Wales: health and care issues for the 2026 election

As voters in Wales look to election day, they see the state of the NHS as the second-most important issue – behind only the cost of living. There are good reasons for this. Health care is the public service employing the most people in Wales, and by far the Welsh government’s largest spending commitment. When social care is added, care services account for an outright majority of the Welsh budget for the current year. Both are struggling in ways that have an important impact on the lives of tens of thousands of people in Wales.

This briefing gives an overview of the past trends and current commitments that voters are likely to be considering when they bring these concerns to the ballot box. What has the state of health and social care been in Wales since the last election in 2021? And how are parties promising to change it in the coming years?

We draw on administrative data on health and care performance, spending and staffing in Wales and the other countries of the UK, as well as survey data and other public information. Where possible, we draw comparisons with other UK countries with comparable data to understand how services in Wales compare. We examine public statements from the main political parties in Wales about the NHS to assess their commitments. We have looked at the four parties which recent opinion polls suggest will attract the most votes – Plaid Cymru, Labour, the Conservatives and Reform. In places, we also look at the Green Party, which some polls suggest may be close to the top four.

The headlines: NHS performance

Long waits for planned hospital care and for emergency department visits are a matter of public concern across the UK, and they appear to be linked to levels of public concern. But in Wales, waiting times tend to be longer. 

All UK countries share a target for 95% of people in A&E departments to be moved onto wards, sent home, or passed to another service on time within four hours. Patients in Wales had always been a little more likely to wait longer than this compared to those in England and Scotland, and that largely remained the case as performance fell during and following the Covid-19 pandemic. As English hospitals struggled, the gap diminished, but it has now slightly reopened.

When it comes to waiting for planned appointments or operations, the picture again grew worse following Covid-19, as it did across the UK. Wales is currently far from meeting its main targets. Key targets state that 95% of people should be waiting less than 26 weeks, and nobody should wait more than 36 weeks. Recent data shows that 59% of people wait less than 26 weeks, and 30% wait more than 36 weeks.  

It is difficult to compare waits for planned care in Wales, England and Scotland, due to differences in standards and measures – particularly relative to Scotland. However, the comparable data that does exist suggests people are more likely to be on a waiting list in Wales, and to be on it for longer. Polling by the ONS has been conducted across Great Britain, though not Northern Ireland. It found that people in Wales were much more likely to say they had been waiting more than 18 months.

In 2024, the ONS produced a figure to compare Welsh waits to those in England. This showed that the number of waits for planned care is 66% higher in Wales relative to the size of the population. 

Since then, the number of entries on the waiting list has fallen by about 10% in Wales and about 5% in England. That suggests slightly faster progress very recently, but is not nearly enough to eliminate the gap between the two countries.

What are the parties promising on NHS performance?

Perhaps wisely, given how far out of sight most existing targets are, the competing parties are not promising new goals or benchmarks. Many share a goal of expanding hubs for surgery or other types of planned care – a longstanding emphasis of the Royal College of Surgeons and already a policy of the incumbent government to some extent – though implemented cautiously and on a limited scale. These commitments are not costed. Labour does specifically pledge a £4 billion fund for new and upgraded hospitals, but without spelling out what areas of performance these might focus on improving.

How are resources being deployed and used in the Welsh NHS, and how might that change?

Although it struggles to deliver care in as timely a fashion as other UK countries, Wales is now the UK’s highest spender per person. 

From 2000 until the mid-2010s, the pattern was that Scotland tended to spend most on day-to-day NHS costs. Since a boom in spending during the pandemic, however, spending has fallen off more in Scotland, Northern Ireland and England, meaning funding per person has been highest in Wales during each full year of the 2021-2026 Senedd period.

Wales also spent more proportionately any other UK country last year on capital expenditure for buildings and equipment – £155.54 per person, which is 6% more than England. However, it has generally been similar in capital spending to Northern Ireland and, since the pandemic, to England, with all three countries spending considerably more per person than Scotland.

Why might Wales struggle for comparable NHS performance while spending more? One possibility is that population need is higher, in a country with more people in older age brackets than the rest of the UK, and a higher level of deprivation. Previous reviews have often compared Wales to the north-east of England, which has an older and more deprived population than England on average. Wales spends fractionally less on day-to-day health care per person than the north-east of England – £3,418 compared to £3,448 in the north-east.

Another possibility is that resources are not used efficiently. The length of time that patients spend in hospital has historically been an important factor in how many people a given number of hospitals and staff can treat.

Despite post-pandemic efforts, the average length of stay in Wales is much higher than in England, at 6.7 days against 5.1 days in 2024/25. Patients in Wales are kept in hospital a little more than one-and-a-half times as long, on average, than those in England.

Emergency admissions to hospital will always be vital for some patients, but reducing them is often seen as a key sign that a health care system is doing better at keeping people well, instead of only reacting when they are in crisis. 

Wales has historically had the highest number of emergency hospital admissions per 100,000 population compared to its English and Scottish neighbours. This dropped sharply during the pandemic in all countries, to a roughly similar level. In Wales, it has now risen again, but remains slightly lower.

Lastly, we can look at how health care expenditure is allocated in Wales, and how this has been changing. From 2019/20 to 2023/24, the share of resources allocated to secondary care through local health boards – such as hospitals for physical and mental health – has risen from 75% to 78%. The proportion dedicated to primary care through these boards, such as general practice, has fallen by 3 percentage points, from 23% to 20%. 

This is not a desirable direction of travel for Wales, where the Future Generations Commissioner recently warned that “Wales is investing in sickness not health”, and where there is now the lowest number of GPs per 100,000 people (89 per 100,000) of any UK country. 

The parties’ plans for running the NHS

Generally, although they promise new plans, targets and sometimes funding pots, manifestos do not envisage major changes to the way the NHS in Wales is run. The exception is that most of the opposition parties set out different ways to strengthen control, accountability and grip over health boards. Plaid Cymru would create a new financial control team and review how central government intervenes in struggling health boards. The Conservatives are promising an NHS Ombudsman, a new inspection mechanism and hospital performance ratings. Reform UK suggests performance-related pay and legislative changes to “enhance ministerial intervention mechanisms”.

These measures could be seen as addressing a criticism made by the OECD and the 2018 Hussey review that the NHS in Wales lacks enough accountability, benchmarking and support. Central control can, of course, tip over into a chaos of too many enforced targets, as at times has been seen in England. Welsh Labour will feel that their establishment of an NHS Executive was an attempt to address this in a less punitive fashion. 

Two other strong priorities are shared across all the parties: delivering separate hubs for planned care as discussed above, and improving digital access and infrastructure. 

Social care

Spending on social care in Wales is now 50% higher, in real terms, than it was 10 years ago. Wales spends comparatively more per head on social care than England – £100 per head more on care for older people. This can be partly explained by its older and ageing population, with over a fifth of people in Wales now aged over 65 and potentially requiring social care, and by Wales’s comparatively more generous system. The rise in spending will also be driven by the positive measures over the last parliamentary term to improve terms and conditions for social care staff, who are now paid the Real Living Wage, and support to unpaid carers.

But while spending has risen, it has not kept pace with the growth in demand for social care support, and Wales’s social care system remains under significant pressure. For people with care and support needs, this translates to long waits to access the services they require, and a stronger reliance on unpaid carers to fill the gaps. The waiting times for people needing home care between their care and support plan being developed and the service actually starting peaked at almost three weeks in 2022/23. This has slightly improved in recent years to become a two-week wait, but remains considerably higher than in 2020/21 where the wait time was only around three days.

One area of celebration for Wales is the improvement in the number of days that people spend in hospital after being deemed ready for discharge. In April 2023, over 95,000 days were lost to discharge delays, which improved to just over 60,000 in February 2026. However, changes to the way that data is collected make it difficult to compare the current situation with performance prior to the pandemic, and it is possible that the discharge delays remain high compared to before this period.

Despite the relative improvements to delayed discharge over the last three years, all parties have committed to better integration with health to address this evergreen problem, but the specifics around the proposals are weak. Many have also considered ways to improve the sustainability of funding for the system, including the Conservatives’ proposal for a commission on the future of social care funding, which echoes the current commission underway in England, led by Baroness Casey. While such commissions hold the potential to build consensus on the future of reform, they do little to address with urgency the problems facing the sector at present. 

Any incoming government will face crucial decisions about whether to continue to progress plans to implement a National Care and Support Service free at the point of need, and crucially, how to fund it sustainably without further destabilising the system.

The challenges ahead

The new Welsh government, of whatever party or coalition, has a particularly difficult inheritance in health and social care. Waiting times are poor and the public deeply unhappy. Wales’s older, more deprived population means that needs for care are elevated, and sustained high levels of health funding reflect that. The incoming ministers will know that there is not enough money in the coffers to simply spend their way to success.

Improvements in delayed discharges and waiting lists provide a glimmer of hope. Sustaining this is likely to require planning out spending carefully with a seriousness not present in election manifestos, and balancing the case for more grip and accountability with avoiding the flurry of unachievable targets that has long blighted the English NHS. It is likely to require confronting difficult questions such as why Wales has a surprisingly low number of GPs and consultant doctors per capita compared to England and Scotland, given its high spending, and why plans to focus planned care on fewer sites have moved so slowly so far. 

Recovery from the pandemic has been slow, but it has clearly begun, in Wales, across the UK and in many other countries. The new government’s task will be to keep inching forwards so that by the date of the next election, in 2031, those glimmers of hope have started to grow.