Assessing the health of our NHS

The NHS matters a great deal to people across Wales. So naturally the management and funding of the service is a matter of constant public debate and attention. Our report, NHS Wales: Overview of Financial and Service Performance 2013-14, provides a sober assessment of the three main aspects of the NHS in Wales: financial management, service performance and plans to meet the big future challenges.

As a side note, it’s important to clarify that when we talk about NHS Wales we mean the Welsh Government’s Department of Health and Social Services as well as the 10 NHS bodies (health boards and trusts) – together they manage a very complex service spending some £6 billion a year.

NHS Wales Finance Image

Landing the Jumbo Jet

We start with the financial management of the Welsh NHS. Getting NHS Wales’ finances to breakeven each year has been described as ‘trying to land a jumbo jet on a postage stamp’. In 2013-14, the NHS did break even as a whole and reported some £185 million of savings. But one of the biggest points we pulled out was that the breakeven was only achieved because the Welsh Government found an additional £200 million from other departments and reserves.

Add this to the fact that we had to qualify (ie. raise concerns) three NHS bodies’ accounts in June this year (you can read more on our website here) and you start to paint a very difficult financial picture. This further underlines the challenges that the Welsh NHS faces in attempting to manage during a period of austerity budgets.

Putting performance in the spotlight

Of course, the main business of the NHS is not managing the budget – it is about providing services that make a difference to people’s health. As you can imagine, these services have wide-ranging targets, objectives and aims. We looked  at the ‘Tier 1’ targets: the things that the Welsh Government considers most important.

We found there to be a mixed set of results. There was good news in improving access to GPs in the evening and also some improvements against targets for unscheduled care services (read our report here) and mental health services (…and here as well): all things we have previously focused on before. The news was less good in other areas such as deterioration of cancer and stroke care, waiting time targets on planned treatments (another area we focused on with a recent survey) and ambulance response times.

Planning an NHS that is fit for the future

The last thing we looked at was the NHS’s future planning and thinking. It’s positive to see that one of our key recommendations from the 2012-13 report (which you can see online here) about establishing integrated three-year plans is being implemented. This is a big step forward, it needs more work but it helps move away from a short term focus on annual plans and towards developing services that are fit for the longer term.

It’s a fact of life that we are all now living longer and are more demanding on NHS services – this has a direct impact on the way that services are run. And the pressures on public spending are not going away in the short to medium-term. Simply put: financial and demand pressures mean that the NHS can’t carry on doing what it has always done. There needs be change:  big change. We think that the NHS now has some good ideas that can support the radical changes to services that are needed. But making change actually happen in the NHS is notoriously difficult. Tough decisions need to be made to get the NHS fit for the future – to make these changes the NHS will need the support of the Welsh public and our politicians.

About the Author 

Geraint Norman is the Audit Manager for the Wales Audit Office. He was one of the lead authors on the NHS Wales: Overview of Financial and Service Performance 2013-14 report.

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