Diagnosis and treatment delays for children.

Concerns have been raised by a senior NHS official that children with illnesses unrelated to Covid-19 are being taken to hospital too late during the pandemic and suffering as a result, a leaked email seen by the BBC says.

The possible reasons for the late hospital visits include general advice given about Covid-19; patient access to helpline, NHS 111, and parental concern about taking children to hospital during the coronavirus pandemic.

The comments by the national clinical director for children and young people in NHS England coincided emerged with figures showing A&E attendance numbers in England were down 29% from the same time last year.

NHS England and the Department for Health and Social Care have said people should always come forward for urgent care. They say that parents with serious concerns about their child’s health should use the online NHS 111 service or call 999 in an emergency.

The clinical director’s email, dated March 31, detailed several cases from one part of the UK. The children described were aged between 10 years to six months old.

In one case, a mother reported that she was waiting to be spoken to on NHS 111 for more than 60 minutes while her child "arrested" - medical terminology for the heart or breathing stopping. The child subsequently died.

In another case referred to in the email, a mother says she was told the ambulance service was too busy whilst her child was "semi-conscious and vomiting."

And another set of parents were reported not to have taken their unwell child to hospital for five days as they believed there was "risk in hospitals of Covid-19." The child also died.

The email made it clear that all the evidence was anecdotal.

Chair of the Royal College of GPs, Dr Martin Marshall, said that children coming to doctors with symptoms similar to Covid-19 were "more likely to have a non-Covid condition."

A consultant paediatrician at Addenbrooke's Hospital, Cambridge, Dr Richard Brown, said there had been "recurrent themes" like ruptured appendixes and severe sepsis in young children who had not come to hospital as soon as they should.

He added that children were among a cross section of the population not seeking medical care when appropriate.

He said: "The kinds of things we'd expect to see in general practice, that we're concerned we might not be seeing now, would be early presentation of cancer type symptoms, for example, which we'd usually recognise and refer rapidly for assessment."

Anecdotally, fewer patients than doctors expect are seeking medical help after heart problems and strokes. Some doctors have said that they are keeping notes on patients who may have received a lower-than-acceptable standard of care because resources have been diverted elsewhere.

Medical director for NHS England, Stephen Powis, encouraged people needing emergency care - including those with sick children - to seek out help "just as you always have done."