NHS leaders are raising the alarm over chronic staff shortages in critical community health services, that leave patients facing longer waits and at risk of missing out on life changing treatments.

The situation has become critical with growing vacancies for district nurses, health visitors, podiatrists, community dentists and speech and language therapists. NHS leaders are now warning that unless urgent action is taken, the size of the waiting list for community services – which already stands at more than a million people, including hundreds of thousands of children – will continue to rise. Delays to accessing services such as speech and language therapy – or assessments for autism – can have profound impacts on the lives of children.

Existing staff shortages in the community have been exacerbated by the pandemic, and many NHS leaders are seeing clear evidence that staff are leaving their organisations due to early retirement and COVID-19 burnout.  NHS leaders are also deeply concerned about how the soaring cost of fuel and other cost of living pressures are making it harder to retain staff. This is a particular problem for community health services as many staff have to travel in their cars every day to see patients and are therefore bearing the full brunt of crippling fuel prices.

The NHS Confederation and NHS Providers have been warning of the scale of the community services backlog for months. Their new briefing published today outlines how persistent staff shortages will cause longer waiting times. Both organisations have consistently called for government to commit to a fully funded and costed national workforce plan to meet existing and future demand for healthcare, including for vital community health services.

They also warn that the government's target to recruit 50,000 new nurses by the end of the parliament, which is largely relying on international recruitment, will provide little or no benefit to community services as the vast majority of overseas recruits are joining hospitals.

Matthew Taylor, chief executive of the NHS Confederation, said:

"Community services are absolutely essential in keeping people well at home or in their community and preventing demand on other parts of the healthcare system. But to do so effectively they need the right numbers of people in the right roles. At the moment, they are trying to provide services with one hand tied behind their backs.

"Without action we are condemning patients, including young children, to lengthy waits and storing up problems in GP practices, A&E departments and other urgent and emergency care services that could have been dealt with earlier in the community."

Saffron Cordery, interim chief executive of NHS Providers, said:

"NHS leaders are once again raising the alarm over the consequences of the government's failure to deliver a fully costed and funded workforce plan for the health service.

Like much of the NHS, vital community services haven't been able to fill significant staffing capacity gaps.

Saffron Cordery    Deputy Chief Executive

"Like much of the NHS, vital community services haven't been able to fill significant staffing capacity gaps and this is now having dire consequences for the health and welfare of some of the most vulnerable in our society.

"We are seeing first-hand how delays to access for services such as speech and language therapy can have profound impacts for the rest of a child's life, exacerbating longstanding health inequalities.

"Investing in community services could put us in a win-win situation, letting the NHS deliver higher quality care while reducing pressure on our urgent and emergency services but we need national action on this – and fast."

Siobhan Melia, chair of the Community Network, which is hosted by the NHS Confederation and NHS Providers, added:

"The size of the waiting list for community services must act as a wake-up call about the need to take seriously these backlogs of care. These services are not subject to the same political scrutiny as waiting times in hospitals but they are just as vital. But we won't have any chance of making progress with the backlog unless urgent action is taken to help address the widespread staff shortages we are seeing among our district nurses, health visitors, speech and language therapists and other vital community roles."

Elliot Howard-Jones chief executive of Hertfordshire Community NHS Trust said:

"Children and young people have been impacted significantly by the pandemic. Access to early support to services such as speech and language therapy, occupational therapy and audiology is essential to support a child's development and enable them to reach their potential.

These services not only require additional investment, but also long term action to train, recruit and retain a skilled workforce.

Elliot Howard-Jones    Chief Executive, Hertfordshire Community NHS Trust

"These services not only require additional investment, but also long term action to train, recruit and retain a skilled workforce, not only in health services but in schools and nurseries where education staff are in the ideal position to embed strategies and techniques into the child's environment.

"Health must work across organisations with system colleagues including health, social care and voluntary sectors if we are to reduce waiting times and meet the needs of the local population effectively."

Kamini Gadhok MBE, chief executive of the Royal College of Speech and Language Therapists, said:

"The pressures in speech and language therapy were building long before the pandemic, particularly in children's services, which are at crisis point. The absence of a joint national workforce strategy has resulted in speech and language therapists becoming a shortage profession.

"We urgently need an increase in speech and language therapists and in funding. Speech and language therapy assistants could help bridge the workforce gap in the short term, however, barriers to CPD and leadership roles need to be removed, to ensure everyone with speech, language and communication needs and/or eating, drinking and swallowing issues, get the support they desperately need."

Pat Cullen, general secretary and chief executive of Royal College of Nursing, said:

"There is a dire workforce shortage across nursing and it is biting particularly hard in community services.

"The impact on patients must not be underestimated by ministers. It leads very directly to treatment delays and patient outcomes of every kind.

The number of district nurses has fallen significantly in the last decade.

Pat Cullen    General Secretary and Chief Executive, Royal College of Nursing

"The number of district nurses has fallen significantly in the last decade, while demand has soared and care needs have become increasingly complex.

"Ministers must recognise their short-sightedness before more damage is done. With greater investment in nursing professionals, including fair pay, they will boost retention and patient care standards at the same time. Frequent political boasts on nurse recruitment will feel particularly hollow for those working in community care at present."

In the new briefing, NHS Providers and the NHS Confederation call for a number of measures to help address staff shortages and develop a resilient and skilled workforce for the future, including:

• The creation of new roles, or alternative routes into existing roles, such as the development of nursing associate and healthcare support worker roles and greater use of apprenticeships and volunteering programmes. These would be targeted across the allied health professional roles, including speech and language therapy, podiatry, physiotherapy, dietetics and occupational therapy. So far, there have been barriers to scaling this up relating to a perceived lack of flexibility over skills mix, inadequate access to training and development for professionals in these roles and incomplete professional guidance for nursing associate roles.
  
  
• Greater national support from NHS England and from professional regulators, such as the Nursing and Midwifery Council and Social Work England, for blended roles that span NHS and social care services. These roles can help reduce duplication across services and improve the experience of patients. However, there are ongoing challenges around pay parity between staff working across the NHS and social care, which can damage morale when these staff come together in multi-disciplinary teams.

The briefing also includes examples of how community providers across the country are already innovating to meet their workforce challenges:

• Partnerships between community providers and the further education sector offer a key route into the health and care sector, and should be expanded where possible. Some community providers are working with local further education colleges on T-Level qualifications in health and care, and level two and three apprenticeships in health and social care. T-Levels are two-year technical courses designed with employers to provide students with the skills that industries need. They represent a significant opportunity to tap into a new talent pipeline and make careers in healthcare more accessible to a broader talent pool including those at the start of their careers.
  
  
• Developing career pathways can support the retention of existing staff working in the community sector. In many community providers, there is a significant unregistered workforce who have important experience of working in health and care, and with the support of a clear career path, can progress into registered roles.

In Greater Manchester, staff working in care homes have been trained to administer insulin, which reduces duplication and frees up capacity for community services staff to dedicate to those with more significant needs.

Another example is Tameside and Glossop Integrated Care NHS Foundation Trust, which is now working with home care agencies, sheltered accommodation centres and domiciliary care providers in similar ways, such as delivering non-complex wound care through so-called blended roles.

Finally, City Health Care Partnership CIC in Hull, East Riding and the North West has launched an Academy of Clinical Excellence to support those who would struggle to train as health and social care professionals through traditional routes to undertake clinical apprenticeships in services such as physiotherapy, podiatry and occupational therapy.