OA36 Paediatric rheumatology and health inequalities: findings and recommendations from the Getting it Right First Time (GIRFT) report

Abstract Background/Aims Health inequalities arising from social, environmental, and economic factors can impede equitable access to the most effective care. The 2025 paediatric rheumatology Getting It Right First Time (GIRFT) review aimed to identify and address unwarranted variation, highlighting best practice to inform improvement across England. This study represents the first use of routinely collected NHS data to examine the impact of wider social determinants of health on paediatric rheumatology care. Methods We extracted data from the Hospital Episode Statistics dataset (HES) for all in-patient and out-patient encounters coded to Paediatric Rheumatology across one financial year (2023/24). Data items relevant to health inequalities, including outpatient appointments recorded as ‘Was Not Brought’ (WNB), Index of Multiple Deprivation (IMD), and geographical and travel time measures, were extracted for analysis. The national data were contextualised using local information from self-reported pre-visit questionnaires and a review of health inequalities monitoring systems during peer review meetings. Results Sixteen specialist paediatric rheumatology providers (Hubs), together with their network hospitals (Spokes), participated in the GIRFT review. Between April 2023 and March 2024, 5.4% of outpatient appointments were recorded as ‘Was Not Brought’ (WNB), with rates ranging from 1.12-10.62% across providers. Higher WNB rates were seen in Trusts serving more deprived populations. Average travel times by public transport during peak hours were 46 minutes for inpatient encounters (range 25-74 minutes) and 69 minutes for outpatients (range 49-97 minutes). Only five Hubs (31%) reported routine mechanisms to identify or mitigate health inequalities, including charity-funded transport, peer support workers, or flexible appointment scheduling. Peer review discussions highlighted that clinical teams were not always aware of local interventions, such as transport assistance, for patients at risk of WNB. Hub sites participating in a pilot of the Children’s Health Alliance WNB Artificial Intelligence Tool reported innovative examples of excellence. Conclusion This analysis indicated notable inequities in access to paediatric rheumatology care, including higher WNB rates at Trusts serving more deprived populations. Long travel times, compounded by limited transportation options and financial constraints, further restrict timely access and exacerbate health inequalities. Hub teams reported systemic barriers to improving equitable access for families experiencing poverty. Paediatric healthcare professionals require operational support to examine and adapt care pathways, ensuring services are accessible and acceptable for all children and young people. GIRFT recommends a coordinated approach to reducing health inequalities, with providers collaborating with patients, families, patient support organisations, and local family hubs to co-produce strategies that improve self-management and access for vulnerable populations. Disclosure F. McErlane: None. S. Olson: None. C. Pidgeon: None. R.D. Sandler: None. C. Tranter: None. G. Ward: None. G. Cleary: None.