Trust CEOs warn ‘generation of children’ at risk from failing services

The Care Quality Commission’s annual State of Care report, published today, warned of poor care and specialist staff shortages within providers, alongside “far too long” waits for treatment.

NHS Providers’ deputy CEO Saffron Cordery said trust leaders were “deeply concerned” about meeting demand, particularly in mental health services.

But she added: “Their ability to do so comes against a backdrop of soaring demand, resource pressures and the poor condition of the mental health estate, much of which isn’t fit for purpose.

“A cross-government approach to improving health and wellbeing is vital to protect a whole generation of children and young people at risk of being left behind.”

The CQC has faced two damning reviews of its own, as well as fundamental questions about the quality of its inspections, but NHS Providers and others have said it “echoed what NHS trust leaders tell us.”

The report warned average waiting times for an autism diagnosis reached 356 days in April, with 81 per cent of those on the waiting list in June referred without a first appointment.

NICE guidelines recommend people referred for a possible diagnosis should have an assessment within three months of referral.

It also said of the 363,000 children on the waiting list for consultant-led paediatric services in June, more than 140,000 had already waited for more than 18 weeks for treatment.

CQC chair Ian Dilks said: “The health and wellbeing of a nation’s children has been described as the best predictor of its future prosperity; failing to ensure good, safe care for our children today also risks failing their future.”

The report said such impacts were illustrated in research commissioned by CQC from the NHS’s strategy unit, which revealed people aged 18 to 21 consistently had the highest rates of attending accident and emergency with mental health problems during 2023-24.

Additionally, children aged 0-17 were the only age group to see an increase in attendance rates at type 1 (major) A&Es since 2019-20.

‘Serious concern’ over care

Inspectors of providers also said they had serious concerns about children’s access to services in an emergency due to widespread shortages of children’s nurses, and about gaps in staff training in areas such as safeguarding and sepsis recognition.

HSJ previously revealed widespread failures in sepsis recognition across the NHS, with multiple avoidable deaths occurring in children.

Further CQC analysis of workforce data revealed a significant reduction in health visitors with the monthly average of full-time equivalent positions decreasing by 45 per cent, around 4,500 FTEs, between 2015-16 and last year.

The report also said ambitions in the NHS long-term workforce plan to expand training places for such positions only by 2031-32 suggested it could take more than a decade before improved resources could have the desired effect.

Although the CQC has been ordered to pause its inspections of integrated care systems following government concerns over its inspection methodology, it said limited analysis it carried out revealed variation in published plans for children and young people’s services.

It found some systems lacked clarity about their intended outcomes while others had examples of actions already taken, with one describing virtual wards which had supported more than 1,150 children.