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Wales Air Ambulance Landing at University Hospital Wales


Health spending in Wales makes up almost half of Welsh Government spending, and its performance is under the spotlight like never before, both by politicians and the wider public at large. Hardly a day goes by without a story on the performance of, or some issue within, the health service in Wales.

The first decade of devolution was characterised by a policy direction Welsh Labour called ‘clear red water’. This described the different policy approaches by the then Welsh and UK Labour governments. Rather than follow UK policy of increasing patient choice, the NHS in Wales underwent a complete overhaul of its services into seven health boards that were created in 2009. This period also saw increased spending on health, but has more money meant a better service?

Opposition politicians argue no. The best example of this can be seen when the Prime Minister referred to Offa’s Dyke (an ancient earthwork along the English-Welsh border) as the line between life and death. They would also draw attention to long waiting list times and poor ambulance response rates to emergencies as serious issues affecting the delivery of health services in Wales.

But the Welsh Government’s recent National Survey of Wales suggested that over 90% of people in Wales are happy with the service of their GP and hospitals. The Welsh Government would also point out that they spend more on health per head by comparison with England.

As health policy issues outlined by the Royal College of Nursing in Wales below this article show, there are significant challenges facing the health sector in Wales (as elsewhere in the UK), but these challenges also provide opportunities for change and innovation.

With health by far and away the most important issue in this year’s election for the Welsh electorate, it is no surprise that health and health-based issues have been under so much scrutiny in recent years. It is very likely that this will continue throughout the election as parties in Wales put forward their solutions for the NHS and other health matters in Wales.

Overview of health policy issues in Wales from the perspective of the Royal College of Nursing in Wales

Policy Issues

  • Health is one of several key areas of responsibility held by the Welsh Government. Funding is received under the Barnett formula: this is a ratio determining how much money Wales receives in proportion to other parts of the UK
  • The Welsh Government is seeking to better integrate health and social care, whilst the NHS in Wales places greater emphasis on public health and ‘prudent healthcare’ principles.
  • Wales differs geographically, linguistically and socially from other countries of the UK and therefore requires a different approach to health policy (eg rural areas where delivering services can be challenging).


  • Areas that are not devolved, agendas such as crime, impact upon the model of health services in Wales.
  • There are differences in workforce planning systems and priorities to the rest of the UK. Changes to the workforce in England inevitably affect Wales due to the size and overlap of the two countries’ health systems.

Professional factors

  • An ageing population and increasing numbers with chronic conditions are challenging. With the rise in comorbidity, services must respond to meet changing needs of the population. But new technology is also revolutionising health care, eg decisions increasingly informed by data.
  • The Health Professional Education Investment Review (2015) recommended a single body for workforce planning, education and training. Wales-specific direction related to the public sector is conducted through the Workforce Partnership Council set up by Welsh Government. There is also the key challenge of attracting, training and maintaining nurses across Wales.

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This article is from the free online course:

Scotland and Wales Vote 2016: Understanding the Devolved Elections

The University of Edinburgh