What are people telling us about three key community services?
One of the key commitments from the NHS 10 Year Plan, published in July, is to make care easier and more convenient for people to access by moving services into community-based settings. This includes plans to move as much care as possible from hospitals to Neighbourhood Health Services.
In light of this focus, we looked at people’s experiences of three key services that are already being delivered in the community:
- Health visiting, which focuses on the health and wellbeing of families with babies and young children.
- Speech and Language Therapy, which supports children and adults with speech and swallowing difficulties.
- Podiatry, which provides preventative care, diagnosis, and treatment for conditions that affect feet, ankles, and lower legs.
These services are important because they provide preventative care, identify hidden problems, and support children and adults in addressing key healthcare concerns, such as regaining speech after a stroke, tongue-tie in babies, or foot ulcers.
People value the care that these services provide
We heard very positive feedback when people can access and use community services. For example, parents of new babies valued being able to access advice and support from health visitors when needed, and people with diabetes appreciated access to regular podiatry appointments to check on their foot health.
“I’m getting looked after well after one of my toes has been amputated. I get regular and frequent appointments with the podiatrist to get my foot dressed. It is frequent to make sure they can treat it.”
Story shared with Healthwatch Hounslow
People accessing speech and language therapists told us about friendly, helpful and empathetic staff:
“My son is non-verbal and for a few years he had excellent SLT (speech and language therapy) input, including a couple of home visits, school visits and phone call updates to keep me informed. They referred him for an ACC (augmentative and alternative communication device), which he got, and he is brilliant with it.”
Story shared with Healthwatch North Somerset
Parents also valued the role of health visitors in identifying developmental issues with their children and support needs for themselves (such as postnatal depression and anxiety) and referring them on for more help:
"At the age of two, difficulties with eating began, and we were advised that they were 'just a fussy eater' and that they would grow out of it. The food aversions continued to escalate. By 9 years old, my child's diet was restricted to just pasta and cheese. We discussed the situation with a health visitor who was visiting a sibling, and they referred my child to the hospital, who referred to CAMHS (Child and Adolescent Mental Health Services), where they received an ARFID (avoidant/restrictive food intake disorder) diagnosis and were under their care for 2 years."
Story shared with Healthwatch Blackburn with Darwen
People can’t always access the care that they need
However, we heard about access issues across all three services. People talked about long waiting times to access support from speech and language therapy or podiatry for the first time, resulting in delays to treatment.
We also heard about support being limited to a fixed number of sessions, which wasn’t sufficient to address patients’ needs, or the service being limited in other ways.
"The nurse could not dress his foot because she told him they could not get fresh dressings and plasters until the new financial year, about six weeks away. Fortunately, the patient was able to apply dressings at home.”
Story shared with Healthwatch Portsmouth
Recent research by the Institute of Health Visitors found that in England, demand for health visiting support is far in excess of what services are commissioned and able to provide. In some areas cuts meant reduced services for parents. We heard concerns from parents about the impact of cuts to services:
"Several mums feel the health clinics and stay and play sessions should be brought back. These were important for isolated mums, enabling them to interact with other parents face-to-face and ask for advice, support and signposting. Also it’s important to be able to get your baby weighed, especially first-time mums. A mum hadn’t had her baby weighed for over 9 months."
Story shared with Healthwatch North Yorkshire
The access issues people are telling us about are likely to be caused by substantial staff vacancies in each service. The NHS faces a workforce crisis in speech and language therapy, with vacancy rates around 23% for adult services, and research by the Royal College of Speech and Language Therapists highlighted barriers that services face in providing therapy for children and young people, including insufficient staffing, time constraints and funding.
Similarly, there has been a drop in the number of podiatrists over the last decade, while demand for services has risen. Workforce projections on health visiting suggest that the overall number of health visitors will fall by 44% between 2009 and 2029.
The impact of not being able to access care
People told us about the way their lives were affected when they weren’t able to access timely and appropriate care from the NHS. People with diabetes need good-quality footcare to prevent ulcers and amputations:
“I am a type two diabetes patient with peripheral neuropathy, and my feet and legs are classified as "at risk". My local podiatry service will not give me appointments at intervals of less than 13 weeks. In thirteen weeks, my toenails are too long and I am suffering small wounds, bleeding and bruising. I have repeatedly asked for a shorter time between appointments, unfortunately, to no avail. In desperation, I have decided to make an appointment with a private podiatrist.”
Story shared with Healthwatch Wirral
Recent research by the Institute of Health Visitors found that over seven in ten health visitors in England reported a reduction in qualified health visitors in the last year, with the result that many staff are managing chronic excessive workloads. Overworked health visiting staff increases the likelihood of missing the signs that children need specialist support:
"From an early age, my third child had extreme meltdowns that could last for hours, wouldn't sleep, and exhibited quirky behaviours that set her apart. For the next five years, I desperately sought help from health visitors, GPs, nursery and school staff, but nothing seemed to change. I used my savings for a private autism assessment, which found she had ASD (autism spectrum disorder). When I asked her GP for referrals to community paediatrics and occupational therapy, I was told there was a two-year wait for both. I looked at her two-year health visitor check, which showed a high ASQ-SE (ages and stages questionnaire) score. I hadn’t understood the significance of this at the time, but discovered that this score was used to monitor behavioural development. When I called the health visiting team, I learned that any child with a high ASQ-SE score should have had a repeat assessment if the issues were still ongoing. A referral to community paediatrics should have been made if the score remained high. But there was no record of either in my daughter's case."
Story shared with Healthwatch Herefordshire
Research for the Royal College of Speech and Language Therapists found that seven in ten NHS therapists surveyed were concerned about the wait that children and their families experience for a first appointment. We heard that children may have to wait years to get the therapy they need from the NHS:
“My son appeared to have speech delays aged 3, we completed a short intervention and were discharged until going to school. I paid privately during this time as his issues were not resolved. In reception, he was placed on the waiting list to be assessed. Over 4 years, he was assessed (poorly) with minimal, if any, interventions put in place. It is only now (in year 5), after going to the tribunal to get the right support for my son, that he is having weekly therapy. The NHS has done nothing to support my son's speech needs. Early intervention is critical, and I couldn't afford to keep paying privately for this once he reached school. I feel NHS SLT have let my son down.”
Story shared with Healthwatch Hertfordshire
Our recommendations to improve care
1. Explain how community services will improve waiting times
The government’s 10-Year Health Plan delivery strategy should explain how the shift to neighbourhood health will improve access to services, including a preventative approach to care and increasing access to services.
Our findings that podiatry care and speech and language therapy have long waits and limited access back up the calls from professional and campaigning bodies to make more resources available to tackle these issues.
2. Person-centred workforce planning
In its refreshed Long Term NHS workforce plan, the government and NHS England should report on progress against targets for boosting community staff set in the previous version of this plan, published in 2023. It should also set out any new goals for expansion or better retention of health visitors, podiatrists, therapists and other key community-based staff, to ensure people can access these services.
NHS England are due to publish a new workforce plan this year to replace the 2023 Long Term Workforce Plan, which set out the significant workforce shortages in all three of the areas we’ve identified. The new plan commits to increase training in these specialist areas.
3. Build successful neighbourhood health services
The Department of Health and Social Care and NHS England should commit to an evaluation of the initial programme of 42 neighbourhood health services that are due to start running from September 2025.
This evaluation should identify if and how local people were involved in shaping neighbourhood services that meet their specific needs. It should also measure people’s awareness of services, their experiences of using them, and any impact on health outcomes. These findings should inform future development of neighbourhood health services, and the shift from care provided in hospital to care close to home in the community.
4. Involve local communities in deciding where neighbourhood health centres will be located
Consulting with communities will help to ensure they are accessible to their intended users, including people living in deprived areas.
As the one-stop centres are launched, commissioners and providers should also ensure they effectively communicate what services can be found under the same roof, hours of operation, and whether people can access services by appointment or drop-in.
5. Focus on early intervention
The new Strategic Authority model should be used to coordinate and enhance joint commissioning between the NHS, Local Authorities and schools to fund early interventions for children.
We have heard that some children are not receiving services until they reach school age, including for issues identified at a much younger age via health visitor checks. Children are therefore starting their school journey at a disadvantage, leaving schools with limited resources to pick up the pieces.
