The Welsh NHS has a poor reputation, and despite higher per capita spending has longer waiting lists, longer waiting times in A&E departments and lower overall patient satisfaction than in other parts of the UK

Access to primary care services is patchy in many parts of Wales, especially rural areas, with people having to travel long distances or wait a long time to see a GP or a dentist. Medical staff face high levels of stress and sometimes burnout, which contributes to difficulties with recruitment and retention

There is a stubborn public perception that the NHS is ‘underfunded’, even though total spending since 1948 has increased by a factor of 10 in real terms and doubled as percentage of GDP, and no government from any party has ever cut funding during its term

In our view, much of the strain on Welsh health services arises from poor matching between primary care (GP and dental surgeries), secondary care (district hospitals and specialist centres) and ‘after care’ (provision for patients who no longer need acute hospital treatment but cannot yet look after themselves.

Many people have difficulty accessing primary care – particularly in rural areas – which results in greater pressure being placed in secondary services. This may happen because patients see no other choice than to go straight to A&E departments to receive care, or because in the absence of treatment their conditions deteriorate to the point where this becomes unavoidable. Likewise, lack of adequate after-care provision puts pressure on hospitals from the other direction, taking up beds which could otherwise be used to treat patients with more acute needs.

Our first priority will be to enhance primary care provision and so reduce the pressure on secondary care, particularly upon A&E departments, and to reduce waiting times.

This will require more primary care practitioners to be made available, since this is itself a major issue. Many GPs and dentists are individually self-employed and work under contract for the NHS, at payment rates (particularly for dentists) that make it impossible to make a living from NHS work alone. At the time of writing our manifesto (late 2024), the Welsh Government has recently announced proposals to change the contract basis for dentists, replacing the previous system which dates from the Blair era. Reaction from dentists has been negative, with 72% (in a poll conducted by the British Dental Association3 ) saying that the changes would make it less likely that they’d be willing to carry out NHS work.

We would therefore look for different business models, such as salaried services (which have been found to work well in rural counties of England) or making contracts with whole clinics operating as businesses or co-operatives, rather than individual practitioners. However, we would require that these be locally owned and run, and resist the intrusion of large corporates into this sphere.

We would promote the combining smaller GP clinics into ‘Polyclinics’ which are able to provide a wider range of services locally, including some outpatient services, similar to former ‘cottage hospitals’. In particular, these clinics could provide Minor Injury Units which could absorb much of the burden currently falling on hospital A&E departments and provide faster, more local care. Such clinics should be sited in easily accessible locations, such as town centres or near public transport hubs. Larger clinics could even provide short term convalescent care, freeing up acute hospital beds while patients prepare to go home.

For specialist acute care and elective surgery, services are best provided by larger institutions ; but we recognise that this presents particular challenges in a country with as scattered a population and such poor transport infrastructure as Wales currently has. We therefore regard investment in transport infrastructure as a high priority, not only because of its direct benefit to the economy as a whole but because of the extent to which it would facilitate more efficient healthcare provision across the country.

Nevertheless we recognise that for some very specialist fields of medicine, Wales’s population is simply too small to sustain world -class centres of excellence and we shall continue to use specialist facilities over the border (e.g. orthopaedics at Gobowen, neurology at Walton, paediatrics at Alder Hey, oncology at Clatterbridge, ophthalmology at Bristol Eye Hospital etc.) where this is the best way to provide appropriate care to Welsh patients.

We shall ensure that Wales trains enough medical and nursing staff to meet its own requirements without relying on medical staff brought in from outside. Nevertheless, recognising that a thorough medical education may need exposure to specialisms only found in larger centres of population, we would want to see continued collaboration with medical schools in England and elsewhere.

Even so, we accept that recruitment and retention of professional staff is a serious problem in many parts of Wales. To some extent this is a symptom of the country’s relative poverty, with qualified people gravitating towards population centres where there are better amenities and a higher perceived quality of life. In some cases this may require that higher salaries be offered for roles in particularly challenging areas.

We are not opposed to and will not discourage the provision of private healthcare over and above the services provided by the NHS; individuals should be free to obtain medical procedures privately, for example via private health insurance. Private-sector hospitals should be allowed to operate freely, subject to appropriate regulation and liability insurance as is already the case across the UK.

We’d encourage a pragmatic relationship between the public and private healthcare sectors where the NHS is able to use private hospitals’ facilities to provide extra capacity when needed at busy times, and private practitioners are able to hire NHS facilities at appropriate commercial rates when excess capacity is available