Report highlights top concerns and calls for long-term vision

THE WELSH public want the government to prioritise improvements to the NHS, tackle the cost of living, and invest in infrastructure, according to Deloitte’s latest State of the State report.

The 2025 report, published in partnership with the independent think tank Reform, reflects the views of both public sector leaders and the people who use public services.

For the third consecutive year, the state of the NHS and the cost of living were the most pressing concerns for people in Wales, with both issues cited by 75% of those surveyed. Social care for the elderly and vulnerable adults followed, mentioned by 48%.

Jobs and the economy (47%) and affordable housing (43%) were also high on the public’s list of priorities. One of the most notable increases was in concern about infrastructure—roads, railways and broadband—with 42% calling for improvements, a rise of six percentage points on last year.

When asked about the biggest drivers of future growth, respondents in Wales chose improving the nation’s health (45%), boosting education and skills (44%), and increased investment in infrastructure (39%).

Despite these priorities, most people were pessimistic about the outlook. Some 75% expected the NHS to stay the same or get worse, while 74% said the same about infrastructure.

Council chief executives interviewed for the report stressed that government infrastructure spending would be key to future growth. Other public sector leaders highlighted progress in Welsh transport, crediting a clear vision and strong partnership working for recent successes.

The biggest challenge facing public services, according to respondents, was a lack of funding, with 66% citing it as a concern. A further 55% expressed fears about a loss of trust in public services.

While trust in the Welsh Government remains higher than in the UK, Scottish or Northern Irish governments, the public remain sceptical about delivery. Some 63% said they had low trust in its ability to deliver major projects on time and on budget, while 61% doubted it could deliver outcomes people want.

On the question of taxation, Welsh public opinion was divided. Some 31% supported higher taxes and public spending, while 37% preferred lower taxes and reduced spending. Nearly half (47%) said they expected higher taxes and spending regardless of their preference.

Deloitte’s interviews with senior public sector leaders revealed ambitious long-term goals, including frictionless digital interaction with government services, improved collaboration between agencies, place-based planning for integrated transport and healthcare, and a shift toward long-term, commercially aware decision-making.

Dave Tansley, Deloitte’s senior partner for the South West and Wales, said: “The State of the State 2025 report shows the Welsh public remain concerned about the cost of living and the NHS. But our survey also found heightened interest in infrastructure, more so than in other parts of the UK, suggesting the public recognises the importance of connectivity to economic growth.”

He added: “Infrastructure investment supports jobs, housing, roads and rail—but more importantly, it provides the platform for long-term economic resilience. With public finances under pressure and the 2026 Senedd election approaching, the next administration faces difficult choices and the chance to deliver transformational change.”

Ian Howse, Deloitte’s senior partner for Wales, said: “Public sector leaders want bold reform—services that are joined-up, citizen-focused and tech-driven. While the Welsh Government is addressing immediate pressures, our research points to the need for a long-term vision. Leaders report growing urgency to deliver ahead of the next election, especially on economic growth, which is a positive sign for the future.”

Woman from Pembrokeshire in campaign to raise awareness

A NEW campaign has been launched to reverse a worrying decline in family consent rates for organ donation in Wales—now the lowest in the UK.

Just five years ago, Wales had the highest consent rate in Britain. Today, it lags behind all other UK nations, with a 56% consent rate—down from 77% in 2018/19—despite having pioneered a “presumed consent” law in 2015.

Under that system, unless individuals opt out via the NHS Organ Donor Register, they are presumed to have agreed to donate their organs after death. But transplant specialists say the law may have had an unintended consequence: fewer families are talking about donation.

“Many people think presumed consent means everything is sorted, so they don’t have the conversation,” said Bethan Moss, a specialist nurse in Wales. “But families are always asked to confirm, and if they’re unsure, they often say no.”

The new campaign—The Best Thing You’ll Do Today—encourages people to both sign the register and speak with their loved ones.

“It’s about peace of mind,” Moss added. “If families know what their relative wanted, they’re far more likely to agree.”

More than 1.3 million people in Wales have declared their willingness to donate organs since the register began in 1994. Over 10,000 patients in Wales have received life-saving transplants. But the lack of conversation is proving deadly.

Across the UK, consent rates are falling, but the drop in Wales is steepest. Current family consent rates are 60% in England, 61% in Scotland, and 66% in Northern Ireland.

“Talking is key,” said Joanna Chalker, a senior nurse with NHS Blood and Transplant who has worked in Wales for 16 years. “When someone has signed the register or told their family, the consent rate jumps to 90%. That can mean the difference between life and death.”

One of those lives saved was 35-year-old Pembrokeshire mum Jessica (pictured), who was diagnosed with Primary Biliary Cholangitis—a rare liver condition—in 2016. After two false alarms, she finally received a successful transplant in 2022.

“I’d always been healthy, so the diagnosis was a shock,” she said. “But I was ready. Now I’m walking the kids to school again and loving life. Organ donation gave me everything back.”

Every day in the UK, someone dies waiting for a transplant. Right now, around 8,000 people—including over 200 children—are on the waiting list. A single donor can help up to nine people.

To register your decision or find out more, visit:
www.organdonation.nhs.uk/register-your-decision

THE WELSH GOVERNMENT is set to roll out its revamped Baby Bundle programme aimed at easing the financial burden on expectant families, particularly in some of the country’s most deprived areas. The initiative, which remains a cornerstone of the Programme for Government, was detailed by Dawn Bowden MS, Minister for Children and Social Care, in a recent statement.

Under the new scheme, £2.5 million has been earmarked for the 2025–26 financial year. Families living within core Flying Start areas will receive a Baby Bundle designed to provide essential items such as a warm blanket, clothing, and crucial information about local support services. The bundles are intended to help reduce everyday costs for families and are aligned with the Government’s broader Child Poverty Strategy.

In addition to the primary distribution, health practitioners will be able to offer Baby Bundles through Flying Start Outreach to a limited number of families outside these designated areas who are in need of extra support. The programme’s targeted approach is expected to make a tangible difference by alleviating some of the financial pressures faced by those living in economically challenged communities.

The tender specification for the procurement of the Baby Bundle programme is scheduled to go live later this week. The procurement process will run until mid-May 2025, with officials set to assess bids and aim for a contract award by the end of June. Once the process is successfully completed, the registration for receiving the Baby Bundle is anticipated to commence by the end of November.

The Government is also working closely with midwives and other health professionals to finalise the registration process, ensuring a smooth rollout. As part of its wider efforts to boost the uptake of Welsh Benefits, the Baby Bundle initiative will feature prominently in campaigns designed to raise awareness among families about the available support.

This proactive step underscores the Welsh Government’s commitment to not only meeting immediate needs but also to fostering long-term improvements in family welfare across the region. Further updates on the programme’s progress are expected in the coming months.