These spotlight interviews aim to raise awareness of the key issues facing the child health workforce in Wales. Our first is with Dr Lizzy Nickerson and is focused on the theme of empowering the child health workforce in Wales.
Lizzy is a Consultant Community Paediatrician based at Nevill Hall's Children's Centre in Abergavenny, Monmouthshire. She is also Designated Doctor for Child Protection in Wales, Chair of the Wales Community Child Health (CCN) Network and is a member of RCPCH Wales's National Specialty Advisory Group (NSAG).
We sat down with Dr Nickerson earlier this month to talk about her roles, the rewards and challenges, and to get her take on what the next Welsh Government needs to do to better support those working on the frontline and to improve outcomes for babies, children and young people. Her insights offer a powerful reminder of the dedication and expertise within Wales’s child health workforce and the urgent need for strategic focus and investment to support it.
Workforce pressures
RPCH Wales: Can you describe your current role, and what you find most rewarding?
Dr Lizzy Nickerson: As a Consultant Community Paediatrician, my role includes caring for children with complex needs, diagnosis and management of neurodiversity and safeguarding children and young people.
In my opinion, the most rewarding parts of the job are two-fold. Offering support and care as a multi-disciplinary team to children and young people and their families including listening and understanding of the challenges they are facing and how we can best support these. Secondly influencing strategic changes, whether on a multi-agency level in improving understanding of health interventions, or at a national level in strengthening equitable care across the nation.
As a community paediatrician, we have a unique insight into the day to day challenges of families and an ethical duty to ensure these real-world issues are highlighted, acknowledged and tackled.
RCPCH Wales: Can you describe the current pressures facing you and your colleagues in paediatrics?
Dr Lizzy Nickerson: Paediatrics, particularly community paediatrics, has always been the voice less heard. While our patient population are not voters, their families of course are, and more importantly they are out future society. There is no better investment for long-term improvement of our society fiscally, ethically and morally. However this is not reflected in the current investment in staffing levels for community paediatrics and the wider multi-disciplinary teams. The lack of standardised metrics for waiting lists and case loads in community paediatrics results in the challenges being further hidden.
The complexity of both community patients and safeguarding cases is acknowledged as increasing, however the time available to invest in these is constantly at threat. As with anything, the ripple effect is felt, with pressures in our partnership agencies, resulting in more families at crisis point rather than investing in prevention.
Supporting the next generation
RCPCH Wales: What message would you give to medical students considering a career in child health?
Dr Lizzy Nickerson: At no point in my career so far have I regretted becoming a Community Paediatric Consultant. The colleagues with whom you will work are compassionate, kind and are exemplars of the Nolan Principles (Committee on Standard in Public Life, 1995). Our patients bring joy and motivate our passion to make a difference now and to the future of our society. Paediatrics offers a huge range off opportunities as an all-encompassing specialty with multi-disciplinary and multi-agency colleagues and exciting progress in areas such as genetics and neurodivergence, constantly keeping you cerebrally challenged!
Collaboration
RCPCH Wales: What one thing in particular would help multi-disciplinary teams (MDTs) work more effectively together?
Dr Lizzy Nickerson: Our work in community paediatrics is particularly reliant on multi-disciplinary working. In the pandemic we moved away from face to face working as was the need at the time. This innovative way of working has its benefits in: accessibility for many, both workforce and patients; as well as perceived efficiency in cutting down on travel time. However, what has been lost is the shared physical space. This feeds into staff wellbeing as well as efficiency. In sharing a space with our multi-disciplinary colleagues we increase the efficiency of the process by cutting out unnecessary steps e.g. the lengthy stream of emails explaining: why a referral is needed, clarifying advice wanted, or searching for the correct service for a patient. In bringing back shared spaces we're able knock on the office door to chat through a challenging case and produce a plan within a few minutes of a conversation. This also improves overall efficiency as it is likely, the next time we are faced with a similar challenge, we will not need to discuss as we already know is the best plan. (Mastalerz et al 2024).
From a wellbeing point of view, the increased stress levels associated with large numbers of emails is evident (Ludivine et al 2025). To reduce this by improving the ease of face to face communication with shared spaces would have a clear benefit for staff as well. This does not have to be confined to multi-disciplinary teams, but can be expanded to multi-agency teams improving efficiency in these pathways too.
Planning for the future
RCPCH Wales: If you could send one message to Welsh Government and health boards ahead of the 2026 Senedd election, what would it be?
Dr Lizzy Nickerson: The need in our child health population is not lessening. The data shows the increasing numbers of children with identified disability. We see the pressure on our colleagues in education adapting strategies for neurodivergence. We see the pressure on the families we support and as a result on our colleagues in local authorities. This need is felt inequitably across Wales with the gap widening.
Our workforce across the public sector and third party organisations have the answers and are a passionate body with a desire to improve support and particularly to focus on preventative measures with interventions to ensure the first 1000 days of a child’s life are optimised.
Empowering the workforce with strategic support from finance to brainstorming these ideas will result in meaningful long-term changes rather than quick fix myopic solutions that result in a lack of patient-orientated care and shifting the crisis elsewhere.