Functional vision promotes quality of life and socio-emotional functioning in visually impaired children and adolescents.

In England, Paediatric Critical Care (PCC) is designated as a NHS service because it is a low-volume, high-cost service that is not available in every hospital. PCC is classified into three levels: : Basic Critical Care; : Intermediate Critical Care; and : Advanced Critical Care []. Unlike most paediatric services, L3 PCC is only available in tertiary centres, which are predominantly located in urban areas and can be difficult to reach, particularly for those living in rural areas without easy access to transport []. Within the North East and North Cumbria (NENC), certain groups of children and young people (CYP) present late to PCC and surgery in children (SIC) services, including paediatric dental surgery, resulting in poorer clinical outcomes. This suggests inequities in access to these specialist healthcare services, however, the factors influencing access are presently unclear. Poverty and low income are known factors influencing CYP’s health []. CYP living in areas of high economic deprivation have increased rates of attendance at Emergency Departments (ED) and higher rates of unplanned hospital admissions than those from less economically deprived areas [,]. Socio-economic deprivation is also associated with an increased risk of admission to PCC [,], poorer clinical outcomes [] and emergency readmissions []. The NENC region has high levels of economic deprivation []. Eight out of the ten local authorities with the highest rates of child poverty are in the NENC, with 35% of children in the NENC living in poverty, ranging from 24.5% (North Tyneside) to 38.7% (Middlesbrough) []. If existing poverty levels remain, future projections of healthcare activity suggest that by 2040, infant hospital admissions are set to increase by 58%, and ED attendance by 144% []. Waiting lists for children’s health services are also increasing at double the rate of adult waiting lists. Children are more likely than adults to have to wait for over a year to be seen by medical, surgical and community paediatric teams, suggesting inequities between adult and children’s health services []. Reducing inequities related to accessing healthcare services has been an aim for the NHS for decades, including addressing barriers to timely access to healthcare. While the NHS provides universal healthcare free at the point of access, many potential barriers to timely access have been identified [] including proximity to services and transport costs [], working in insecure/inflexible employment, ethnic background [], previous bad experiences, lack of access to primary care services, and in some reports, less timely recognition of illness []. The NHS identify that health services must adapt to meet the changing needs of patients, and that high quality care, as close to home as possible, should be provided for all CYP []. To achieve this, it is important to understand the needs of the population and barriers to accessing healthcare services [], which is a key element to achieving equity within a health system []. While much is known about barriers to health services [,], little evidence exists on barriers to accessing PCC and SIC. Insights into the barriers could have relevance to other socio-economically deprived regions of the UK. Identifying and understanding these barriers will enable service improvements to these vital services, which in turn could lead to improvements in health outcomes for CYP and families.