A warning from Wales for Wes Streeting

As the English government sets about reorganising the NHS, Robert Royce discusses the lessons it can learn from devolved healthcare in Wales 

Since 2009, NHS Wales has operated without a purchaser-provider split, the internal market or payment by results (PbR). In its stead, seven integrated health boards were created, funded by block allocations. NHS Wales was explicitly to be a plan-led health system based on “co-operation, collaboration and partnership working”.

The Welsh Government also believed that the creation of health boards would facilitate a shift in the balance of care. That has not transpired, as can be illustrated by the proportion of total spend going to primary care.

In 2013-14, health boards were spending about 25% of their total budget on primary care. In 2022-23 (last nationally available figure) it was down to around 19 per cent. The January 2025 Hywel Dda University Health Board meeting stated that between 2015-16 and 2024-25 its proportion of total expenditure on primary care had dropped by 6 per cent. The picture across the rest of Wales is probably the same, because in Wales overall the number of qualified GPs is essentially unchanged between 2021 and 2024, whilst hospital consultant whole time equivalents had gone up by 13.1%.

This has taken place despite an organisational structure and funding system supposedly designed to do the opposite. The same can be said for achieving financial balance. There was an expectation that health boards would provide (and then deliver) plans that would ensure they would operate within their allocations – something that has failed to transpire.

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Source: HSJ, 16 April 2025