Nuffield Trust report exposes Tory lies on Wales NHS

Tony Beddow says English Ministers attacks on Welsh health delivery are concealing their own shortcomings

Speaking at the Welsh Conservative conference in Llandudno on 11 April David Cameron claimed that the Welsh border was “the dividing line between life and death”. However, a Nuffield Trust report published on the same day demonstrated the dishonesty of his rhetoric. 

At the same conference the English Health Minister Jeremy Hunt claimed the Welsh NHS was “sleepwalking to a mid-Staffs tragedy”. David Cameron went further, telling Welsh Conservatives the Welsh NHS was a “national scandal” and Offa’s Dyke “has become the line between life and death”.

In fact a thorough comparison of the UK health systems by the independent Nuffield Trust – showed that overall, NHS Wales compares well. Challenged on the discrepancy BBC Radio Wales, Vale of Glamorgan Tory MP Alun Cairns was keen to bluster about longer waiting times for hip and knee operations. He didn’t want to hear that cancer care was better, and acute admissions for chronic conditions were falling. Indeed, the Nuffield Trust report found that there was no evidence Wales was “lagging behind”. That it was “broadly in line” with the rest of the country on “avoidable deaths”.

Overall, the Nuffield study showed Wales’ (far less privatised) NHS was improving faster than England’s – on less money. Wales gets less funding per person than areas of England with similar levels of ‘need’ like the North East of England. There, the NHS gets allocated £2,100 per person – 10 per cent more than Wales, which gets £1,900 per person.

The Barnett formula which works out how much money Wales gets was established as a temporary fix – in 1978. Now, 35 years later, its inadequacies are clear to all – except the Tories and the Welsh Lib Dems.

Plugging the gap with funds from education or social care are unattractive options. The devolved Welsh NHS uses about 40 per cent of the total Welsh Government block grant, so the impact of the unfair allocation on its NHS is huge.

And what of that orthopaedic waiting time figure? Reported figures show an average hip and knee operation waiting time in Wales is 170 days as opposed to 70 days in England. However, they do not necessarily indicate much poorer treatment.

The English figures are not collected and reported on the same basis as the Welsh. The English rules allow the English waiting times “clock” to be stopped in different ways. Some of the difference in reported waiting times is almost certainly down to England being better at gaming the data rather than being better at treating patients. Rob Findlay, an expert on waiting times, has observed that it is “striking” how often the clock is stopped in England just before the 18 week target and suggested some English NHS trusts are “systematically” misusing the system of “clock-stopping”.

Average waiting times are in any case a crude indicator. Patients should be treated at the best time. For some patients discussing with their doctors the optimum time for such surgery, it may make sense to wait a while so that revision surgery some years hence is less likely.

Cameron and his fellow pro-marketeers are keen to disparage NHS Wales because it has not followed England’s path of dramatically expanding the amount of private involvement in health provision.  But as Welsh Health Minister Mark Drakeford said, the Nuffield report “has shot Cameron’s fox good and proper”.

Tony Beddow is a former NHS Chief Executive in Wales and also Secretary of the Socialist Health Association (SHA) Cymru Wales. This article was originally published by the OurKingdom website. (

10 thoughts on “Nuffield Trust report exposes Tory lies on Wales NHS

  1. The Nuffield Trust report initially highlights and then goes on to repeat almost page after page how difficult it is to make meaningful comparisons between the various NHS systems (waiting times and ambulance services excepted).

    Certainly the NHS in Wales is performing less well than in England and Scotland (in terms of waiting times and ambulance services) and is expected to continue to perform less well.

    I suspect this has little to do with the NHS in Wales being far less privatised (which effects patients and/or relatives not one jot, it’s a matter solely for NHS accounting),and more to do with incompetence.

  2. The Welsh Health Service is a disgrace.It is getting Worse.!
    9 months ago when Mr Dakeford was given the job of Running the Service he said waiting list times would be reduced. Then the waiting time for a cataract operation in Gwent was six months. In Oct it was increased by 50% to nine months yet the Health Service did not bother to inform those on the list at that time.
    Over Offa’sdike in England the time is 20 week
    This is just one of many failings.

  3. Nuffield was certainly not praising the situation in Wales. Some of the lines in the Report, especially on waiting lists and on the deprioritising of health within the Assembly budget, could have come straight from the lips of a Conservative spokesman. Also it is hardly a compliment to say that cancer care and death rates are no worse than the rest of the UK when international comparison suggests both these areas are a longstanding national disgrace.

    In all due fairness, Nuffield may be right to suggest that there is relatively little difference between Wales and supposedly ‘privatised’ England at the administrative level. If there are some things we might learn from England, there is also a lot of good practice in Wales.

    The differences – and the problems – are rather at the policy level. Since its inception the Welsh Assembly has been responsible for a series of wrong-headed, ideologically-driven political decisions that have impacted negatively on healthcare: the deprioritising of health within the Assembly budget highlighted by Nuffield; the obsession with prescription charges; a misconceived reorganisation and the necessary subsequent re-reorganisation; and a defensive attitude in response to scandals at the flagship UHW and elsewhere. Possibly the biggest problem of all is a tendency to go into denial whenever any shortcomings of the Welsh NHS are exposed. With respect, this article is a good example of that.

  4. I’m sorry, but this article is quite disgraceful. Not as disgraceful as Cameron and Hunt’s comments recently, but still pretty bad.

    You completely misrepresent the report. The report does indeed explicitly says that no country is miles behind any other. That much is true. But then the report does say that Wales has worse waiting lists: by a long way. Whenever comparisons were done in the report, they either say all countries are moderatly the same, or they say Wales is doing worse. That is the clear theme of the report. To pretend otherwise is wrong.

  5. “The Barnett formula which works out how much money Wales gets was established as a temporary fix – in 1978. Now, 35 years later, its inadequacies are clear to all – except the Tories and the Welsh Lib Dems.”

    This article is clueless from beggining to end.

    When have the Welsh Lib Dems ever defended the Barnett formula? They have been consistently critical of it. As have Plaid. I have no idea the Tories view, however the only party that has been consistently supportive of Barnett has been Labour. Is Mr Beddow even aware of this? Some examples for him to read:

  6. Has the author of this confused blog even bothered to read the Nuffield report? He opens by saying that the Nuffield Report shows that “NHS Wales compares well” – he then goes to prove this by saying “cancer care was better, and acute admissions for chronic conditions were falling”. NONE OF THESE ARE EVEN MENTIONED IN THE REPORT.

    Instead, he does refer to one thing in the report: the fact that on average hip and knee operation waiting times in Wales is 170 days as opposed to 70 days in England. However, not to worry he says, as “they do not necessarily indicate much poorer treatment”. You couldn’t make this up!

  7. Forget England. Why is the Welsh NHS worse than that in Scotland, where there is no ideological divergence? Two reasons: bit less money and much worse management.

  8. PS the limitations of Barnett are equally invisible to the Labour Party which did nothing to reform the formula during 13 years in office and has just promised the Scots not to reform it in future. Anyway the shortfall in Wales relative to need was shown to be no more than a couple of per cent of the budget. A shame yes, but 2 per cent wouldn’t change the world. Time to stop whinging, get off our knees and backsides and sort things out. We have the power to do so in health.

  9. This debate has been confused by the interventions of David Cameron and Jeremy Hunt. This is what happens when politicians from one country interfere in another country’s affairs.

    However, as has been consistently said above, it is easy to focus on the inaccurate and hysterical comments of other politicians and much harder to face up to the problems facing our own NHS. As has been previously stated, the better comparison is Scotland. Unfortunately the report suggests that making comparisons between the different nations is difficult because of the different nature of the data. But it is open to the Government and Welsh academics to conduct the necessary research to discover the nature of and reasons for our underperformance rather than devote energy into media management.

  10. With respect to R.Tredwyn (as I agree fully on the point he made about Labour not reforming Barnett), 2 percent of the Welsh budget (if true), if a government wanted to devote it entirely to health for say a rolling period of five years, would be a godsend in the current financial climate. It is absolutely correct though to point out that Labour in Scotland has reinforced its existing defence of Barnett’s injustice, and has said that the formula “serves the whole of the UK well”. Either Labour in Scotland has got it completely wrong (in the midst of a campaign for the future of the union), or they are right and there will be no extra money for the Welsh NHS (or indeed for education).

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