Understanding the disruption of children and young people's health and healthcare use during and after COVID-19 to inform healthcare and policy responses

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.