Our calls for the next Welsh Government:
- Empower the child health workforce: Attract, support and retain a workforce able to care for current and future generations.
- Transform health services: Prioritise children’s health, happiness and wellbeing within the planning, funding and delivery of the NHS.
- Embrace data and digital innovation: Revolutionise child health through data transparency and digitalisation, investment in IT infrastructure and facilitating record sharing across sectors.
- Deliver for all: Ensure every child has an opportunity for a healthy life by mitigating the wider determinants of health.
Darllenwch ein maniffesto yn Gymraeg
From Dr Nick Wilkinson, RCPCH Wales Officer
"With the changes to the electoral system in Wales, the 2026 Senedd elections will be unlike any before. What is clear to me and my child health colleagues across Wales is that we must put children and young people at the centre of this election and make their health and wellbeing a national priority for the next Welsh Government.
"For too long and far too often, the needs of our children and young people have been ignored, overlooked and services that provide for them, underfunded. Inequalities are mounting, services are struggling, and we’re battling to keep their heads above water. The lack of focus on children in policy, and especially in health policy, has resulted in poor health outcomes in children and young people.
"We often hear, ‘children and young people are 25% of the population but 100% of our future’. This is true. We all want to live in a healthier nation in the future, but in order to achieve this, we need to ensure today’s children grow into strong, healthy and happy adults who can reach their potential. We need a Welsh Government that will lead the way to a healthier tomorrow by putting children first.
It’s time for policymakers to value to importance of child health. This manifesto, developed with insight from RCPCH Wales members and children and young people, sets out why child health matters, why we need to act now and provides solutions for the next Welsh Government."
1. Empower the child health workforce
The problem
| 88% of RCPCH Wales members surveyed want the Welsh Government to deliver a long- term child health workforce plan |
|---|
There are significant workforce pressures across the children’s health workforce. Workforce numbers are insufficient to match the growing demand for children’s health services or to meet the increased complexity of children’s health needs.
We are people who love our job but with the pressure of the workload, we are not getting the training opportunities we deserve, and we are burning out.
The current workforce is overstretched, and at risk of burnout. The General Medical Council (GMC) annual survey of trainees and trainers in the NHS reported 61.6% of paediatric trainees and 43.8% of trainers in Wales were at high or moderate risk of burnout.
Our workday pressures are often above and beyond what we can cope with. Over time, the fatigue, working late and expectations are detrimental to our own health as staff
While between May 2021 and November 2024, rising from 8,393 to 11,129, the number of consultant paediatricians only increased by 11 Full Time Equivalent (FTE) paediatric consultants. This translates to a 33% increase in pathways versus a 5.2% increase in consultants. This by no means plugs the gap in completing patient pathways that have built up over more than a decade. Added to this, investment in other child health professions has not kept up with demand.
Our health visiting and school nursing services are woefully understaffed and underfunded - Welsh Government response is more data and monitoring, not enabling and empowering staff to be on the ground with children and families. Welsh Government and the Health Board needs to dramatically change the whole approach to children - in health but also in education and social care - at present we are failing our children, and it feels like no one is listening.
There are persistent challenges with rota gaps and workforce shortages across the breadth of the child health workforce. In 2024, there were over 2,000 registered nurse vacancies in Wales. Added to this, the number of FTE has seen a steady decline over the years, falling by 3% from 851.2 FTE (June 2021) to 827 (June 2024). The number of in Wales has also decreased by 5.1% from 391 (September 2021) to 371 (September 2024).
Other professions such as physiotherapist, occupational therapist and speech and language therapists have also seen sporadic investment which has not kept up with demand. The Royal College of Speech and Language Therapists recently a 51% vacancy rate for registered paediatric SLTs in one rural area and an underinvestment in the profession in Wales compared to other nations. This is causing huge challenges for services to deliver support for children and young people.
Why act now
Chronic underinvestment and staff shortages is having an impact on the provision of safe and timely care for children. It is also contributing to surgical cancellations, reduced capacity and pressures across healthcare services.
Policy agendas and reforms have not adequately addressed the needs of the child health workforce.
Health Education and Improvement Wales (HEIW) and Social Care Wales (SCW) published in 2020. This plan did not reference the child health workforce, or children in general beyond noting agency spend on children services – 4% of posts filled by agency staff compared to 2% in adult services.
The 2021-2026 Welsh Government published a . Of the nearly 80 actions, child health was referenced only once and relates to the implementation of the Welsh Nursing Care Record in maternity and children wards. In contrast, the paper details the need to develop ‘whole workforce planning approaches’ to meet the needs of the older population and embeds the needs of this part of the population across professional education. There is no equivalent reference to children, despite the growing complexities and demand within child health.
Investing in the child health workforce to prevent and manage ill health and reduce risk factors early in life is the most effective way to lay the foundations for a healthier future population. This supports a more sustainable workforce across the NHS by reducing future pressure on adult health services.
If emerging health needs in childhood are addressed by the right people, in the right place, at the right time, we can reduce demand for health services in the future.
| How to guide: Empower the child health workforce |
|---|
Empower the child health workforce: Attract, support and retain a child health workforce capable of caring for current and future generations.
|
2. Transform child health services
| 77% of RCPCH members surveyed said the Government should prioritise fair funding for child health |
|---|
The problem
It is now widely acknowledged that services for children have been left behind and the impact is being felt by the most vulnerable.
Child health teams are working tirelessly to address the backlog and improve access to care. However, systems are frequently prioritising 'high volume, low complexity' interventions, while interventions for children, which can be more complex and require a differently trained workforce, are not receiving the same focus. The lack of adequate funding for child health services and coordination and oversight of funding between services has impacted children's ability to access healthcare.
In February 2024, we published Worried and Waiting which sought to draw attention to the fact paediatric waiting times have increased in Wales by 62% between 2016 and 2024 and that child health services need urgent investment.
I want to feel like they're aware I'm waiting and not forgotten.
As of November 2024, there were 56,080 open pathways for under 18s waiting for treatment: 8,495 waiting over a year and 4,611 waiting over a year for an outpatient appointment and 1,171 waiting over two years.
The challenge is not solely one for elective care but can be seen across the health system. For example, the lack of focus on children's experience of emergency care, consideration of diagnostic capacity, and the impact of pressure within mental health teams and general practice on access to appointments and treatment for children and young people.
Things are getting harder - child health in general is poor as often is mental health. Access to services is difficult so as general paediatricians we're seeing a lot more CYP with physical manifestations of neurodiversity, anxiety or poor mental health as experienced by their parents. It can be tricky to signpost to some meaningful support.
Emergency department attendance across Wales has increased. In November 2021, 7,369 0-4 year-olds presented in emergency departments. The same month, three years later, saw 9,182 0-4 year-olds attend - an increase of 24.6%. Similarly, for those aged 5-17, this rose by 11.5% from 12,224 to 13,639.
The workload is extremely high and can feel often that we are doing the work for two people especially on out of hour shifts. Working in an understaffed department consistently lowers morals and increases sickness which worsens this further.
Community child health is also an area that has faced chronic underinvestment, but data for the number of children waiting in the community is not readily available. What we do know is neurodevelopmental wait lists, specifically for children waiting for an ADHD or autism, is as high as 20,770 and by to between 41,000-61,000.
The demand on paediatric and child health services is compounded by inequalities in service planning. Services that are available for adults are not always available for children and young people. Examples of this include the absence of a pathway for child fatigue and pain management.
Why now
Failure to acknowledge and address the pressures in children's health services, and to transform the NHS by putting children first will worsen health outcomes of the most vulnerable children and their families. This will result in an increase in demand for adult services and require additional NHS funding as well as impacting the wider economy.
Several Welsh governments have experienced difficulties in meeting NHS waiting times targets and challenges with improving productivity due to a high level of demand on services. This will only continue if attention is not drawn to child health.
While the did acknowledge that 'it is clear that the ongoing pressures are having a disproportionate impact on children and young people', services for children continue to be overlooked and underfunded. This has resulted in lengthy waits, despite effort from the workforce.
The (2023) made very few references to children despite children being frequent users of health services, and being the future of the nation. The paper instead comments that the issues raised should be considered with a children and young person focus to examine the impacts on the NHS and our future generations. It is unclear if this research has been undertaken.
Transforming health services with a 'putting children first' approach and designing services around child health, early intervention and prevention can increase productivity and reduce demand on adult services, and therefore save the NHS and Government money in the long term.
| Recommendation from children and young people |
|---|
| During a RCPCH& Us Innovation Lab, held in Cardiff, children and young people expressed wanting more support when transition from child to adult services. They shared that they struggled during this time and wanted an advocate who was familiar with the service, to help them navigate and liaise with services on their behalf. The next Welsh Government should ensure every child transition from child to adult services is supported by a dedicated individual who can support them in navigating this time. |
| How to guide: Transform child health services |
|---|
Transform health services: Prioritise children’s health, happiness and wellbeing within the planning, funding and delivery of the NHS.
|
3. Embrace data and digital innovation
| 92% of RCPCH members surveyed said improved NHS IT systems would benefit the child health workforce |
|---|
The problem
We all know improving data and investing in digital innovations has the power to transform child health outcomes whilst also increasing efficiency. Sadly, child health data in Wales is poor and digital innovations rarely reach child health services.
There are notable gaps in routinely collected and publicly available data relating to community health, school readiness, health needs in school, childhood disabilities, treatment or services children are waiting for, and only high-level data on the paediatric workforce and even less on allied health professions. This makes it difficult to identify where pressures are, how services are coping, or is a service redesign and investment would be beneficial.
I am constantly annoyed by the inefficiency due to poor IT equipment and infrastructure. It leads to wasting time, wasting resources and huge frustration.
Services in Wales are still using paper-based records, which in 2024 the Welsh Government acknowledged 'limits the accuracy of data collected' in reference to the . The paper-based system relating to this universal programme which aims to support new families, address health inequalities, and ensure every child has the best start to life has led to families missing out. Over 57,500 contacts which should have been offered were not recorded as taking place. In 20% of these cases the reason for the non-contact was missing or invalid data - simply put, 11,500 families went without due to the current system.
A Healthcare Inspectorate Wales (HIW) report, , found insufficient communication and information sharing arrangements to be presenting a risk to child protection as some health professionals were unaware of whether child protection arrangements were in place or not. This was compounded by staff using handwritten records in some areas of practice, which at times were found to be illegible.
The workforce is constantly challenged by a lack of, and inability to share and access child health data and information across health systems and with key partners in education and children's social care.
I am about 25% as productive as I might be in terms of delivering healthcare to children, because IT and support systems are so primitive.
Children rely on a wider range of services to meet their needs, including early years settings, schools, health services, and when necessary, children's social services. As a result, there are different 'identifiers' assigned to them by various agencies, including the NHS number in health settings, a Unique Pupil Number in each school, and different local identifiers in local authorities and social care. This makes it much harder to link records about the same child which are held by different services, meaning care is hard to join-up, and health or safeguarding risks may not be identified.
| Message from children and young people |
|---|
| Through RCPCH &Us, children and young people have repeatedly told us that they don’t want to have to “tell their story twice”. This is particularly important for children who confide in a ‘trusted adult’ (this could be a teacher, doctor, youth worker) and may not feel comfortable telling their story to others. |
Why now
Wales can no longer be left in the dark about the state of child health. Both at a national level to identify trends and patterns in child health needs, and a local level to support individual patients. Investment in data and digital solutions should be the next Welsh Government's priority.
Since 2018, a Child Health System (CYPrlS) has been steadily implemented across Health Boards. This sought to ensure every child has an active record and aims to ensure child health services keep pace with digital technologies. However, the child health workforce continues to express challenges and frustrations with the lack of progress with information sharing and insufficient digital infrastructure.
Many organisations, including RCPCH Wales and the Welsh NHS Confederation, have expressed concerns that the NHS is faced with an ageing estate, including digital infrastructure. The ageing infrastructure was not designed for current or future demands and therefore fails to meet modern standards. Investment is needed to not only move away from dated paper-based systems but also ensure we have a digital infrastructure that facilitates connectivity across the health and care system, and also mitigates cyber-security risks.
Not only is there a need to invest in the digital infrastructure within the NHS (both hardware and software) but there's a desperate need to facilitate easier information sharing across services. In 2023, the Welsh Government should work alongside Health Boards to commission a centralised, accessible IT system that is able to capture all health information relating to children, including the location of any non-digitalised records. This has yet to be completed.
Numerous reports over the last 20 years have explored the benefits and feasibility of a consistent child identifier (CCI), otherwise known as a Single Unique Identifier (SUI). A SUI could greatly improve information sharing, reduce the risk of incorrect patient identification, improve care pathways and child protection, and importantly, reduce the burden on children and families to tell their story multiple times. Adopting the existing NHS number as a SUI has long been called for by organisations including the Royal College of Paediatrics and Child Health, Royal College of General Practitioners, Royal College of Speech and Language Therapists and charities.
The UK Government's Children's Wellbeing and Schools Bill (England only) takes the first steps towards removing barriers to data sharing with an SUI in England, If done well, this will ensure no child falls through the gaps across agencies. Wales should not be left to catch up, the next Welsh Government need to ensure digital equity.
| How to guide: Embrace data and digital innovation |
|---|
|
Embrace data and digital innovation. Revolutionise child health through data transparency and digitalisation, investment in IT infrastructure and facilitating record sharing across sectors.
|
4. Deliver for all
The problem
| 69% of RCPCH Wales members surveyed said reducing the impact of poverty would benefit their patients and families most |
|---|
A healthy childhood can significantly benefit adult life by laying the foundation for good physical and mental health, including aspects like increased life expectancy, disease prevention, improved cognitive function, stronger social skills, and greater resilience to stressed in adulthood. This sets the foundations for a healthier adult, able to contribute to society.
However, not all children have the same opportunities, and this is impacting their health. Health inequalities are the avoidable, unfair and systematic differences in health outcomes between different groups of babies, children and young people.
By the time we see children for a number of the big issues, the horse has already bolted. Early years investment and education on parenting could prevent so many of the issues we see in later years.
The drivers of health inequalities are the social, economic and environmental factors in which individuals live that have an impact on their health outcomes. This includes income, ethnicity, housing, climate change and being looked after by local authorities.
Reducing socioeconomic inequalities and place children at the centre of policy making decisions.
Children living in poverty are more likely to have poorer health outcomes, including higher risk of mortality and poor physical and mental health. In Wales, nearly a third (29%) of children are living in relative income poverty.
Child poverty is a significant driver of inequalities.
- : For those eligible for free school meal, 64.3% were persistently absent from secondary school, compared with 33.9% ineligible for free school meals
- : Obesity is nearly twice as high in children living in the most deprived quintal (13.6%), compared to those in the least deprived (7.8%).
- : People living in poverty are more likely to have experienced ACEs. With 13.1% of people in the least deprived areas experiencing 4 or more, compared to 27.8% in the most deprived.
- : The prevalence rate in the most deprived areas is 43.4% compared to 20.7% in the least deprived areas
- : 25% of children from low-income households have tried an e-cigarette compared to 19% of children from high-income households.
The influence of poverty on children's health and wellbeing is undeniable. also have a significant impact on children's health. Cold, damp housing conditions lead to increased risk of asthma, respiratory infections, slower cognitive development, and mental health problems in children.
But poverty and housing conditions are not the only factor driving inequalities.
Health inequalities also exist between ethnic groups. Disparities occur across health including mortality, access to care, use of services, prevention and disease burden. in ethnic minority children (aged under 16 years) is markedly greater than in white children. has shown those from a White Gypsy or Traveller ethnic group were the least likely to meet the Welsh national indicator of two or more healthy behaviours (66%) compared to all other ethnic groups. The for at least 60 minutes per day in the past seven days was lowest amongst those from a Bangladeshi (11% or Chinese (12%) ethnic group compared to those from other ethnic groups.
Children and young people have also identified climate change as a significant concern and one driving inequalities. Climate change poses an existential threat to the health and wellbeing of children and young people, but it is not experienced equally. Exposure to air pollution is the second leading risk factor for death in children under 5, both in the UK and globally.
| From the RCPCH Climate Change Position Statement, 2024 |
|---|
|
Voicebank data highlighted that children and young people are becoming increasingly worried about climate change resulting in a higher prevalence of eco-distress. For example, an individual from Caerphilly noted that something has to be done to improve the climate in order to reduce the mental health decline that is impacting children and young people. |
Why act now
Health inequalities are widening, and the impact is being felt by the most vulnerable.
According to a recent report by the , prioritising early childhood development by supporting working parents and caregivers, improving social and emotional skills, and reducing public spending on remedial measures could add at least £4.5 billion to the UK economy annually.
A report by reveals how children living in poverty in Wales who are already behind when they start school may never catch up with their classmates. This has a significant impact on their life opportunities.
In 2024, the Welsh Government implemented the . While health inequalities did feature in this, following a campaign by RCPCH Wales, the strategy as a whole fell short. We agree with the Children's Commissioner for Wales, and several other organisations, that the does not match the gravity of the situation facing children and young people. In 2024, RCPCH led 47 organisations in writing to the Welsh Government to demand action to reduce the impact of poverty and inequalities.
RCPCH Wales has since called for a comprehensive Action Plan and monitoring framework which sets out targets and measurable outcomes and which embeds the .
In recent years the term 'firefighting' has been adopted to describe the state of the NHS, with the Welsh Government focussing on meeting targets and reducing the longest waits. However, suggests that, at most, 20% of a nation's health and wellbeing is dependent on healthcare services. Simply put, reducing pressure on the NHS through 'firefighting' is not going to be possible unless the demand reduces and with an increasingly unhealthy, or sickly child population, this is unlikely to happen.
The has also called for the Welsh Government to protect and ringfence funding in all future budgets. This is in response to a proportion of preventative spend in last year's Welsh Government budget being reallocated to deal with frontline NHS pressures. The Commissioner said "without action, spending on prevention will continue to be a casualty of intense pressures on day-to-day budgets and a victim of short-term thinking. This will undermine the Welsh Government's commitment to taking a long-term, prevention-led approach".
The NHS alone does not have the levers to reduce levers to reduce inequalities: this is why we need to shift the focus from public health initiatives delivered through the NHS and local authorities, to addressing factors such as climate change, poor housing, transport and food quality. Addressing the wider determinants of health and supporting all children to have a healthy life should be a central focus for the next Welsh Government.
| How to guide: Deliver for all |
|---|
|
Deliver for all: Ensure every child has an opportunity for a healthy life by mitigating the wider determinants of health including poverty and climate change.
|
How these calls were developed
RCPCH Wales conducted a survey of members between September-December 2024. The survey received responses from 74 members and includes responses from all University Health Boards.
The RCPCH Wales Officer and staff attended an All-Wales Grand Round in November 2024 to further gather insight from paediatricians in Wales. In total RCPCH interacted with nearly 100 paediatricians in Wales to inform the calls in this manifesto.
Key findings:
- 92% said improved NHS IT systems would benefit the child health workforce
- 88% wanted the Welsh Government to deliver a long- term child health workforce plan
- 77% said the Government should prioritise fair funding for child health
- 69% said reducing the impact of poverty would be the most beneficial preventative measure to improving child health.
When surveyed ‘What wider determinates of health should the Welsh Government prioritise’, members chose (in order of priority): poverty, mental health, inequalities, healthy weight and school attendance. Other options included, climate change, vaping, smoking and sexual health education.
When surveyed ‘What should the Welsh Government do to prioritise child health at a national level?’, 61% of members said increased NHS funding.
Quotes from RCPCH Wales members are present throughout the manifesto.
What do you want the next Welsh Government to focus on?
A key theme that emerged from RCPCH Wales members was the impact and need to invest in community child health services, with 52% of members wanting the Welsh Government to prioritise community child health and 48% wanting the Welsh Government to prioritise the interface between community, primary, secondary and tertiary care. In response RCPCH Wales will be developing a community paediatrics paper to sit alongside the manifesto.
| ʼһ the Royal College of Paediatrics and Child Health (RCPCH) Wales |
|---|
| The RCPCH works to transform child health through knowledge, innovation and expertise. We have over 600 members in Wales, 14,000 across the UK and an additional 17,000 worldwide. The RCPCH is responsible for training and examining paediatricians. We also advocate on behalf of members, represent their views and draw upon their expertise to inform policy development and the maintenance of professional standards. For further information please contact Sarah Williamson, Policy and Public Affairs Manager (Wales), enquiries-wales@rcpch.ac.uk. |