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Concerns have been raised by a senior official in the NHS that children with illnesses unrelated to Covid-19 are going to hospital too late and coming to harm as a result, a leaked email seen by BBC Newsnight says.

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

The comments by the National Clinical Director for Children and Young People in NHS England emerged on the same day as figures showed 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 said people should always come forward for urgent care.

They added that parents with serious concerns about the health of their child should use the online NHS 111 service or call 999 for an emergency.

Ambulance 'too busy'

The email, dated 31 March, detailed several cases from one part of the UK. The children described were aged from 10 years old down to just six months.

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 this evidence was ultimately anecdotal.

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

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

He added that it was not just amongst children that they were seeing a drop in people coming to seek medical care.

"The kinds of things we'd expect to see in general practice that we're concerned we might not be seeing 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 coming to them with heart problems and strokes. Some doctors have told Newsnight they are keeping notes on patients who may have received suboptimal care because resources have been diverted elsewhere.

On Thursday, the medical director for NHS England Stephen Powis encouraged people needing emergency care - including those with sick children - to seek out care "just as you always have done" - and the interim Chief Medical Officer of Scotland said that parts of the health service were "eerily quiet".

Experts say they think there'll be a spike in all cause mortality - deaths for all different reasons not just Covid-19. This has been flagged as a potential problem in reviews of previous outbreak including the 2009 swine flu pandemic

"We know that in previous pandemics both overseas and in the UK when they've hit mortality from other conditions has gone up," Dr Marshall said adding: "In the flu crisis 10 years ago in the UK we saw a higher mortality rate for heart attacks and strokes."

All doctors Newsnight spoke to, as well as the government, urged people to seek medical help if they needed it.

"The important message that I want to get across today is that children who are seriously ill should present to their emergency department. We can keep children safe and will continue to do so if we receive these referrals," Dr Brown said.