Health
Crumbling NHS faces £1bn repairs bill in Wales
Senedd election promises collide with the harsh reality of ageing hospitals, fire safety concerns and a maintenance crisis stretching across the country
WALES’ NHS is facing a repair and maintenance crisis of almost £1bn, with some of the country’s biggest hospitals burdened by ageing buildings, serious safety concerns and growing pressure on already stretched budgets.
New figures covering 210 NHS sites show that the backlog of work classed as high risk or significant risk has now reached £917m — up 71% in just four years.
The data, published for 2024-25 by NHS Wales Shared Services Partnership, shows more than £616m of the total relates to serious problems at 12 of Wales’ 13 main hospitals.
Ysbyty Gwynedd has the biggest backlog of high and significant risk repairs at £110.5m, followed closely by University Hospital of Wales in Cardiff, where the figure stands at £106.8m.
The scale of the problem is not just financial. Three hospitals — Bronglais, Prince Philip and Ysbyty Gwynedd — have 40% or more of their space rated as not fire safety compliant. At Ysbyty Gwynedd, 35% of space is also not regarded as health and safety compliant.
Aging estate
The figures highlight the deep-rooted problem of an ageing NHS estate across Wales.
More than 30 NHS sites have buildings where over half the estate predates the creation of the NHS in 1948. Another 17 sites, including University Hospital of Wales and Bronglais Hospital, are mainly made up of buildings between 50 and 60 years old.
Only one major hospital in Wales — the Grange Hospital near Cwmbran — is said to have no maintenance backlog. But even that project, which cost £350m, was first proposed in 2004 and only opened during the Covid pandemic, showing how long major hospital developments can take.
When the wider risk-adjusted backlog is considered across all NHS buildings in Wales, focusing on problems where safety may be at risk, the total cost rises to more than £1bn.
The largest overall figure is in the Betsi Cadwaladr health board area, where the backlog stands at nearly £278m.
Despite the Grange being one of the newest hospitals in Wales, Aneurin Bevan health board still faces a backlog of almost £233m, much of it linked to older sites including the Royal Gwent and Nevill Hall hospitals.
In Hywel Dda, where hopes of a new west Wales hospital remain some way off, the total backlog has reached £221m. Among the worst affected sites is Glangwili Hospital in Carmarthen, where high and significant risk repairs and maintenance amount to £82m.
West Wales pressure
FOR west Wales, the figures are especially troubling.
Hywel Dda residents have already faced years of uncertainty over the future of hospital services, and the scale of the maintenance bill raises fresh questions about how long ageing buildings can continue to serve local communities safely and effectively.
Bronglais Hospital is among the sites with major fire safety compliance concerns, while Glangwili carries one of the largest repair backlogs in the region.
The growing cost of patching up older hospitals will inevitably intensify the political argument over whether ministers should prioritise maintaining existing buildings or push ahead with long-promised new developments.
The chair of Cardiff and Vale health board recently acknowledged that the age and condition of University Hospital of Wales was affecting morale and efficiency, describing the quality and upkeep of buildings as an ongoing concern.
Expert warning
Mark Dayan, a policy analyst at the Nuffield Trust, said Wales had a worryingly large maintenance backlog by any standard.
He warned that poor infrastructure could directly affect the way care is delivered, making it harder for the NHS to reorganise services, improve patient flow or create safe, modern working environments.
The issue is not unique to Wales. NHS England is facing its own enormous repair backlog, estimated at £16bn. But in Wales, where budgets are tighter and hospital plans often move slowly, the pressure is especially acute.
Election battleground
WITH the Senedd election set for Thursday, May 7, parties are offering different solutions to the growing crisis.
Labour has pledged a £4bn Hospitals of the Future fund, promising new hospitals including replacements for Wrexham Maelor Hospital and University Hospital of Wales, as well as a major development in west Wales.
Plaid Cymru says Labour’s sums do not add up, and argues urgent high-risk repairs should come first.
Reform UK says the Welsh Government should concentrate its capital budget on clearing the maintenance backlog rather than making promises on multiple new hospitals.
The Conservatives say they would declare a health emergency and expand capacity through new community hospitals, diagnostic centres and surgical hubs.
The Liberal Democrats say they would upgrade the worst parts of the NHS estate while backing a replacement for University Hospital of Wales, linking investment to wider reform of social care and community services.
The Green Party has called the backlog a disgrace and says it would launch a multi-year programme to bring NHS facilities up to a safe and modern standard.
Whatever the result in May, the next Welsh Government will inherit a stark reality: before it can deliver a new generation of hospitals, it must first confront the spiralling cost of keeping the current estate from falling further into decline.
Health
Have your say on new West Wales learning disability strategy
RESIDENTS across Ceredigion, Pembrokeshire and Carmarthenshire are being invited to help shape a new regional Learning Disability Strategy.
Views sought on five-year plan
The strategy, covering 2026 to 2031, will set out the future direction of services and support for neurodivergent people and people with a learning disability across west Wales.
Over the past two years, Ceredigion County Council, Pembrokeshire County Council, Carmarthenshire County Council and Hywel Dda University Health Board have been working with people with lived experience to help shape the proposals.
At present, each county has its own Learning Disability Strategy. The new plan would bring these together into one regional approach, aimed at making services more consistent and joined-up across the three counties.
The draft recommendations have been developed and reviewed by the Regional Improving Lives Partnership, which includes the three county councils, Hywel Dda University Health Board, The Dream Team, Carmarthenshire People First, Pembrokeshire People First, the West Wales Regional Partnership, and projects funded through the Regional Integration Fund.
Cllr Alun Williams, Ceredigion County Council Cabinet Member for Through Age Wellbeing, said: “We’re committed to ensuring that people with a learning disability and neurodivergent people are at the heart of shaping services that affect them.
“We encourage everyone to take part and share their views to help us develop a strategy that truly meets the needs of communities across West Wales.”
The consultation is open until Sunday, July 5.
Residents can complete the West Wales Learning Disability Strategy Survey online, or request a paper copy from a Ceredigion library or leisure centre. Paper copies can also be requested by calling 01437 764551 or emailing [email protected].
Completed questionnaires should be returned to Norman Industries, Units 1-2, Snowdrop Lane, Haverfordwest, Pembrokeshire, SA61 1JB.

Health
Withybush Emergency Department wins national award for green improvements
WITHYBUSH HOSPITAL’S Emergency Department has won national recognition for work to cut waste, reduce emissions and save money.
The department, based at Hywel Dda University Health Board’s Withybush Hospital in Haverfordwest, has been awarded Bronze accreditation by the Royal College of Emergency Medicine as part of its Green ED programme.
The scheme recognises emergency departments which introduce practical changes to reduce their environmental impact while maintaining safe patient care.
At Withybush, the work was led by a small team made up of consultant Dr Vicki Hughes, resident doctor Dr Lizzie Caisley, ED secretary Janet Bird, and ED clinical fellow Dr Oyewale Osundeyi.
Their changes included replacing plastic medicine pots with paper alternatives, reducing unnecessary cannulas, improving waste segregation, and reviewing computer screen brightness and older equipment to identify where energy savings could be made.
Dr Osundeyi led a project to increase recycling and reduce waste sent for incineration.
He said: “Trying to reduce waste comes with a lot of challenges, because you are trying to change people’s habits and trying to make sure people understand the importance, but we were lucky to get a lot of people involved from the estates team to the nursing departments who helped us achieve this.”
The department also targeted unnecessary coagulation testing in admission bloods, a project led by Dr Caisley.
The change is expected to save around £30,000 a year, as well as cutting carbon emissions.
Dr Caisley said: “By reviewing our routine practices, I was able to identify simple changes that benefit both patients and the environment. It shows how quality improvement work can deliver meaningful financial and environmental savings.”
ED secretary Janet Bird supported the work by gathering information, co-ordinating meetings and helping to put sustainability plans into action.
She said she also created a Green ED information board and presented the programme at resident doctor induction sessions to raise awareness of the changes already introduced.
Dr Hughes said: “A group of individuals, cutting across resident doctors, nurses, administrative staff, and myself as a senior consultant, all got involved in this work.
“There were many different elements to achieving this bronze award. The next step is making sure the team is supported to build on it.”
Withybush was one of eleven emergency departments across England and Wales recognised through the programme.
Together, those departments are estimated to have achieved £216,000 in cost savings and 131,502kg of CO2e savings through more sustainable working practices.
Dr Ian Higginson, President of the Royal College of Emergency Medicine, said: “On behalf of the College – a massive congratulations to the team at Withybush General Hospital who have been awarded a Bronze accreditation through our GreenED programme.
“This accomplishment has been driven by a dedicated, innovative team, who have reduced emissions, as well as waste and saved costs – all to tackle the climate crisis.
“A healthier planet means healthier patients, and we have a duty to act to protect both.
“As a College, we are proud to support Emergency Departments across the UK, and beyond, in playing their part to become more environmentally friendly.”
Health
NHS waiting lists falling — but west Wales faces fresh healthcare uncertainty
Improving treatment figures welcomed, but local concerns grow over pharmacy changes, service reorganisation and access to care
WAITING times across NHS Wales are continuing to improve, according to the latest national figures — but patients in west Wales may question whether those improvements are being felt on the ground as concerns continue over changing local services, pharmacy provision and healthcare access.

New figures released by the Welsh Government show there were just under 666,700 referral-to-treatment patient pathways waiting to start treatment in March — down by around 21,300 compared with February and the lowest level recorded since August 2021.
It marks the tenth consecutive month that waiting lists have fallen, while the proportion of pathways waiting less than 26 weeks rose to 65.9 per cent — the highest figure since May 2020.
The average waiting time for treatment also dropped to 15.5 weeks, the lowest level since April 2020.
However, despite the improving national picture, NHS leaders have warned that Wales remains under significant pressure and that progress must not mask wider challenges facing the health service.
Responding to the figures, the Welsh NHS Confederation said scheduled care was “going in the right direction” but cautioned that emergency pressures, social care pressures and financial constraints remain major concerns.
The organisation’s director, Darren Hughes, said NHS leaders were ready to work with the new Welsh Government as part of its first 100 days in office, but stressed that reforms would require difficult decisions and honest conversations with the public.
He said: “While it’s not a perfect picture across the board, with high demand on urgent and emergency care, scheduled care waits continue to go in the right direction.
“Now is the time to build on this progress and make further inroads into the backlog of care that has built up in recent years.”
But for many people in Pembrokeshire, Carmarthenshire and Ceredigion, improving national statistics may feel at odds with the reality of healthcare closer to home.
Recent changes affecting community pharmacy provision, alongside continuing concerns over access to services, travel distances and healthcare reorganisation within the Hywel Dda University Health Board area, have left some residents questioning whether NHS recovery is being experienced equally across Wales.
Community pharmacy provision has become an increasing concern locally following recent changes affecting some chemist services, raising fears over access to medication and frontline healthcare support — particularly in rural areas where alternatives may involve lengthy travel.
At the same time, debates around the future location of services, staffing shortages and the long-term sustainability of care in west Wales continue to generate concern among patients and campaigners.
For many residents, the NHS debate is no longer only about waiting times — but whether services remain accessible in the first place.
The figures also require some caution. NHS waiting-list totals are measured in “patient pathways” rather than individual patients, meaning one person can appear on the list more than once if waiting for multiple treatments or appointments.
The Welsh NHS Confederation warned that any future improvements would need a “whole-system approach”, involving primary care, community healthcare and social care, alongside action to reduce demand before patients require hospital treatment.
Mr Hughes added that NHS organisations also face tightening budgets and renewed inflationary pressures linked to global events.
He warned: “NHS leaders will need clarity from political leaders on a focused set of priorities and the backing to make the difficult decisions required to reform services, being honest with the public around timelines and expectations.”
Professor Jon Barry, Director in Wales at the Royal College of Surgeons of England (RCS England), said: “The new Welsh Government inherits a significant challenge, and these figures reflect the reality across Wales – long waits, repeated delays, and too many people left in pain.
“There were commitments during the election campaign to develop a clear plan for expanding elective capacity, including early work to establish new surgical hubs across Wales. The priority now is to start delivering on those plans without delay.
“More surgical hubs will help bring down long waits and ensure fewer patients are left dealing with uncertainty and disruption to their daily lives while they wait for treatment.”
The Herald has approached Hywel Dda University Health Board for comment on how improving national waiting-time figures compare with the experience of patients in west Wales, including concerns around pharmacy provision, service changes and access to local care.
The Welsh Government has also been asked what the new administration’s healthcare priorities will mean for communities in rural Wales over the coming months.
Welsh Government response
The Welsh Government said it had pledged to “pick up the pace” to ensure people across Wales are seen faster for NHS treatment.
Health and Care Minister Mabon ap Gwynfor said: “Too many people are waiting too long for NHS treatment. That is the reality and it is an issue we are determined to fix.
“It is people’s lives we are talking about – and my job is to make sure the Welsh Government works closely with the NHS to ensure people who need treatment get it much quicker.”
The new minister said improvements were needed not only in waiting lists, but also in ambulance response times and emergency department access.
The Welsh Government said it would commission an independent review of NHS performance in Wales within its first 100 days, with a particular focus on the impact of waiting lists on population health.
It also plans to set up an expert task group to develop plans for up to ten new elective care hubs across Wales, with a delivery plan due by the end of 2026.
Mr ap Gwynfor added: “Today’s figures are a starting point. We will be honest with the people of Wales about the progress we make, and we will rightly be judged on results. We intend to meet the scale of the challenge ahead.”
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