Medicine is a social science, and politics nothing but medicine at a larger scale
In paediatrics we are all inherently involved in advocacy. To be effective our work has to be holistic, touching on most aspects of a child’s and family's life. It requires us to speak out at many levels from promoting local access to care, to interagency working through to influencing social determinants.1 So how do we step this up for the upcoming Senedd elections as we tackle increasing inequality for children and young people?
Introducing the RCPCH manifesto for the Senedd elections
Here at RCPCH Wales we know the Senedd elections - 7 May 2026 - will be more of a scrum than normal. No knowing where the ball will pop out, but the way it is played will change... Changes to the electoral system, the way we vote and more politicians means this election could be momentous for Wales. So what better time between now and then to make sure child and adolescent health and wellbeing top the list for debate?
To do this we need to make it easy for politicians to hear our pitch and more importantly make it feel easy for them to deliver, no matter which party or parties are successful. This is why our manifesto, Putting children first: Prioritising Wales's future, is structured around four themes: workforce, innovation, data and health equity.
Since effective advocacy is a team game,2 this also makes it simple for you to pick one that aligns with your needs and the needs of your population, and to gain traction not only with your local politicians but influence through other discussions and actions in your hospital, community or health board. Work too with others to find a common agenda and create a louder voice for a larger population of children and young people.
“Inferior doctors treat the patient’s disease; mediocre doctors treat the patient as a person; superior doctors treat the community as a whole...
Getting involved
Everything we do in medicine is political, from who sits on our clinic lists, how we engage with the patient and how they hear us, through to what happens next, whether to the patient and their family, within our service and our health board, or across the whole system and onto future needs and care.
There are many ways to influence the debate, support the RCPCH Wales manifesto and get involved in advocacy. This does not mean we all have to speak or write to politicians, although it would help.
I have garnered advice from our College and colleges elsewhere including the United States, India and Australia.4 And I've jotted a few suggestions for you to consider.
- Give voice to your questions “What is wrong here? Couldn’t we do better?”
- Have to hand salient examples of care and frame the needs of the child or young person - this moves people more than data
- Invoke the UN Convention on the Rights of the Child to help answer the complexity that often surrounds these issues
- Include the voice of the child where at all possible
- Keep an eye out for the RCPCH template letter (coming in 2026), but in the meantime if you do want to write to your MS let us know and we might be able to help.
- Share your concern and potential solutions - with senior organisational or health board leadership and share with us at enquiries-wales@rcpch.ac.uk
- Listen out for our campaign and join in where you can
This aligns with other RCPCH recommendations such as the climate change advocacy for action toolkit which focuses on four key components: information, patient story, leverage and accountability.
Workforce, innovation and data
Although the RCPCH Wales manifesto has been published, engagement with politicians is a live process. It requires adaptation to current events and equally to the examples of needs and solutions you send us. We need to hear from you under each of our key themes.
We have heard from you about better access to school nurses, paediatric therapies and interdisciplinary care to allow early intervention, reduced investigations, admissions, wait lists and ultimately costs. We have heard of innovations across all health boards - exemplary collaboration between paediatrics, CAMHS and schools in Central Integrated Healthcare Community in North Wales, Adferiad services in Aneurin Bevan and Swansea Bay Health Boards, and new interfaces between primary and secondary care. Send us more. For RCPCH Wales members, we want to hear more from you. Send us your examples on enquiries-wales@rcpch.ac.uk.
Like you we have made effective use of the recent increase in access to paediatric data and realise the wealth of change that can be brought about by greater access not only in identifying priorities but also, critically, evaluating redesign of care.5 What data do you have? What data do you need? How can Health Boards make this available?
When a flower doesn't bloom, you fix the environment in which it grows, not the flower
Collaboration with others on inequalities
To address major drivers of poor health outcomes such as income inequality, persistent school absence, and climate change, we need to collaborate across sectors - just as we call on politicians to set up cross-government solutions.
To this end we will be collaborating closely with the Children’s Commissioner for Wales, Children in Wales and other Royal Colleges and will continue our work with schools and social services. This may be another way you wish to engage.
Future health
Of course all of this is in a moment of time and change is brought about incrementally but change is driven by advocacy so why not you and why not now? Join the discussion and drive the debate.
- Case study
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Early in the establishment of my services in Oxford the mother of a patient with juvenile arthritis bemoaned local access to physiotherapy. Despite the use of long term medication her daughter still had stiff and restricted upper and lower limb joints and was struggling to join in at school and with family activities. A health professional herself she could see the marked contrast to adult healthcare and wrote to her local MP.
At the time I was advocating through a national charity but learning from her lead I started to write to MPs too and soon enough we found ourselves part of an early day motion at the Houses of Parliament. It is not entirely clear what happened next but we gained the ear of the local commissioner and access to therapies in my service was consolidated although we were unable to address local provision. Perhaps this was because we did not have a systems view that we now have in Wales.
Nonetheless I am indebted to my patient and her mother and continue to use the inspiration.
- 1Waterston T. Teaching and learning about advocacy. Archives of Disease in Childhood - Education and Practice 2009;94:24-28 ep.bmj.com/content/94/1/24
Devakumar D et al The role of advocacy in promoting better child healthArchives of Disease in Childhood 2016;101:596-599 adc.bmj.com/content/101/7/596.long - 2Keller DM. Child Advocacy in Action: If Not You, Who? If Not now, When? Pediatr Clin North Am. 2023;70:1-10
Waterston T. Teaching and learning about advocacy. Archives of Disease in Childhood - Education and Practice 2009;94:24-28 ep.bmj.com/content/94/1/24 - 3Keller DM. Child Advocacy in Action: If Not You, Who? If Not now, When? Pediatr Clin North Am. 2023;70:1-10
- 4onlinelibrary.wiley.com/doi/10.1111/jpc.14134
- 5Brennan L, Stres DP, Egboko F, et alHow do children’s hospitals address health inequalities: a grey literature scoping reviewBMJ Open 2024;14:e079744