Children waiting for consultant-led care at all-time high

15th May 2023

The number of children waiting for NHS hospital appointments has reached an all time high, the latest NHS figures show.

There are currently 403,955 children waiting for consultant-led care, of which 18,000 have been waiting for more than a year for essential treatment, the UK’s Royal College of Paediatrics and Child Health has warned.

The College notes that while there has been considerable progress made in shrinking the adult backlog, the children’s list ‘continues to rise at an unprecedented rate’, with ‘children not being prioritised’.

Long waits for children are of particular concern, given many treatments and interventions must be administered within specific age or developmental stages, a statement from the College said. And the data does not capture the full scale of the problem, it added, with hidden and growing waiting times for community care.

The RCPCH has called on the Government to set aside ringfenced funding for children’s service recovery at all community, elective, and urgent care levels, as well as publishing a fully-costed NHS workforce plan immediately.

‘Stuck in limbo’

The figures come as NHS England said the number of patients waiting more than 18 months fell to just 10,737 by April – down by more than 90% from 124,911 in September 2021 and by more than four-fifths since the start of January when there were 54,882.

RCPCH president Dr Camilla Kingdon said: ‘It is a national scandal that over 400,000 children are stuck in limbo on a list, waiting for treatment.

‘These children could fill Wembley stadium four times over. NHS England has a zero-tolerance policy for 52-week waits, so it is deeply concerning that these targets are being missed.

‘The clear regional variation in size of waiting lists also means that this is an equity issue for children and their families. Child health teams are working tirelessly to address the growing backlogs, but without proper support, their efforts are unable to make a meaningful dent in the problem.’ 

Calls for Government support

RCPCH officer for health services, Dr Ronny Cheung added: ‘It’s clear now that the voices of children are not being heard. It seems that the focus in the lead up to the next election is primarily on voting-aged adult issues.

‘Lengthy waits are unacceptable for any patient but for children and young people the waits can be catastrophic, as many treatments need to be given by a specific age or developmental stage.

‘In recent months we’ve heard about children missing school, quitting sports, and missing out on the important aspects of a healthy, happy childhood. This is not a trivial matter.’

Meanwhile, statistics published by NHS England showed that the overall elective waiting list has grown to a record high, with 7.3 million people now waiting for treatment.

A version of this story was originally published by our sister publication Pulse.

Onward referral among primary-secondary care interface improvements from UK Government

9th May 2023

Patients requiring an onward referral from one consultant to another will no longer be sent back to their GP, the Government has announced.

In its recovery plan for general practice, published today (9 May 2023), the Government said that where a patient has been referred into secondary care and they need another referral ‘for an immediate or a related need’, the secondary care provider should make this referral, rather than sending them back to general practice.

It said that this was the ‘most common request’ from GPs about bureaucracy and would improve patient care and save time.

This is a step further than in 2016, when the GP Forward View said that onward referral within secondary care for a non-urgent condition relating to the original referral was ‘permitted’.

The pledge was one of several measures aimed at reducing the time practice teams spend on ‘lower-value’ administrative work and work generated by issues at the primary-secondary care interface, which ‘practices estimate they spend 10-20%’ of their time on, the plan said.

Working together

Together with onward referral, other measures detailed in the plan include:

• Fit notes should be issued by secondary care
• NHS trusts must establish their own ‘call and recall’ systems for patient follow-up
• ICBs should ensure providers establish single routes for GPs and consultant-led teams to communicate rapidly.

The recovery plan was published alongside a report from the Academy of Medical Royal Colleges (AoMRC) on general practice and secondary care working together.

The AoMRC report includes a series of case examples of improvements that have already been made across the country and offers a series of ‘quick-win’ suggestions to improve collaboration.

This included areas establishing regular ‘interface groups’, which it said should bring together local GPs and secondary care consultants to discuss interface issues.

New requirements

The Government’s plan said NHS England is asking ICB chief medical officers to ‘establish the local mechanism’, which will allow both general practice and consultant-led teams to raise local issues, jointly prioritise working with LMCs, and tackle the high-priority issues including those in the AoMRC report.

In addition to this, ICBs must address onward referral, and three other key areas: complete care (fit notes and discharge letters), call and recall, and clear points of contact.

NHS England said it will expect ICBs to provide a progress update on these four areas to their public board in October or November 2023.

A version of this story was originally published by our sister publication Pulse.