Decisions about distributing health resources between different people and medical needs are difficult and controversial. In this project we propose to investigate how healthcare resources should be distributed across the lifespan and across different age groups. This investigation, relatively unexamined within healthcare policy research and ethics, is particularly timely. Shifting demographics, resource constraints, and exacerbated by the pandemic inequalities, pose significant challenges for the NHS and highlight the pressing need to ensure fair treatment for all age groups in healthcare services. In healthcare decision-making, connections between age and resource allocation have predominantly focused on adhering to the apparent requirement that we do not discriminate based on age. This often leads to a simplistic approach that people of all ages should be treated the same in order to be treated fairly. Regrettably, despite best intentions, this approach cannot consistently achieve fairness. Instead, it gives rise to new forms of injustice by obscuring underlying realities and needs. Currently, distinctive needs across the lifespan and the unique ways in which individuals at various life stages are impacted by healthcare are not properly considered in decision-making processes. Important challenges are often overlooked. These, for instance, include transitional phases; the specific requirements on individuals dealing with conditions at atypical ages; and the complex interplay between vulnerabilities associated with different life-stages and socio-economic factors. These omissions contribute to and exacerbate existing inequalities. Many older individuals, lacking post-operative support, experience isolation and diminished well-being. Children with complex medical conditions, waiting on backlogged lists, often miss out on time-critical developmental treatments constraining their life opportunities. Women experiencing menopause and adolescents battling mental health challenges frequently encounter suboptimal care, exacerbating health and social issues that could otherwise be alleviated. Children within palliative care services, which are generally tailored and funded for older patients, may not receive the emotional and physical support they require. This project will illuminate these currently overlooked inequalities. By exploring the critical intersection between age and healthcare justice, this work will help determine how to allocate resources in order to avoid unfair discrimination against different population groups. The study will proceed, first, to identify and analyse age-related assumptions in healthcare resource allocation in order to understand their impact on healthcare access from early life to late adulthood. Second, it will explore the legal and ethical dimensions of healthcare inequalities among age groups in order to identify overlooked injustices. Finally, collaborating with commissioners, providers, patient and policy organisations, it will develop and test the applicability of a 'stage-of-life sensitive' approach for decision-making. This approach will be more responsive to healthcare needs across the lifespan and will be adaptable to different processes and regional policy contexts. Findings will raise awareness of overlooked healthcare injustices among decision-makers, academics, and the public, aiming to prompt policymakers to revise existing guidelines. This will lead to tangible healthcare access benefits for individuals of all ages and needs. We will also establish networks among ethicists, lawyers, healthcare providers, policymakers, and other stakeholders, fostering continued dialogue to facilitate societal change.

Around one in four young people are missing a large amount of education through persistent absence from school (10% or more missed). While it was presumed that school attendance levels would recover following the pandemic, a large proportion of young people still not consistently attend school. It is reported that young people are predominantly absent from school due to health concerns, including mental health symptoms such as anxiety. Yet, we do not know how maternal health, social service contacts, and individual mental and physical health contribute to inequalities in persistent school absence and educational attainment. Disadvantaged young people more often perform poorly in assessments and spend more time absent from education compared to privileged peers. Poor health during childhood and adolescence has the potential to explain some of the relationship between family socioeconomic circumstances (SECs) and poor educational outcomes. Poor health is likely to impact educational attainment through negative symptoms, disruption of learning, and school absence. Furthermore, long-term school absence is likely to contribute to young people's risk of mental health difficulties through distance from peers, social isolation, and anxiety. In addition, parents with low SECs are more likely to have poor mental and physical health. Parental mental health has a substantial impact on young people's own mental health, not only through inherited characteristics but also through parents' psychological problems that may lead to negative parenting behaviours, lack of attention to children's needs, increased dysfunction at home and social service contact. The context: Public health challenges for young people have been exacerbated by both the Covid-19 pandemic and the current cost of living crisis. The number of young people living in absolute poverty continues to rise dramatically, and the indirect impacts of the pandemic include a step-change increase in rates of mental health problems among young people, as well as reduced access to, and uptake of, key preventive and early intervention services. Aims and research questions: The overall aim of this fellowship is to assess the relative importance of maternal health, family social service contacts, and young peoples' mental and physical chronic conditions associated with social inequalities in adolescent (aged 11-18 years) persistent school absence and educational attainment in England. Using the ECHILD database; linked data on education, social care, and health before and after the covid-19 pandemic, I will examine the following questions: What proportion of young people experiencing repeated absence, poor attainment, or school exclusion have underlying chronic mental or physical health conditions? How much of the association between family disadvantage and educational outcomes is attributable to family risk factors or underlying chronic mental or physical health conditions in young people? Has the impact of health on educational inequalities changed since the pandemic? Does the relationship between health and educational inequalities vary by school, Local Authority or region? The fellowship will also be used to scope the ability of the ECHILD data to answer future research questions on whether frequent absences or poor educational attainment during adolescence predict health into early adulthood. Applications and benefits: I will address important gaps in the interplay between health and education/social care needs, including the compound disadvantage experienced since the pandemic. Digital co-produced materials on findings will inform and empower families and young people, practitioners, and teachers to better manage the relationship between health and education.

National and local organisations produce a wealth of valuable data, which can be used to understand how we can reduce the number of children at risk of poor social, health and educational outcomes. However, at present, this administrative data is not being used by enough researchers or analysts. In addition, researchers and analysts are not consistently addressing the questions that policy makers, practitioners or families themselves consider to be the most important. Funded by Administrative Data Research (ADR) England, we will establish a national community catalyst that will provide a vital point of connection, information and coaching for a broad and diverse community of child and family focused researchers and analysts, using (or aspiring to use) administrative data. The community catalyst will focus on children involved with early intervention and children's social care services. We will deliver a 2-year programme of online and face-to-face networking events and information, together with focused coaching workshops. The actions of the catalyst will build a community of researchers who are better connected and better informed. In addition, we will foster tighter connections between researchers and the end users of their work, to ensure close alignment between research and stakeholder priorities. The community catalyst will achieve these over-arching objectives, through four inter-linked work packages (WPs). WP1 will provide national strategic leadership, by delivering a far clearer and up-to-date understanding of the scope of current research using administrative data for child-focused research, together with a firm indication of priorities for new research. An open access research report will integrate learning across the WP, making recommendations about how any barriers to the delivery of new priority knowledge, can be tackled. WP2 will build capacity in the use of administrative and other large-scale datasets by establishing a web-based "one-stop shop" for child-focused researchers, complemented by an effective communication strategy and online information giving events. WP2 aims to raise awareness of the value and availability of administrative data resources, attract new entrants to the community of researchers, and forge greater connections between those already using these data. WP3 aims to strengthen and expand a diverse administrative data research community, through online and face-to-face networking events, focused on the ADR UK flagship datasets and use-cases. Focused coaching workshops will target and support new-comers to administrative data research, and provide opportunities for new collaborations among more experienced researchers. WP4 will provide a bespoke opportunity for an embedded research fellow, to access and use the valuable EChild resource, with supervision from the core team. To deliver on this ambitious project, we have brought together a highly experienced interdisciplinary project team - across five academic institutions in the UK; all members of the core team have pioneered the use of child and family administrative data, across sectors. The core team will be supported by a wider expert reference group, who will share their experience and use-cases, against each of the ADR England flagship datasets and related data resources.