Introduction
By placing children at the centre of policy, funding and service design, Northern Ireland can build a health system that gives every child the opportunity to thrive.
From early childhood through to adolescence, children’s experiences and opportunities lay the foundations for lifelong health, development and wellbeing. When children receive the right support early, they are more likely to thrive throughout childhood and into adulthood. Yet too many babies, children and young people in Northern Ireland experience long waits for care, widening health inequalities and missed opportunities for early intervention.
Our manifesto, which you can download below, has been shaped by the expertise of paediatricians across Northern Ireland alongside the voices of children and young people. Their experiences highlight the growing pressures facing services and the opportunities to improve outcomes and advancing child health in Northern Ireland.
The recommendations within this manifesto are practical, evidence based and achievable. They focus on building a sustainable workforce, creating a data-informed system, ensuring equitable investment in child health services and tackling the root causes of poor health and inequality. Together, they offer an opportunity to create a healthier future where every child has the best possible start in life.
As clinicians, advocates and leaders, we stand ready to work with government, policymakers, communities and families to deliver this vision. Every child deserves the opportunity not only to survive, but to thrive. The decisions we make today will shape the health and wellbeing of a generation. We cannot afford to miss that opportunity.
Key priority 1: Investing in the workforce
The Executive must deliver a long-term child health workforce plan, including a detailed review of the current landscape, key actions and associated investment to enable effective delivery.
- The case for change
Paediatric services are under increasing pressure from rising demand, increased complexity in child health, workforce shortages and difficulties in recruiting and retaining staff. A strong and sustainable child health workforce is key to enabling prevention, early intervention, and reducing risk factors of poor health. In the absence of comprehensive long-term workforce planning, it is likely that children will continue to face increasing waiting lists while the child health workforce will experience increasing pressure.
In order to meet the needs of children and young people, it is vital that the size, skill and welfare of the child health workforce are prioritised. Research in the British Medical Journal notes that burnout is widely observed among the paediatric workforce due to workload as well as emotional demands. Moreover, a recent General Medical Council survey shows high burnout risk among paediatric trainees and trainers, with moderate burnout risk affecting over 40% of both groups.
Burnout, understaffing, and constant pressure are the main reasons people are leaving.
In our recent survey, paediatricians in Northern Ireland identified workforce planning as a priority, with 81% of respondents supporting the development of a long-term child health workforce plan. This should be co-designed with child health experts across hospital, community, and primary care, and address areas such as training, career progression, retention, and staff wellbeing.
Invest in a sustainable, long-term workforce plan that provides safe staffing levels, protected time, and genuine support for clinicians.
- The change needed
All children deserve timely access to high-quality care no matter where they live. The ability to provide this level of access relies on a skilled, sustainable paediatric workforce.
To prioritise and invest in child health, the next Northern Ireland Executive must:
- Carry out a comprehensive review of the child health workforce to gain a clear understanding of the current landscape including the identification of areas of need as well as to evaluate capacity and resources.
- Develop a child health workforce plan through co-design that will ensure long-term sustainability, a strategic approach to recruitment and retention, and enable the delivery of timely and effective care for children and young people.
- Provide sustained, needs-based investment in the child health workforce that is aligned with the five principles of public budgeting for children’s rights: effectiveness, efficiency, equity, transparency and sustainability, while taking account of increased demand and complexity in child health.
- Strengthen safeguarding medical leadership and capacity through sustained workforce investment to ensure timely expert and clinical input, and an effective multi-agency approach for children and families.
Key priority 2: Investing in data
The Executive must ensure a connected and data informed child health system that enables better understanding of child health and paediatric services, identifies gaps and need early, informs future policy and service delivery, and delivers for children.
- The case for change
Children’s health journeys often require a multi-agency pathway that spans across health, social care, education, and the voluntary and community sector. To ensure policy and services meet the needs of children and young people, it is vital that paediatric focused data, especially around developmental milestones, chronic conditions, safeguarding, neurodevelopmental conditions and mental health, is routinely collected by all relevant agencies.
There is currently limited published data relating to the whole of child health therefore we cannot clearly understand the full extent of the pressures on paediatric services, what specialities are under strain and where targeted intervention is required. Effective data insights can facilitate the delivery of joined up, child-centred services with increased opportunities for appropriate early intervention by better informing policy design, service delivery and funding requirements.
Improved data and digital infrastructure are essential to understanding demand across hospital, primary and community services. Although Health and Social Care (HSC) Trusts can now publish regional data following the implementation of the digital care record system Encompass, it is vital that the information collected is utilised to enable a clearer understanding of child health and paediatric services.
- The change needed
Information that can be used safely and consistently across health, social care and education supports better planning, earlier intervention and more joined-up care. To enable effective change and service delivery for paediatricians and children, the next Northern Ireland Executive must:
- Strengthen and improve data collection and analysis to support policy making and service planning by:
- Ensuring all HSC Trusts collect high-quality, standardised and readily disaggregated data across hospital and community settings to better understand service need, enable strategic planning and improve children’s care.
- Collect comprehensive paediatric focused data that can be disaggregated and utilised to better understand the child population health in Northern Ireland.
- Implement processes that enable effective co-ordination between education and health services in relation to identification, diagnosis, assessment and delivery of support needs.
- Examine the viability of establishing a single unique identifier for children and young people to facilitate consistent and appropriate information sharing across health, social care and education services, ensuring more integrated, holistic support and outcomes.
- Strengthen and improve data collection and analysis to support policy making and service planning by:
Key priority 3: Investing in child health services
The Executive must recognise the growing complexity of paediatric needs, ensure equitable investment in child health services, and embed the needs and rights of children at the centre of policy development, service design and delivery.
- The case for change
Equitable investment in child health services that is on a par with adult provision is essential for achieving an effective and sustainable system for children and young people, ensuring the best start in life and helping to build the foundations of a healthy adulthood for all in our society. It is important that new health initiatives and systems, such as the Neighbourhood Health and Wellbeing model, includes provision for babies, children, and young people from the outset so as to ensure equity of access, opportunity and outcomes.
The demand is escalating, and the services simply aren’t there.
Children’s services do not receive an equitable share of health investment which has led to children and young people waiting too long for assessment, treatment and support. Recent Department of Health (DoH) paediatric outpatient figures show some children waiting several years for specialist appointments, including Ears, Nose and Throat (ENT) and plastic surgery.
Delays at key developmental stages permanently limit a child’s potential.
For children, many interventions are needed early and within a specific developmental window to prevent escalation and ensure better outcomes. Delays in assessment or treatment can detrimentally impact on a range of areas including a child’s communication, learning, mental health, mobility and long-term wellbeing. This includes children and young people currently awaiting an autism assessment. We know that early diagnosis can help facilitate assessment for possible co-existing conditions and enable early management, ensure reasonable adjustments are made in the education system, and signpost parents/carers to relevant support, yet over 17,000 children remain on a waiting list, with some waiting up to five years for diagnosis.
Furthermore, despite mental health issues continuing to be a significant area of concern, recent figures demonstrate that 1,682 children are waiting to access Child and Mental Health Services (CAMHS), with 511 children waiting more than 9 weeks. A recent report from the Northern Ireland Commissioner for Children and Young People (NICCY) highlights the continued pressures faced by mental health services with timely access to appropriate support yet to be realised for many children and young people. Mental health can impact on all areas of a child’s life, from school to friendships and relationships to their physical health. As with other chronic conditions, early intervention is key to addressing problems and limiting poor outcomes. With more than half of mental health problems reported in adulthood starting by the age of 14, effective support provided at the earliest opportunity is vital to enabling positive outcomes.
We are failing children at vital stages, and the consequences will follow them for life.
In addition to addressing lengthy waits for children and young people, it is vital that there are effective pathways to enable smooth transition from paediatric into adult services. It is important that strategies are in place to allow for transition planning that is flexible to individual need, allows for engagement with the young person, and ensures cooperation between paediatric and adult services.
Young people fall off a cliff between children’s and adult services.
- The change needed
As part of the pathway to achieving this, the next Northern Ireland Executive must:
- Put children and young people at the centre of decision-making by embedding children's rights, actively seeking their views, and using Child Rights Impact Assessments (CRIAs), the Children’s Services Co-operation Act 2015, and effective Equality Impact Assessments (EqIAs).
- Invest in sustainable, child-centred healthcare infrastructure and services including paediatric capital development and long-term funding for essential regional services such as bereavement support.
- Improve access to the right care at the right time through better referral pathways, early identification, and integrated routes to specialist assessment and support.
- Strengthen mental health and wellbeing support through investment in crisis services, workforce expansion, community provision, youth services, mentoring programmes and safe spaces for children and young people.
- Ensure seamless care and accountability across the system by improving transitions from paediatric to adult services.
- Establish and fund a multi-disciplinary Child Death Overview Panel to undertake reviews of all child deaths in Northern Ireland and make evidence-based recommendations that inform policy development and help improve services.
Children make up around 25% of the population but only a small proportion of the health budget comes to paediatrics.
Key priority 4: Investing in prevention
The Executive must ensure that children have the best start in life, free from poverty and avoidable health inequalities, and embed an effective accountability framework that ensures appropriate actions where areas are lacking in progress.
- The case for change
Children and young people today are growing up in a very different world from previous generations. The effects of the COVID-19 pandemic continue to shape children's health and development, while a growing demand for mental health and neurodevelopmental services, increasing complexity of need and widening health inequalities have exacerbated the challenges facing the child health service.
At the same time, children are navigating emerging issues including the impact of social media and online harms, rising rates of vaping, the cost-of-living crisis and increasing demand for support within education and health services.
Kids are people too. They may not vote but should be prioritised.
Poverty, insecure housing, food insecurity and unequal access to services continue to undermine children's health, development and life chances. Around one in four children are growing up in poverty, with approximately 67,000 children living in relative or absolute low-income poverty. A 2025 RCPCH UK wide survey laid bare that children and young people are experiencing more severe health issues due to poverty, placing a system already stretched thin under much more considerable strain as well as affecting health outcomes in childhood and later in life. Northern Ireland regional inequality figures disappointingly continue to show evidence of the significant disparity between children and young people living in the most and least deprived areas especially with regards to infant mortality, low birth rate, obesity and breastfeeding indicators.
Reducing child poverty would do more for child health than any single medical intervention.
Early intervention, timely access to services and proactive education can support healthy development, prevent illness and identify needs before they escalate. Too often, paediatricians see these opportunities missed. Unequal access, variation between Trust areas and workforce pressures mean many families experience delayed or fragmented support.
The Executive’s ambition to give every child the best start in life must be underpinned by strong child health services and sustained investment. From oral health to mental health, or from vaping to online harms, children’s health is shaped by decisions across all government departments. These issues cannot be solved by health services alone. They require a cross-government approach that puts children first in funding, policy and delivery.
Prevention is number one — we act far too late.
Embedding prevention across government, with clear accountability for improving child health outcomes and reducing inequalities, is essential to giving every child the best start in life.
- The change needed
Prevention and early intervention are key to addressing many health inequalities. To create a society where every child can thrive, the next Northern Ireland Executive must:
- Establish, monitor and report on specific targets aimed at improving children’s health outcomes and provide a clear assessment of progress including the identification of areas for further action.
- Monitor and report on the health impact of poverty on children, young people and their families and ensure targeted early intervention.
- Ensure funding for the effective implementation of Healthy Futures, the strategic framework to prevent the harm caused by obesity, reviewing and updating the actions as needed.
- Implement strong online safeguards for children and young people, and ensure access to effective mechanisms to raise concerns, enabling them to benefit from the digital world, without being exposed to harms.
- Ensure the effective implementation of the Tobacco and Vapes Act 2026 and examine areas where devolved powers should be used to guarantee there are no gaps with regards to marketing/selling of vape products, particularly where products are designed or promoted in ways that appeal to young people.
- Provide children with equal protection from physical assault by removing the defence of reasonable punishment.
Without significant investment in children’s health there will continue to be generational missed opportunities.