BackgroundAdmission of infants to hospital with bronchiolitis consumes considerable healthcare resources each winter. We report an analysis of hospital admissions in England over five decades.MethodsData were analysed from the Hospital In-Patient Enquiry (HIPE, 1968–1985), Hospital Episode Statistics (HES, 1989–2011), Oxford Record Linkage Study (ORLS, 1963–2011) and Paediatric Intensive Care Audit Network (PICANet, 2003–2012). Cases were identified using International Classification of Diseases (ICD) codes in discharge records. Bronchiolitis was given a separate code in ICD9 (used in England from 1979). Geographical variation was analysed using Local Authority area boundaries. Maternal and perinatal risk factors associated with bronchiolitis and subsequent admissions for asthma were analysed using record-linkage.ResultsAll-England HIPE and HES data recorded 468 138 episodes of admission for bronchiolitis in infants aged <1 year between 1979 and 2011. In 2011 the estimated annual hospital admission rate was 46.1 (95% CI 45.6 to 46.6) per 1000 infants aged <1 year. Between 2004 and 2011 the rates rose by an average of 1.8% per year in the all-England HES data, whereas admission rates to paediatric intensive care changed little (1.3 to 1.6 per 1000 infants aged <1 year). A fivefold geographical variation in hospital admission rates was observed. Young maternal age, low social class, low birth weight and maternal smoking were among factors associated with an increased risk of hospital admission with bronchiolitis.ConclusionsHospital admissions for infants with bronchiolitis have increased substantially in recent years. However, cases requiring intensive care have changed little since 2004.

This paper presents the results of an exploratory study linking the national data-sets for all children in need and child protection services in England. The study was informed by an emerging literature on systems thinking in public services, and aimed to examine variations and patterns of response in local authorities to demand for child welfare services in their area. One hundred and fifty-two local authority census returns and other statistical indicators covering up to a thirteen-year period were combined into a single data-set. Statistical analysis was undertaken to explore the characteristics of demand, workload and workforce, trends over time and variations between local authorities. The results showed that the overall system has become increasingly geared towards protective interventions, especially since the Baby P scandal of 2008. Deprivation levels continue to be the key driver of referrals and other categories of demand, and are strongly associated with variations in service response, particularly in the initial stages of referral and assessment. Implications are considered for the current organisation of child welfare services in light of recent reviews and reforms.

This article presents findings from a quantitative study of the national data-sets for statutory children’s social care services in England. The aim of the study was to examine how demand management varied in local authorities with differing levels of area deprivation. About 152 local authorities census returns and other statistical indicators covering the period 2014–2017 were combined into a single data-set. Statistical analysis was undertaken to explore trends over time and correlations between indicators that might indicate patterns in the way demand was managed. Findings showed that high levels of deprivation have continued to be strongly linked to high levels of activity and that local authorities have continued to increase their use of protective interventions relative to referrals. Evidence was found for three interconnected mechanisms, through which local authorities tended to manage demand for services: screening, rationing and workforce churn. The article describes these mechanisms and comments on their significance for the current crisis of demand in the sector.

This paper presents new findings from a study of performance measures for children in need and child protection services in England. National datasets and census returns from 152 local authorities over a 13-year period were combined in order to analyse trends and correlations in quality indicators. The study also explored the relationship between these measures and inspection ratings from the Office for Standards in Education, Children's Services and Skills (Ofsted), with a particular focus on services rated as inadequate. The available quality measures mainly focused on the timeliness of work processes, but these did not seem to affect outcomes in the form of re-referral rates. However, re-referrals were higher in local authorities with a tendency to close cases quickly and in those with high rates of agency workers. A small number of indicators were able to predict an inadequate Ofsted rating in 2012 and 2013. Changes in performance measures in the year following an inadequate Ofsted rating may suggest greater use of protective interventions compared with similarly performing local authorities. Implications are considered for performance measurement, management and inspection in the field of child protection.

This paper reports on an empirical study of child protection services in a local authority where rates of investigations and interventions rose to unprecedented levels during the course of a single year.The aim of the research was to explore explanations for this rise in demand among the providers of children's social care in the area. Using an interpretative qualitative design, a series of focus groups and interviews were carried out with practitioners and managers (n=25) from statutory services and Early Help. The findings identified a combination of long-term and short-term drivers of demand.Long-term factors emphasised the impact of rising levels of deprivation combined with cuts to community-based services for children and young people. Short-term factors ranged from a more proactive approach to child neglect to more effective multi-agency partnerships and joint decisionmaking. The interaction between these factors was found to be accentuating an underlying shift to 'late intervention' across the sector. The findings are contextualised in relation to contemporary debates about the crisis of demand for children's social care and the complex relationship between prevention and protection.

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Demand for children’s social care is often conflated with rates of intervention and associated with a limited constellation of parental risk factors. This article reports on a more comprehensive picture of demand obtained through a quantitative study of child welfare interventions in England. Longitudinal child-level data were combined from children’s social care services in six English local authorities over a four-year period (2015–2018). Latent class analysis was undertaken for a random sample of child episodes where an assessment was undertaken (n = 15,000). The results were tested for consistency across LAs and to identify the most appropriate number of classes. Conditional probabilities were used to interpret the demand represented by each class, and to explore the relationship between typologies and child characteristics such as age, gender and ethnicity. The analysis found seven classes, or typologies of demand, to be present in factors at assessment across all the LAs, which were linked to certain child characteristics and intervention pathways. The findings go beyond the ‘toxic trio’ terminology often used to profile risks to children and support the innovative use of administrative data to provide insight into patterns of demand. Implications are discussed for strategic responses to child welfare problems and the multi-agency context of prevention.

The social gradient in children’s social care refers to the relationship between socio-economic status and the likelihood of a child welfare intervention. This article reports on a quantitative study of national administrative data, aiming to identify social gradients across all local authorities in England and to examine the factors affecting their relative strength. An anonymised extract of case-level information on all school-aged children involved with statutory social care services in 2018–2019 was combined with income deprivation data for 32,837 small neighbourhoods. Poisson regression models were used to calculate how much intervention rates could be expected to rise for each 10 percent increase in neighbourhood deprivation. This produced a single number indicator of the social gradient that could be compared for different groups of children. The strongest social gradients were found for younger children, White children, children assessed with neglect and children on protection plans under the category of neglect. For children receiving statutory services the social gradient increased at every threshold of intervention. Findings suggest the shift from prevention to intervention in children’s social care is exacerbating inequalities and encouraging a disproportionate focus on poorer families. Implications are discussed for reforming child welfare services in the context of widening social inequalities.