East Kent Hospitals University NHS Trust records rise in rickets cases between 2019 and 2023

The number of rickets cases recorded in one part of Kent has rocketed in the last five years.

The disease - once synonymous with Victorian Britain and urban poverty - affects bone development in children, causing pain, poor growth and soft weak bones that can lead to deformities.

East Kent Hospitals University NHS Trust, which is one of the largest hospital trusts in England, had just 122 recorded cases in 2019.

However last year that figure had swelled to more than 580 - a 380% increase - according to a Freedom of Information request.

In rare cases, says the NHS, children can be born with a genetic form of rickets but it is a lack of vitamin D or calcium that remains the most common cause.

Aches and pains, poor growth, muscle weakness or spasms, dental problems and seizures can be among the signs.

In the Victorian era the disease was widespread - particularly in low socio-economic areas - where meagre diets and a lack of sunlight caused by industrial city smog blighted children’s health.

And it wasn’t until the early 1900s did researchers realise how critical vitamin D was to the development of healthy bones thanks to its role in helping the body absorb calcium.

The trust says it interprets part of the increase to a greater awareness of the condition.

Early warning signs?

Back in 2013 - the UK’s then chief medical officer Dame Sally Davies said she was concerned rickets was one of a number of diseases showing signs of a comeback as rising child obesity rates, a lack of effective mental health services for children and growing rates of vitamin deficiency were affecting youngsters’ health.

In her report ‘Our Children Deserve Better’ she called for a universal handout of vitamins to all under fives and claimed that the UK had fallen behind the rest of Europe in caring for its children.

Speaking at the time Dame Sally said: “We are seeing rickets again. I used to see rickets when I trained in the late Seventies, and it’s coming back again.”

The picture in Kent

East Kent Hospitals Trust, with its five hospitals and numerous community clinics, serves more than 700,000 people across the entire east of the county.

Within its patch are also significant areas of deprivation - with some parts of Thanet among the poorest in England - where more than 20% of the district’s population live in the bottom 10% of the most deprived nationally.

In 2015 the ward Cliftonville West was named as the fourth most deprived neighbourhood in the country.

East Kent’s Chief Medical Officer Des Holden said the Trust attributes part of the increase in reported cases to an increased awareness of the condition among medics.

More accurate recording, he explained, may also play a role but he said his teams are ‘robust’ in recommending additional vitamin D.

In a statement, he explained: “We interpret that part of the increase is due to increased recognition and more accurate recording of rickets.

“Our neonatal teams are robust in recommending vitamin D for babies at risk, including mothers who have low vitamin D.

“There is also increased awareness in our team to screen for vitamin D levels. For example, vitamin D screening is now included in our guidance for children with obesity as this group is at increased risk of vitamin D deficiency.

“Children with rickets may previously have been recorded as having vitamin D deficiency and treated appropriately, but we have improved recording in our coding systems that they meet criteria to diagnose rickets”

Medway GP Dr Julian Spinks says people of all ages should follow the national guidance and take vitamin D supplements to avoid what he says is an entirely preventable condition.

He said: “We thought we’d got rid of it. But it is now back.

“There is a possibility if a pregnant woman is very deficient herself that the baby will be born with a relative lack of vitamin D. However in most cases it’s because they’re not actually getting enough vitamin D and the two main ways we get it in the UK are from sunlight - particularly from April to September - and from food.

“Definitely diet plays a part. If children are not eating things like oily fish or eggs or for example - breakfast cereals which are often supplemented with vitamin D - then this will have an effect.

“Whilst it’s a very small proportion of the population, it is worrying that this is making a comeback and it’s because it’s a very preventable condition.”

While East Kent’s figures, according to the FOI submitted by online pharmacy and health service NowPatient, show a more than 300% leap in cases, overall numbers remain lower than in some other trusts in England.

For example - University Hospitals of Morecambe Bay saw more than 4,700 rickets cases last year.

Nationally, NHS England figures point to a sharp increase in hospital admissions for a vitamin D deficiency - rising from 31,576 admissions in 2013/14 to 188,114 last year - which can lead to the skeletal disorder if left untreated.

There were also an additional 498 admissions in 2013/14, where the main or secondary reason was rickets, rising to 530 the year after, followed by 474 in 2018 and dropping to 482 last year. Almost all cases are understood to be in children.

In Kent - Medway NHS Foundation Trust said the number of hospital inpatients diagnosed with rickets during their stay in 2019 was 28 and last year was seven.

Dartford and Gravesham NHS Trust, which runs Darent Valley Hospital, said it had no recorded cases of an ‘inpatient diagnosis’ within the hospital last year.

While Maidstone and Tunbridge Wells NHS Trust - which had figures for the number of individual people with a rickets diagnosis who were admitted to the hospital for treatment as inpatients - put the number at two for 2019, rising to 38 patients in 2021 and two hospital admissions for rickets patients last year.

Are Victorian diseases making a comeback?

Prolonged periods of austerity, the ongoing cost of living crisis and the pandemic’s impact on healthcare has led to considerable debate over whether once-eradicated disease are now witnessing a resurgence.

Prompting the UK Health Security Agency - in 2019 - to address reports that Dickensian or Victorian illnesses like rickets, whooping cough and Scarlet Fever were again on the rise.

In an article the government department published online it argued such complaints had ‘never gone away’ but that a mixture of science and public health policy mostly now kept them contained.

It wrote: “In the UK some diseases have been eliminated and others still circulate at low rates and can periodically increase or re-emerge as a problem.

“Nevertheless, for the most part in the UK, “Dickensian diseases” are at nowhere near the scale nor have the same impact on public health they once did. And the good news is that all can be preventable through either good hygiene, vaccination, or getting the correct nutrients.”

But getting the correct nutrients into people’s diets has been of growing concern to anti-poverty charities as the cost of living crisis has driven more households towards less nutritious foods.

Sky-high food prices, they say, have made healthy diets for increasing numbers of households unaffordable forcing people to abandon cooking from scratch in favour of using cheaper, processed food that can lack the desired nutrients.

According to a report by the Joseph Rowntree Foundation - 14.4 million Britons, or one in five people, were living in poverty between 2021 and 22 while six million people were in “very deep” poverty, with an income way below the poverty line.

Sarah Calcutt is the chief executive of City Harvest, a charity which wants to reduce food insecurity and protect the planet by redistributing edible surplus food to those facing food poverty.

She said the cost of living crisis was having a significant impact on some people’s health.

She explained: “We are incredibly concerned

“There is rickets, scurvy.

“There is a whole Dickensian list of diseases that come around because key food groups are missing from people’s diets.”

In December the Liberal Democrats accused the government of a ‘Dickensian attitude’ to healthcare after data it obtained from Freedom of Information requests to 78 health trusts revealed 269 cases of scurvy since 2019.

Driven by a lack of vitamin C in the diet, scurvy was once commonly associated with sailors who would run out of fresh food while at sea.

Medway NHS Trust, according to the Lib Dem data, had recorded six cases of scurvy and East Kent one case.

While statistics from The Times Health Commission, also obtained in 2013, suggested cases of malnutrition had more than doubled in a decade and quadrupled since 2008 with 10,896 NHS patients — including 312 children — hospitalised with the condition in England between 2022 and April 2023.

In East Kent - according to Now Patient’s FOI data for the trust - the change in malnutrition cases between 2019 and 2023 went from 75 to 117.

Hitting back at Christmas, the government described the Lib Dem figures as ‘misleading’ - saying the causes of malnutrition are not always because of a poor or inadequate diet.

A spokesman added at the time: “We are determined to support people to have a healthy and balanced diet and through our healthy food schemes - Healthy Start, Nursery Milk and the School Fruit and Vegetable Scheme - the government is helping more than three million children and providing a nutritional safety net to those who need it the most.”

Increasing vitamin intake

Vitamin D comes from exposing the skin to sunlight but is also found in foods such as oily fish, eggs and some cereals.

People not consuming foods naturally containing or fortified with vitamin D should consider a daily 10-microgram supplement in autumn and winter, advises the UKHSA.

While those who get no exposure to the sun or completely cover their skin when outside need to take a daily 10-microgram supplement throughout the year.

Babies up to the age of one, it adds, should be given daily vitamin drops containing 8.5 micrograms of vitamin D unless they are consuming more than 500ml of infant formula which is already fortified with vitamin D.

The NHS’s Healthy Start scheme can support cash-strapped households with buying healthy food and milk.

For those who are more than 10 weeks pregnant or have a child under four, and are eligible, a benefit card is topped up every four weeks to help with the purchase of fresh food.

The card can also be used to collect Healthy Start vitamins for pregnant mothers and those breastfeeding and vitamin drops for babies and young children up to four years old to support their intake of the required nutrients.