Timely health care for children and young people 1 is vital. Missing out on the right interventions at the right time can have a lifelong impact not only on children's health but also on their wider life chances. Yet despite repeated national commitments to improve child health, children are still waiting too long for care, and there is ample evidence of stark inequalities in the health of children between more and less deprived areas.
This long read examines whether the policy ambition to shift more care from hospitals into the community – a centrepiece of the recently published 10 Year Health Plan – can deliver lasting benefits for children and young people. We examine the potential upsides of this shift, before looking at the main barriers to improving community services for children and young people.
A shift from hospital to communities could be positive for children
The long-term trend in children’s health has seen a reduction in infectious disease and an increase in ill health due to long-term and multiple conditions. As a result, children and young people stand to benefit from better and more integrated provision in the community, with interventions put in place as early as possible.
When hospital care is not clinically necessary, providing joined-up and holistic care in their communities can spare children and their families the distress of hospital stays or visits, reduce disruption to education and caregiver work, and could be more cost-effective. Patterns of ill health impacted by poverty and inequality may be also better addressed by understanding the child’s community and social context.
However, evidence suggests that for children there were falling rates of GP use (except for infants) and increasing use of outpatients and urgent care (for all), including numbers of short-stay emergency admissions, before the Covid-19 pandemic. Recent trends for these are not publicly available, but there were more A&E attendances for children and young people in 2023/24 compared to 2017/18. Actions to address child poverty and improvements in integrated services for children have the potential to reduce potential future increases in hospital activity.
What are the main barriers to improving community services for children and young people?
Workforce challenges
A clear barrier to better joined-up care in the community for children and young people is the gap between the staff available and the growing demand for care. As of March this year 2 , more than one in five children (22%) on the waiting list had been waiting more than a year for community health services, and 87% of all community health care waits of over a year were experienced by children. Specifically, long waits were seen for community paediatric services and speech and language therapy.
The NHS workforce plan aimed to resolve issues with the NHS workforce through a target to grow mental health, primary and community care roles by 73% by 2036/37. But it doesn’t differentiate between the adult and children community workforce. What’s more, the new 10 Year Plan effectively writes this plan off, describing it as “a fiction” and promising a new plan with a “decidedly different approach”.
If the next new plan follows suit and contains specific targets for increasing training places for health visitors and school nurses, that would signal a welcome shift after historical declines in their numbers 3 , even if it’s important to remember that children’s community health care is more than just those two work groups.
Health visitors and school nurses have recently been under more pressure, however, as they increasingly support families with significant safeguarding and child protection needs (work previously under the remit of children’s social care), as well as more challenging development needs. Too often, staff report feeling like they are ‘firefighting’ and dealing with enormous caseloads, resulting in poor retention and a loss of staff along the training pipeline.
The Royal College of Paediatrics and Child Health have also reported that although paediatric hospital nursing capacity has increased over the past decade, paediatric community nursing capacity has decreased – and there is significant regional variation.
Working in partnership across organisations and with communities
A big enabler of the shift towards community services for children and young people is the development and effective working of neighbourhood multidisciplinary teams (MDTs) to provide integrated care.
Beyond the NHS workforce (community, hospital, GPs and mental health), MDTs for children also include early years settings like nurseries and childminders, education, youth work, and the voluntary, community and social enterprise (VCSE) sector.
While better cross-organisational working is the right goal, it is important to recognise context: this shift is being made when each sector that makes up an MDT is experiencing significant pressures. For example, there are documented pressures on early years provision in the face of workforce challenges, in primary schools and in the VCSE. NHS leaders worry about their wider partners’ ability to meet the demand for children’s services.
The 50% cut in operating costs facing integrated care boards (ICBs) is likely to affect their capacity to coordinate this shift, making collaboration harder and exacerbating longstanding challenges to hearing children and young people’s voices in local service provision.
A further challenge for partnership working concerns the large numbers of different organisations involved in children’s services – many of them with vastly different funding structures, professional disciplines and working cultures. Having a shared cross-organisational language is crucial to understanding a patient’s needs and having a shared vision of what good outcomes are, while understanding the roles of those involved to achieve them. But getting this shared language is more difficult to achieve across such diverse and disparate organisations.
System priorities and accountability
Successfully implementing the community shift for children will also need a change in the way children’s services are prioritised – or not – in both local and national policy-making.
The Health and Care Act 2022 4 and NHS England’s 2025/26 priorities and operational planning guidance mandates that ICB 5 plans should explicitly reflect the needs of children and young people. The neighbourhood health guidelines also state that the focus for 2025/26 is to support people with complex needs, highlighting this is for both adults and children.
However, services for children are one among a long list of priorities for NHS organisations. Analysis of their initial plans shows some progress in considering the needs of children, but it also found multiple issues in how children were reflected. A survey of NHS providers found that only a third of respondents (33%) said they were satisfied that their local plans adequately prioritised children’s services, and 39% of respondents felt dissatisfied.
Better prioritising children’s services will also mean ensuring that data collections more accurately reflect patterns of use among children and young people. Currently the performance assessment framework and the 2025/26 NHS priorities and operational planning guidance focus heavily on hospital care and waiting times, and include very few child-specific measures and none broken down by age. In a system where too often only what gets counted tends to count, children risk being overlooked.
The right aspiration but are the tools there?
Shifting care into the community is the right aspiration for the NHS – and the right one for children and young people. There are potentially huge gains in ensuring that care is more convenient for children and their carers, more joined up, and better tailored to their changing needs. But with community services for children currently falling short, there are big question marks about how to make this a meaningful shift for children.
The 10 Year Plan and the Best Start in Life strategy do include specific initiatives to improve children’s and family services. These commit to expanding family hubs to all local authorities, bringing together different services in one place to make it easier for families to get the help, and expanding ‘start for life programmes’ to five years of age instead of two, providing support on various aspects of child development. The role of health visitors will also be expanded – through measures like administering childhood vaccines – and strengthened. The emphasis on commissioning for partnership working across the local area could have a positive impact on children’s health services.
While the 10 Year Plan does include some welcome references to children and young people, the sheer volume of priorities it sets out risks diluting focus. History shows that unless children are clearly prioritised in implementation – with success measured specifically for this age group – they are all too easily overlooked.
Good data on children’s needs and services can sharpen policy-makers’ focus and drive better care. At a national level, this might involve linking information about social care, education and health needs to facilitate research and improve policy-making for children services. At a local level, this could be to share and link information with the potential for systems to better understand users’ needs, reduce the need for children and their families to repeat their stories, and enable more targeted services to address inequalities.
The 10 Year Plan contains the laudable ambition to raise “the healthiest generation of children ever”. Getting timely care in the right place at the right time is core to this, and the promised shift to community services should play a vital role. But when it comes to children’s services, the NHS is starting at a disadvantage. Sustained, meaningful improvement will only come if these services are prioritised.