OECD report: How does health in Wales compare with UK?

Hospital bed Image copyright Thinkstock

A major international review has looked into how the health service is operating in Wales - alongside the NHS in England, Scotland and Northern Ireland.

The Organisation for Economic Cooperation and Development (OECD) found that NHS Wales appears to be performing no better or worse than the rest of the UK.

But how does Wales sit alongside the other nations in what it does and the challenges it faces?


Wales spends 48% of its budget on health and social care - set to be £7.1bn over the next year (2016/17).

The issue of how much Wales spends on health compared to England - and how the NHS is performing in the two nations - has been a political hot potato.

The OECD says following the 2008 financial crisis and budget squeezes, Wales decided to balance spending cuts more evenly between health and social care - whereas in England, social services have borne the brunt.

It pulls out these three figures to illustrate this:

  • Between 2010/11 and 2012/13, health spending fell by 1% a year in Wales while it grew by 1% in England and Scotland.
  • The Institute of Fiscal Studies estimates that health spending in England increased by 4.3%, but social services spending fell by 11.5%; in Wales, health spending fell by 2% but social services spending fell by only 0.8%.
  • The Nuffield Trust estimates that England and Wales spent £2,022-£2,020 per head on health care, with spending 6-7% higher in Northern Ireland (£2,151 per head) and Scotland (£2,181 per head, at 2014/15 prices)

But Mark Pearson, head of the health division at the OECD, said: "Let's get something very clear - it's not to do with money. It's not that you spend more money and get better quality of care.

"Poor quality care costs you - if you mess up your operation it will cost you a lot more to put right. It's not to do with the amount of resources in the system but to get the people on the ground to actually do the things the fantastic policies want them to do.

"That's not really happening across the four nations of the UK but for different reasons in each country."


It's not straightforward comparing like with like; that's the first point.

There are a "surprisingly limited" number of indicators to compare patients in the different UK nations.

Based on the available information, "no one health system appears to consistently outperform the others," says the OECD.

It goes on to look at some specifics:

  • Wales is very similar to rest of UK in uptake of breast cancer screening (70%) for example.
  • But Wales was the lowest (68% in 2013) for the elderly getting flu vaccines, compared to 76% in Scotland and Northern Ireland and 75% in England.
  • Looking at MRSA mortality rates per one million of the population, the rates for men in England fell from a peak of 27 in 2006 to 3.7 in 2012; in Wales, from a peak of 28 in 2005 to 7.6. In Northern Ireland, it peaked at 43 in 2008 and fell to 9.7 in 2012. No data is available for Scotland.
  • A 2013-14, a national survey found that 92% of people in Wales were satisfied with their GP and 91% with their local hospital.
  • Wales falls in between England and Scotland for life expectancy. England has the highest for men (78.9 years in 2011) and females (82.9) and Scotland has the lowest life expectancy (76.1 and 80.6).
  • There is praise for the "fantastic" 1,000 Lives initiative which looks at doing the basics well to save lives, also using teams of cancer specialists to visit other hospitals to improve care.

The OECD suggests concerns over comparing Wales with England could be overcome if Wales was compared with a region like the north east of England instead.

This chimes in with the Nuffield Trust's research for BBC Wales last year, which looked to compare Wales with that region.


Image caption This shows how the proportion of over 75s in Wales is expected to rise
Image copyright ONS
Image caption Looking at it another way - this shows the projected ageing population over more than a century

AGEING: The UK's population is getting older - and the over 65s will make up a quarter of it by 2050. The issue is even more pronounced in Wales. More than a third of the population of Wales is expected to be over the age of 60 by 2055 and by 2069, those aged over 75 will be the biggest proportion of all age groups.

Our mid-2014 estimated median age is 42.1 years, compared to 38 years in Northern Ireland.

CHRONIC CONDITIONS: With people living longer, this means more people with chronic and complicated conditions to treat.

The burden is increasing in the UK - including diabetes and kidney disease - but is even higher in Wales.

ECONOMIC DISADVANTAGES AND HEALTH NEEDS: The OECD recognises that Wales is the most economically deprived of the UK nations and that this lower income per head has "likely impacts" on health and wellbeing, and demand for NHS services.

Drinking, smoking and obesity are well publicised issues and relative health needs are higher in Wales than in all nations apart from Northern Ireland.

The OECD looked at National Audit Office estimates of health need in the different nations and health boards and primary care trusts within them.

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