{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T18:24:47Z","timestamp":1785867887833,"version":"3.56.0"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T00:00:00Z","timestamp":1785801600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["NIHR200173"],"award-info":[{"award-number":["NIHR200173"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Certain groups of children and young people (CYP) living in the North East and North Cumbria (NENC) present late to paediatric critical care (PCC) and surgery in children (SIC) services, resulting in poorer clinical outcomes. This suggests inequitable access; however, the factors influencing access to these services are presently unclear.<\/jats:p>\n <\/jats:sec>\n \n Aim<\/jats:title>\n To explore inequitable access to PCC and SIC for CYP and inform recommendations for service improvement.<\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Qualitative study using semi-structured interviews.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n Community settings in NENC, United Kingdom.<\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n CYP with experience of PCC\/SIC, their caregivers, healthcare professionals, and charity staff.<\/jats:p>\n <\/jats:sec>\n \n Analysis<\/jats:title>\n Data were analysed using a combined deductive-inductive approach, informed by the UK Paediatric Critical Care Society Quality Standards.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Barriers to access were grouped into three categories: communication, system-level, and socio-economic factors. Communication and system-level barriers align with existing quality standards, whereas socio-economic influences are not explicitly addressed but play a significant role in shaping access for some families.<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Access to PCC and SIC is shaped by interacting communication, system, and socio-economic factors that may delay timely care. Greater recognition of socio-economic influences within service standards and policy may support more equitable access. Further research should focus on improving engagement with CYP and caregivers from underrepresented groups.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0355278","type":"journal-article","created":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:22:11Z","timestamp":1785864131000},"page":"e0355278","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Barriers to accessing paediatric critical care and surgery: A qualitative study"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4041-2379","authenticated-orcid":true,"given":"Catherine","family":"El Zerbi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emer","family":"Cullen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elaine","family":"Bidmead","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4795-0148","authenticated-orcid":true,"given":"Helena-Ulrike","family":"Marambio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Agbeko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Bloomfield","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Rankin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,4]]},"reference":[{"key":"pone.0355278.ref001","unstructured":"Paediatric Critical Care Society. Quality Standards for the Care of Critically Ill or Injured Children (6th Edition). 2021. https:\/\/pccsociety.uk\/wp-content\/uploads\/2021\/10\/PCCS-Standards-2021.pdf"},{"issue":"4","key":"pone.0355278.ref002","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0292983","article-title":"Poverty proofing healthcare: a qualitative study of barriers to accessing healthcare for low-income families with children in northern England","volume":"19","author":"E Bidmead","year":"2024","journal-title":"PLoS One"},{"key":"pone.0355278.ref003","volume-title":"The Child of the North: Building a fairer future after COVID-19","author":"K Pickett","year":"2021"},{"issue":"1","key":"pone.0355278.ref004","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1186\/s12913-019-3922-7","article-title":"Socio-demographic patterns in hospital admissions and accident and emergency attendances among young people using linkage to NHS Hospital Episode Statistics: results from the Avon longitudinal study of parents and children","volume":"19","author":"L Johnson","year":"2019","journal-title":"BMC Health Serv Res"},{"key":"pone.0355278.ref005","volume-title":"Admissions of inequality: emergency hospital use for children and young people","author":"L Kossarova","year":"2017"},{"issue":"3","key":"pone.0355278.ref006","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1136\/adc.2007.134403","article-title":"Epidemiology of critically ill children in England and Wales: incidence, mortality, deprivation and ethnicity","volume":"94","author":"RC Parslow","year":"2009","journal-title":"Arch Dis Child"},{"issue":"4","key":"pone.0355278.ref007","doi-asserted-by":"crossref","DOI":"10.1016\/j.jaip.2021.10.065","article-title":"Geospatial analysis of social determinants of health identifies neighborhood hot spots associated with pediatric intensive care use for life-threatening asthma","volume":"10","author":"JR Grunwell","year":"2022","journal-title":"J Allergy Clin Immunol Pract"},{"issue":"6","key":"pone.0355278.ref008","doi-asserted-by":"crossref","DOI":"10.1542\/peds.2019-0748","article-title":"Neighborhood poverty and pediatric intensive care use","volume":"144","author":"E Andrist","year":"2019","journal-title":"Pediatrics"},{"key":"pone.0355278.ref009","volume-title":"No time to wait: an ambitious blueprint for tackling child poverty in the North East.","author":"A Bailey","year":"2024"},{"key":"pone.0355278.ref010","volume-title":"Health and healthcare inequalities report 2024-2025","author":"North East & North Cumbria Health & Care Partnership","year":"2025"},{"key":"pone.0355278.ref011","unstructured":"Royal College of Paediatrics and Child Health. Data and evidence: The future \u2013 Paediatrics 2040. 2021. https:\/\/paediatrics2040.rcpch.ac.uk\/our-evidence\/data-and-evidence\/future\/"},{"key":"pone.0355278.ref012","volume-title":"From left behind to leading the way: a blueprint for transforming child health services in England","author":"S Jenkins","year":"2024"},{"issue":"10","key":"pone.0355278.ref013","doi-asserted-by":"crossref","first-page":"1177","DOI":"10.1111\/tmi.13651","article-title":"What factors affect patients\u2019 ability to access healthcare? An overview of systematic reviews","volume":"26","author":"B Dawkins","year":"2021","journal-title":"Trop Med Int Health"},{"key":"pone.0355278.ref014","volume-title":"Ethnic inequalities in healthcare: a rapid evidence review","author":"D Kapadia","year":"2022"},{"key":"pone.0355278.ref015","volume-title":"The NHS long term plan","year":"2019"},{"issue":"1","key":"pone.0355278.ref016","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1186\/s12939-020-01281-6","article-title":"Does healthcare inequity reflect variations in peoples\u2019 abilities to access healthcare? Results from a multi-jurisdictional interventional study in two high-income countries","volume":"19","author":"J Haggerty","year":"2020","journal-title":"Int J Equity Health"},{"issue":"3","key":"pone.0355278.ref017","article-title":"Seven practices for pursuing equity through learning health systems: notes from the field","volume":"5","author":"A Parsons","year":"2021","journal-title":"Learn Health Syst"},{"key":"pone.0355278.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2288-6-35","article-title":"Conducting a critical interpretive synthesis of the literature on access to healthcare by vulnerable groups","volume":"6","author":"M Dixon-Woods","year":"2006","journal-title":"BMC Med Res Methodol"},{"issue":"1","key":"pone.0355278.ref019","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1136\/archdischild-2021-323191","article-title":"How equitable is the NHS really for children?","volume":"107","author":"E Cecil","year":"2022","journal-title":"Arch Dis Child"},{"issue":"6","key":"pone.0355278.ref020","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"A Tong","year":"2007","journal-title":"Inter J Qual Health Care"},{"key":"pone.0355278.ref021","volume-title":"Paediatric critical care GIRFT programme national specialty report","author":"K Morris","year":"2022"},{"key":"pone.0355278.ref022","unstructured":"Office for National Statistics ONS. Statistical bulletin, ethnic group, England and Wales: Census 2021. 2022. Accessed 2024 October 22. https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/culturalidentity\/ethnicity\/bulletins\/ethnicgroupenglandandwales\/census2021"},{"key":"pone.0355278.ref023","unstructured":"NHS England. Service specifications. Level 3 - Paediatric critical care. 2018. https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2018\/08\/Paediatric-high-dependency-care.pdf"},{"key":"pone.0355278.ref024","volume-title":"NVivo qualitative data analysis software","year":"2022"},{"key":"pone.0355278.ref025","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1186\/1741-7015-9-39","article-title":"Using framework-based synthesis for conducting reviews of qualitative studies","volume":"9","author":"M Dixon-Woods","year":"2011","journal-title":"BMC Med"},{"key":"pone.0355278.ref026","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/1471-2288-13-37","article-title":"\u201cBest fit\u201d framework synthesis: refining the method","volume":"13","author":"C Carroll","year":"2013","journal-title":"BMC Med Res Methodol"},{"issue":"11","key":"pone.0355278.ref027","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1136\/bmjqs-2014-003642","article-title":"How to build up the actionable knowledge base: the role of \u201cbest fit\u201d framework synthesis for studies of improvement in healthcare","volume":"24","author":"A Booth","year":"2015","journal-title":"BMJ Qual Saf"},{"key":"pone.0355278.ref028","first-page":"173","article-title":"Qualitative data analysis for applied policy research","volume-title":"Analyzing qualitative data","author":"J Ritchie"},{"issue":"1","key":"pone.0355278.ref029","first-page":"1","article-title":"Using the framework method for the analysis of qualitative data in multi-disciplinary health research","volume":"13","author":"NK Gale","year":"2013","journal-title":"BMC Med Res Methodol"},{"issue":"7","key":"pone.0355278.ref030","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2019-034970","article-title":"\u201cCaring About Me\u201d: a pilot framework to understand patient-centered care experience in integrated care - a qualitative study","volume":"10","author":"A Youssef","year":"2020","journal-title":"BMJ Open"},{"issue":"3","key":"pone.0355278.ref031","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0265342","article-title":"Perspectives of individuals with sickle cell disease on barriers to care","volume":"17","author":"S Phillips","year":"2022","journal-title":"PLoS One"},{"issue":"714","key":"pone.0355278.ref032","doi-asserted-by":"crossref","first-page":"4","DOI":"10.3399\/bjgp22X718013","article-title":"Addressing language as a barrier to healthcare access and quality","volume":"72","author":"KL Whitaker","year":"2021","journal-title":"Br J Gen Pract"},{"key":"pone.0355278.ref033","unstructured":"General Medical Council. Professional standards: 0-18 years: guidance for all doctors. 2007. https:\/\/www.gmc-uk.org\/-\/media\/documents\/gmc-guidance-for-doctors---0-18-years---english-20200211_pdf-48903188.pdf"},{"key":"pone.0355278.ref034","unstructured":"General Dental Council. Standards for the dental team. 2013. Accessed 2024 January 12. https:\/\/www.gdc-uk.org\/docs\/default-source\/standards-for-the-dental-team\/standards-printer-friendly-colour86d42fee1e2f440e8faaa3b80983334a.pdf?sfvrsn=98cffb88_5"},{"key":"pone.0355278.ref035","volume-title":"Babies, children and young people\u2019s experience of healthcare","author":"National Institute for Health and Care Excellence","year":"2021"},{"issue":"12","key":"pone.0355278.ref036","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1136\/archdischild-2022-324132","article-title":"Effective healthcare communication with children and young people: a systematic review of barriers and facilitators","volume":"107","author":"A Navein","year":"2022","journal-title":"Arch Dis Child"},{"key":"pone.0355278.ref037","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1163\/1571818054545277","article-title":"Listening and responding? Children\u2019s participation in healthcare within England","volume":"13","author":"A Franklin","year":"2005","journal-title":"Int J Children\u2019s Rights"},{"issue":"7","key":"pone.0355278.ref038","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1136\/archdischild-2015-310280","article-title":"Inequalities in access to a tertiary children\u2019s chronic pain service: a cross-sectional study","volume":"101","author":"MA Jay","year":"2016","journal-title":"Arch Dis Child"},{"key":"pone.0355278.ref039","first-page":"1","article-title":"Does time taken by paediatric critical care transport teams to reach the bedside of critically ill children affect survival? A retrospective cohort study from England and Wales","author":"SE Seaton","year":"2020","journal-title":"BMC Pediatrics"},{"key":"pone.0355278.ref040","volume-title":"Equity of access to health care","author":"M Goddard","year":"1998"},{"key":"pone.0355278.ref041","unstructured":"N H S. Enabling people to make informed health decisions. Health literacy. 2024. Accessed 2024 February 28. https:\/\/www.england.nhs.uk\/personalisedcare\/health-literacy\/"},{"key":"pone.0355278.ref042","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/j.1475-5890.2016.12109","article-title":"Socio\u2010economic inequalities in health care in England","volume":"37","author":"R Cookson","year":"2016","journal-title":"Fiscal Studies"},{"issue":"6","key":"pone.0355278.ref043","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1097\/01.PCC.0000137354.19807.44","article-title":"Traumatic stress in parents of children admitted to the pediatric intensive care unit","volume":"5","author":"A Balluffi","year":"2004","journal-title":"Pediatric Critical Care Medicine"},{"issue":"5","key":"pone.0355278.ref044","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.injury.2019.01.004","article-title":"Parent experiences and psychosocial support needs 6 months following paediatric critical injury: a qualitative study","volume":"50","author":"K Foster","year":"2019","journal-title":"Injury"},{"key":"pone.0355278.ref045","unstructured":"NHS North East and North Cumbria. NHS healthier together North East & North Cumbria. Accessed 2025 August 13. https:\/\/nenc-healthiertogether.nhs.uk\/"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355278","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T17:22:21Z","timestamp":1785864141000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355278"}},"subtitle":[],"editor":[{"given":"Nik Hisamuddin","family":"Nik Ab. Rahman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,4]]},"references-count":45,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,4]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355278","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,4]]}}}