"Longer waits exacerbate the needs of vulnerable groups already disadvantaged within the health system. If unmet need is increasing where there are already complex issues, the longer-term health outcomes for children will be potentially worse than if they were getting timely access to support."
That's what one of scores of leaders of community health leaders from across England told a survey by the Community Network, jointly hosted by NHS Providers and the NHS Confederation, to probe more deeply into reports of long waiting times for children and young people's community services.
The findings paint a stark picture of the post pandemic pressures on services, particularly community paediatrics, speech and language therapy, neurodevelopment pathways and health visiting. This is echoed in the latest NHS England figures which showed more than 225,000 children and young people waiting for community services, with almost 7% waiting more than a year.
Health leaders responding to our survey estimated an average waiting time of 40 weeks for an initial assessment of a neurodevelopmental pathway and an average waiting time of a further 32 weeks for treatment. Almost nine in 10 (88%) reported that waiting times for children and young people to access initial assessment and treatment for community services have increased either significantly (48%) or moderately (39%) compared to pre-pandemic figures.
Delays to diagnosis and treatment cause anxiety and can increase complexity for all patients and families.
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Almost three quarters (72%) were also extremely concerned about the impact of long waits on staff morale. As one put it: "The workforce is tired but committed. Investment and support in workforce supply and development are crucial."
Delays to diagnosis and treatment cause anxiety and can increase complexity for all patients and families and many health leaders described the particular impacts on the mental health and wellbeing for children and young people including "relating to coping with impact of neurodiversity, anxiety and gender identity".
Delays can also be particularly significant for children and young people in terms of physical and/or social and linguistic development often impacting school readiness and educational outcomes. Identifying and providing the right support within key windows of a child's development, is critical in enabling them to realise their potential.
And although long waits are hitting hundreds of thousands of children and young people across the country, the impacts are felt disproportionately by more marginalised families, exacerbating health inequalities when more affluent families can opt to pay for private healthcare or be more confident to escalate their case effectively.
Investment alone, however, will not be enough. There are significant staff shortages in key children and young people's community services, making it challenging for providers to address these waits effectively.
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So what would improve the situation? Community service providers know they have a responsibility to do all they can with partners at a local level to reduce waiting times but national support would also be welcome. This means better investment in early intervention, a fully funded and costed NHS Long Term Workforce Plan, and a cross-departmental strategy with less fragmented commissioning, overseen by a lead minister.
Two-thirds (66%) of respondents to our survey said that greater investment in prevention and early intervention for children and young people would help reduce pressure on community services and enable them to expand innovative work. To achieve this, it is important that community services are given the same focus as adult and acute services, accompanied by due priority within national and local policy frameworks.
Investment alone, however, will not be enough. There are significant staff shortages in key children and young people's community services, making it challenging for providers to address these waits effectively. The much-anticipated NHS Long Term Workforce Plan cannot come soon enough.
Long waits for community services impact a child's development, cause distress for families and add pressure to dedicated NHS staff doing all they can to deliver these vital services at a time of constrained resources.
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Finally, improving support for children and young people in the community must mean greater alignment across public health, community health, social care, education and mental health services. Community health providers are keen to work with government, national bodies and local partners to get this right.
Community providers, and the frontline staff delivering services for these services, are acutely aware of their responsibilities to reduce waiting times and are working incredibly hard to deliver these important services.
Long waits for community services impact a child's development, cause distress for families and add pressure to dedicated NHS staff doing all they can to deliver these vital services at a time of constrained resources. This comes at a time when demand and waiting times for mental health services for children and adolescents have risen significantly since the pandemic, along with pressure on acute, specialist paediatric beds.
Behind every statistic are real life consequences. Without recognition of these challenges and nationally co-ordinated action, children in need of support, risk slipping through the net.
This blog was first published by the National Health Executive.
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