Over the last few years, following pressure from the sector and stakeholders, NHS England started collecting and publishing more data on the community sector. This data now provides us with a national picture.
Waiting lists
Demand, activity, and performance of community services providers all impact the community health services waiting list. After the highest month on record in May, community services patient numbers reduced in June by 20,000 patients, totalling 1.07 million. The waiting list has been over one million for five consecutive months since February 2024, when 13 new providers came into scope of reporting for CYP services.
There are 783,600 adults and 283,400 children and young people on community services waiting lists in June 2024, falling by 2% and 1.4% respectively compared to record highs recorded in May 2024. After reducing to around 8,000 at the start of 2024, the number of adults waiting over 52 weeks climbed to 11,500 in June, remaining below the highs of over 13,000 seen in 2023.
There are particular challenges addressing waiting lists for children and young people's services, with an increasing number of children and young people waiting over 52 weeks for treatment. 40,700 children waited over 52 weeks for community services in June 2024, an increase of 48.3% since February 2024 when 13 new providers to the scope of reporting. We look in further detail at the unique combination of pressures facing children’s services in our new report Forgotten generation: shaping better services for children and young people.
122 NHS trusts and foundation trusts reported waiting list information in June with a combined total waiting list of 921,800. When ordered from highest to lowest number of patients waiting, the trusts in the top half make up 83% of the total waiting list. Six trusts report over 20,000 patients waiting for treatment, and of these, five predominantly provide community services only.
Community health services total reported waiting list
This waiting list data shows that patients in community services are waiting longer and longer. It is important that the national political and media narrative move beyond the focus on operations and take a broader and more considered approach to the less visible waiting lists across all sectors that are impacting patients.
Demand and activity
Growing demand for community services adds to waiting list pressures and shows no sign of slowing down, as shown in figure 4. The total number of referrals in May 2024 was the highest ever reported at 1.73 million, overtaking April’s record high (1.68 million). In the year prior to the Covid-19 pandemic, there were on average 1.1 million referrals. After reducing in the early months of the pandemic, the total number of referrals has consistently risen since autumn 2020. In May 2024, total referrals were 14% higher than a year ago.
As figure 4 shows, community providers have increased care contact activity to meet this unprecedented demand. Care contacts – a contact or appointment between a person and a care professional – also reached a record high of 8.99 million in May 2024. In the year ending May 2024, the average monthly recorded number of care contacts was nearly 550,000 higher than the year ending May 2023.
Total referrals received to community services
The 2023/24 priorities and operational planning guidance set out a national objective for trusts to consistently meet or exceed the 70% two-hour urgent community response (UCR) standard. Trusts met this standard every month recorded in the dataset. As of May 2024, 85% of UCR referrals met the two-hour standard for delivering UCR services, maintaining the improvements seen over the previous four months. The target has been met across most reporting trusts: 78 out of 88 reporting trusts met the 70% target in May and 26 of 91 trusts delivered UCR services within the two-hour window to 90% of patients.
Percentage of two-hour UCR referrals achieving the two-hour standard
Delayed discharges
More recent data for July considers patients residing in, and discharged from, community providers. The data tells us about discharge delays: the number of patients not discharged by the end of the day despite no longer meeting criteria to reside. On average in July, 87.1% of patients who no longer met the criteria to reside remained in the care of community providers each day. This percentage has been broadly consistent since data was first recorded in October 2022.
Reducing discharge delays is critical to improving whole system flow for providers. This applies to any transfers of care between acute, ambulance, community and mental health settings and partners across domiciliary and social care. But, as we outline in our five shared commitments for delivering the next generation NHS, patients must be discharged into the right care at the right time. We must meaningfully support flow through the system with investment better following patient and community needs.