Population Context
Wales has the largest proportion of older population in the UK. In Wales, 21.4% of the population is aged 65 or older. At the UK level, it’s 18.7%
The Welsh NHS is dealing with around 2million contacts a month in a population of 3.1million and that does not include contacts to 111, mental health services, maternity and diagnostic staff. This is unpublished management information not official data
Funding
Wales spends 8% more on health per person than England (£3,461 for Wales v £3,189 for England)
Country and regional analysis: 2022 – GOV.UK (www.gov.uk)
Wales spends 44% more on personal social services per person than England (£830 for Wales v. £578 for England)
https://www.gov.uk/government/statistics/country-and-regional-analysis-2022
Health and Social Services Workforce
Wales pays the Real Living Wage to all NHS workers.
Wales paid the Real Living Wage to all care workers in Wales from April 2022, and will increase it again by 10% in line with the recommendations again in April 2023.
The number of registered nurses (FTE) has increased 2.8% from 31 March 2022 to 31 March 2023 (latest published data).
The number of registered nurses (FTE) has increased 9.8% from 31 March 2019 to 31 March 2023.
Nursing, midwifery and health visiting staff, by grade and area of work (gov.wales)
Waiting Times
The overall growth in waiting lists in Wales is smaller than in England.
- In the last 12 months waiting lists in Wales have only increased by 1.9% compared to 10.7% in England.
NHS activity and performance summary: July and August 2023 | GOV.WALES
Statistics » Referral to Treatment (RTT) Waiting Times (england.nhs.uk)
- Waiting lists increased in Wales and England between 2020/21 and 2022/23. In Wales there was a 29% increase in the number of pathways waiting between March 2021 and March 2023, and in England the increase was 48%.
Wales counts more pathways in our waiting lists than England does.
Unlike in England, Wales reports monthly waits for therapies (Allied Health Professionals) against the national target of 14 weeks. Wales also reports monthly waits for diagnostic pathways as part of RTT as well as for the 8 week diagnostic stage wait.
Although not reported nationally in England, individual NHS Trusts, publish their average waiting times on their websites. A snapshot Google search (16/08/23) identified several indications of at least similar lengths of waiting times for AHPs in a number of different organisations.
Wales has always prioritised urgent waits over longest waits
Long waiting times are falling every month in Wales and have more than halved in the past year.
The average waiting time for treatment in Wales is 19.3 weeks – 10 weeks less than the peak three years ago, and two and a half weeks shorter than a year ago.
July saw the highest proportion of people waiting less than 26 weeks for treatment (59.7%), for over three years, and two-year waits for treatment continue to fall. Waits over a year for an outpatient appointment have fallen by 50% since the peak in August 2022.
Waits over two years have now fallen by over 60% since the launch of our Covid recovery programme.
The number of patients starting treatment for cancer and the number informed they don’t have cancer have been increasing in recent years.
This is despite the continued demand on our hard-working NHS staff. Referrals for cancer and other specialities continue to increase, with overall referrals for treatment up 14% in the latest year, reaching the highest annual figure on record.
Emergency Department performance
Wales has outperformed England in major emergency department performance in nine out of the last twelve months for people spending fewer than four hours in ED before returning home or being admitted to hospital.
https://statswales.gov.wales/v/NnrZ
NHS England » Monthly operational statistics – August 2023
In August, the ambulance service responded to 12% more incidents within 8 minutes than in August last year. In the latest year, the ambulance service responded to more incidents within 8 minutes than ever before.
Since April 2022 Wales has introduced
- The 111 service across the whole of Wales
- 12 New Urgent Primary Care Centres
- New Same Day Emergency Care services across Wales
Cross Border Care
People from England who live near the Welsh border can be treated in Wales and vice versa.
Between 2020/21 and 2021/22 alone there was a 55% increase in the number of patients not resident in Wales who were treated in Wales. Data for 2022/23 are not yet available.
For both Wales and England, numbers treated in 2020/21 were affected by the COVID-19 pandemic, meaning figures for that year are low and should be expected to increase in subsequent years.
Community Care
Wales increased community bed capacity over winter.
Wales delivered more than 675 additional stepdown beds and community beds (bought from care homes etc) last winter to cope with the pressures.
In England it was announced in September 2022 that they would deliver 7,000 community beds. The proportionate equivalent in Wales would have been 350 beds. We have vastly exceeded that number already through close cooperation between health and local government.
Primary Care
Wales has already reformed access to GPs through the introduction of a new access commitment that is on course to eliminate the 8am bottleneck.
This year GPs are working to achieve the second phase of standards. 89% have achieved the first phase of standards already.
As part of the commitment, the release of all appointments at 8 am, or other narrow window of time, is no longer acceptable. Patients can expect to have their needs met at first point of contact without the need to contact the practice on multiple occasions.
Wales has proportionately more GPs than England per head of population and we are increasing the numbers of nurses and midwives and have increased training funding by 8%.
As of March 2023, Wales had 51 fully qualified, full time equivalent GPs per 100,000 population, whereas England had 48 per 100,000 population.
Number of GPs employed in general practices, by GP type and local health board (gov.wales)
General Practice Workforce – NHS England
National level population estimates by year, age and UK country (gov.wales)
Since April 2022 the Community Pharmacy has been able to provide the UKs first nationally commissioned independent pharmacy prescribing services
where a suitably qualified and competent pharmacist independent prescriber is available.
In 1 in 5 pharmacies (Dec 2022) now provide the prescribing service. Plans are in place for 1 in 3 pharmacies to be providing the service by the end of the 2023. (unpublished management data)
Access to Optometry
Wales is further ahead in journey to reform eye health care, than in England, due to the reform of optometry services through the introduction of a new contracted term of service, with specific legislation, policy and resources having been in place for some time to drive forward this long-term transformation and meet the agreed future approach for eye health care. This is increasing access and improving outcomes for citizens across Wales.
Patients will have their needs met at first point of contact without the need to contact their GP practice. The reform will help relieve pressure on hospital eye care services by increasing the range of services delivered closer to home in primary care optometric practices. Moving more eye care services into primary care optometry, where there is a skilled workforce with the capacity to respond to growing patient demand, is both a viable and sustainable solution.
Access to NHS dentists
Wales has introduced a new optional contract for NHS dentists which has enabled around 174,000 (173,918) new patients to receive NHS dental treatment during 2022-23, a further 72,000 new patients have received treatment so far this year. There is no requirement for practices in England to see new patients.
Legislation
Wales is further ahead in its integration journey on health and care than England with specific legislation, policy and resources having been in place for some time to drive forward this long term transformation
Under the Social Services and Wellbeing Wales Act 2014, Wales established Regional Partnership Boards to drive forward regional working and integration between Health and Social Care.
The Welsh Governments ambition in relation to integration was further set out in A Healthier Wales, our 10-year plan for health and social care. We have a significant fund to drive change to deliver more health care in the community and focus on prevention.
We recently introduced the Duty of Candour and the Speaking up Safely Framework to ensure NHS staff can be open and honest when things go wrong and help create an NHS which is always listening, learning and improving.
The NHS Duty of Candour | GOV.WALES
Written Statement: NHS Wales Speaking up Safely Framework (20 September 2023) | GOV.WALES
Cancer
Wales is further ahead on delivery of rapid diagnostic centres for suspected cancer.
By March 2024, NHS England aims to ensure that all patients with non-specific symptoms will be referred via a non-specific symptoms pathway. We already have rapid diagnostic clinics for our whole population.
We introduced a modernised target system – the Single Cancer Pathway – four years ago. England have announced this year they will overhaul their target system.
Screening and prevention measures
As of 4 October 2023, Bowel Screening Wales is offering screening to all men and women who are registered with a GP practice in Wales aged between 51-74 and increasing the sensitivity of the faecal immunochemical test (FIT) from 150µg to 120µg of haemoglobin/g of faecal material.
Wales was the first UK country to introduce high-risk human papilloma virus (HPV) testing as the routine cervical screening test for all those in the eligible cohort. This test looks for the presence of HPV which causes 99.8% of cervical cancers. The new test, which was introduced nationally in Wales in 2018, helps to prevent more cancers than the previous primary cytology testing as it identifies people who are at risk of cervical cancer before cell changes have occurred.
In 2018 Wales was the first UK country to introduce a new non-invasive test for Down’s Syndrome, Patau’s Syndrome and Edward’s Syndrome. NIPT is more accurate and non-invasive for pregnant women avoiding the need for amniocentesis in most cases, thus reducing risk of miscarriage.
Hospitals
Wales has considerably more hospital beds than England relative to the size of the population.
Figures from 2020/21 show that the Welsh health service had around 270 General hospital beds (not including maternity, mental illness or learning disabilities, for each 100,000 people. This compares to 170 in England – How well is the NHS in Wales performing? | The Nuffield Trust
Wales is building six times the number of “new hospitals” compared to England if we use the same definition as the Conservatives use of a new hospital.
Tories said they were going to build 40 ‘new hospitals’ between 2019 and 2030. ‘New hospitals’ were defined as
- A whole new hospital on a new site or current NHS land
- A major new clinical building on an existing site or a new wing of an existing hospital
- A major refurbishment and alteration of all but the building frame or main structure
If we use the same criteria for Wales, we get 14 ‘new hospitals’ in Wales – based on schemes that have completed since 2019 and those that are currently planned to be completed by 2030. As a crude comparison to the 40, when we take into account the respective populations, Wales is building more than six times the number of ‘new hospitals’.
Mental Health
Wales has ringfenced money for mental health in Wales
Wales spends £760m a year around 10% of health budget on mental health.
We have rolled out the 111 press 2 to access urgent mental health advice across Wales. (This is not yet national in England). Providing access to mental health services without the need for a referral from your GP.
Mental health support for young people
Scotland, Wales and Northern Ireland all have government funded school counselling services. England does not.
In the current year we extended the CAMHS school in-reach pilots, which sees dedicated mental health practitioners in schools providing consultation, liaison, advice and training, into a national service covering all-Wales. We have provided over £5.3m in the current year and health boards inform us they have recruited over 100 (whole time equivalent staff) to work with schools. There does not appear to be anything equivalent elsewhere in the UK.
We have also created specialist hubs for young people in mental health crisis which can be accessed via the 111 Press 2 service.
Access to new medicines
People in Wales have better and faster access to new, NICE-approved treatments than people in England, thanks to the Welsh Government’s flagship New Treatment Fund. The £16m-a-year fund has improved access to new treatments for all conditions not just cancer – on average they are available just 13 days after approval.
Earlier this month the Association of the British Pharmaceutical Industry published its report Transforming lives, improving health outcomes which shows uptake of NICE approved medicines in Wales is the higher than all regions in England included in their analysis and singles out the Welsh Government’s New Treatment Fund is an example of best practice in ensuring prompt equitable access to innovative medicines.
The English Cancer Drugs Fund undermined the established system for the assessment of medicines for use in the NHS and spent millions of pounds on non-approved medicines.
Research published in respected and authoritative journals highlights the inequity, unfairness and poor value of the English Cancer Drugs Fund.
Drugs
A recent Home Affairs Committee Report on Drugs recommends UK Government learns lessons from work in Wales around WEDINOS, Naloxone and Buvidal – Drugs – Home Affairs Committee (parliament.uk)
Specifically, the report recommended that the Home Office and Department of Health and Social Care jointly establish a national drug checking service in England to enable people to submit drug samples by post anonymously. It recommended that the UK Government learn lessons from the Welsh Government and Welsh partners on the experience of WEDINOS.
The report also recommended that the Government establish a national naloxone programme in England to bring it in line with the devolved nations, and noted that the use of Buvidal in Wales provided a very encouraging UK evidence base and proved that it is an effective form of opioid substitution treatment.
