RCPCH Ambassadors resource hub: Recovery of children and young people's services

We highlight the current data for CYP waiting times, signpost priorities and resources from NHS England to help address the backlog and suggest actions for Ambassadors.

This page forms part of the RCPCH Ambassadors resource hub.

Waiting times for children's services

Recent data  for March 2023 shows that the number of children awaiting consultant led treatment has reached an all-time high with 403,955 children currently on the waiting list. During this period, there has been considerable progress made in shrinking the adult backlog but the children's list continues to rise at an unprecedented rate. Worryingly, 17,991 of these children have been waiting for more than a year for essential treatments.

The waiting lists for community health services are also very concerning with data showing 71,925 children waiting for community paediatrics with 8,054 waiting over a year.

Such long waits are unacceptable for any patient but missing opportunities to intervene at the right age or developmental stage can have a significant and life-long impact on children and cause huge stress and worry for families.

Consultant-led referral to treatment (RTT) data

NHS England collects and publishes monthly Consultant-led referral to treatment (RTT) data, which are used to monitor the length of time from referral through to elective treatment.

The latest data for March 2023 can be found here.

Data for children's services are listed as 'Other-Paediatric Services'. Data is also listed by ICB.

The dataset for March 2023 shows:    

  • Total waiting list: 403,955  
    • This is the highest list since records began  
    • The waiting list has grown by 158,256 between April 2021 and March 2023.   
    • This is a 39% increase in just two years  
    • This figure do not represent the children waiting for other treatment specialisms.   
  • 59.8% of paediatric patients were seen within 18 weeks where the NHS target is 92%.  
  • The average waiting time for children and young people is well over the three month target – at 13.5 weeks.  
  • Total waiting more than 52 weeks: 17,991  
  • Total waiting more than 78 weeks: 452   
  • The total waiting list is 7,282 more than the previous month.    
  • There are 642 more children who have been waiting longer than year for treatment in March than February. So the year long waiting list is rising  

We know that waiting lists for elective care for CYP are now increasing at double the rates of adult waiting lists. Nationally, admitted pathways are rising by 28% for children compared to 8% for adults, and non-admitted pathways are rising by 42% for CYP compared to 30% for adults.

The RCPCH response to this data can be found here.

Community health services waiting lists

The Community Health Services (CHS) SitRep collects monthly data on waiting lists and waiting times for Children and Young People’s (CYP) and Adult’s community health services. Note - not all areas have submitted figures so this data isn't complete.

Data is available by service, region, ICB and provider.

The dataset for March 2023 shows:

  • the CYP community waiting list is growing three times faster than adult community services. whilst the number of adults waiting for community services has increased by 3.2 per cent since October 2022, wait lists for children and young people’s services have increased by 10.2 per cent over the same period to 227,490.
  • The waiting list for community paediatrics was 71,925. This has risen from 59.955 in October 2022.  A rise of 20% in 5 months.
  • The waiting list for children's speech and language therapy was 73,316. This has risen from 64,102 in October 2022. A rise of 14%.

NHS England monthly data dashboard for community health services

NHS England provides a monthly data dashboard that further analyses this data accompanied by a set of user friendly slides that pull out the key issues. In addition to waiting lists and times it shows mean wait times and reasons given for backlog. You are able to filter the results by cycle, region, provider, system, and type of service. Further guidance on how to use these filters is available on the front page of the dashboard, including how to select multiple providers or services. You will need to sign up to the FutureNHS platform and request access to the Community Health Services workspace. 

Community Network survey on waiting times in children and young people's services

A survey by the Community Network (NHS Confederation and NHS Providers) on children and young people's waiting times in community services highlights the scale of the challenge, the impact long waits have on children and young people, their families, and staff morale, as well as outlining some core asks for national and local policy makers.

Community providers estimated an average waiting time for a community paediatrics appointment of 33 weeks, with an average wait of 40 weeks for a neurodiversity appointment. There is significant regional variation, with some services reporting an average wait of 104 weeks.

There were concerns that such long waits could seriously impact not just children's physical health but also their development, education, communication, and mental health.

Respondents particularly highlighted the impact on those children presenting with more complex or specialist needs. They said that deterioration in conditions over time could lead to increased needs when the individual is seen, as well as more children presenting at A&E or in crisis.

The RCPCH response to the Community Network survey can be found here.

Elective care priorities 2023/24

In a letter sent to NHS Acute Trusts and ICB Chief Executives on 23 May 2023 NHS England set out their key priorities for the year ahead. The letter asks NHS Trusts and ICBs to continue to address the recovery of paediatric services and states that provider, system, and regional-level elective recovery plans should set out actions that will be put in place to accelerate CYP recovery and ensure that elective activity gap between CYP and adults is reduced. To support this work a best practice toolkit has been published which is detailed below.

NHS England Children and Young People's Elective Recovery Toolkit

On the 22nd May 2023 NHS England launched its CYP Elective Recovery Toolkit the aim of which is to accelerate progress and ensure the recovery of paediatric services keeps pace with the recovery of adult elective care. The toolkit is part of a wider CYP elective recovery campaign which starts with a launch webinar on Tuesday 13th June 2023

The toolkit sets out activity that regions, systems and providers should take to accelerate CYP recovery and reduce the gap between CYP and adults. This includes ensuring robust management, validation and prioritisation of CYP waiting lists. Systems also need to continue to embed measures to reduce CYP health inequalities

Some of the key components of the toolkit are: 

Governance and oversight - All regions are asked to set up a dedicated CYP elective recovery oversight group, reporting directly to a regional elective recovery board, or, ensure CYP features as a standing agenda item at existing regional elective recovery boards.

Examples of good practice

These include: 

What Ambassadors can do?

Below are some suggested actions for Ambassadors to encourage their ICB to tackle the backlog for paediatric services.

  • Look at the waiting times for your ICB for elective and community CYP services. If there are services that have particularly long waits or large numbers waiting you could highlight these with the appropriate ICB Lead or raise at any CYP boards or networks you attend. If you would like support in finding and/or framing the data please get in touch via ambassadors@rcpch.ac.uk and we would be very happy to help.
  • You may also want to ask what actions your ICB and NHS Trust are taking to accelerate the recovery of CYP services. This should be set out in their elective recovery plans.
  • Check if your contacts in the ICB are aware of the NHSE children and young people's recovery toolkit. 
  • If your ICB has any initiatives for promoting the recovery of children's services and addressing the backlogs please let us know so we can share with colleagues.

Other resources

  • Growing problems, one year on: the state of children’s health care and the Covid-19 backlog - The Nuffield Trust's Quality Watch published this report on 1 June 2023 that highlights the growing problems in relation to waiting lists, increased GP referrals, increased waiting time in emergency care and the crisis in CYP mental health.