I came to Wales for many reasons and one of the draws in terms of paediatrics was the appearance of exciting opportunities to develop new approaches to care for children and young people. The policy landscape is innovative and there’s a will and drive for change.
Now that I am here the reality confirms the appearance.
Within six months I was encouraged by a parent peer specialist to contribute to a Senedd review of Pupil Absence. I am struck by the extent of long-term absence attributed to medical conditions, physical as well as mental health (although the distinction is somewhat arbitrary at times). My joint contribution was acknowledged and I have been able to pick this up subsequently since school attendance is a major patient related outcome for the patients for whom I care.
Since then and in my capacity as Officer for Wales, I have become aware of so much more great work that each has the potential to contribute to improved outcomes. In my subsequent discussions with colleagues I have gained the impression that not all of this work is shared in the way it deserves.
Fortunately, I work alongside people like Alex Hicks, in Welsh Government, and Lisa Roberts, from the College, who signpost me to key information so that I can now share this with you, with the thought that it might both inform practice and seek further input from our community.
Below I have divided the latest work into themes in the hope you may click on one or two of the links and contribute to the consultations or to future Senedd reports.
Welsh Government
These links provide an oversight of what the Welsh Government hopes to achieve overall and specifically for children and young people.
Programme for Government - Programme for government | GOV.WALES – sets out the ambitious commitments they intend to deliver the five years 2021-2026. This includes a statement on wellbeing and at the top of this is effective, high quality and sustainable healthcare.
Children Young People’s Plan for Wales - Children and young people's plan [HTML] | GOV.WALES – this includes the set of priorities co-produced with children and young people and what it specifically means to them and their parents and carers.
Key themes
I have selected a few programmes and current consultations I feel have an opportunity to have a major impact on the care we deliver and outcomes we seek.
Child Poverty Strategy Refresh (consultation) - Draft Child Poverty Strategy for Wales 2023 | GOV.WALES – this important consultation requests a response by September 11, 2023 and includes an easy read document that is crystal clear and a young person’s document for our children and patients to complete.
Mental Health Strategy Refresh (consultation) - Mental health strategy | GOV.WALES – this consultation closed on July 14 with the aim of building on work of the previous 'Together for Mental Health'. This included the inspired T4CYP (Together for Children and Young People) programme which delivered the Whole School Approach and NEST/Nyth. We all need to engage with these. There is a video presentation to explain the WG vision.
Whole School Approach to Mental Health (update April 2023) - Framework on embedding a whole-school approach to emotional and mental wellbeing | GOV.WALES – although early in the stages of roll out we all need to know about this approach to supporting CYP in school especially those with mental health difficulties and other forms of distress. Our support will help it to progress and evolve and is a key resource for many of our patients with long term conditions.
School Absenteeism post COVID (Published: June 2023) - National effort needed to increase school attendance post pandemic – Education Minister says | GOV.WALES – as you will know school absenteeism has changed little since the pandemic. Persistent absence of > 10% is associated with reduced life opportunities and poor long term health outcomes and remains high. 27.9% of pupils on free school meals (a population marker of poverty) have persistent absence of >20% and 48% of this is attributed to medical conditions, similar to the US and Holland. I also recently found out that school absence during the pandemic has led to delayed gross developmental milestones with children aged 10 years unable to catch.
Belonging, engaging and participating (consultation) - Belonging, engaging and participating | GOV.WALES – if the trend and causes of school absence beyond simple truancy worries you, here is an opportunity to provide feedback. There is a potential to provide more integrated support for CYP with asthma, headaches, diabetes and all other long-term conditions.
First 1,000 Days (Published: March 2023) - Adopting a Public Health Approach to Supporting Parents Can Help Give Children Best Start in Life - Public Health Wales (nhs.wales) – more than at any other time this early support has the potential to break intergenerational cycles of disadvantage and support the wellbeing of future generations. Amy McNaughton, Consultant in Public Health said “There are unfair differences in the resources and support that parents have and the circumstances they face. Parenting knowledge and skills play a part but, to support parents to give their child the best start in life, system wide action is needed.”
Healthy Weight Healthy Wales (Published: March 2022) - Healthy Weight: Healthy Wales 2022 to 2024 delivery plan | GOV.WALES - food and physical activity choices have been adversely affected for us all. The impact of the pandemic, on access to swimming for instance, and of cost of living crisis has only amplified this. Healthy Weight, Healthy Wales begins to identify systemic solutions as well as our own responsibilities as individuals and professionals.
Learning systems
These links help to describe which systems are there to support our learning and sharing of information not only in health but also across social care. It includes learning from our mistakes as well as from our patients to not only better support patients of the future but also service redesign.
Duty of Candour (Published: April 2023) - The NHS Duty of Candour | GOV.WALES – We all have so much to learn from the tragic case of Robbie Powell and so many others like his. His case and his parents subsequent advocacy has led to a legal requirement from April 2023 to be open and transparent with service users when they experience harm whilst receiving health care.
Llais Cymru (new Citizen’s Voice body for Wales) Llais Wales | LLais – co-production of care is the way forward and helps to avoid the costly mistakes of the past. This site provides guidance for engagement and consultation on changes to health services in Wales as well as encouraging us all to have a voice. I want NHS Wales App to work and the care we offer to be accessible to all.
Digital Health and Care Record - A single health and care record for Wales | UKAuthority – we all have an opinion about WCP and these pages includes spoken insights of Ifan Evans, executive director strategy for Digital Health and Care Wales, on setting up the national record and ambitions for the future including NHS App Wales. This will further enhance real time information, better support decision making and provide a data lake for a learning health system.
[New] Digital Child Health System – Discovery Phase of a forthcoming programme from DHCW.
Welsh Community Care Information System (WCCIS) roll out - Digital Community Care Record - Digital Health and Care Wales (nhs.wales) - A new computer system is being introduced in Wales to help health and social care professionals work together to provide care closer to people’s homes. This system gives community nurses, mental health teams, social workers and therapists the digital tools they need to work better together.
Duty of Quality and Quality Statements for Clinical Conditions (Published: March 2023) - The Duty of Quality in healthcare | GOV.WALES - The Act places an overarching duty of quality on the Welsh Ministers regarding their health-related functions and broadens the existing duty on NHS bodies to deliver a system wide culture of continuous learning and improvement. (Children’s health to follow once the Children’s Health Network has been established in 23/24).
Quality Standards for diabetes - (Published: June 2023) - Quality statement for diabetes | GOV.WALES - The quality statement describes what good quality diabetes services should look like.
Public Health, Social Care and Education
Development of our services needs to understand and integrate with these programmes of care to maximise opportunity for all children and improve the outcomes of the conditions we treat.
Nyth/Nest (Published: April 2023) - Nest Wales | Nyth Cymru – if you don’t already, you need to know about this! Inspired.
Flying Start Expansion (Published: June 2023) - Flagship programme to expand Flying Start exceeds target in first phase | GOV.WALES – Flying Start helps families and Children under four years of age in disadvantaged areas of Wales. Its reach is now being expanded. “High quality learning and care in early years supports child development and plays an important role in preparing children for school.”
Additional Learning Needs Programme (Updated May 2022) - The additional learning needs transformation programme: frequently asked questions [HTML] | GOV.WALES - The ALN Act and wider ALN Transformation Programme plans to transform the separate systems for special educational needs (SEN) in schools and learning difficulties and/or disabilities (LDD) in further education to create a unified system for supporting learners from 0 to 25 with ALN
Anti Racist Wales Action Plan (Updated January 2023) - Anti-racist Wales Action Plan | GOV.WALES – WG has identified that adopting an anti-racist approach requires them, and us, to look at the ways that racism is built into policies, formal and informal rules and regulations and generally the ways in which we work.
LGBTQ+ Action Plan for Wales (Published: February 2023) - LGBTQ+ Action Plan for Wales | GOV.WALES - The Welsh Government wants to make Wales the most LGBTQ+ friendly nation in Europe.
Healthy Child Wales Programme 0-7 yrs (Updated Mar 2022) - Healthy Child Wales Programme | GOV.WALES - Staff in each health board area have worked together to review the latest evidence and develop an agreed all Wales approach to support and improve child development.
[New] Healthy Child Wales Part two, 8-16 years (forthcoming)
Continuing Care Guidance (2020) – the-children-and-young-peoples-continuing-care-guidance.pdf (gov.wales) - guidance to assist Local Health Boards (LHBs), Local Authorities (LAs) and their partners (for example Children’s Hospice, Action for Children, Barnardo’s, specialist educational provision) to plan and support children and young people’s continuing care.
Welsh Network of Healthy Schools - Welsh Network of Healthy School Schemes - Public Health Wales (nhs.wales).
Every Child – (incorporating replacement for Bump, Baby and Beyond) - Every Child (everychildwales.co.uk) - This website is full of ideas to help you give children a healthy and happy future.
Early Years Transformation Programme (Published: March 2022) - Evaluation of the Early Years Integration Transformation Programme | GOV.WALES - The assumption there is a higher level of need amongst families not engaged with existing programmes has been shown to be correct. This programme challenges assumptions around integration increasing costs, loss of services to families through streamlining, lack of positive outcomes, and the belief that silo working (organisations working separately) is too heavily entrenched within the early years sector.
Disabilities
The Welsh Government wants every child to have the best start in life.
Talk With Me (November 2021) - Talk With Me: Speech, Language and Communication (SLC) Delivery Plan | GOV.WALES – exploring how to support development of language skills through play and assisted support with family and professionals.
Disability Rights Taskforce Children and Young People working group (Published: March 2023) - Written Statement: Update on the Disability Rights Taskforce (29 March 2023) | GOV.WALES The work of the taskforce is based on a common understanding of the Social Model of Disability, human rights, and co-production.
Learning Disability Strategic Action Plan (Published: May 2022) Learning Disability Strategic Action Plan 2022 to 2026 [HTML] | GOV.WALES - This action plan sets out the Welsh Government’s overarching strategic agenda for the development and implementation of learning disability policy through to 2026.