Over the past few months, we’ve been exploring the reality of children's neurodevelopmental services in Wales, listening to the people delivering them. While a previous discovery focused on the experiences of patients and carers, our work has centred on clinicians, admin staff, and operational leads – the people trying to make the system work, day to day. 

We realised quickly that in order to make good recommendations, and build on the earlier evaluation of digital tools, we needed to map the full-service journey, to understand frontline user needs, and explore where digital approaches could meaningfully support change, and where they can’t. 

Thanks to the drive and support of Sian Lewis, our sponsor in Welsh Government, we’ve been working alongside multiple health boards, suppliers, and local authorities to build a shared picture of the children’s neurodiversity assessment journey in Wales. And with a new phase of funding now confirmed, we’re excited to be continuing this work in the months ahead. 

What we did 

We focused on the people delivering care: clinical leads, therapists, administrative staff, and operational managers across four health boards. Through interviews, workshops, and site visits, we built a clearer understanding of what the children’s neurodiversity service feels like from the inside. 

We created service maps, traced pain points and innovation already happening, and catalogued the technology currently in use. This allowed us to produce a detailed picture of the end-to-end pathway, from referral and triage to assessment, diagnosis, and post-diagnostic support. We also mapped where technology come into play, and where it creates duplication, delays, or distress. 

We spoke directly with suppliers and local authorities piloting new technologies, including digital records, AI scribes, and pathway tracking tools, to understand what’s possible and where the gaps are.

What we found 

It’s complex and messy. Across the board, we saw dedicated professionals doing their absolute best in a system that’s fundamentally overloaded. We heard stories of moral distress, burnout, and families stuck in loops or left waiting without information. We heard from admin teams building spreadsheets to plug systemic gaps and clinicians wrestling with a maze of poorly integrated systems. 

Some of the key themes that emerged: 

  • You can’t just drop new technology into a people-centred service. On paper, a new digital tool might have looked like a neat solution, but in reality, it often just adds more steps, more duplication, and more confusion. Many of the services we saw are being held together by human workarounds, not digital infrastructure. 
  • Mandated systems are unusable by the people who use them. The tools that are officially required often aren’t useful or usable to those delivering care. Adoption is low, trust is lower, and teams rely on their own spreadsheets, side documents, and improvised processes to get by. In one case, someone joked about “carrier pigeons” being more reliable than their current digital referral process, and it didn’t feel that far from the truth.
  • People are exhausted by trying to do the right thing in a broken system.
  • One clinician told us: “It’s not a case of one broken system – it’s ten broken systems duct-taped together.” 
  • Another said: “You try to be ethical and do the right thing for families, but you can’t win. Every system is set up to say no, to delay, to make you defensive.”
  • And another put it simply: “I spend so much more time writing notes than actually working with children.” 
  • Suppliers vary, a lot. Some suppliers were difficult to engage with or unable to handle the complexity of neurodiversity pathways. Others, brought empathy, lived experience, and adaptability. We learned to think of suppliers not as full-service replacements, but as potential partners in solving part of the problem. 
  • The service map is powerful. Visualising the full pathway, with all its overlaps, blockers, and pain points, was one of the most valuable tools in this work. It helped us, and others, see how even well-meaning changes in one part of the system can have unintended consequences elsewhere. 

What’s next  

We’re thrilled to be continuing the work with new funding. Over the next 12 weeks, we’ll be taking a two-pronged approach: 

  1. Exploring what new tools can offer – starting with AI scribing. We’re particularly excited about the potential of AI scribes to reduce admin burden, reclaim clinical time, improve continuity, and reduce burnout. It’s the kind of technology that could genuinely transform how the service feels, and the feedback from early adopters in other sectors has been hard to ignore. There’s a lot to test, and even more to learn, but the benefits are too promising not to explore. 
  2. Improving what we already have. We know from our work so far that many pain points aren’t caused by the absence of tech, they’re caused by the presence of the wrong kind. So alongside testing new tools, we’ll also be looking closely at how to make better use of what’s already in place. That might mean better configuration, clearer workflows, or just removing friction for the people trying to use these systems day to day. 

Everything we do will be grounded in the bigger picture: the detailed journey maps we’ve created, the patterns we’ve seen across Wales, and the voices of the people doing the work.  

We will focus on pinch points where small, well-run experiments could make a real difference. 

This isn’t about launching a single shiny new tech system that fixes everything. It's about looking, and helping the whole system, and make it work better for the people in it. 

Throughout the next 12 weeks, we will continue to work with the experts who deliver neurodiversity services today. This work will only succeed if we work collaboratively, test and iterate together. 

Thank you 

To everyone who gave their time to speak to us – clinicians, administrators, operational leads, tech teams, and colleagues across the system – thank you. And to Sian, who brought people together and made this work possible. 

We’ll be sharing updates here as we go. If you’re working in this space and want to stay in the loop or get involved, we’d love to hear from you.