Trust leaders are working hard to address the issues outlined above. The task is not easy amid system-wide financial and operational pressures, but delivering safe and timely services for children and young people is a key priority for trusts.

Around two thirds (68%) of trust leaders said they are providing training and development opportunities for staff, or recruitment and retention initiatives (63%), to support them to better meet demand for children and young people’s services. Given issues around staff shortages and morale, steps to improve staff development, recruitment and retention are key to improving access to services.

The areas that trusts reported making the most progress on were improving access to outpatient services, reducing avoidable admissions to hospital or inpatient beds, and reviewing the commissioning and pathways for neurodiversity services such as autism and ADHD.

"We have improved our waiting list position for children accessing outpatient services by focussing on patient tracking processes, management of patients who miss appointments and maintaining open access services for children and families most [in] need."

Chief operating officer, acute trust    

“Establishment of a children and young people’s Alliance as part of our system's provider collaboratives - to bring together the elective recovery effort, diagnostics etc for children and young people specifically.”

Finance director, acute specialist trust    

"Our [regions] wide tier 3.5 intensive home treatment is avoiding admissions for young people into inpatient units. It is helping keep family units together and children living at home. It has reduced the demand for inpatient beds…”

Strategy director, combined mental health/learning disability and community trust    

"Redesign of neurodiversity pathways to make a case for change to include commissioning the private sector to deliver on diagnostic appointments to 'hold' the waiting list at a steady rate. In CAMHS implementation of the “Thrive” model has significantly reduced waiting time for first appointments. In therapies services we are moving to more digital solutions with website development."

Director of children and young people services, combined mental health/learning disability and community trust    

Survey results showed a clear recognition of the value of collaboration and partnership working. More than four out of five respondents (84%) said their trust was working effectively in partnership to meet demand for children and young people’s services, with the most commonly cited partners being local authorities, schools and colleges, and the voluntary sector. Three quarters said they were working to meet demand via collaboration between NHS providers. This demonstrates that trusts are embracing the shift towards collaboration and partnership working through the formalisation of system working in the 2022 Health and Care Act by progressing partnerships within and outside of the NHS. There is scope to continue building on this progress and appetite for joined up care delivery for the benefit of children and young people.