A delicate balance? health and social care spending in Wales

Wales pursued a more balanced approach to NHS and social care spending than England over the period 2009-10 to 2015-16, but, even so, spending through local authorities on social care for the over 65s is not keeping pace with the growth in the population of older people. Spending may need to have increased by at least £129 million (23%) between 2015-16 and 2020-21 to get back to the equivalent spend per-head in 2009-10, which amounts to a 2.5% year-on-year increase. Wales made a distinctive set of choices over its spending on health and social care over the period 2009-10 to 2015-16 in responding to complex challenges. Budgets were squeezed and UK Government austerity measures led to an 8.2% reduction in the funds available for day-to-day spending in Wales. Demand pressures grew, with Wales having proportionately the largest and fastest growing over-65 population across the UK countries and, linked with an ageing population, the highest burden of people with chronic and complex health conditions. An effective interface between health and social care has been seen as crucial in responding to these challenges. Budgets for England have concentrated on increasing health spending while local government spending on social care has declined, whereas Wales pursued a more balanced approach. By health, we mean the total spending on NHS services, medical research, public health and broader health services. We also look at NHS Wales’s delivery in more detail, and refer to that as appropriate.