• Children waiting over a year for community services up by a third in just two months
  • Trusts want national support as “no quick fixes”

The number of children waiting more than a year for community services has risen by a third in two months – mostly driven by referrals for neurological disorders – causing trusts to plead for national intervention.

NHS England figures show the number of children’s community waits of more than 52 weeks grew from 27,429 in February to 35,922 in April (31 per cent).

Data collection changed in February, which resulted in an increase in that month, but, even discounting this, the total appears to have roughly doubled in the year to April (see chart below - Children’s long waits have risen faster since February).

Along with a rise in the overall waiting list for community health services, it has been overwhelmingly driven by a large rise in referrals to children’s “community paediatrics” services, mostly for neurological disorders such as autism and ADHD.

Several trusts have declared they are effectively unable to deal with demand locally and called for national intervention and regional cordination to help.

Sheffield Children’s Foundation Trust said in a board paper  the “size and scale of the improvement required” on long ADHD and autism waits means it “cannot solve these challenges alone” and requires regional and national help to make progress. 

There were “few quick fixes”, it said, adding: “Solutions are neither easy nor quick to resolve and reflect a wider societal/environmental position.”

Solent Trust, in Hampshire, reported in a recent paper that it had tried “numerous initiatives… in the past with little improvement in the position” in children’s waits. 

And Derbyshire Healthcare Foundation Trust said worsening medicines shortages for ADHD – combined with rising demand and complexity of cases since covid, as well as staff vacancies – mean its service could no longer “manage” its mismatch between demand and capacity.

Waits had worsened further recently, it said, because it had to review some patients “as a matter of urgency” due to “withdrawal” from unavailable medicines. The global shortage of ADHD medicines due to manufacturing issues and demand means some are likely to be out of stock until the end of the year.

DHFT said its goal was now to “reduce the growth and speed” of rises in waits, rather than eliminate them, as they were “likely to continue to rise”.

Community trust CEOs told HSJ that despite local initiatives to tackle the waits a national approach was needed. It “really needs to be tackled from a national perspective”, one said.

Staffing gaps were being compounded by the growing pressure on those left, one community services manager said: “There’s been such a rise in demand but not much funding to match it, and senior clinicians are leaving due to the pressure.”

Community paediatrics accounts for 44 per cent of the children’s waiting list but 75 per cent of long waits in April (see charts below -Community paediatrics is driving children’s waiting lists) – specialists pointed out children often waited a long time even before being referred.

 

Referrals ‘through the roof’

Ian Male, a community paediatrician in Sussex who mainly works with autism, and is a former workforce officer at the British Association for Community Child Health, said autism referrals were “through the roof” but “funding has not matched” the rise.

The pressure for clinicians to clear waits means children and families do not get much additional contact after diagnosis and many say they are left “drowning” without support, he said.

NHS England figures show the number of new autism referrals in children has sharply grown in recent years, from an average of 3,099 per month in 2019-20 to 7,118 in 2023-24.

However, additional funding for community paediatrics has largely come in the form of short-term waiting list initiatives, said Mr Male. Instead, he called for “longer term solutions” such as training nurses to carry out diagnostic work and hiring other types of staff to free up doctors’ time. 

Notably, the NHS workforce plan published last summer aims for a 92 per cent increase in adult nursing training places but does not mention child nursing training places.

”NHS priorities are very focused on adult healthcare and that reflects current challenges such as A&E wait times, or early identification of cancer, but children’s services are missing out,” added Mr Male.

Ronney Cheung, officer for health services at The Royal College of Paediatrics and Child Health, told HSJ that children’s community waits were “now some of the longest of any part of the health system”, with a “significant disparity” compared to adults.

The consequences of long waits are “particularly damaging for children,” he added, as “many treatments and interventions must be administered within specific age or developmental stages, making the irrevocable effects of such delays even more pronounced”; such as inhibiting mental and physical development, education, and overall wellbeing.

Only the children’s waiting lists for orthotics and antenatal, newborn and children screening, and immunisation have seen significant improvements. These decreased by 71 per cent (1,092 to 318) and 84 per cent (4,591 to 724) respectively since April 2023. 

NHSE said in a statement: “NHS teams continue to work extremely hard to bring down long waits for care for children and young people, despite facing record demand… 

“As set out in the operational planning guidance, continuing to improve timely access to community health services is a core part of NHS recovery.”

It launched an ADHD task force earlier this year, looking into wide-ranging issues including demand and access, which is co-chaired by Professor Anita Thapar, a leading child psychiatrist, and Local Government Association chief executive Joanna Killian.

Integrated care systems were told in March to develop a “comprehensive plan” to reduce community waits, and to submit “timely, accurate data” to aid better understanding, as part of the 2024-25 NHS planning guidance. 

Source

NHSE data

Source Date

June 2024

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