Failing health policy could break devolution

Jonathan Edwards

New First Minister Eluned Morgan has learnt one thing from her honeymoon tour of the nation: the people of Wales are deeply unhappy with the state of health provision.

Although given her time as Health Minister, I am sure that this came as no surprise.

From my time as a Member of Parliament, I can attest to the discontent people feel about being stranded on long waiting lists, difficulties in accessing GP appointments and the demise of NHS dentistry as a meaningful service.

When challenged about the state of the NHS during an interview with ITV last week, the First Minister said: “Every single week, as Health Minister, I was taking responsibility for the NHS, but I think people [need to] realise that you delegate responsibility to the health boards, and you ask them to deliver for you.”

In rugby terms it was a hospital pass and has been the Welsh Government’s default response over the last 25 years. The other standard strategy has been to throw an ever-increasing share of the Welsh Government budget at the health portfolio.

Inflation

At the onset of devolution in 1999, health accounted for approximately a third of Welsh Government expenditure. Today it is over a half. This is not surprising as inflation in the health sector will always outstrip general inflation. More has to be spent each year just to stand still.

What is clear is that any increases the Welsh Government receives as a result of the Barnett formula does not match the expanding funding requirements of the NHS in Wales, which does not have the levers to raise the funding itself.

The UK Health Secretary of State, Wes Streeting, has warned that the UK could quickly resemble a health service with a country, as opposed to a country with a health service, unless spending is controlled.

That assertion could be magnified in Wales. At this rate, in a few decades Senedd Members could meet for an AGM in early April after Westminster has allocated the block grant, transfer the budget to the health boards and retire to their constituencies for the rest of the financial year!

Waiting lists

Around a fifth of the Welsh population are on waiting lists, yet the Welsh Government and health leaders would point out that the NHS is treating more patients than ever. These are the realities of an ageing population compounded by the challenges we face in Wales of the out-migration of our young people and the moving in of older retirees.

As health consumes more expenditure, it creates a vicious cycle where less money for policy areas such as community services and housing in turn adds to the drivers of ill-health which ends up increasing pressure on health services.

While I understand that the opposition parties in the Senedd want the First Minister to take responsibility for her time as Health Secretary, in the context of an emerging populist challenge from the extreme right developing outside the Senedd, they are going to have to start demonstrating to the people of Wales that they have solutions.

A failure to do so could see them swallowed up in the whirlwind that is likely to hit Welsh politics in 2026. I suspect Reform will be emphasising NHS performance in the next year and a half and providing a simple solution – Senedd abolition.

While policy in health and care is very complex, it is difficult to avoid the conclusion that there is little hope of meeting the challenges ahead without structural change in how services are delivered. The budgets of health boards dwarf local authorities, yet there is little transparency and direct democratic accountability. If, as the Welsh Government claims, health boards alone are responsible for the NHS in Wales, then this needs to be addressed.

Health boards

One option would be to align local authority and health board areas, creating a combined Local Services Board with directly elected local members. A second option would be to scrap health boards and manage the health service as a national service with the Minister directly responsible. A third, and nuclear option, would be to return total responsibility for health to Westminster to allow the Welsh Government to concentrate on other policy areas to develop the nation, in particular the economy.

Reconfiguration of services is extremely difficult, and I am not advocating for any specific option, but it is clear that the current situation is unsustainable. The combined annual deficit of the NHS in Wales in 2023-24 was £183m. Hywel Dda, has a staggering cumulative deficit of nearly £150m.

If the Senedd is serious about addressing this crisis, then there is a clear case to be made for our political parties to commit to agreeing to implement the recommendations of a cross party and expert commission to take the politics out of the question of how to organise the health and care service for a generation.

If the Welsh Government and the Senedd opposition are not able to improve matters together then the populist right will be waiting in the wings with their easy answers which the people of Wales could find appealing in their frustration.

Jonathan Edwards was the MP for Carmarthen East & Dinefwr from 2010 to 2024.