Over the last few years, following pressure from the sector and stakeholders, NHS England started collecting and publishing more data on the community sector. For instance, data on the total waiting list size is only available from 2022. This data now provides us with a national picture.
Waiting lists
Community services waiting lists have surged over the last couple of years. There was little change in the total community health services waiting list in September: the number of people waiting fell slightly compared to last month (-1,500) to 1.10 million in September. The waiting list has stayed above 1 million for eight consecutive months since February 2024 (when 13 new providers came into scope of the community health services monthly sitrep).
The total waiting list consists of children and young people and adults waiting for their respective community services. The number of children and young people waiting for community health services fell by 2.1% compared to last month, to 272,700 in September. Whereas, compared to August, the number of adults waiting for community services increased by 0.5% to 828,500 in September.
123 NHS trusts and foundation trusts reported waiting list information in June with a combined waiting list of 952,100. When ordered from highest to lowest number of patients waiting, the trusts in the top half make up 75% of the total waiting list. Eight trusts report over 20,000 patients waiting for treatment, and of these, seven predominantly provide community services only.
Figure 5
Community health services total reported waiting list
Waits over 52 weeks
As highlighted by the Lord Darzi report, long waits for community services are being normalised. Amongst adults, long waits are increasing: in September, there were 13,100 adults waiting for over 52 weeks for community services, which 15.7% higher than last month. The number of children and young people waiting over 52 weeks also increased, but by less in comparison to adults: there were 43,900 children waiting for community services in September, an increase of 2.7% compared to August. Although the rate of increase is slowing for children, since February 2024, when 13 new providers were added to the reporting scope, the number of children waiting over 52 weeks increased by 60%. This change in reporting scope shone a light on the scale of the challenge and highlights the possibility of hidden waits due to reporting processes.
Of the children and young people waiting for community services, 16% have done so for more than 52 weeks, compared to 2% of adults waiting for their respective services – this shows that children and young people are disproportionately suffering the longest waits for community services. Our report Forgotten generation: shaping better services for children and young people examined the current challenges children and young people services are facing and highlights the growing concerns for children and young people waiting to access services.
Demand and activity
After record demand for community services in July, referrals requests fell by 12% in August to 1.63 million. However, as figure 6 shows, over the longer term, referral requests remain elevated: compared to last year referrals are up by 6% and compared to five years ago, before the pandemic, referrals are significantly higher (+49%).
Care contact activity also slipped back to 8.28 million after a record high July (9.37 million). Care contact activity measures a contact or appointment between a person and a care professional. In August, care contact activity was a similar level compared to the same time last year (0.3% increase in care contacts).
Figure 6
Total referrals received by community services
Both the demand for services, and the activity trusts undertake, impact how long patients wait for community services. The Lord Darzi report highlighted community services as one of the main areas where patients waiting a long time for care from services is being normalised. Following the Darzi review, it is clear that shifting care from hospitals to community will be a key focus in the upcoming 10-year health plan.
UCR services, virtual wards and intermediate care
The 2023/24 priorities and operational planning guidance set out a national objective for trusts to consistently meet or exceed the 70% two-hour urgent community response (UCR) standard. In August, 85% of 2-hour UCR referrals achieved the 2-hour standard, with trusts exceeding the national objective for another month. The target was met across most reporting trusts with 85 out of 91 reporting trusts meeting the 70% target in August. Of these, 31 trusts delivered UCR services within the two-hour window to 90% of patients.
Intermediate care - delayed discharges
The intermediate care data collection provides comparable data with the community discharge sitrep for discharge delays: the number of patients not discharged by the end of the day despite no longer meeting criteria to reside. The latest data shows that on average in October, 87.9% of patients who no longer met the requirements to remain in intermediate care services remained in hospital. This is down from 88.6% in September and 88.8% in October 2022, when the data was first recorded.
The proportion of patients remaining in hospital at the end of the day despite no longer meeting the requirements to remain has never dropped below 87%. Reducing discharge delays is critical to improving whole system flow for providers. This applies to any transfers of care between acute, ambulance, community and mental health settings and partners across domiciliary and social care.
Figure 7
Percentage of patients remaining in hospital by the end of the day despite no longer meeting the requirements to remain (%)
Virtual wards
Virtual wards are a vital part of patient care which allows patients to receive the care they need at home rather than being in hospital. This helps prevent avoidable hospital admissions or supports people to safely leave hospital sooner. In October, the virtual ward capacity was 12,700, increasing by 1.2% compared to September. There were 9,900 patients in a virtual ward meaning the occupancy rate was 78.2% in October, an increase of 7.9 percentage points from 70.3% in September 2024.
The virtual ward capacity per 100,000 GP registered population aged 16 years and over was 20, which is a slight increase on last month's rate (19.8 per 100,000 GP registered population). But this rate remains below the longer-term ambition of 40 to 50 virtual beds per 100,000 people - as outlined in the Delivery Plan for Recovering Urgent and Emergency Care.
Expanding UCR services, virtual wards and intermediate care further will require a shift in resource to ensure funding follows ambition. The government has set out its ambition to deliver a neighbourhood health service, with more care delivered in the community via primary care and community services. This is a welcome step and community providers are clear that they have a key role to play as this work progresses.