Darren Hughes examines the cross-party promises to the NHS and looks at what is missing from their manifestos.
Finally, all six of the main political parties in Wales have published their manifestos for the Senedd election. While there has been no shortage of speculation, polling and commentary, our focus at the Welsh NHS Confederation has been on influencing all parties’ thinking to ensure the voice of Welsh NHS leaders is heard, ultimately to improve the health and wellbeing of people in Wales.
As the only membership body representing every organisation that makes up the NHS in Wales, we surveyed NHS leaders to identify their most urgent priorities for the next Welsh Government. Five clear priorities emerged:
- A whole-government national strategy to improve health and wellbeing and reduce inequalities, shifting the system towards prevention and the wider determinants of health, supported by long-term budgets and planning.
- A fully costed plan for the NHS and social care workforce, including education and training.
- A long-term capital and infrastructure strategy to unlock productivity, improve safety, reduce waiting lists and future-proof services – covering hospitals, primary care, community services, mental health and, crucially, digital infrastructure.
- A joint health and social care performance and financial framework, with meaningful, person-centred measures focused on outcomes, prevention and providing care closer to home.
- An independent rapid review of social care to develop a long-term plan for its future, addressing system-wide challenges, stabilising the sector and improving transparency, funding and workforce conditions.
These five priority areas are, in broad terms, reflected across the six party manifestos. There is a notable degree of ’agreement’ in what parties say they want to achieve in health and social care – the differences are in how they say they’d deliver. It’s therefore clear that, largely, parties have been listening – to the public, to the health and care sector and to the evidence – and have made an effort to begin to understand what is needed to transform the system to face ever-increasing demand with the same, or less, resources.
There is a notable degree of ’agreement’ in what parties say they want to achieve in health and social care – the differences are in how they say they’d deliver.
All parties have recognised the overwhelming public view that the NHS should remain free at the point of need, echoing the findings of the 2026 British Social Attitudes survey. With health and social care accounting for over half of the Welsh Government’s budget, it’s unsurprising that healthcare remains a key electoral battleground. This is reflected in its prominence across every manifesto, as is the recognition of the need for improvements across the system.
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Waiting times
As expected, reducing waiting times features heavily across all manifestos. Parties propose a range of measures, from expanding surgical hubs to increasing diagnostic capacity and improving patient flow. Some offer detailed commitments; others simply promise to develop a plan. While we don’t have a specific call on waiting lists, all five of our priority areas would, if implemented, contribute to reducing them and improve patient experience. The consistency of focus across parties undoubtedly reflects the importance of this issue to the public, and its political salience.
Workforce
Every party acknowledges workforce pressures and proposes some combination of recruitment, retention and training reforms. However, only some commit to a long–term workforce review or plan – essential for both the NHS and social care workforce. Most proposals centre on clinical roles, with less emphasis on the wider multidisciplinary workforce essential to delivering care in the 21st century. Nonetheless, the cross–party recognition of workforce challenges is a starting point.
Providing care closer to home
All manifestos include proposals to improve access to primary care, particularly GP services. Commitments range from recruiting more GPs to expanding community diagnostics and telehealth. Most parties address NHS dentistry – an area facing long–standing struggles – with pledges to improve access, reform contracts or expand training. The consistency of focus here is encouraging, though the feasibility of some proposals remains unclear. This emphasis on primary care links to our call for frameworks to enable us to shift resources and focus to deliver care closer to home, reducing pressure on hospitals and enabling earlier intervention. While there’s widespread acknowledgement of the desired direction of travel, it will take time and whole-system change, starting with a joint health and social care performance and financial framework – something that is reflected in only some manifestos. The idea of frameworks may not be eye–catching to the public, but they are essential if Wales is serious about improving integration, patient flow and population health.
Across all manifestos, the biggest gap is the “how”. Parties set out what they want to achieve, but not always how they will deliver it – or how they will pay for it.
Investment in NHS estates and infrastructure
All parties touch on NHS infrastructure and capital investment, whether through new hospitals, community hubs or upgrading existing estates. However, the level of detail varies significantly and across the board there appears to be an underappreciation of the scale of the challenge and a lack of long-term strategy, given around three quarters of the NHS estate is over 20 years’ old. There is also a substantial NHS estates maintenance backlog (£1bn for the most critical improvements alone), alongside the need for major new projects. While some manifestos include ambitious capital commitments, it is unclear where the funding would come from. Digital infrastructure also features prominently, but again, the scale of the work required to modernise systems and achieve interoperability is not fully reflected. That said, capital investment receives more attention than in previous Senedd elections – a shift we have worked hard to influence, given its importance to the capacity and productivity of healthcare services.
Social care
Social care is the area where manifestos diverge most. Some parties recognise the need for radical reform, including moves towards a national care service. Others focus primarily on supporting unpaid carers or improving workforce conditions. While these are important, they do not address the fundamental challenges of an unstable provider market, rising demand and challenges in furthering integration. Few manifestos set out a clear plan for tackling the longstanding structural issues in social care, meaning it is highly likely that social care will continue to be the can that gets kicked down the road. The Casey Review will be critical in shaping this debate.
Prevention and public health
Prevention is noticeably higher up the agenda than in previous elections, with several parties proposing whole–government approaches to public health. However, interpretations of prevention vary. Many proposals focus on expanding primary care services, lifestyle interventions, public health campaigns or early diagnosis, with less acknowledgement of the impact of wider determinants of health such as housing, employment, food, arts, culture and the environment. The pressure to address waiting lists risks tipping the balance back towards secondary care unless we take a cross-sector, whole-government approach to health and wellbeing. Still, there is more recognition than before of the need to reshape public health policy through ministerial portfolios, the significant role of local authorities, funding models or health inequalities reviews.
Without decisive action in the next four years, the level of demand on health and social care services could become insurmountable.
The missing pieces: implementation and costings
Across all manifestos, the biggest gap is the “how”. Parties set out what they want to achieve, but not always how they will deliver it – or how they will pay for it. At the time of writing, no party has published full costings. A key challenge for the next Welsh Government will be turning ambition into reality within a constrained financial environment and shorter political cycle.
Critical to making meaningful progress is ensuring we take the public with us. This will require honesty about the scale of the challenge and the demographic pressures facing all parts of Wales. Over the next 5–10 years, our ageing population and projected worsening health will place increasing strain on health and social care services. Without decisive action in the next four years, the level of demand on health and social care services could become insurmountable.
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Looking ahead
We look forward to working with all parties and hold the Welsh Government to account to support progress over the next four years and tackle the ‘how’. The manifestos show that parties are saying many of the right things, but only time will tell whether they can deliver the system-level change that NHS leaders, staff and the public know is needed.
Read the Welsh NHS Confederation’s full election report.
The Welsh NHS Confederation is the only membership body representing all the organisations making up the NHS in Wales. We host NHS Wales Employers and are part of The NHS Alliance. Find us at: www.thenhsalliance.org/wales
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