The state of health care and adult social care in England 2024/25
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Health and care services for children and young people
Community health services for children and young people
In last year’s State of Care report, we highlighted the sustained decline in the number of qualified health visitors who provide support and advice for families with children up to 5 years of age.
This year, we turn our spotlight more widely on community health services for children and young people, which, as well as health visiting, deliver school nursing, speech and language therapy, and community paediatric services. The latter services provide care for children who need diagnostic assessments and initial support for complex and ongoing physical and mental health issues, including neurodivergent conditions, such as attention deficit hyperactivity disorder (ADHD) and autism.
According to NHS England data, between January 2023 and December 2024, the number of children and young people waiting to access community health services increased by 26%. This is higher than the 19% reported for adult services.
But the most glaring difference lies in the number of people waiting over a year for community health treatment. From January 2023 to December 2024, waiting lists for adults have reduced by 13%. By contrast, the number of children and young people on these waiting lists increased almost threefold (by 291%), from 12,156 to 47,494 over the same period (figure 20).
Figure 20: Number of people waiting over a year for community health service treatment in England – children and adults, January 2023 to December 2024
Source – CHS Sit Reps. Definitions of service types included in the reporting changed in February 2024, and February to April represent statistical outliers compared with the preceding monthly pattern. The higher levels reported from this point have nevertheless persisted above the expected range through to December 2024.
As at December 2024, the majority of people waiting over a year for community health treatment are those waiting for community paediatric services. They make up 85% of the community healthcare waiting list, compared with the next most-awaited service – speech and language therapy – which accounts for 10%.
A personal story – waiting for an ADHD diagnosis
Charlotte and her husband first started to notice a decline in their daughter Izzie’s mental health when she was 14 years old. Once she had turned 16, these signs became more apparent, and Izzie’s boyfriend suggested that she might have ADHD.
Izzie’s GP asked her to complete an online test, which showed that she was extremely likely to have ADHD. Her GP therefore added her to a waiting list for a formal assessment.
While waiting, Izzie’s mental health rapidly worsened. She started to hurt herself and retreated into her own bubble. She stopped going out. She even had to quit education.
At 17, Izzie finally received a formal diagnosis of ADHD. On receiving it, she burst out crying because she finally felt seen. She felt validated. She was offered medication, which has helped her to manage the impact of ADHD on her day-to-day life.
Izzie now plans to focus on navigating life with ADHD, while her parents help her to get the help that she needs.
(Interview with a member of the public)
The backlog of children and young people waiting for community paediatric services varies by region. As at December 2024, nearly half (45%) of children and young people in the South West of England were waiting over a year for treatment from community paediatric services, compared with 14% in the South East. To put these figures into context, the National Institute for Health and Care Excellence states that people with possible autism should have their diagnostic assessment initiated within 3 months of their referral.
Protecting children from serious youth violence
The report on our joint targeted area inspections discussed how some groups of children are particularly vulnerable to being affected by serious youth violence, including children with special educational needs or disabilities – especially those with neurodivergent conditions, such as those mentioned above.
Joint targeted area inspections are carried out by CQC, Ofsted, His Majesty’s Inspectorate of Constabulary, Fire and Rescue Services, and His Majesty’s Inspectorate of Probation (HMI Probation). They look at how local partnerships and services, including health services, respond to children and their families when children are affected by serious youth violence.
The report says how children with special educational needs or disabilities are having to wait too long for their needs to be assessed, and how there are delays in children being able to access services, as reflected above. This is making some children more vulnerable to serious youth violence, as needs can increase while they wait for an assessment or support. Waiting times are especially long for children who need a neurodevelopmental assessment, including for ADHD and autism. Out of the 6 areas we visited, 3 areas had waits of at least 2 years for a neurodevelopmental assessment. In one area, children then had to wait a shocking 10 years to access support following a diagnosis, by which time some of them would be adults.