Welsh NHS Confederation highlights key health and care priorities with the Senedd's Committee

We agree with the Welsh Government’s aim to transition the NHS towards a more sustainable health and care system, with greater emphasis on preventing ill health, providing more care closer to home, developing a long-term workforce plan for health and care, and setting out a clear vision for digital health innovation. 

Prevention

We welcome that the Welsh Government has a dedicated Deputy Minister for Public and Preventative Health. Wales faces significant population health challenges that stall life expectancy and widen inequalities, including high levels of obesity, unhealthy alcohol consumption, smoking and poor levels of physical activity. With an ageing population and changing patterns of disease, many people will be living with multiple long-term health conditions in the future, with profound implications for the NHS, wider public services, the economy and public finances. There are also widening inequalities, which have a significant impact on health outcomes, as well as the public purse. 

Care closer to home

Progressing the Community by Design model to improve access to general practice and community services will require coordinated action on pathways, workforce and supporting infrastructure. Our members would like to work with the Welsh Government to make deliberate and transparent decisions about how NHS activity, staff and resources can be shifted into community settings in a safe, sustainable and evidence-led way. 

The challenge will be translating this into consistent delivery on the ground, at scale, while managing ongoing pressure and demand on acute services. Our members would like to see support from the Welsh Government to create stronger alignment between NHS and local government planning and investment, including through the Regional Partnership Boards. Active engagement with Royal Colleges, trade unions and the third sector is also needed to build shared ownership of the future models of care.  

Visible political leadership from all parties will also be essential to ensure the public understand and are informed when service change is proposed. While NHS organisations regularly engage with their populations through two-way engagement activities, the current process can be costly and onerous, with consultation requirements not always proportionate to the scale or impact of the proposed change. 

Workforce planning

The NHS is Wales’ biggest employer, directly employing over 110,000 people and rising. We welcome that the Welsh Government is developing a new workforce plan for health. The people working in health are our biggest asset. Without their hard work and dedication, the health system would collapse.  

With a projected declining working population over the next 10 years and growing demand for flexible working, we need new workforce models that are agile and responsive to the fast pace of change, and that includes scenario planning models for future need. Health Improvement and Education Wales have been implementing a workforce strategy that was agreed in 2020, so there are important themes and lessons resulting from this work that the Welsh Government should consider in developing the new workforce plan. For example, any effective workforce plan will need to be integrated with longer term service planning as well as digital planning. There will also need to be alignment of approach with the social care workforce. We would also like a future workforce plan to include the development of effective leadership and management to support career development, and improve talent management and learning.  

Digital innovation

We welcome the Welsh Government’s overarching ambition to make Wales a world leader in digital health innovation, but it is vital that a clear vision and sustainable funding are provided to enable this ambition to be met. Health and social care bodies must be supported to maximise the potential of digital innovations. This will enable people to access a wider range of health and care services from home, maintain their independence, health and wellbeing, and stay up to date with information relating to their care. Tackling digital exclusion will be key to ensuring everyone has the capability and confidence to navigate and access services digitally as society continues to make this shift. 

Two important priorities are currently missing or underdeveloped: the long-term sustainability of the NHS estate and infrastructure, and the sustainability of the social care sector. Both are fundamental to the delivery of the Welsh Government’s wider health and care ambitions, because service transformation cannot be delivered without safe, modern infrastructure and a resilient social care system. 

Estates and infrastructure 

While we welcomed that the Welsh Government supplementary budget for 2026/27 allocated £20m for maintenance work on hospital buildings, we need a longer-term plan to sustain the NHS estate and boost productivity.   

The NHS needs a long-term 10-year capital and infrastructure strategy that invests in its entire estate, including buildings, equipment, and digital systems, while also leveraging technological and research advancements like genomics and AI. This would drive efficiency, productivity, and sustainability, ultimately improving patient outcomes and staff working environments. It would also support the NHS to reduce its carbon emissions, regenerate the local economy and improve patient care outcomes.  

Currently, the NHS has an ageing estate that was not designed to meet current demands. Many hospitals in Wales were built in the 1960s or earlier, with 12% of the estate built pre-1948 and only 6% since 2015, meaning significant investment is required to bring them in line with modern standards. Due to the age profile of much of the NHS estate, a significant amount of money is spent on essential maintenance and repair work to maintain staff and patient safety rather than investing in new infrastructure. While extremely challenging, NHS leaders would like to work with the Welsh Government on developing a medium and longer-term plan for improving capital spend.    

Case Study 

As highlighted in the recent NHS Alliance report Towards a new co-investment model: what is next for NHS public-private partnerships?, NHS leaders across the UK have argued that a new model of private co-investment alongside public investment could play an important complementary role in addressing the NHS’s capital challenges. The report outlines how other countries are responding to similar challenges associated with capital investment in health infrastructure. 

An effective Public Private Partnership (PPP) model that has the support of both the public and private sector will be critical in rebalancing the NHS estate. The Velindre Cancer Centre Mutual Investment Model (MiM) is a refinement of a traditional Private Finance Initiative (PFI) and demonstrates how a project can be off the Government balance sheet while also addressing some of the perceived challenges of PFIs. The Welsh Government’s MiM ensured that the complex contractual model they agreed with private industry worked for HM Treasury. 

To try to address some of the criticisms of PFI models around lack of governance and rights for the public sector, the Welsh Government took a 15 per cent equity stake via the Welsh Development Bank. The Welsh Government also has a seat at the board, meaning more public sector visibility to reduce risks. The Velindre MIM has developed a ‘lessons learned’ table which can be found on page 16 of the report.  

Social Care 

We would welcome further clarity around the Welsh Governments vision for the sustainability of the social care sector and how they will work with the UK Government on the recent announcements that the Prime Minister has made around social care and the Casey Commission. 

The Welsh NHS Confederation would like to see a review of the social care system in Wales so that a long-term, sustainable service can be developed. Such a review should involve all parties in the Senedd to support cross-party discussion and agreement on the long-term future of social care in Wales. 

The adult social care system across the UK is in desperate need of reform. State-funded social care is only available to people with the highest needs and lowest means, while many face potentially catastrophic costs. Services are under extreme pressure, with high levels of unmet need, patchy quality of care and an unstable provider market. This places a heavy burden on families and friends to plug the gaps by providing informal care, often with limited support. The sector is facing a workforce crisis, with high vacancies and uncompetitive pay and conditions. The challenges in the sector mean that people are missing out on vital care and support, leaving them less independent, more vulnerable and more likely to rely on healthcare services. But despite the pressing need for change, successive governments across the UK have failed to reform social care for decades. 

The challenges facing social care have a direct impact on the wider healthcare system. The NHS is reliant on a sustainable social care system because capacity and workforce pressures in social care affect patient flow through hospitals and the NHS’s ability to discharge patients safely and promptly. Across Welsh hospitals, there are typically 1,200 to 1,500 patients who are medically fit to be discharged but cannot leave hospital because an appropriate package of care is not available. These delays reduce the capacity available to treat other patients and increase pressure across hospital services. 

Remaining in hospital longer than needed increases the risk of a patient catching a hospital-acquired infection, losing mobility and cognitive function. For every 10 days of bed rest in hospital, a person over the age of 80 will experience 10 years of muscle ageing. These factors can make it harder for people to regain their independence after leaving hospital and lead to an increased need for further care and support. 

In scrutinising future Welsh Government policy work on social care, the Committee should consider how the system needs sustainable funding, improved workforce pay and conditions, better integration and the collection and reporting of social care data. 

Case Study 

Across Wales, there are initiatives that demonstrate how closer working between local authorities and the NHS can help people to recover and keep well. These initiatives focus on prevention and early intervention, make better use of primary care and community services, improve access to community support and advice, and support people to manage their conditions. 

Llesiant Delta Wellbeing’s blue army is supporting hospital discharge and patient flow in Carmarthenshire, helping to free up much-needed hospital beds. On average, patients have been able to be discharged from hospital five days earlier as a result. Working closely with Hywel Dda University Health Board, Carmarthenshire County Council and Welsh Ambulance Services University NHS Trust, a multi-disciplinary team of different health and care professionals has been set up. In Glangwili Hospital in Carmarthen social workers, occupational therapists, staff from Care & Repair and members from the Delta Wellbeing team are regularly part of the ward rounds to support patients. 

Accountability and ways of working  

While previous Welsh Government policy intent has moved in the right direction, a clear operating framework is needed to strengthen delivery by setting out the roles and responsibilities of different parts of the health and care system. This would help to get the best value from the national bodies that have been established by Welsh Government, and to ensure all parts of the system are working to common objectives. 

Our members would also like to see quality and safety priorities kept at the heart of decisions and plans, so any changes should continue to support safe, high-quality care for patients and services. For example, the Path to Safer Beginnings Assessment of Maternity and Neonatal care has some useful recommendations for increasing joined up national leadership, to ensure consistency in strategic planning, quality and safety across Wales. These recommendations can also be applied to other areas of NHS operating frameworks.  

Partnership working  

Although it is positive that the partnership landscape in Wales has grown, there are now at least 164 formal partnership groups in areas relating to health and care. There is a need to simplify partnership structures in Wales if they are to have long-term, effective impact on public services and the wellbeing of the population.  

We welcome the Welsh Government's review of Regional Partnership Boards and the work being undertaken to further embed the principles of One Welsh Public Service.  

Strengthening partnership working arrangements will support the sustainability of the health and care sector in Wales, making it more efficient and enabling the delivery of more integrated, person-centred care across Wales.  

Better use of data  

We need to embrace new multidisciplinary models of care that bring together primary, community and mental health services. However, properly assessing demand and access in NHS community services is hampered by the lack of data. There are three essential requirements for delivering integrated care: understanding the population and its needs through integrated datasets; creating multidisciplinary teams of health and care professionals; and enabling the whole team to work to a shared care plan, developed in partnership with individuals, carers and families, that includes preventative interventions to keep people well. Without these population insights, multidisciplinary teams and shared care plans, integrated care cannot become properly embedded. 

Performance and Financial Frameworks  

We must ensure performance and financial frameworks shift from focusing on emergency and acute care towards supporting the system to grow and redesign. Performance frameworks need to focus on prevention, effective treatment and timely support for individuals and be measured consistently across health and social care. Unless we broaden targets and performance measures and collect and publish comprehensive data across the breadth of NHS and social care services, it is difficult to evidence system working and joined up models of care.   

Whole government approach  

A cross-sector whole-government effort is needed to build healthier and more prosperous communities and reduce demand. 

We need strengthened collaboration across all public sector bodies to create innovative solutions against a streamlined set of priorities, which effectively balance short-term need with long-term vision. We welcome the work that the Welsh Government is currently undertaking around One Welsh Public Service.