The government wants more people to get healthcare near where they live, instead of going to hospital. It sounds like a good idea. But some of the services that would provide this care are already struggling to find enough staff.
THIS WEEK IN SMOKE | HEALTH | 6 NOVEMBER 2026
Imagine needing help from a doctor or therapist, but being told you might have to wait more than a year.
For thousands of children in England, that is already happening.
In July 2026, 86,279 children and young people had been waiting at least a year for community health services.
Almost 40,000 had been waiting two years or longer.
These are services that help people outside hospitals. They include support for children with disabilities, speech and language therapy, physiotherapy and specialist medical care.
And now the government wants these services to take on even more work.
So there’s an important question: if community health services are already struggling, how will they cope with more patients?
What has the government promised?
In July 2025, the government published its 10 Year Health Plan for England.
It wants to change how the NHS works. Instead of sending so many people to hospitals, it wants more care to happen in local communities.
For example:
- Someone recovering from an operation could receive more help near home.
- An older person might get regular support without travelling to hospital.
- A child with communication difficulties could receive specialist therapy locally.
- Doctors and nurses could help people stay healthy before they become seriously ill.
The government also wants better computer systems and technology to make healthcare easier to access.
It plans to develop neighbourhood health centres where different health professionals can work together.
In March 2026, the government announced the first 27 centres, backed by up to £50 million, with plans for them to open by 2027.
These ideas could make life easier for patients. But a new health centre cannot treat anyone without the people needed to run it.
The problem: some services cannot recruit staff
In August 2026, the Chartered Society of Physiotherapy published a survey of its NHS members.
Physiotherapists help people recover from injuries, operations and illnesses. They also help people with movement and mobility problems.
The survey found that:
- 68% of those responding reported recruitment freezes in their services.
- 37% reported that physiotherapy jobs had been removed.
- 79% were worried that there were not enough staff to meet patients’ needs.
A recruitment freeze means an organisation stops or limits hiring people, often to save money. Sometimes this means that when someone leaves, the organisation does not replace them.
That can leave fewer people doing the same amount of work.
These results came from a survey, so they do not tell us what is happening in every NHS service. But they show that recruitment is a serious problem in some places.
Speech and language therapy services are facing similar difficulties. These therapists help children and adults who struggle with speaking, understanding language or swallowing.
In November 2026, the Royal College of Speech and Language Therapists reported that, among 86 NHS services responding to its survey:
- 74% said they did not have enough qualified staff.
- 33% had experienced frozen jobs.
- 16% had lost qualified staff positions.
These are the kinds of services the government wants to expand.
What does this mean for children?
Some children need specialist help with speaking, learning, movement or development. Getting help early can make a difference to their lives.
But waiting lists for community services are already very long.
The King’s Fund, an independent health research organisation, reported that in July 2026:
86,279 children and young people had waited at least a year for community health services.
Of those, 80,399 were waiting for community paediatric services.
Paediatric simply means healthcare for children. These services help children with disabilities, developmental conditions and other health needs.
The number waiting over a year for community paediatric care had risen from 19,657 in February 2024.
And 39,436 children had been waiting two years or longer across community health services, according to the September 2026 NHS Activity Tracker.
That matters because childhood is a time when people grow and develop quickly.
A child who needs speech therapy may find school and communication more difficult while waiting. A child who needs physical rehabilitation may struggle with everyday activities.
Families may also spend months or years trying to get answers.
Not every child will experience the same effects. But long waits can mean important help arrives later than it should.
But hasn’t the NHS provided millions more appointments?
Yes.
During the 2024 election, Labour promised 40,000 additional NHS appointments, scans and operations every week.
Official figures showed about 5.2 million more of these NHS activities between July 2024 and June 2025 than in the previous year. That was above the number Labour had promised.
However, the NHS had already been increasing its activity before Labour took office. According to Full Fact, the increase in the previous year was even larger, at about 6.5 million.
And these figures measure selected hospital appointments and treatments. They do not tell us whether children waiting for community speech therapy or other local services are getting help more quickly.
More appointments are useful. But what matters to patients is whether they receive the care they need.
Even the NHS watchdog is worried
The Care Quality Commission, or CQC, checks the quality of health and social care services in England.
In October 2026, it published its annual report on the state of care.
It found improvements in some areas of the NHS. But it also raised concerns about moving more healthcare into the community.
The CQC reported that numbers of health visitors and school nurses had continued to fall.
Health visitors support families with young children. School nurses help children and young people with their health and wellbeing.
The report also described worries among some NHS leaders about whether the plans for community healthcare could actually be delivered.
This matters because hospitals need community services too.
For example, someone who is well enough to leave hospital might still need nursing care or rehabilitation at home.
If that support is not available, they may have to stay in hospital longer.
Improving community services could help both patients and hospitals. But those services need enough staff and money to work properly.
Why are NHS jobs being frozen?
The NHS has limited money and must decide how to spend it. Some hospitals and health services are trying to reduce costs.
The government also wants the NHS to rely less on expensive temporary staff. For example, an agency nurse is usually employed through an outside company rather than directly by the NHS.
Reducing expensive agency staffing may save money. But there is a difference between reducing agency spending and stopping the recruitment of permanent staff.
The government has not ordered every NHS trust to stop recruiting permanent workers. Individual NHS organisations make many of their own staffing decisions.
The question is whether those decisions leave enough people to provide safe and timely care.
Where is the plan for the workforce?
The government has promised a separate 10 Year NHS Workforce Plan. That should help explain how many doctors, nurses, therapists and other health professionals will be needed in the future.
But in October 2026, the Department of Health and Social Care still had not given Parliament a date for publishing it.
Training health professionals can take several years. That makes long-term planning particularly important.
The government has said it is working with NHS organisations on staffing and future services.
But the public still needs to know how community services will get the staff required to take on more patients.
What still needs investigating?
The evidence shows that some community services face recruitment freezes and staff shortages. It also shows that many children are waiting a long time for care.
But we cannot automatically say that those recruitment freezes caused every delay.
To understand what is happening, we need answers to four questions:
- How many community healthcare jobs have been frozen or removed?
- How many extra staff will be needed to deliver the government’s plans?
- Are waiting times getting longer in places where recruitment has been restricted?
- How will the government make sure patients receive better care, rather than simply moving services out of hospitals?
These are questions the NHS and government should be able to answer using staffing records, budgets and waiting-list information.
A good plan needs people to make it work
The NHS 10 Year Health Plan could improve healthcare.
Getting treatment near home could mean less travelling, earlier help and fewer unnecessary hospital visits.
And the plan is meant to take years, so it would not be fair to expect every improvement to happen immediately.
But today’s problems cannot be ignored while waiting for tomorrow’s changes.
Children are already waiting years for some services. Health professionals are reporting shortages. Some services are unable to fill the jobs they need.
The government has explained where it wants healthcare to happen.
Now it needs to show how enough people will be there to provide it.
Because care closer to home only helps when the care is actually available.
Where the information came from
This article uses the NHS 10 Year Health Plan, the King’s Fund’s analysis of children’s community waiting lists, NHS community waiting-list data, the Chartered Society of Physiotherapy survey, the Royal College of Speech and Language Therapists survey, the CQC’s 2025/26 report, Full Fact’s review of the appointments promise and parliamentary answers about the workforce plan. Links to these original sources are listed in the article’s source panel.
Evidence note: The staff survey results describe the people or services that responded, not every NHS organisation. Waiting-list figures do not prove that any particular recruitment freeze caused a particular patient’s delay. No patient interview or new government response has been claimed.