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Welsh public want NHS, cost of living and infrastructure prioritised

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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.”

 

Health

Have your say on new West Wales learning disability strategy

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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.

 

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Health

Withybush Emergency Department wins national award for green improvements

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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.”

 

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Health

NHS waiting lists falling — but west Wales faces fresh healthcare uncertainty

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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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