Over the last few years, following pressure from the sector and stakeholders, NHS England started collecting and publishing more data on the community sector. For instance, data on the total waiting list size is only available from 2022. This data now provides us with a national picture.
Waiting lists
There has been a marked increase in the community services waiting list over the last couple of years. The total community services waiting in England was reported at 1.07 million in October, decreasing by 2.9% compared to September. The waiting list has stayed above 1 million for nine consecutive months and is now 6.9% higher than February 2024 (when 13 new providers came into scope of the community health services monthly sitrep).
The total waiting list consists of children and young people and adults waiting for their respective community services. There were 270,200 children and young people waiting for community services in October, a slight fall of 2,600 people since last month. The number of adults waiting for community services saw a sharper decline in October, dropping by 29,600 to 798,900. This fall accounts for nearly all (92%) of the overall reduction in the community waiting list.
123 NHS trusts and foundation trusts reported waiting list information in October with a combined waiting list of 927,209. When ordered from highest to lowest number of patients waiting, 25 trusts comprise the top half of the total waiting list. Eight trusts report over 20,000 patients waiting for treatment, and of these, six predominantly provide community services only.
FIGURE 5
Community health services total reported waiting list
Waits over 52 weeks
As highlighted by the Darzi report, long waits for community services are being normalised. After a sudden increase last month, long waits have improved for adults in October: There were 10,932 adults waiting for more than 52 weeks for treatment. This is down by 16.8% since last month.
The monthly increase in the number of long waits for children and young people appears to be plateauing; there were 44,066 children and young people waiting for 52 weeks or more, a small increase of 0.4% since last month. But there is a still a way to go. Since February 2024, when 13 new providers were added to the reporting scope, the number of children waiting over 52 weeks has increased by 61%. This change in reporting scope shone a light on the scale of the challenge in children and young people’s services and highlights the possibility of hidden waits due to reporting processes.
Our report Forgotten generation: shaping better services for children and young people examines the challenges children and young people services are facing and highlights the growing concerns for children and young people waiting to access services.
Demand and activity
After falling back in August, referral requests for community services increased by 6.3% from August to 1.73 million in September. This is 10.6% higher than a year ago and 57% higher than five years ago, before the pandemic, showing that demand for community services has been significantly elevated recently.
Activity also increased in September to 8.69 million care contacts, which is up by 4.9% from August. Care contact activity measures a contact or appointment between a person and a care professional. Overall care contact activity was 6.9% higher than last year.
Both the demand for services, and the activity trusts undertake, impact how long patients wait for community services. Following the Darzi review, it is clear that shifting care from hospitals to community will be a key focus in the upcoming 10-year health plan. Community providers are already working with partners to accelerate the shift of care from hospitals to the community through the delivery of different services, which you can find out more about below.
FIGURE 6
Total referrals received by community services
UCR services, virtual wards and intermediate care
Some of the ways community providers are already working with partners to deliver care in the community is through urgent community response (UCR) services, virtual wards and intermediate care. Expanding these services in the future will require a shift in resource to ensure funding follows ambition. The government has set out its ambition to deliver a neighbourhood health service, with more care delivered in the community via primary care and community services. This is a welcome step and community providers are clear that they have a key role to play as this work progresses.
Urgent community response (UCR) referrals
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. As of September 2024, 85% of urgent community response (UCR) referrals met the two-hour standard for delivering UCR services, with trusts exceeding the national objective for another month. The target was met across most reporting trusts with 85 out of 91 meeting the 70% target in August. Of these, 9 trusts delivered UCR services within the two-hour window to 95% of patients.
Intermediate care - delayed discharges
The intermediate care data collection provides comparable data with the community discharge sitrep for discharge delays: the number of patients not discharged by the end of the day despite no longer meeting criteria to reside.
On average in November, there were 2,300 patients who no longer met the requirements to remain in intermediate care each day. Of these, 88.4% remained in hospital at the end of the day, up from 87.9% in October. This means that only 11.8% of patients (1 in every 9) who could be discharged from community settings at the end of each day, were discharged. The proportion that remain in intermediate care each day, despite no longer meeting the criteria to remain, has never dropped below 87%.
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.
Virtual wards
Virtual wards are a vital part of patient care which allows patients to receive the care they need at home rather than being in hospital. This helps prevent avoidable hospital admissions or supports people to safely leave hospital sooner.
In November 2024, the virtual ward capacity was 12,800 – an increase of 0.7% from the previous month. There were 9,800 patients in a virtual ward meaning the occupancy rate was 77%, down from 78.2% in October 2024.
The virtual ward capacity per 100,000 GP registered population aged 16 years and over was 20.1 – in line with last month, but this rate remains below the longer-term ambition of 40 to 50 virtual beds per 100,000 people - as outlined in the Delivery Plan for Recovering Urgent and Emergency Care.
FIGURE 7
Virtual ward occupancy rate (%)
