A&E performance: England v Wales

"The latest annual data on 12-hour waits in A&E show that 3.4% of patients waited more than 12 hours in Wales compared with 1.3% in England. If he wants to talk about meeting targets, he should talk to the Labour Government in Wales."

Theresa May, 14 March 2018

It’s correct that 3.4% of Welsh A&E patients spent more than 12 hours in A&E in 2016/17. That compares to 1.3% for England.

Asking who is responsible for that is a complex question. The Labour-run Welsh government is responsible for the day-to-day management of the NHS in Wales, and decides how to allocate the funds it has between the NHS and other public services.

But most of the overall amount of funding it has available comes from the Conservative-run UK government, which allocates a grant to Wales according to a formula.

Some experts have argued this formula has historically underfunded the Welsh NHS, because it doesn’t reflect the specific needs of people in Wales. More recent figures suggest this may no longer be as significant an issue though.

Similar comparisons have been made before

This is not the first time claims have been made about comparative Welsh and English A&E waiting times. In January, the Prime Minister inaccurately reported a much bigger disparity between the two countries, using figures that weren’t comparable. After the UK Statistics Authority stepped in, the Prime Minister issued a clarification to parliament, using the figures we’re checking today.

Those new figures are comparable. 3.4% of Welsh A&E patients spent more than 12 hours in A&E in 2016/17. That compares to 1.3% for England.

Who is responsible for A&E waiting times in Wales?

The Welsh government runs the day-to-day management of NHS Wales and determines how much funding different health services get.

But the overall budget from which the Welsh government allocates is determined by the block grant it receives from the UK government, which is set by something called the Barnett Formula.

The idea behind the Barnett Formula is that, if government funding of the overall services covered by the Formula changes in England, it should increase or decrease by the same proportion per person in Wales, Scotland, and Northern Ireland. So if education spending were to be raised by £100 per person by the UK government, Wales’ block grant would increase by £100 per person.

The Formula also factors in if some aspects of spending on a service are already devolved. This is known as the comparability percentage, and in the case of health spending Wales’ block grant would increase by 99.4% per person rather than 100%.

However, the devolved administrations don’t have to spend their block grant in the same way as the UK government does—an extra £100 per person generated by an increase in UK health spending wouldn’t have to be spent on health in Wales.

So UK government spending decisions and the Barnett Formula determine the Welsh government’s overall budget. The Welsh government decides how much of this budget to allocate to health, and can set strategies to try and improve NHS performance.

How much funding does the NHS in Wales get?

Health spending per person is slightly higher in Wales (£2,233 per person) than in England (£2,169 per person), based on the latest figures for 2016/17.

But the Nuffield Trust points out that, rather than just thinking about population share, funding needs will be affected by regional factors like age, public health, poverty, and how rural somewhere is.

The English and Scottish NHS each have their own internal formula, which tries to account for these more complex needs (such as age and socioeconomic deprivation) in allocating funding to different regions. In 2013, The University of Stirling applied this formula to overall healthcare spending needs in the UK.

It found that the Welsh NHS required a level of funding 9-10% higher than England’s in order to meet its specific healthcare needs. In 2016/17, Welsh healthcare spending per person was 3% higher than England’s.

Is Wales underfunded overall?

An independent Commission on funding for Wales also argued in 2010 that a needs-based formula should be applied to the funding of Welsh services. At the time it said that the Barnett Formula underfunded overall Welsh public spending by £300 million per year.

Yet in late 2016 the economist who led the Commission’s review said Wales was no longer “significantly” underfunded by the Formula.