Children’s surgery backlog grows as NHS prioritises adult waiting lists

Exclusive: More than 350,000 paediatric patients are now waiting for surgery

Doctors and NHS leaders warn that the official data fails to show the true scale of the issue (Getty/iStock)

Hundreds of thousands of children are waiting for surgery as new figures show the backlog has spiralled by almost 50 per cent in two years.

The latest NHS data for December lays bare the parlous state of paediatric medicine, with NHS leaders and doctors warning that adult care is being prioritised over children’s.

In December 2022, 364,000 children were waiting for treatment, from neurosurgery to ear, nose and throat operations, while a further 200,000 needed community services such as speech and language therapy.

The surgery figure is up by 48 per cent since April 2021 – a far bigger increase than was seen in the overall NHS waiting list, which grew by 36 per cent over the same period.

Mike McKean, vice-president of policy at the Royal College of Paediatrics and Child Health, said intensive care capacity was being “pushed to the limits”.

“Lengthy waits are unacceptable for any patient, but for children and young people, waits can be catastrophic, as many treatments need to be given by a specific age or developmental stage. It is not the same as for adults. If you miss the right window to treat a child, or wait too long, the consequences can be irrevocable.”

An analysis of the figures by The Independent shows that almost 3,000 children were waiting more than 18 months in November, while more than 15,000 were waiting for more than a year.

Urgent referrals of children by GPs have also risen from at least 2,500 a week in 2019 to a record 5,400 in December. The real figure, however, will be far higher, as this data only includes electronic referrals. Doctors say the increase is a result of health conditions being missed because of reduced access to healthcare services during the pandemic.

The parents of a six-year-old girl awaiting brain surgery told The Independent that her procedure had been cancelled in January at the last minute because of short staffing.

Dr Michael Absoud, clinical academic at the Department of Women and Children’s Health at Kings College London, said: “On the ground, it feels like it has gotten worse, not better, because there has been no specific funding for recovery to cover the disproportionate increase in complexity.

“Despite the fact that children were not very impacted by Covid, these services were disproportionately impacted. As a paediatrician, I find it remarkable it is not a priority topic.”

Doctors and NHS leaders warn that the official data fails to show the true scale of the issue because it doesn’t include written or telephone referrals. Referring to the total waiting list figures, one senior NHS source said they believed waiting lists had grown by 70 per cent in some specialities between 2021 and 2023.

The news comes as the Royal College of Paediatrics and Child Health expressed fears that children’s services would not feature in the government’s forthcoming major long-term plan for the NHS.

The college has called for the government to launch a strategy for managing children’s health conditions.

Last week, NHS England said paediatric services were experiencing “significant pressures in emergency departments and paediatric intensive care units” alongside long-standing challenges such as “insufficient” bed availability.

‘Lack of urgency’

Rosie, six, whose name has been changed, was referred for brain surgery in November as she is at risk of having a stroke. Her surgery was cancelled at the last minute last month, her mother said, as there were not enough paediatric intensive care nurses.

She said: “The surgeons, anaesthetists, operating department staff, porters, recovery staff and countless others are all assembled, but they haven’t got enough specialist paediatric intensive care nurses to safely cover the intensive care unit.

“They explain that this regional intensive care unit is busy, and some children can’t be moved because they’re still too ill. The surgical teams have each been making the case for which of the poorly or high-risk children should have tonight’s intensive care bed. It will not be our daughter.”

Dr Absoud said there had been a “lack of urgency” about helping children’s services to catch up on delays caused by Covid.

He added: “It’s always been a Cinderella service, but when you’re teetering and get a big shock to the system like the pandemic, then you get this hit [to services]. There needs to be new thinking with regard to integrating physical and mental healthcare delivery, multidisciplinary workforce planning, and capital investment.”

Another NHS trust leader said that the way surgical cases are prioritised means that a lot of children’s cases do not count as urgent compared with serious adult cases. “However, those decisions don’t consider the impact of delaying surgery on children, developmentally and socially. That’s the bit we’ve been very mindful of ... I think there’s that risk for children’s surgery in general.”

A trust executive in the North said: “If paediatric [surgeries] are held to the same standard as adults, then relatively they get deprioritised. There is no national target on paediatric cases.”

An NHS director in the Midlands said that the reason waits for children’s care are increasing disproportionately are complex, but include “a combination of surgeon skill loss over Covid, no desire to replace retiring consultants with those that cover paediatrics, and an overfocus on recovering adult services, as numbers are bigger, at the expense of paediatrics.”

One paediatrician told The Independent that one of the problems in clearing the backlog is that far fewer options are available for private-sector referrals for children’s services. Another NHS trust executive said that community service waiting lists, combined with long waits for mental health treatment, meant it was a “grim time to be a child needing healthcare”.

Dr Umang Patel, a paediatrician in Hampshire, said that during the pandemic, when children’s services went remote, it became “easier to deal with one [medical] problem than the wider problems ... I think we’re now seeing people that are coming back needing new referrals, because actually, it wasn’t just that singular problem ... there is also the general increase in pressures on primary care, as you can imagine.”

Shadow health secretary Wes Streeting said: “Every child matters. But the Conservatives have failed to train the staff the NHS needs, leaving more children than ever before waiting to be treated. Labour will give every child a healthy start to life. We will scrap the non-dom tax status to train 7,500 more doctors, 10,000 more nurses a year, and 5,000 new health visitors.”

A spokesperson for the Department of Health and Social Care, while not setting out any specific plans for children in the department’s forthcoming major conditions strategy, said: “Reducing waiting lists is one of our top priorities, and we want patients to have fast access to high-quality care.”

Referring to overall waiting lists, they added: “The NHS has already made strong progress in tackling the Covid backlogs, virtually eliminating waits of over two years for treatment – the first target in the Elective Recovery Plan – and 18-month waits cut by over 55 per cent since the peak in September 2021.

“All efforts are being made to deliver the next ambition, to eliminate waits of 18 months or more by April. We have opened 92 community diagnostic centres, which have delivered 3 million checks since July 2021 and will mean patients are diagnosed and treated more quickly.”

An NHS spokesperson said: “NHS services have been under significant pressure – with the combined impact of Covid and flu alongside huge demand for all services – but despite this, hardworking staff have virtually eliminated two year waits, and are making good progress on reducing 18 month waits, which includes many children.

“The NHS is investing in new surgical spaces and local teams continue to find innovative ways to tackle the backlog such as paediatric super Saturdays, where surgery is extended for children at the weekend.

“It remains as important as ever that children and families come forward for care through 999 in an emergency or use 111 online or their local GP for other health conditions.”