Vulnerable children report: 15 May 2020

Health Services and the preventative role of health

59. New information is available about the health of children and young people, and about how health services are responding to the pandemic.

60. We have a strong, high quality universal health service for all children under 5, starting from pregnancy. This enables us to continue to reach out to all those families across Scotland, including continuing to provide more intensive support for families who need it. It also allows us to proactively explore what additional supports families might need who have been adversely affected by COVID-19, and who may not have previously required support beyond universal provision.

61. By using the strength of universal services such as maternity, health visiting and family nurse partnership, we have established routes and relationships with all children, families and pregnant women across Scotland, who continue to offer support and advice at this challenging time in multiple ways.

62. Scottish Government published guidance for Community Clinical Nursing services, which included minimum requirements for delivery of the health visiting and Family Nurse Partnership services on 7 April. A workforce monitoring tool has been developed to assess adherence to this guidance, and early signs are that the majority of this workforce has been retained in their existing role, and that the services continue to be delivered. During early mobilisation planning in Health Boards some redeployment took place, but we have sought assurances that the capacity of these services remain to meet the needs of the children and families they serve.

63. There is some evidence that families, particularly from younger mothers, are seeking additional reassurance from services to support them in their daily lives. These are not child protection concerns, but as a result of the increased anxiety that is felt across the population. So, although alternative contact methods are being used with the majority of families through video and telephone, which means reduced travel for these services due to reduced home visiting, their time is being used in other ways to be available for families to contact them more frequently than they may have done previously. Routine contacts are also taking longer, again as part of the 'containment' activity to reassure families at this time.

64. Data from Public Health Scotland indicate that for children up to the age of 14 years, calls to NHS 24, attendances at A&E and hospital admissions have dropped by about 50%, 70% and 50% respectively during the pandemic compared to average activity over this period during the last two years. Figures for each local partnership are available at https://scotland.shinyapps.io/phs-covid-wider-impact/

65. Constraints on societal activity in relation outside space may be one factor for reduced attendance at A&E and associated hospital admissions, so less road traffic accidents for example. This will continue to be monitored closely.

66. There are no reported excess deaths[3] of children in Scotland to date, nor any child deaths directly related to COVID-19 infection.

67. Parent Club have included children and the concerns of parents in their most recent media campaign 'The NHS is Open', and RCPCH (Royal College of Paediatrics and Child Health) have produced some material for parents to encourage them to seek medical help and attention based on the symptoms presented. A national campaign to further promote the need to continue to immunise young children and pregnant women also launched through Parent Club and Public Health Scotland two weeks ago. Immunisation uptake will be monitored through national data by Public Health Scotland.

(https://www.parentclub.scot/articles/immunisations-and-non-coronavirus-illnesses)

68. There has been a greater amount of calls to the NHS 24 helpline for Covid-19 related symptoms for younger children (0-4) than older age groups, and this is likely because the symptoms associated with COVID-19 are very similar to symptoms of other infections and diseases common on this age group.

69. The secondary health impacts for children and young people of not seeking help early are usually less immediate than for adults, but are more likely to be longer lasting for both physical and mental health and wellbeing. Action taken to date includes pausing of some routine health screening and surveillance activity, parents delaying attendance for medical concerns, limiting outdoor activity and discerning the as yet unquantifiable impact on mental health across the population.

70. The evidence strongly suggests that the impact of the pandemic will be felt unequally, and those already disadvantaged are likely to be affected more. Many factors associated with chronic ill health, frailty and premature death in older adults have their origins in the earliest years of life, and developing a strategy to maintain and enhance developmentally age and stage appropriate interventions to counter these effects will be crucial. . Scottish Government is working alongside Public Health Scotland and Child Health Commissioners to drive this forward.