Children getting ‘conveyor belt’ care due to waiting list pressure

It comes after routine community health services waiting list figures were published for the first time by NHS England last week.

They revealed more than 200,000 children were waiting, of whom 12,000 had been waiting more than a year, and 65,000 more than 18 weeks. While adult community services lists have been coming down fairly steadily since the autumn, children’s services are failing to make progress, with a larger list in February than in October (see chart below — total waiting lists for community services), HSJ  analysis shows.

The children’s services with the longest lists are community paediatrics (which mostly deals with neurological development issues such as autism and ADHD), speech and language therapy, and children’s occupational therapy, analysis shows (see chart below — waiting lists by service type). Together these account for four-fifths of waits between 18 and 52 weeks (see chart below — waiting times by service).

Specialists in those areas told HSJ  it was the result of staffing gaps, rising and more complex demand, covid backlog, and years of underfunding. They also told HSJ  that the rush since 2021 to clear waiting lists build up during covid was harming the quality of care provided.

Royal College of Speech and Language Therapists chief executive Kamini Gadhok warned the increased focus on waiting lists had created “a conveyor belt to get children in and discharged”.

Some children were being assessed and wrongly discharged “with no treatment”, she said, while others were offered a “one-size-fits-all” approach, receiving only advice or “very limited intervention”.

It was harming education and wellbeing, she said, and “leaves staff feeling demoralised and looking for opportunities to work outside the NHS where they feel like they will be more able to make a difference”.

One senior manager in local community services said: “Every minute a child waits for help to diagnose and support their development issues means a minute they are not learning at school, and school attainment and life chances are totally linked.

“With these waiting lists we are miles away from the DHSC aspirations and government strategy [for autism].”

Sally Payne, professional advisor for children, young people and families to the Royal College of Occupational Therapists, agreed that “pressure” from performance managers to clear waiting lists meant “resources are [being] pulled away from some intervention approaches”, such as motor skills groups for children with developmental coordination disorder, or independence groups for teenagers with cerebral palsy, which also impacts staff job satisfaction, she said.

“Occupational therapists feel they’re not able to do the things they’re trained to do, and new staff don’t have the opportunity to see how their work can make a difference,” she added. “We’ve also got experienced staff leaving, which creates a vacuum of skills and knowledge.

Ian Male, a community paediatrician at Sussex Community Foundation Trust and workforce officer at the British Association for Community Child Health, argued children’s and community health had been “consistently low priorities in NHS spending” despite rising demand.

He said autism referrals in Sussex had increased by 400 per cent since 2015, with “very little funding nationally” to match.

“The reality is that with the numbers we’re dealing with, even if you had the most efficient system in the world, without additional resources, you’re not going to make much difference,” he said. NHS community services funding has been squeezed over the past five-10 years. The 2019 long-term plan committed to growing it as a share of total spend, but it is unclear if this has been delivered or remains the intention.  

There are also not enough community paediatricians to fill vacant roles, with several unfilled consultant posts in his area of Sussex and a scramble to sign up trainees because there are far more empty posts than available staff, he added. 

Presenting with higher needs

Children were now presenting at more severe stages across speech and language therapy, occupational therapy and in community paediatrics, the clinicians told HSJ. 

Dr Male said children diagnosed later with autism are at a greater risk of developing secondary mental health problems in their teenage years, while Dr Payne said long waits can “widen the gap” between children who need occupational therapy and their peers. 

Queen’s Nursing Institute chief executive Crystal Oldman added: “There is a lack of capacity within community services to meet the demand for care. In the case of services for children and young people, this can be especially devastating because of the lasting impacts of lack of timely interventions at a young age.”

A government spokesperson said: “We are working with the NHS to transform the way services are delivered to ensure children and young people are able to receive the right support, in the right place, at the right time.”

An NHSE spokesperson said services have been under “significant pressure” because of the ”combined impact of covid and flu, huge demand for services and strike action”.

“NHSE is working with the Department of Education to improve access and reduce waiting lists for children with speech, language and communication needs by delivering early language support,” they added. 

The £70m Change Programme  will “trial new ways of working to better identify and support children with speech, language and communication needs in early years and primary schools”, and “improve access to speech and language therapy for those who need it”, they added.