Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Profile photo of a child looking pensive.

This project aims to address questions of health justice arising out of changes to service restrictions and innovative practice in the delivery of healthcare for children with chronic illness in the UK during the pandemic.

To respond to the pandemic the NHS deployed strategies (e.g. usual service restriction, changes in care delivery, redeployment of staff and clinic space) which had an immediate effect on children’s usual care. To date, the direct impact of Covid-19 infection on children’s physical health has been recorded as being far milder than for other groups. By contrast the indirect impact on children has been profound, with substantial reductions in urgent activity in hospitals. The extent to which health service restrictions and changes in care delivery are fair for children has not been ethically assessed.

This project, undertaken in collaboration with NHS child healthcare specialists, aims to address the omission of a children-related ethical dimension in Covid-19 related research and policy. It will achieve this by exploring which risks on children’s physical and mental health can be morally justified in health systems’ response to the pandemic.

It aims to provide accessible ethical guidance to medical authorities and government departments on how the needs of children with long-term conditions should feature in the prioritisation process required in the pandemic context. This guidance will be assessed, in context, in conjunction with a range of decision-makers who are responsible for making decisions about the allocation to resources and by working closely with the clinical-academic Children and Young People’s Health Partnership (CYPHP) in South East London.

The project is collaboration between University of Oxford and King's College London.

** Call for Paper for special issue of Monash Bioethics Review: Ethical, Practical and Systemic Challenges Facing Children with Complex Chronic Conditions: A Global Health Perspective - deadline 30 September 2024. Visit the Monash Bioethics Review website for details. **

Project Team

  • Sapfo Lignou (PI) Senior Researcher in Bioethics, Ethox Centre, University of Oxford
  • Mark Sheehan (Co-I) Oxford Biomedical Research Centre Ethics Fellow, Ethox Centre, University of Oxford
  • Ingrid Wolfe (Co-I) Director, Institute for Women and Children's Health; Clinical Senior Lecturer, Consultant, Paediatric Population Health, King's College London
  • Jenny Greenwood Research Assistant, Institute of Women and Children’s Health, Kings Health Partners, King’s College London
  • Dominic Reed, Post-doctoral Researcher, Institute for Women and Children's Health, King's College London 

Focus groups

We worked with the National Children's Bureau to recruit parents/carers of children with chronic illness (asthma, diabetes, cancer, mental health, neurodiversity)  to join our focus group discussions. The aim of this study is to understand the impact of changes in healthcare delivery on the care of children with chronic illness.


Paper: Lignou S, Sheehan M, Parker M and Wolfe I. Lignou S, Sheehan M, Parker M and Wolfe I. Healthcare resource allocation decisions and non-emergency treatments in the aftermath of Covid-19 pandemic. How should children with chronic illness feature in prioritisation processes? [version 2; peer review: 2 approved]. Wellcome Open Res 2024, 8:385 (

Paper: Lignou S, Wolfe I, Healthcare prioritisation and inequitable inequalities: why a child health perspective should be incorporated into the current NHS guidance. Archives of Disease in Childhood Published Online First: 19 May 2023. doi: 10.1136/archdischild-2023-325634

Paper: Dominic Reed, Ingrid Wolfe, Jenny Greenwood & Sapfo Lignou, Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of the experiences of parents and carers of children with chronic illness to inform future policies in times of crisis. BMC Health Serv Res 23, 530 (2023).

Paper: Lignou, S., Sheehan, M. Children with medical complexities: their distinct vulnerability in health systems’ Covid-19 response and their claims of justice in the recovery phase. Med Health Care and Philos (2022).

Paper: Lignou S, Greenwood J, Sheehan M, Wolfe I. Changes in Healthcare Provision During Covid-19 and Their Impact on Children With Chronic Illness: A Scoping Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing. January 2022. doi:10.1177/00469580221081445

BlogThe NHS sometimes neglected the needs of younger people with chronic conditions during the pandemic (March 2022), Jenny Greenwood & Sapfo Lignou, LSE Covid-19 Blog

Blog: The impact of covid-19 on healthcare provision for children with long-term conditions (April 2022), Jenny Greenwood & Sapfo Lignou, The Pandemic and Beyond,  Wellcome Centre for Cultures and Environments of Health, University of Exeter

Report: How have health systems policy responses to Covid-19 affected children with chronic illness in the UK? (September 2022), Sapfo Lignou, Jenny Greenwood, Mark Sheehan and Ingrid Wolfe 

This research is funded by a grant from UKRI/AHRC AH/W003945/1