Children in social care show sharply higher healthcare use across Welsh groups

Children who receive care and support from statutory social care services in Wales use substantially more healthcare than comparable children without social care involvement, and the pattern holds across nearly every ethnic and religious group examined, according to a study published in BMC Health Services Research. The research drew on linked administrative records covering the Welsh population, connecting social care status between 2017 and 2019 with primary care, hospital inpatient and accident and emergency records, and with Census data from 2011 and 2021 to identify religious affiliation and improve the completeness of ethnicity recording.

Children receiving care and support are among the most vulnerable in the population, often carrying experiences of abuse, neglect or disability. Previous research on their healthcare use has been limited, however, particularly studies that compare them with similar children who have no social care involvement while also examining differences across ethnic and religious identities. The Welsh data linkage infrastructure allowed the research team, led by Yongchao Jing and colleagues, to address both gaps at once, because the same anonymised individuals could be followed across social care, primary care, hospital and census records.

The study assessed two broad questions. The first was whether children with social care status were more likely to access general practitioner services, hospital inpatient care and accident and emergency departments at all. The second was whether they were more likely to use healthcare for common conditions, for mental health problems and for injuries. Because the comparison cohort was matched to children with social care experiences, the resulting estimates reflect differences in healthcare use associated with social care status rather than raw population contrasts.

The headline result was consistent: social care status was associated with higher healthcare use for most outcomes in every ethnic and religious group analysed. The most striking and most consistent elevations appeared in mental health-related care and in hospitalisation. Among White children, those with social care status had roughly three and a half times higher odds of mental health-related GP use, with an odds ratio of 3.63 and a 95 percent confidence interval of 3.33 to 3.96. Their odds of hospitalisation were more than ten times higher, at 10.40 (9.04 to 11.97), and their odds of accident and emergency use were 7.46 times higher (5.60 to 9.95). All-cause hospitalisation odds were 2.03 times higher (1.92 to 2.16) and injury-related hospitalisation odds were 2.51 times higher (2.24 to 2.82).

Christian children showed a very similar profile. Social care status in this group was associated with an odds ratio of 4.36 for mental health-related GP use (3.71 to 5.12), 13.68 for hospitalisation (10.59 to 17.66), and 12.40 for accident and emergency use (6.86 to 22.40). All-cause hospitalisation odds were elevated 2.47-fold (2.22 to 2.76) and injury-related hospitalisation 2.86-fold (2.28 to 3.59). The study reports that these patterns were broadly mirrored across the other groups analysed, with mental health-related use and hospitalisation standing out as the outcomes most consistently elevated among children with social care involvement.

Where the groups diverged, the divergence was uneven across the two dimensions the study examined. Ethnic heterogeneity in the association between social care status and healthcare use was limited, and appeared mainly for hospitalisation outcomes. Religious heterogeneity was more pronounced. Compared with Christian children, those reporting no religion showed weaker increases associated with social care status in both mental health-related GP use and hospitalisation. Muslim children, by contrast, showed stronger increases in injury-related hospitalisation and in all-cause and injury-related accident and emergency use. These contrasts indicate that the association between social care status and recorded healthcare contact is not uniform across communities, although the study reports associations rather than testing explanations for them.

Methodologically, the study illustrates what linked administrative data can offer. Census records supplied religious affiliation and helped fill in missing ethnicity information, while linking social care records to primary and secondary care records meant healthcare use could be measured across the linked Welsh population. The matched comparison cohort design also meant the estimates are anchored to similar children without social care experiences, rather than to the general child population, which differs from children in social care in many respects beyond the care status itself.

The findings carry implications for service planning. If children in social care consistently show several-fold higher odds of mental health-related GP contact, hospitalisation and emergency department attendance, then improving their outcomes is likely to require more integrated mental health provision, strengthened coordination between social care and healthcare services, and sustained efforts to address the underlying inequalities that shape both social care entry and health, as the study concludes.

Several cautions apply to the interpretation. The study is observational, so the associations describe differences in healthcare use linked to social care status rather than proven causal effects of care experiences on health. The estimates come from an early-access, peer-reviewed accepted version of the article that remains subject to further editorial revision before the final version of record. The heterogeneity findings are narrower than the overall elevation in use. Even with those limits, the scale of the associations, particularly the tenfold-plus hospitalisation odds among White and Christian children with social care status, marks children in social care as a group whose elevated healthcare use is visible across the Welsh health system, not only in the services that know them best.

Subject of Research: Association between children's social care status and healthcare use across ethnic and religious groups in Wales

Article Title: Children’s social care status and healthcare use across ethnic and religious groups: evidence from linked administrative data in Wales

Article References: Jing, Y., Bailey, G. A., Cheung, S. Y., Griffiths, L. J., & Scourfield, J. (2026). Children’s social care status and healthcare use across ethnic and religious groups: evidence from linked administrative data in Wales. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15803-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15803-5

Keywords: children's social care, healthcare use, Wales, linked administrative data, mental health, hospitalisation, ethnicity, religious affiliation, health services research, health inequalities, accident and emergency, primary care