The size of the community care waiting list for children has increased by 58% since data began in 2022, compared with a 23% increase for adults, according to a new briefing on growing waits for community care by the Nuffield Trust.
Children are facing unacceptably long waits for NHS community services that deliver care closer to home, including for paediatric services that help with developmental problems or disabilities. Almost one in four children spend over a year on the waiting list, and one in 15 wait over two years. In comparison, one in 100 adults wait over a year for community care. These long waits for essential healthcare can not only impact children’s health but also their future life chances.
The new briefing has been published as part of Nuffield Trust’s joint QualityWatch programme with the Health Foundation. It found that over half of children and young people on the waiting list are waiting for community paediatric services (55%) – that includes support for developmental problems and diagnosing and managing conditions like autism and ADHD – and 21% are waiting for speech and language therapy services.
Government targets have focused on reducing long waits for hospital treatment, but the overall community care list – which stands at almost 1.2 million – has received much less attention. As part of the 10 Year Health Plan, the Government has big ambitions to shift more care from hospitals into communities, but the QualityWatch analysis reveals how existing community services are already struggling to keep up with demand.
Further findings from the analysis include:
• Large and concerning variation in waiting times across the country for NHS community services
• 44% of adults on the community waiting list are waiting for musculoskeletal services, raising concerns about services in the NHS not keeping up with the ageing and increasingly obese population.
• The largest percentage increase of any community service since 2022 occurred in weight management services for adults (512%).
• In recent years, NHS staffing levels have increased more in hospitals rather than in community settings. Between 2010 and 2025, the number of nurses working in community settings increased by only 1%, while the number of adult hospital nurses increased by 42% and children’s hospital nurses increased by 93%. The authors say that boosting community staff will be key if the ‘hospital to community’ shift is to be successful, and there should be a particular focus on services and parts of the country that are struggling the most.
Shifting resources
In a health system where targets tend to increase visibility of key issues, there are limited national targets for community health services, with most focusing on hospitals. To begin to tackle the issues around neglected community services, the authors say that introducing a waiting time target should be considered, to draw attention to how they are coping. As the Government says community services and “neighbourhood health” are a priority, this needs to come with a shift in resources, along with realistic workforce and service plans to drive faster access for patients and reduce variation across local areas. The briefing also calls for a dedicated strategy to tackle community waits for children and young people as part of the implementation of the 10 Year Health Plan.
Nuffield Trust Fellow and author of the briefing, Jessica Morris says: “Children across the country are waiting far too long for the community care they desperately need. For the families affected it can feel like life is on hold while they’re stuck waiting for support. To take just one example, many children on the list are in urgent need of lifechanging speech and language therapy because of difficulties with communicating or swallowing.
“The increasing number of people living with long-term conditions together with our ageing population mean that more and more people are likely to need support from community health services in the coming years. The Government’s health plans recognise the importance of community services and include laudable aims to expand them, but our analysis shows how difficult realising that goal will be when existing community services are already on their knees.”
Dr Luisa Pettigrew, Senior Policy Fellow at The Health Foundation adds: “This report should be a wake-up call for the government. Waiting lists for community services are a major problem, with too many people, including children, waiting far too long for vital care. If the Government is serious about moving care from hospitals to the community and from sickness to prevention then addressing long waits in community care is crucial.”
