It can’t have escaped many people’s notice that English politicians continue steadily to throw the limelight on the performance of the Welsh NHS. With Wales the only UK administration controlled by Labor, the Conservative party has regularly sought to highlight the state of the Welsh NHS, perhaps in response to Labor’s comparative political benefit on the NHS in the forthcoming UK election. Because of its part, the Labor party – both in Cardiff and Westminster – has repeatedly defended its record by claiming it is difficult to compare the NHS in England with its counterpart in Wales. Comparisons are difficult, but some can be made.
Last 12 months the Nuffield Trust and Health Foundation published a report taking the long view of NHS performance across the four countries using around 20 comparable signals of performance, from patient satisfaction to ambulance response times. No one country lagged behind or outperformed another consistently, relative starting factors were taken into account once.
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A foreigner would be more struck by the similarities than the variations. However, Wales and England differ in many ways as countries, and since 1999 their two health services have been individually run. So it must not be very surprising that there are some important differences. Wales does not have the “purchaser-provider split” – the internal market, where elements of the English NHS buy services from other areas. Instead the Welsh NHS operates through integrated health planks. Unlike England, it makes hardly any use if the private sector.
However, our bottom line in the Four Countries survey was that much as this kind of framework is debated and focused on by analysts and politicians, they have very little effect on relative performance. The Welsh population is old, sicker, and has more deprivation than the population of England. All these factors impact people’s health and therefore mean higher demands on the Welsh health service. Any comparisons need to take this into account.
There is also an inherent unfairness in evaluating performance for a human population of three million with this for one of 54 million. So evaluating Wales with an English region may very well be fairer, although not straightforward, which is why we used the North East of England as a comparator in our report where possible. Its population characteristics are much nearer to those of the devolved countries than England as a whole. The devolved government in Wales has used its powers to create different priorities and a different tone from its London counterpart. It has emphasized avoidance and public health more than England.
Difficult decisions have been required since 2010 and the start of austerity. Different methods have been used. England (and Scotland) have safeguarded NHS spending which has seen some small real terms growth during the last four years. Not in Wales, where health spending has been cut in real conditions by 4.3% between 2009/10 and 2012/13, although there have been further cash injections in 2014/15 and prepared for 2015/16 to invert this tendency.
On the other hand, England has cut authorities grants or loans to local regulators, resulting in a 16% reduction in funding for social care for the over 65s – an underlying cause of some stress and anxiety. In Wales, local authority spending has organized, although this is currently planned to improve. Wales has chosen to prioritize its spending differently within the medical sector, implementing insurance policies like free car and prescriptions parking. The collective impact of different populations, policy choices, and investment decisions on recent performance can be seen in the next graphs.