The March 2026 NHS England Board papers show that community waits are becoming one of the most important hidden access pressures in the NHS. 

Elective waiting lists receive the greatest public attention. Urgent and emergency care performance is highly visible. Cancer and diagnostic standards are closely watched. But the Integrated Performance Report shows a major access challenge outside the acute spotlight: 90,049 patients were waiting more than 52 weeks for community services in January 2026. That was slightly lower than December 2025, but 32.7% higher than January 2025, equivalent to 22,170 additional patients waiting over a year.  

The children and young people signal is particularly strong. NHS England states that 90% of all over-52-week community waits are in children’s services, with 82% of all community waits over 52 weeks in community paediatrics, largely driven by demand for neurodevelopmental assessment.  

The core signal is clear: access recovery cannot be understood through acute elective performance alone. Community waits are now a material system pressure, with direct implications for children, families, workforce resilience and long-term demand.

Community waits are deteriorating beneath the headline access story

The March Board pack contains positive access signals. The total elective waiting list fell to 7.25 million in January 2026. Under-18 elective waits also reduced year on year. Long elective waits over 52 weeks continued to fall. Urgent and emergency care showed improvement in several areas, including Category 2 ambulance response times and A&E 4-hour performance.  

But community waits tell a different story. 

In January 2026, the number of patients waiting more than 52 weeks for community services was 90,049, compared with 90,220 in December 2025. That small month-on-month improvement suggests the position may have stabilised recently. However, the year-on-year picture is significantly worse. In January 2025, the equivalent figure was 67,879.  

This matters because community services are often less visible than hospital pathways, but they are central to how patients experience the NHS. Community services support children, adults, older people, people with long-term conditions, people recovering after hospital admission, and patients who need care closer to home. Long waits in these services can delay assessment, intervention, rehabilitation, diagnosis, support planning and escalation. 

The risk is that the system celebrates improvement in acute access while community access deteriorates. That would create an incomplete picture of recovery. A patient waiting for community paediatrics, community musculoskeletal services, neurodevelopmental assessment, rehabilitation or other community support is still waiting for care. 

The March Board signal is therefore not simply that community waits are high. It is that community waits may become a limiting factor in the wider recovery model if they are not treated as part of the same access problem.

Children’s services carry the greatest pressure

The most important feature of the community waiting-list data is the concentration of long waits in children’s services. 

NHS England states that 90% of all over-52-week community waits are in children’s services, and that 82% of all community waits over 52 weeks are in community paediatrics, largely driven by demand for neurodevelopmental assessment.  

This is one of the strongest patient-impact signals in the March Board pack. Long waits in children’s community services can affect development, education, family wellbeing, safeguarding confidence, school support, parental employment, primary care demand and mental health need. The Board papers do not quantify those impacts, and it would be inappropriate to infer harm beyond the evidence presented. But the pathway risk is clear: where children and families wait a year or more for assessment or support, the consequences can extend beyond the original referral. 

The autism waiting-time data reinforces this pressure. In December 2025, 84.8% of patients with suspected autism were waiting more than 13 weeks for contact, up from 80.3% in December 2024. ICB-level variation was also substantial, with the proportion waiting more than 13 weeks ranging from 29% to 97%.  

This is not a niche performance issue. It is a system-wide children and young people access challenge. It sits at the intersection of community paediatrics, neurodevelopmental pathways, education, mental health, family support, primary care and local authority services. 

The February Board minutes show that this issue was already visible before the March pack. Board members noted significant concerns about long waits in community services, particularly community paediatrics and neurodiversity assessments, where previous system plans had not delivered the expected reduction in the longest waits. They requested clearer data on numbers waiting, conditions involved, workforce and productivity measures to support effective oversight.  

That request matters. It shows that NHS England recognises the need for better oversight of the community waiting-list problem, not only further reporting of the headline number.

Community access is now a productivity and variation issue

The Integrated Performance Report states that NHS England has implemented interventions to improve community waiting-time performance, with further activity planned now that formal waiting-time targets have been published in the Medium Term Planning Framework. These include 2026/27 ICB targets for 78% of waits to be under 18 weeks and a requirement for plans to eliminate waits over 52 weeks.  

The report also identifies specific planned actions: development of a system-wide action plan with system- and provider-level checklists to baseline provision and drive improvement, and a national community musculoskeletal service specification to reduce waits in a high-volume service line. NHS England states that these actions are designed to reduce variation and address drivers of long waits, with impact expected in 2026/27 data.  

This is a significant direction of travel. Community access is being brought more clearly into the same performance logic as elective care: targets, baselines, checklists, service specifications, provider-level improvement and system-level accountability. 

The Strategy Committee papers support this wider direction. The Committee reviewed a productivity plan aimed at 2% annual productivity growth, with reducing unwarranted variation identified as the core strategy for baseline productivity gains. It also reviewed the 10 Year Workforce Plan assumptions, including workforce demand, productivity and shifting care closer to communities.  

This matters because community waits cannot be solved only by asking existing services to do more. The system needs to understand where variation is coming from: referral thresholds, workforce availability, assessment models, clinical prioritisation, local authority interfaces, administrative processes, digital infrastructure, estates, commissioning arrangements and demand growth. 

The community waiting-list signal is therefore both operational and strategic. It is operational because patients are waiting now. It is strategic because the NHS’s future model depends on shifting more care closer to home. That shift will not be credible if community pathways remain unable to absorb current demand.

The pressure falls heavily on workforce and families

Community waits are often experienced in quieter ways than emergency department waits or cancelled operations, but they create real pressure for patients, families and staff. 

For children and families, long waits can mean prolonged uncertainty. Families may wait for assessment, diagnosis, therapy, support planning or advice about how to manage needs at home or in school. In neurodevelopmental pathways, delay can also create additional pressure on general practice, schools, mental health services and voluntary sector support. 

For healthcare workers, community waiting lists create a different type of operational strain. Staff are not only managing booked appointments. They are also managing triage, risk stratification, safeguarding considerations, repeated queries, family distress, prioritisation decisions and professional concern about unmet need. 

The workforce picture in the March Board pack shows why this matters. Staff engagement has fallen, sickness absence remains slightly higher than the previous year, and the NHS Staff Survey raising-concerns score has weakened.  

Community teams cannot be treated as an unlimited buffer for system pressure. If community services are expected to take on more activity as part of neighbourhood health, admission avoidance, earlier intervention and discharge support, workforce planning will need to match that ambition. 

The Strategy Committee’s discussion of the nursing and midwifery strategy is relevant here. It focused on modernisation, community-based care, digital integration, education reform, recruitment, retention and professional development, with members discussing the need for flexible workforce models and targeted cultural interventions to support retention and leadership.  

The implication is clear: community recovery must include workforce recovery. Waiting-list plans that do not account for workforce capacity, skills, supervision and retention are unlikely to be sustainable.

Data and accountability are becoming more important

The March Board papers also suggest that community and delegated services will be subject to stronger data-led accountability. 

The Summary of Delegation of NHS England Direct Commissioning Functions Evaluation and Monitoring of Services Directions 2026 states that NHS England is responsible for making sure that health services commissioned by ICBs are safe, effective, delivering value for money and reducing health inequalities. It also states that NHS England retains overall accountability for delegated functions and requires assurance from ICBs that functions are being discharged safely and effectively.  

The Directions require NHS England to collect and analyse information relating to delegated functions so it can monitor national and local service performance, understand the impact services have on the wider NHS, understand patient pathways and care outcomes, support population health management, enable benchmarking, inform decision-making and target inefficiencies.  

Although those Directions relate to delegated direct commissioning functions, the wider signal is relevant to community access: local responsibility is being paired with stronger national data collection, benchmarking and oversight. 

For ICBs, this matters because community waiting-time improvement will require accurate data, consistent definitions, service-line visibility and a clearer understanding of pathway outcomes. For providers, it means long waits are likely to become less hidden over time. For patients and families, better data should support more transparent prioritisation and improvement, provided it is used to drive action rather than simply describe pressure. 

The February Board minutes show the same direction. The Board supported greater transparency and increased use of the Federated Data Platform for reporting, with a standing commitment to continuous improvement in data quality.  

The challenge is that data alone will not reduce waits. But without better data, systems will struggle to understand where demand is rising, where capacity is constrained, which pathways are most pressured, and which interventions are working. 

What this means now

The March Board papers show that community waits are no longer a peripheral access issue. 

The headline figure is significant: 90,049 patients waiting more than 52 weeks for community services in January 2026, up 32.7% year on year. The concentration in children’s services is even more important, with community paediatrics and neurodevelopmental assessment demand driving much of the longest-wait pressure.  

For patients and families, the risk is prolonged uncertainty, delayed support and increased pressure across other services. For healthcare workers, the risk is rising caseload complexity, difficult prioritisation and sustained operational strain. For provider and ICB leaders, the risk is that the NHS’s future model of care closer to home is undermined by current community capacity constraints. 

The system response is beginning to sharpen: formal waiting-time targets, plans to eliminate over-52-week waits, system and provider checklists, service specifications, stronger data collection and increased focus on variation. But the success of that response will depend on whether community access is treated with the same seriousness as elective recovery and urgent care performance. 

The central system implication is this: the NHS cannot shift care closer to home while community pathways remain under such visible long-wait pressure. 

Community services are not a secondary layer of access. They are part of the core delivery architecture for prevention, children’s care, long-term condition management, discharge support, admission avoidance and neighbourhood health. 

If community waits remain hidden, recovery will remain incomplete. 

References

• NHS England, Integrated Performance Report, March 2026. 
• NHS England, Minutes of a public meeting of the NHS England Board held on Thursday 5 February 2026, published March 2026. 
• NHS England, Board Committee updates – NHS England Strategy Committee, March 2026. 
• NHS England, Summary of Delegation of NHS England Direct Commissioning Functions Evaluation and Monitoring of Services Directions 2026, March 2026. 
• NHS England, Month 10 financial position 2025/26, March 2026. 
• NHS England, Meeting of the Board of NHS England – agenda, 26 March 2026.