West Country Chronicle: Another troubling waiting list

Six months ago, health chiefs in Devon told the Chronicle that the growing backlog of children waiting for autism assessments would be cleared by November.

As readers will recall, autism assessment is the most troubled service within the multi-million-pound contract awarded to a consortium of NHS providers in 2019 after six years of being run by Virgin Care.

Under the NHS, waiting times for autism assessments for under-18s ballooned, with the pandemic exacerbating long waits for children and their families.

Last May there were 2,844 children in Devon waiting for an assessment. With estimates suggesting around 90 per cent of children assessed end up with an autism diagnosis – this means around 2,500 under-18s are waiting to be told they are living with autism.

The average waiting time was around 80 weeks.

What’s changed?

Six months on, Devon’s backlog has not been cleared.

Despite a “rapid improvement plan” agreed last spring between Devon Clinical Commissioning Group and the consortium (named Children and Family Health Devon), there were still 1,883 children waiting for an assessment at the end of October.

In papers published last month, the CCG admitted that the November target would not be hit, and chiefs are now saying the backlog will remain until at least the end of March.

Why is this problem so hard to fix?

According to Lorraine Webber, associate director of commissioning (community services) at the CCG, there have been “significant staff recruitment and retention issues”, as well as “the continuing impact of the pandemic on staff absence”.

At one point the service team was only operating with half its workforce, which CFHD said was down to “a range of reasons”. One reason is found in the CCG’s own governing body papers, which state that staff have been targeted with offers to work for an unnamed private company.

Ms Webber said measures have been put in place to address the staffing levels, which are now “improving”.

“We have extended the enhanced assessment capacity, which is designed to reduce the waiting list, through to the end of March 2022, meaning hundreds more children will be assessed between now and then,” she added.

Not just Devon

While Devon’s problems with autism assessment make worrying reading, it is even more concerning that the picture is similar in other parts of the South West and – most likely – across most of the country.

In Bristol, North Somerset and South Gloucestershire integrated care system, there were 1,862 under-18s awaiting an autism assessment as of the end of October. The average waiting time was 35 weeks, nearly three times higher than the 12 weeks recommended by the National Institute for Health and Care Excellence.

A spokesman for BNSSG CCG said demand for services were “currently in excess of what our local NHS and care services can offer”.

“We are working with our health and care partners to reduce this wait and have developed new services including the Autism Hub in south Bristol, which has been successful in reducing diagnosis times since it opened in autumn 2020.”

Further west, in Cornwall, the CCG reported last May that more than 800 children were waiting for an assessment. The average wait was nearly 60 weeks. Kernow CCG told the Chronicle at the time that they were looking to invest £100,000 to “support clearing the waiting list for autism assessments”.

In Somerset, the CCG didn’t provide figures for how many under-18s were waiting. Neil Hales, Somerset CCG’s director of commissioning, told HSJ work was “ongoing” to improve “data flows and quality ti ensure we have the full end-to-end (from referral to outcome) picture for the county).  

He added: “Somerset CCG, along with system partners across the county, are working on an extensive piece of work to consider the unmet needs of children with behavioural presentations.”

Neither Kernow CCG or Gloucestershire CCG had responded to our questions about waiting lists at the time of publication.

Much of the NHS’ focus at the moment is, rightly, on recovering the elective waiting list. But, as these numbers demonstrate, there are other services struggling with demand which is causing people and their families to miss out on the quality of care that they deserve.