COMMUNITY child health services provide care for children with the greatest needs in our communities, diagnosing conditions, assess safeguarding concerns and supporting children with complex medical needs outside of hospital settings.

Reading the report by the Royal College of Paediatrics and Child Health (RCPCH), ‘Collaborative Healthcare in Wales: Delivering the Services Children Need in the Community’, unveils the scale of crisis facing community child health services across the country.

To obtain data relating to community child health, RCPCH Wales submitted Freedom of Information (FOI) requests to all health boards.

“All health boards responded, however the FOI responses are not comparable across health boards as they lack uniformity, and at times are inconsistent or incomplete,” the report acknowledges. “This makes it impossible to provide a meaningful All-Wales narrative of the pressures on community child health services.

“We also conducted a survey among members working in community paediatrics in 2025 and received responses from all health boards. This report has been guided by their views and the views of children and young people.”

The analysis of the data obtained between March to May 2025 from health boards across Wales reveals dramatic increases in waiting times and growing waiting lists.

For example, in Swansea: the number of children waiting for community paediatric services increased by 112 per cent since 2020, from 597 to 1,271. The average number of weeks has risen from 36 weeks to 80. In Cardiff, community paediatric waiting lists have grown by 302 per cent since 2018, from 1239 to 4,990. The number of community paediatricians decreased by 8 per cent during this time.

Within Hywel Dda, which covers Pembrokeshire, Carmarthenshire and Ceredigion, the number of children waiting for community paediatric services has increased by 4.1 per cent between 2018- 2025, rising from 1,477 to 1,538.

However, the number waiting for an Autism Spectrum Disorder assessment in the area served by Hywel Dda University Health Board has risen by a massive 781 per cent since 2018.

The number waiting for an Attention-Deficit/Hyperactivity Disorder (ADHD) assessment has risen by 331 per cent since 2018.

“Neurodevelopmental (ND) conditions profoundly impact the lives of children and their families, making it imperative to ensure timely access to appropriate support services,” the report states.

“Despite this, we know ND services are currently under extreme pressure due to multiple complex factors that have significantly increased the demand for assessment services. Support for families remains under-resourced.”

In February 2025, Wales Minster for Mental Health and Wellbeing, Sarah Murphy MS, announced a further investment of £13.7m to continue the transformation of neurodivergence services for adults and children.

The report adds: “The Welsh Government also relaunched the National Autism Team as the National Neurodivergence Team with the task of evaluating the impact of the Statutory Code of Practice.”

Despite this investment, RCPCH members have expressed concern that the extra provisions put on to reduce waiting times is not sustainable, as the funding being short term and the workforce will be unable to make a significant reduction in waiting lists before the funding runs out.

The were further concerned that “the overwhelming pressure to reduce waiting lists can come at the cost of a rigorous, high quality assessment,” while other say that the constant changes to ND services and plans have “reinforced the postcode lottery of service provision.”

Some families can find it hard accessing support in school settings until a diagnosis is confirmed, resulting in some children failing to have their social and educational needs met. The waiting period can lead to frustration, anger, school refusal, diminished attendance and withdrawal, limiting social, educational and occupational opportunities.

One parent said: “There should be a basic level of care for people who are waiting for a diagnosis – she should have help that’s already accessible to her while she waits.”

The report finds that consecutive Welsh Governments have championed a shift to community services with the intention of delivering care closer to home, which is intended to relieve pressures on hospital services and reduce admissions. But investment in community child health service has not kept pace with demand.

“In addition, far too often, the voices and experiences of babies, children and young people are forgotten and overshadowed by the focus on the pressures within the adult health system. This is evident within the recent report from the Ministerial Advisory Group on NHS Wales Performance and Productivity. The report and the Welsh Government’s subsequent response did not reference child health… This is not atypical.”

Calling current situation for Welsh community health services “unsustainable,” RCPCH is calling on the Welsh Government to deliver on its long-standing ambition of care closer to home by investing in early years support and ensuring adequate staffing across disciplines like community paediatrics, speech and language therapy, and mental health.

The body also stresses the need to enhance awareness of neurodiversity and create a standardised pathway for child ND assessment across all regions, providing a needs-led service with a robust system of data collection.

RCPCH Officer for Wales, Dr Nick Wilkinson, said:

“Community child health remains underfunded — with too few health visitors, continence nurses and speech and language therapists. These gaps have serious consequences, from poor school readiness to long-term health issues and we’re seeing the impact of this on all our services.

“Early intervention is vital, yet growing waiting lists and delays are leaving children without the timely care they need.”

Dr Lizzy Nickerson, Chair of the Wales Community Child Health Network & Consultant Community Paediatrician, said:

“This report puts the spotlight on the part of the iceberg that has been ignored for too long. Political priorities now need to focus on the long-term consequences of neglecting the cohort of children with neurodivergence and complex needs, taking a multi-agency, holistic and need-based approach to early intervention and the vital importance of early years.

“For so long we have heard how parents and carers are struggling, and this is very evident in the long waiting lists, increased safeguarding concerns and the rising need for community paediatric services. We must end the over-reliance on the good will of NHS practitioners working in an under-resourced system. These children are tomorrow's adults and without the investment into their needs and the workforce who cares for them, the socioeconomic future is bleak.”

Children’s Commissioner for Wales, Rocio Cifuentes, MBE, said:

“The wider themes raised in the report are issues my office has consistently raised over the years, like poor transitions to adult care, a system that can be complex to navigate, and care being reliant on assessments rather than need. These deficiencies must be a priority for the Welsh Government.”

Samuel Kurtz MS commented:

“This report lays bare the heartbreaking reality facing too many families across Wales: children with the most complex needs are being left behind because of Labour’s long-term failure to invest in community healthcare.”

“Behind each shocking statistic is a child waiting too long for a diagnosis, a family under immense pressure, and a system struggling to cope. The situation is unacceptable.”

“If the Welsh Labour Government can’t provide adequate health care for our children, then they should move out of the way and allow others who will. They have damaged Wales and our people enough.”