What does the NHS Medium Term planning framework mean for community services - and for SLT?

Introduction

In March 2026, NHS England published new guidance on waiting times for community health services (https://www.england.nhs.uk/publication/community-health-services-waiting-times/).

For those working in - or waiting for - speech and language therapy (SLT), these documents are important. They signal a shift in how community services are being viewed, measured, and prioritised nationally.

In this post, I’ll explain what the guidance says, why it matters, and what it might mean in practice.

A big shift: community services are finally in the spotlight

One of the most significant aspects of this guidance is simple:

Community health services now have a national waiting time ambition.

Specifically:

• The NHS is aiming for 78% of waits to be under 18 weeks by the end of 2026/27
• Increasing to 80% by 2028/29 

If that sounds familiar, it’s because the 18-week standard has been used for a long time in hospital (elective) care. Some community services have chosen to use this standard before but this is the first time that they will all be nationally required to.

Why now?

This change reflects a broader direction of travel in NHS policy.

There is a growing emphasis on:

• Providing care closer to home
• Reducing pressure on hospitals
• Supporting people to return to school, work, and daily life more quickly

Community services are central to this vision.

But until recently, they have had:

• Less consistent data
• Fewer national targets
• Less visibility in public reporting

This guidance is, in part, an attempt to address that.

A note of caution: not all services are starting from the same place

While the introduction of targets is important, the documents are clear about something else: Progress will not be even across all services.

In fact, NHS England explicitly states that:

• Early improvements are likely to come from adult services, particularly high-volume areas such as musculoskeletal (MSK) care
• The longest waiting times are concentrated in children and young people’s services

This is a crucial point when considering implementation for SLT.

Much of children’s speech and language therapy sits within community paediatric services - the very area identified as having the longest waits and requiring the most sustained effort.

What counts as “waiting” in community services?

Another key message is that waiting in community services is complex.

Unlike hospital care, it is rarely a simple pathway of:

Referral → Appointment → Treatment

Instead, people may be waiting for:

• Triage
• Initial assessment
• Intervention
• Review or follow-up
• Onward referral (e.g. for neurodevelopmental assessment)

The data used nationally tries to capture this, but it is still evolving.

This matters because a single ‘waiting time’ figure cannot reflect the full experience of waiting.

What are services being asked to do?

Alongside the headline ambitions, the guidance includes practical ‘action checklists’ for services.

These focus on four main areas:

1. Managing waiting lists

• Keeping lists accurate and up to date
• Removing duplicate or outdated referrals
• Clarifying referral criteria

2. Improving flow and productivity

• Reducing unnecessary steps in pathways
• Making better use of available capacity

3. Managing appointments

• Reducing missed appointments
• Improving scheduling systems

4. Supporting people while they wait

This is particularly interesting and picks up on some of the themes already identified in conversations with the WAIT-UP SLT advisory groups.

Services are encouraged to:

• Provide information, advice, or online resources
• Offer group support or workshops
• Signpost to community and voluntary services
• Monitor risk and prioritise those most in need

Supporting people while they wait: opportunity or challenge?

The emphasis on ‘support while waiting’ is important - and somewhat overdue.

In SLT, this might include:

• Home practice guidance
• Parent training sessions
• Advice lines or drop-ins

These approaches can be helpful.

But they also raise important questions:

• Are these supports accessible to all families?
• Do they feel like meaningful help - or a substitute for therapy?
• How do we ensure that support reduces inequality rather than widening it?

These are not new questions—but this guidance brings them into sharper focus.

What does this mean for speech and language therapy?

For SLT colleagues, there is both opportunity and challenge here.

Opportunities:

• Greater national recognition of community services
• Improved data and visibility
• A stronger case for investment and prioritisation

Challenges:

• Targets that may not fully reflect complex SLT pathways
• Risk that children’s services remain slower to improve
• Ongoing questions about how waiting is experienced - not just measured

What does this mean for families?

For parents and caregivers, this guidance may not lead to immediate change but it is a promising shift in direction.

It means:

• Waiting times in community services are now being looked at more closely
• There is increasing expectation that services should:
• Be transparent
• Offer support while you wait
• Monitor and prioritise need

But it also means that:

• Progress may be uneven
• Children’s services may take longer to improve

Bringing it back to WAIT‑UP SLT

The WAIT‑UP SLT project is focused on understanding experiences of waiting in children’s speech and language therapy.

These new documents reinforce why that work is needed.

They show that:

• Waiting is now recognised as a system-level issue
• But it is still imperfectly understood and measured
• And the areas where waits are longest - children’s services - are also those where evidence is most needed

Final reflections

The introduction of waiting time ambitions for community services is an important step.

But it is just that - a step.

Because improving waiting times is not only about:

• Reducing numbers
• Meeting targets

It is also about:

• Understanding experiences
• Supporting people meaningfully while they wait

And measuring outcomes for children and young people, not just contacts.

References

NHS England (2026) Community health services waiting times. Available at: https://www.england.nhs.uk/publication/community-health-services-waiting-times/ [Accessed 29 May 2026]

About WAIT-UP SLT

WAIT-UP SLT is a research project focused on understanding the experiences of waiting within children's speech and language therapy (SLT) services in England. The project aims to explore these experiences from the perspectives of speech and language therapy teams, parents, caregivers, and children and young people, specifically addressing the gap in knowledge about the subjective experiences of those waiting for and within SLT services. Follow our work and find out more via Linktree: https://linktr.ee/waitupslt

WAIT UP SLT © 2026 by Gillian Rudd is licensed under CC BY-SA 4.0