You can read our full report, funded by @nuffieldfoundation.org, here: ifs.org.uk/publications...
This includes great analysis by my colleagues of public spending and school performance.
[10/10]
The Welsh NHS is clearly struggling. Despite some recent improvements, pre-planned waiting times are much higher than in 2019, and than in England. A&E waits are the longest in GB. Hospital activity has recovered well vs Scotland, in part as staffing has grown by more.
[9/10]
It’s also noticeable that the big surge in Welsh outpatient appointments hasn’t obviously improved elective waiting times relative to England and Wales. Perhaps similar to the gap we have seen in England between hospital activity and completed waiting list pathways?
[8/10]
Chart showing changes to staffing and hospital activity, April to September 2025 vs April to September 2019
But although hospital activity has increased, it has grown more slowly than staffing levels, which are 24% higher than in 2019. This suggests a fall in hospital labour productivity, as seen in England – although Wales lacks the detailed productivity estimates produced by NHSE.
[7/10]
Chart showing changes to hospital activity in Wales, England and Scotland
Welsh hospitals have increased outpatient appointments well above 2019 levels, but have only just got hospital admissions above pre-pandemic levels. Broadly, hospital activity recovery has been better than in Scotland but worse than in England.
[6/10]
Chart showing share of patients waiting less than four hours in major A&E departments in England, Wales and Scotland
A&E waiting times are also worse than pre-pandemic, and worse than in England and Scotland. Even more concerningly, and unlike elective waiting times, they are still getting worse – largely driven by deteriorating waiting times in North Welsh A&Es in 2025.
[5/10]
Chart showing share of patients waiting over a year from referral to elective treatment in Wales
Very long waits have also become much more common in Wales. 19% of patients were waiting longer than a year for treatment in December 2025, compared with 2% in December 2019. That’s despite Welsh government targets to eliminate most of these waits by spring 2025.
[4/10]
Chart showing median waiting time for elective treatment in Wales and England
But Welsh NHS services are in a relatively bad state. Waiting times for pre-planned hospital activity in Wales are far longer than pre-pandemic, and longer than comparable waiting times in England. This chart, for example, shows median waiting times across all specialties
[3/10]
Chart showing spending per person on health in Wales relative to England
Wales has long spent more per person on health than England, though the gap has fluctuated over time. In 2024–25, Wales spent 9% more per head than England, and 6% more per head than Scotland.
[2/10]
NEW: How is the Welsh NHS performing, and how does it compare to England and Scotland?
We have a new @theifs.bsky.social report out today looking at public service spending and performance in Wales, in advance of the Senedd elections.
🧵on the key Welsh NHS takeaways [1/10]
Read our full report, funded by @therobertsontrust.bsky.social and @nuffieldfoundation.org, here: ifs.org.uk/publications...
This includes great analysis by my colleagues of public spending, school performance and justice performance.
[10/10]
The NHS in Scotland is clearly struggling post pandemic. This is also true in England and Wales. But there are differences - A&E waits look better in Scotland (though still worse than pre-pandemic), but English and Welsh hospitals have recovered activity more quickly.
[9/10]
Chart showing changes to staffing and hospital activity, April to September 2025 vs April to September 2019
England and Wales have seen hospital activity recover faster, in part because they have increased staffing by more. But both countries also seem to have seen a fall in hospital labour productivity, like in Scotland.
[8/10]
Hospital activity in Scotland is lower than in 2019, despite a 14% increase in staffing and higher funding. This suggests a fall in hospital labour productivity. Productivity is complex, though, and Scotland lacks detailed NHS productivity estimates, unlike England.
[7/10]
Chart showing changes to hospital activity
Strikingly, hospital activity in Scotland remains below pre-pandemic levels. That’s not the case in either England or Wales, and the Scottish govt has repeatedly set targets to increase hospital activity. (Note this isn't all the NHS does though)
[6/10]
Chart showing share of patients waiting less than four hours to be admitted, transferred or discharged in major A&E departments
A&E waits in Scotland are much worse than pre-pandemic, but remain shorter than in either England or Wales.
[5/10]
Chart showing share of patients waiting over a year from referral for elective treatment in Scotland
Turning to the NHS, waiting times have worsened dramatically since the start of the pandemic. A much larger share of patients wait longer than a year for elective activity, for example, despite Scottish government plans to eliminate most of these waits by 2023 and 2024.
[4/10]
Chart showing the relationship between life expectancy and median income in parliamentary constituencies in England, Scotland and Wales, 2023
Scotland has long had worse life expectancy than England or Wales – the gap in life expectancy at birth between England and Scotland was ~2 years in 2023. In areas with similar average incomes, life expectancies are similar in England and Wales, but lower in Scotland.
[3/10]
Chart showing the difference between real-terms health spending per person in Scotland and England
Scotland has long spent more per person on health than England. But that gap has narrowed a lot over time, as health spending has grown faster in England. In 2024–25, Scotland spent just 2% more per head, compared with 11% more in 2010–11. Wales now spends the most in GB.
[2/10]
How is the Scottish NHS performing, and how does it compare to England and Wales?
On Saturday we published a new @theifs.bsky.social report looking at public service spending and performance in Scotland, in advance of the devolved elections.
🧵on the key Scottish NHS takeaways [1/10]
The Spring Forecast confirmed that the Spending Review next year looks tough. Plans are currently for departmental spending to grow by just 0.9% per year on average in real terms in the next Spending Review period, much slower than planned for the first part of the parliament.
The government plans to reduce government borrowing by 2.5% of GDP over the next four years – a sizeable fiscal consolidation.
The question is now one of delivery. And past experience clearly shows that promising lower borrowing is easier than delivering lower borrowing.
We at @theifs.bsky.social will be presenting our overnight analysis of the Spring Forecast from 10:30am. @nickridpath.bsky.social and I will present on the government's plans, the risks to their delivery and the broader UK fiscal position. You can watch online here: ifs.org.uk/events/sprin...
The OBR’s current budget forecast has barely changed, with borrowing still set to fall over the next few years.
Past governments have often set out plans for a current budget surplus, but it’s very rare that they’ve achieved it. That will be the key challenge going forward.
Here it is, my magnum opus: an analysis of what’s wrong with the UK’s approach to fiscal policy (under this and previous governments), and a proposal for what an alternative to pass-fail fiscal rules could look like.
I’ll follow up with a longer thread later.
Very pleased that our paper examining how doctors respond to changes to their pensions is now published in the Journal of Health Economics. We find that consultants in the English NHS responded to changes in their pensions similarly to how existing evidence suggests they may respond to pay.
There is an increasing sense that the UK's approach towards fiscal policymaking, and in particular the excessive focus on "headroom", isn't delivering good outcomes.
Come along on 19 February to hear me make the case for how we could do things differently, and to hear from our terrific panel.
The @lowpaycommission.bsky.social annual report is out. As always contains lots of insights. This is key chart for me: 20% of jobs are now paid within £1 of the minimum wage, up from 14% in 2015. Whatever you think of the minimum wage, its increasingly important!
NEW PODCAST: Why isn't the NHS improving faster?
@helenmiller.bsky.social, @maxwarner.bsky.social and Olly Harvey-Rich examine the latest data on NHS performance, progress on waiting lists and the big challenges around staffing, winter and flu cases.
🎧 Listen here: ifs.org.uk/articles/why...
DHSC published its impact statement for the 10 Year Health Plan this week (yes, that is 6 months after it published the plan)
It's more measured and clear-eyed than the original document and quite a contrast to some of the effusive optimism in the plan
Some of the things that caught my eye 👇
