Health Systems in Transition

Wales is situated to the west of England, with a population of approximately 3 million (5% of the total for the United Kingdom), and a land mass of just over 20 000 km. For several decades, Wales had a health system largely administered through the United Kingdom Government's Welsh Office, but responsibility for most aspects of health policy was devolved to Wales in a process beginning in 1999. Since then, differences between the policy approach and framework in England and Wales have widened. The internal market introduced in the United Kingdom National Health Service (NHS) has been abandoned in Wales, and seven local health boards (LHBs; supported by three specialist NHS trusts) now plan and provide all health services for their resident populations. Wales currently has more than 120 hospitals as part of an overall estate valued at £2.3 billion. Total spending on health services increased in the first decade of the 21st century, but Wales now faces a period of financial retrenchment greater than in other parts of the United Kingdom as a result of the Welsh Government's decision not to afford the same degree of protection to health spending as that granted elsewhere. The health system in Wales continues to face some structural weaknesses that have proved resistant to reform for some time. However, there has been substantial improvement in service quality and outcomes since the end of the 1990s, in large part facilitated by substantial real growth in health spending. Life expectancy has continued to increase, but health inequalities have proved stubbornly resistant to improvement.