data, RCGP dataset We will: Calculate ratios of observed:expected NHS activity for CYP (0-24 years) during the initial Covid-19 period and subsequently. Expected (denominator) rates will be modelled using 5 years historical data, thus accounting for seasonal variation, secular activity trends and coding changes over time. Separate analyses will be performed by setting, diagnostic category and patient characteristics (including age, sex, deprivation, ethnicity, geographical location) Estimate impact of reduced activity on health outcomes Estimate cumulative unmet need for care WP3: Analysis of new linked datasets. We will explore wider Covid-19 impact through new data linkages, with a range of planned linked datasets accessed through NHS England and PHE. Timelines for Delivery The project will run for 18 months from November 2020 (Month 1) to May 2022 (M18). WP1 will run M1 to 18 WP2 will run M1 to 12 WP3 will run M6 to 18 Anticipated Impact and Dissemination As a partnership between two universities and three key national bodies, this project will have rapid and meaningful impact on major policy decisions, as well as influencing local service planning across the country. We will disseminate findings through PPI partners, academic publications and directly to policymakers, particularly NHS England and regions.

Lay abstract: During the Covid-19 pandemic, rapid changes were made to NHS services for children and young people (CYP). Many GP, outpatient and community services stopped or were done remotely, while many resources from paediatric inpatient units and Emergency Departments were re-deployed to treat adult patients. At the same time, school closures and lockdown restrictions were imposed. We now face a further 6 months of uncertain restrictions. There are serious concerns about the potential short and long-term impacts of these Covid-19 restriction on CYP, including greater risks of abuse, malnutrition, missed diagnoses of cancer and other serious conditions, and increase in mental health problems and suicides. More broadly, the Covid-19 pandemic wave revealed the siloed and uncoordinated nature of data on children and young people across - and also within &ndash; health bodies. There is currently no single point of truth where children s data are collected and interpreted centrally to improve the performance of NHS services for CYP. The aims of this project are to study trends in healthcare activity by CYP during the Covid-19 period investigate the impact of reduced activity on health outcomes make recommendations to policy makers about areas of significant harm or potential harm to CYP, and the mitigation policies that should be considered. develop a new model for monitoring the quality and activity of NHS services for CYP in the future. CYP, as well as their parents/carers and the wider public will be closely involved in designing these analyses and helping us to interpret the findings. We will also work closely with expert groups within the Royal College of Paediatrics & Child Health. To analyse trends in activity, we will develop and validate a new way of predicting expected levels of healthcare activity. This method takes account of the usual natural variation in CYP activity as well as changes in coding and patterns of NHS use over time. It will allow us to calculate the activity changes due to Covid-19 restrictions in a comparable way across settings, age groups, diagnostic/procedure groups, and among more deprived or Black, Asian and Minority Ethnic groups. We will then study the impact of activity changes on short and long-term health outcomes, including death, complications due to delayed or missed treatment, and avoidable pain or distress. Analyses will use standard national datasets of activity in primary care and hospital settings. In addition, we will explore using the new opportunities for data sharing to link data between these and other datasets (including NHS111, paediatric intensive care and Public Health England data on immunisations and Covid-19 tests). As a partnership between two universities and three key national bodies, this project will have rapid and meaningful impact on policy decisions locally and nationally.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE