Written by Dr Ronny Cheung, RCPCH Officer for Health Services and Louise Dyer, Health Policy Officer
Last month, a mother told me [Ronny] her son had been on a waiting list for an autism and ADHD assessment since he was seven. He's now ten years old. In that time, he's gone through three years of formative primary schooling with only a limited amount of the support that he requires and is entitled to and missed the window where early intervention makes the biggest difference. A week before, I had seen another patient, living in a different area and referred by a different pathway, who received her initial assessment in a fraction of the time.
Stories like this are not rare. Sadly, they remain, if anything, closer to the norm. While there is significant national focus on shifting care from hospitals into the community through the implementation of the 10 Year Health Plan in 2025, community health services have been consistently overlooked for many years, resulting in longstanding inequalities, including disparities in waiting times between adult and paediatric services.
NHSE target highlights long waiting times for community health services
Just over one year ago, in May 2025, we published our Collaborative Healthcare in England report, which showcased how waiting times for community child health services are some of the longest of any part of the health system, highlighting the significant disparity between adult and children’s community services. We called for a greater focus on and investment in children’s community health services to support some of our most vulnerable children and their families and a distinct waiting time target for community health services to match the elective care target.
NHS England (NHSE) has introduced a new target through the Medium Term Planning Framework, for community health services, which came into effect in April 2026. By March 2027, the aim is for at least 78% of community health service activity to occur within 18 weeks, an ambition which feels very far away from being achieved, especially for children who are waiting much longer than their adult counterparts.
Why this is important
Community Child Health (CCH) is the largest paediatric sub-specialty, focused on supporting vulnerable children, those with long-term or complex conditions, developmental and neurodevelopmental disorders and children with safeguarding or care needs. Community paediatricians work in multidisciplinary teams alongside health, education, social care and voluntary sectors. In recent years, rising referrals for assessments of neurodevelopmental conditions, increased safeguarding awareness and expanding statutory duties have significantly increased both the demand and complexity of community paediatric care.
A sustained rise in demand in recent years, combined with growing capacity pressures, has resulted in some Community Paediatrics pathways experiencing waiting times that exceed clinically acceptable limits.
Our recent State of Child Health report shows that child health outcomes are worsening, as health inequalities continue to persist and, in some cases, are widening, with the greatest impact felt in deprived areas and among ethnic minority communities. Without urgent action, paediatricians are clear that we risk raising one of the unhealthiest generations of children ever.
Children and young people data spotlight
Waiting times for community paediatric services can stretch for months and even years. Waiting this long for vital community health services can have detrimental long-term health impacts for children, particularly when care is not initiated within a specific developmental window.
In June 2026, there was a total of 327,411 CYP on the waiting list for community health services and 906,987 adults.
Community child services have a long way to go before they meet the NHSE waiting time target. Currently, only 49% of CYP are waiting within the 18 weeks target, making up under half the total waiting list. In contrast, 85% of adults are within this target for community health services.
No child should be waiting longer than 18 weeks to access community health services, yet more than ever, children are waiting disproportionately as long for community health services, than adults, with some waiting up to a year or longer. Currently, almost 15% of CYP are waiting longer than a year to be seen, with a further 11% waiting more than two years. In comparison, less than 1% of adults are waiting longer than a year on community health services waiting lists.
Specific services and pathways
Community child health services support children and families with a range of service lines. Some services are experiencing greater pressures and waits. This includes:
- (CYP) Therapy interventions: Speech and language waiting list of (66,129)
- (CYP) Therapy interventions: Occupational therapy (20,548)
- (CYP) Therapy interventions: Physiotherapy (20,989)
The highest service line is for community paediatric service, with almost 180,000 children or young people waiting to be seen. Anecdotally, RCPCH has heard that the highest demand is for neurodiversity, with around 80% of community paediatrics focussing on this.
What children, young people and paediatricians think
In the 10 Year Health Plan, children and young people emphasised the need to reduce waiting times for appointments and treatments. They called for faster and more efficient processes, such as reducing delays in scans and check-ups and improving appointment booking systems.
There is usually a very long queue to get seen by a doctor or nurse. I think the NHS could be quicker for patients to get seen and to leave.
Children and young people also highlighted the importance of ensuring that community centres are well-equipped with medical tools and adequately staffed with trained professionals. Some raised concerns about regional inequality in the availability of services.
Local health centres must be staffed with experts and have access to medical records to offer proper care.
What we’re calling for
Now more than ever, with attention on community health services through the new waiting time target and roll out of the 10 Year Health Plan, there is a chance to make transformational changes for children and young people accessing healthcare in the community.
While there is still more to be done to improve community paediatric services, there is cause for optimism. NHS England is taking steps to improve services for children and young people and we’re hoping the new waiting time target helps shorten waits. The NHSE Community Waits & Transformation team is working to produce guidance documents to enhance pathway transformation for CYP community services, including outlining core waiting list management actions and further improvement opportunities for integrated care boards (ICBs) and providers in 2026/27.
We welcome the announcement of an upcoming Modern Service Framework for Children and Young People, which we hope will be used as a mechanism to drive improvements across services, including for paediatric community services. Along with the forthcoming Health Bill, we hope that these structural changes will drive change and reduce the longstanding inequities seen by children and young people in the community.
To improve community services for children and young people, we call for the following:
- Ensure national prioritisation categories and risk frameworks take into account the differential risks experienced by children. This should include consideration of the proportion of life spent waiting and the impact of long waits in childhood when prioritising resources.
- Introduce a Children’s Health Investment Standard to address the investment gap between child and adult health services, requiring ICBs to increase their spending on children’s health services, particularly community health services, at a faster rate than their spending on other services, and gradually move towards more equitable service funding.
- Prioritise creating a sustainable child health workforce through a comprehensive child health workforce strategy. Invest in the training, skills and support needed to deliver paediatric care and new service models in the community.
- Ensure neighbourhood health models of care have principles for good community service design that work for children and young people.
- Ensure timely access to neurodevelopmental services and support and invest in the training, skills and support needed for neurodevelopmental services in paediatric care.
Next steps
If you are interested in hearing more about our policy and advocacy work and staying involved in topics including community health services, register for the Paediatric Influencing Network.
For further information, please contact the Health Policy team on health.policy@rcpch.ac.uk.