NHS Wales must increase its use of the private sector to improve service delivery, argues think tank

Martin Shipton

A new report from the centre right Welsh think tank Prydain has called for the increased use of private healthcare to alleviate the worsening “health emergency” in NHS Wales.

The report, titled Performing Major Surgery, highlights that the NHS in Wales is under unprecedented strain due to an ageing population, rising disease prevalence, and record-high waiting times exacerbated by the Covid-19 pandemic.

Despite the Welsh Government’s £11bn health and social care budget, NHS Wales continues to struggle with performance metrics that lag behind other UK nations. According to Prydain, incremental reforms have failed, and the healthcare system requires a fundamental reset to recover and refocus on long-term sustainability.

Sharper focus

The report states: “With Labour assuming power in London, it brings NHS Wales delivery to sharper focus. Wes Streeting, Labour’s Health Secretary in the UK Government, has positioned himself as a pragmatic reformer, advocating for the use of private sector resources to alleviate NHS England’s backlog.

“His approach acknowledges that while the NHS remains a fundamentally public service, private sector involvement is a necessary tool to clear waiting lists and improve patient outcomes.

Streeting’s strategy has included commissioning private hospitals to conduct NHS procedures, ensuring that patients who have been waiting the longest receive timely care.

This aligns with UK Labour’s broader commitment to reducing waiting times without fundamentally altering the NHS’s public-funded nature. He has argued that ideological opposition to private sector involvement has hindered progress and that embracing a mixed economy approach within the NHS will help tackle immediate crises.

“His stance has received criticism from within his party, with concerns that increasing reliance on private providers could erode the NHS’s long-term sustainability. However, Streeting maintains that this is a temporary measure aimed at clearing backlogs, preventing further deterioration in patient outcomes, and alleviating pressure on NHS staff.

“This context is interesting. Conversations are happening daily in the Welsh Government and NHS Wales about what Streeting’s reforms mean.

“Why does it take a new UK Government to generate reform in NHS Wales? Is this because the quality of policymakers and healthcare executives in Wales is poorer than its English counterparts? Do the structures established by devolved government make delivery harder? Or is this because devolved Wales cannot deliver NHS reform like England can? Whatever the answers to these questions, it results in significantly worse outcomes for Welsh patients. For any unionist, this should be a crying shame.”

Strategy

Describing Welsh Labour’s strategy to deal with the crisis, the report states: “Their approach … focusses on increasing surgical activity through weekend and evening clinics, opening new diagnostic and treatment centres, and creating more community-based services to reduce hospital demand. Additionally, they have aimed to recruit and retain healthcare professionals by improving working conditions and offering incentives to prevent staff shortages from undermining service delivery.

“It is important that workforce supply has increased, and vacancies have started to fall. However, it has not been sufficient to dent the backlogs. Digital innovation is another pillar of their plan, with efforts to expand virtual consultations, integrate AI-driven diagnostics, and streamline patient pathways to minimise delays.

“Strengthening GP services and improving coordination between primary and secondary care are intended to prevent unnecessary hospital admissions, while targeted initiatives, such as centralised booking systems and selective outsourcing, are designed to prioritise long waiting and urgent cases.

“Despite these measures, NHS waiting lists in Wales remain the worst in the UK, raising serious concerns about the effectiveness of Labour’s approach. Waiting times have continued to rise, demonstrating that increasing capacity has not kept pace with growing patient numbers. Although new treatment centres have opened and service hours have been extended, the persistent workforce shortage limits the impact of these additional facilities. Without enough trained professionals to staff clinics and hospitals, expansion efforts have struggled to deliver meaningful reductions in waiting times.

“The crisis in workforce recruitment and retention remains a significant obstacle. The shortage of doctors, nurses, and specialists continues to hinder progress, with many leaving due to burnout and dissatisfaction with working conditions. Efforts to attract new healthcare professionals have also faltered. However, recent pay awards mean Agenda for Change pay is higher than in England now which may increase the attraction of healthcare professionals from England. That does however lend itself to two centralised systems- NHS Wales and NHS England- being in direct competition with each other. Given Labour’s aversion to competition within the health system, this seems logically inconsistent. But make no mistake: there is an ongoing staffing crisis which is undermining Labour’s claims that investment in personnel will resolve the backlog.

“Digital innovation, while a promising avenue, has so far had little effect on the backlog. Virtual consultations and AI-driven diagnostics may improve efficiency in some areas, but they do not directly reduce surgical or urgent care waiting lists. The adoption of digital tools has also been sluggish, with NHS Wales lagging behind NHS England in implementing technology that could streamline patient management and treatment pathways.

“Efforts to improve integration between primary and secondary care have likewise been slow to materialise. GP services remain overwhelmed, leaving patients struggling to access early interventions that could prevent hospital admissions. Moreover, a growing number of GP practices are handing back their contracts, with health boards increasingly having to directly intervene. While better coordination between services may bring long-term benefits, it has done little to ease the immediate backlog of patients awaiting treatment. But fixing the front door – getting people seen in primary care – will reduce demand in enormously ‘hot’ areas, such as emergency care and ensuring only hospital beds are given to those who need one.

“Although Labour has claimed some success in reducing the number of patients waiting over two years for treatment – down two-thirds since its coronavirus peak – it is still very high, and the extent of this problem does not exist in England and Scotland, not just in per capita terms but in absolute terms. The number of patients waiting over a year remains stubbornly high. Other UK nations have made faster progress in reducing backlogs by outsourcing more procedures to the private sector, yet Welsh Labour has largely resisted this approach. Their reluctance to utilise private sector capacity has left many patients facing prolonged delays for essential care.

“Despite their ambitious rhetoric, Welsh Labour’s strategy has not delivered the promised results. NHS waiting lists continue to grow, and the workforce crisis remains unresolved. While their long-term vision may eventually yield benefits, their failure to act with sufficient urgency has left patients waiting longer than ever. Without a more decisive response, including a willingness to explore all available options for increasing capacity, it is unlikely that Welsh Labour will succeed in clearing the backlog anytime soon.”

Recommendations

The report concludes by making a series of recommendations:

* Immediate Access to Private Healthcare for Long-Wait Patients – Patients waiting over two years for treatment, as well as those with life-threatening conditions exceeding key treatment benchmarks, should be offered private healthcare at no cost.

* Cross-Border Commissioning of Services – NHS Wales should work with NHS England to provide urgent treatments for Welsh patients stuck on long waiting lists.

* Private Sector Partnerships to Reduce Backlogs – The Welsh Government should invite private sector providers to bid for contracts to clear patient backlogs, ensuring fair competition and cost-effective solutions.

* Reforming Emergency Department Triage – More efficient triage processes, including the employment of additional bank nurses, will help redirect non-urgent cases away from emergency care and reduce pressure on hospitals.

* Expanding GP Capacity Through Private Partnerships – Contracting non-NHS GPs, expanding pharmacy-led care, and deploying additional private sector clinicians will improve access to primary care services and ease the burden on hospitals.

* Establishment of an NHS Volunteer Service – Mobilising volunteers to assist with administrative and service functions would support NHS recovery efforts.

* Reallocation of Resources – The think tank calls for a minimum of £500m to be dedicated to these reforms, highlighting that treating patients promptly will generate long-term cost savings and improve health outcomes.

Opposition

Charlie Evans, managing and communications director of Prydain, and author of the report argues that opposition to private sector involvement in the NHS is misguided – and goes on to suggest that there should be a debate about the fundamental future of the NHS, whose core offer is that treatment is free at the point of delivery.

He said: “Private sector involvement in the NHS is already significant- the sector already manufactures drugs, provides general practice services, and supplies critical medical equipment. Expanding this role temporarily is a pragmatic response to the crisis, not a fundamental shift away from a publicly funded NHS. It requires all hands on deck to tackle the health emergency- including asking for help from the UK Government.

“However, what this paper hopes to do is start a debate about the future of the NHS as well. Should the foundational principles that established the NHS in 1948 remain in place in light of a demographic crisis in Wales and in Britain? Is the health board model working in Wales? Has devolution created a two-tiered NHS in Britain? All of these are important questions that the political parties hoping to form the next Government in Wales must answer.”