Mounting backlog in community services will exacerbate inequalities for children and other vulnerable patients

Patients are facing significant delays for key health services delivered in the community due to a mounting backlog of care.

10 February 2022

Patients are facing significant delays for key health services delivered in the community due to a mounting backlog of care which must now become a key priority for the Government.

That is the call today from NHS Providers and the NHS Confederation amid concerns that waiting lists for a range of community health services are increasing significantly, with community providers reporting significant impact on children and young people.

Before Christmas the backlog in community services was estimated at around one million and is likely to have grown as a result of efforts to tackle the Omicron variant.

The highest numbers and largest volumes of long waits are for community paediatric diagnoses, audiology and speech and language therapy. One community provider said it has seen a 300 per cent increase in referrals to consultant-led child development services over the last five years, and this has been exacerbated by the COVID-19 pandemic.

Leaders from community providers fear that inevitable delays will exacerbate health inequalities and risk having an enduring impact on those children left waiting. Although long waits for adults remain a concern, long waits can impact outcomes for children much more severely.  In many of these cases, delays can have an impact on mental wellbeing, social development and educational outcomes, which not only has an impact on the life chances of individual children, but on the economy and wider society too. Community leaders would like support and cover to make addressing health inequalities a priority feature in how they tackle waiting lists going forwards, building on recent initiatives to cut elective waiting time data in a similar fashion

Waiting lists for these services were significant before the pandemic, and some of this is attributable to growing demand for community health services alongside increasing staff shortages in parts of the sector. Now, NHS leaders say waiting lists are increasing substantially amid high vacancy and sickness absence rates across the health and care system, and given the need to redeploy key community staff to other services to support the Government’s priorities of COVID-19 vaccination and hospital discharge, which led to the scaling back of community services such as audiology for older adults, smoking cessation, children’s autism diagnostic services and some children’s therapies. This comes despite the best efforts of community providers and their staff who are seeking to innovate and collaborate to see more people, including virtually, where appropriate.

Community providers report that services with the largest waiting lists, such as podiatry, face the most intense staff shortages and pressures. Data from one community trust shows that referrals to speech and language therapy services are now 22% above pre-COVID levels, despite significant staffing shortages.   

NHS Providers and the NHS Confederation are calling for a whole system approach to recovery, and an acknowledgement that support to address backlogs in the community sector will be key to recovery across the whole health and care system. The organisations argue that this must become a priority for the Government in its post-COVID-19 recovery planning.

While dentistry and elective acute waits have been prioritised by the Government, community services have not. The NHS Confederation and NHS Providers argue that the Government needs to put resources into all sectors and support areas with the highest inequalities and waits. This is also essential to delivering the Government’s ambitions to reduce health inequalities, which were set out in this week’s levelling up white paper.

Matthew Taylor, chief executive of the NHS Confederation, said: “Before we faced the Omicron wave, the majority of community services had recovered to pre-COVID levels of activity or higher. But even then, many community providers said it would take most services at least six months to clear the backlog, with some predicting it would take three to five years. The pressures of recent months have made the recovery challenge even harder, with a disproportionately high number of children and young people now waiting for treatment.

“We need a properly resourced plan that treats this community backlog with the same energy and urgency as the government is treating the elective care backlog. Otherwise we risk condemning patients to lengthy waits and storing up problems that could have been dealt with in the community that end up landing at the door of GP practices, A&E departments and other urgent and emergency care services.”

Chris Hopson, chief executive of NHS Providers, said: “Community services are essential in supporting and caring for people at home or in community based settings to support rehabilitation after a stay in hospital, rebuild confidence and independence, and prevent readmission unnecessarily.  As such they sit at the heart of a system wide offer of health and care, and at the heart of the NHS’ recovery from the pandemic.

"The intrinsic value of these services was proven during the height of the pandemic when community providers supported the NHS to free up 30,000 additional beds for patients requiring acute hospital care. 

“There is no doubt the pandemic, and mostly recently the Omicron wave, has piled pressure on community services. While clear national data does not exist to make this fact inescapable to policymakers, leaders of those services have told us just how difficult it has become to meet rapidly rising demand. They will need to be integral to a properly resourced plan for recovering backlogs in this critical part of the health service.”

Siobhan Melia, chief executive of Sussex Community NHS Foundation Trust and chair of the Community Network, which is hosted by the NHS Confederation and NHS Providers, said: “Community services are often misunderstood and the challenges they face obscured. These are services that make significant differences to people’s lives and support people to live independently in their local communities.

“We are now seeing real challenges in meeting demand in areas such as children and young people’s services – including mental health services - muscolosketal services, podiatry, speech and language therapy, occupational therapy and physiotherapy.

“Our members are particularly concerned about children’s services. Delays to access for things like speech and language therapy and autism diagnoses can have profound impacts for the rest of a child’s life. It is important we target intervention at children’s services to avoid worsening inequalities.

“If we fail to grasp the scale of the problem and to adequately address it then we will be letting down huge swathes of the population who depend on our services, and contributing to increased pressure across the health and care system.”

While NHS performance data has provided a clear picture of the pressures faced by hospitals over the course of the pandemic, there is no comparable dataset for community services which are wide-ranging and include specialist care for long-term conditions, recovery and rehabilitation beds, school nurses and health visitors. While significant work is underway to improve data collection and quality in the sector, at the moment, pressures in the sector can remain invisible to the public and policymakers.

At the same time, the latest Office for National Statistics figures show an estimated 1.3 million people in the UK are living with Long Covid – a number that is likely to increase due to the Omicron wave and add further pressure to community providers.

Earlier this month, the House Commons Health and Social Care committee’s key recommendation in its report on clearing the backlog caused by the pandemic called for the Department of Health and Social Care to work with NHS England to produce a broader national health and care recovery plan that goes beyond the elective backlog to emergency care, mental health, primary care, community care and social care.