Health spending under austerity: the Welsh Government changes course

Ed Poole and Guto Ifan look at the changes in spending on health across the UK.

The publication of the Treasury’s Country and Regional Analysis data gives us an important annual look at spending patterns in Wales, and how decisions on devolved spending in Wales compared with those taken for the rest of the UK over the previous five years.  Significantly, the latest report gives us a first picture of how each country dealt with the challenges of austerity budgets over the entire course of the last parliament.

Welsh Government decisions on health have rarely been far from political attention (and criticism) since the start of devolution, and no more so than during the 2015 General Election campaign. The most recent Treasury data starkly illustrate the Welsh Government’s decision early in the parliament to use Barnett consequentials from protected English NHS spending to moderate the impact of cuts across other areas of Welsh spending such as local government. As shown in in figure 1, per capita expenditure on health in Wales fell from being much higher than the UK average in 2010-11, to being just below it in 2013-14.

However, since 2013-14, the Treasury data also document the change in approach by the Welsh Government. Health expenditure in Wales grew by more than 4.6% in nominal terms from 2013-14 to 2014-15, reflecting the Welsh Government draft budget of October 2013 that found additional funding for health by cutting deeper elsewhere. This decision once again pushed per capita spending on health back above the UK average in the last financial year.

As could be expected, the change in spending priorities did not fully reverse the effects of earlier budgets. As can be seen in figure 2, health spending in Wales remains below (-2.1%) its 2010-11 level, comparing with a 6.1% increase in health spending over the same period in England. Scotland saw a slight decrease of -0.8%, although Scottish health spending has been much more consistent than in the rest of the UK over the past five years.

The change in the Welsh Government’s approach is also reflected in the 4.1% real terms decrease in local government expenditure in Wales since 2012-13. In contrast, local government expenditure in England was cut earlier in the last parliament, and is down by 12.1% since 2010-11.

Adding social services to the mix

Changes to healthcare provision and in particular its degree of integration with social care have led to calls for a more complete accounting of health spending across the different countries of the UK, one which also incorporates spending on social services under the control of the devolved administrations.

A Welsh Government written statement coinciding with the CRA publication notes the relatively steep increase in health spending per head in Wales from 2013-14 to 2014-15, and also draws attention to ‘combined spending per head on health and social services [that] was £172 or 7 per cent higher than in England in 2014-15’. Although it does not feature in the headline categories of spending, this combined figure for health and social services for 2014-15 can be calculated from various subcategories in the Treasury data.

Figure 3 shows a comparison of this combined health and social services measure by country from 2010-11 to 2014-15. As with health spending considered on its own, total Welsh expenditure in these combined areas had been falling in real terms but changed course to track the reprioritisation of health spending midway through the five-year period. Interestingly, although the Welsh Government statement draws attention to Wales’ positive advantage in per capita spending, England was in fact the only UK country to record a (slight) real terms increase in combined health and social services expenditure over the five year period, primarily due to the per capita increases in health spending shown in figure 2.

In contrast, combined Welsh expenditure on health and social services per head remains slightly below 2010-11 Welsh levels in real terms.  As in Scotland and Northern Ireland however, total per capita health and social services spending was greater in Wales than was comparable spending in England in each year of the five-year period.

Accounting for Austerity

Notwithstanding the problems of comparing and contrasting spending across the countries of the UK, the Treasury’s Country and Regional Analysis data gives us a useful annual look at the divergences and continuities in spending and policy decisions taken by the UK and devolved governments through their budget decisions. With further fiscal consolidation for the next five years likely to be announced in the Comprehensive Spending Review later this month, the Welsh Government elected next May will once again have to decide how far to diverge from spending decisions taken elsewhere to distribute budget cuts across its many areas of policy responsibility.

Ed Poole is a Lecturer in Territorial Politics and Guto Ifan is a Research Assistant, both at the Wales Governance Centre at Cardiff University.

7 thoughts on “Health spending under austerity: the Welsh Government changes course

  1. Interesting well written stuff. Thanks.

    The only thing that seems apparent in recent years is that NHS outcomes have little relation to money spent.

  2. “Notwithstanding the problems of comparing and contrasting spending across the countries of the UK…”

    Not least because we still don’t have anything remotely resembling an accurate idea how much the WG’s decision to run Wales bilingually top-slices from the health and other budgets – in Wales even less actually goes into the front-line than the headline figures suggest.

    It isn’t just the money it’s what you do with it! So let’s have that “more complete accounting” analysis and let’s find out how much of the health budget actually goes into propping up a dead language rather than into healthcare. Some people are probably dying to find out!

  3. Is there an election in May 2016? Welsh Labour has been consistent for many years now in depriving essential services of cash in order to fund Social Engineering and privileges for the minority!

  4. Figures for 2015/16 are going to be very very interesting. In an attempt to drive down hospital waiting list times prior to the election huge funds have, in Q3/4 2015, been mysteriously ‘discovered’ allowing for NHS Wales patients to be seen by private sector healthcare businesses at private healthcare prices. This is a bonanza on a scale that has never been seen before for businesses both sides of the border. Don’t imagine our NHS surgeons are upset about it – they are the ones doing the work weekends, evenings and (incredibly) during core NHS hours via their various private practice consortia. Christmas has come very early in some households.

  5. John Walker back on the trail of the Anti-welsh bigot. The money comes from Welsh speaking taxpayers as well as the majority of Non-welsh taxpayers who support the future of the language.

    The article however is about healthcare; anything helpful to say on that subject?

  6. The funding of all public services in Wales clearly depends of the a)health of UK economy,b)level of borrowing that UK government,however the influence of Wales has been reduced in last 20 years,and clearly to the well being of ordinary people,like myself. The NHS is clearly at a crisis throughout the UK,no matter the structure of a)management,b)political control and with the standard of health in this region of UK the crisis is bound to be accentuated. As a 71 year old with lots of friends of similar age and social backgrounds it is clear that OUR demands on the service are increasing in alarming manner,so the crisis/underfunding is clearly visible at all parts of the service. At the same time the totally ‘unmentioned’ reaction to the crisis is the growth of private medicine,both within and without the NHS,so in this so called ‘socialist’ paradise the well off are able to by pass very long waiting lists for a)scans,b)meeting consultants.In my very humble opinion this is a disgrace,however done it myself,and probably will have to do so in near future,however this should be recorded as part of NHS statistics which is in the end reducing waiting lists and making our socialist masters in Caerdydd look as though they are doing a better job than the reality would suggest. In conclusion I agree with JP above in that there should be a CULL of welsh language ‘enforcement’,and other favoured projects like pushing ‘green’ propaganda and get back to basics ASAP.Any political party would reap HUGE BENEFITS by opening up the books,however current lot have all joined the ‘nation building’ rubbish rather than getting the basics as right as possible.

  7. @ Lynne. Well said and private medicine WITHIN the welsh NHS is the great ‘unmentionable’ subject,especially as we live in a nationalist/socialist paradise. On a person level,and after 46 years hard work,and still paying heavy taxation I need a scan due to excessive pain in both shoulders,however been waiting for about 4 weeks,and still no prospect,but if I PAY then ipso facto it will be done. It all STINKS.

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