Six of Wales’ seven health boards failed to balance their books as funding fell in real terms

NHS WALES recorded an annual deficit of £199 million last year, despite receiving what Audit Wales described as record investment in the health service.

The watchdog’s audit of NHS bodies’ accounts for 2025-26 found that six of Wales’ seven health boards again failed to meet their legal duty to break even over a rolling three-year period.

The combined three-year deficit across NHS Wales increased to £506 million, up from £457 million the previous year.

NHS Wales received £11.76 billion in revenue funding during 2025-26, an increase of £198 million compared with 2024-25 and around £2 billion more than it received in 2021-22.

However, once inflation was taken into account, funding was 1.5% lower in real terms than in the previous financial year.

Audit Wales said increasing demand, rising pay and other day-to-day costs meant financial pressures were not being brought under control.

The annual deficit was £75 million higher than the £124 million shortfall recorded in 2024-25.

The accounts of all 12 NHS bodies were found to present their financial positions fairly. However, the Auditor General qualified his regularity opinion for the six health boards that failed to break even because they had exceeded their legal authority to spend.

Cwm Taf Morgannwg University Health Board was the only health board to meet its three-year break-even duty.

However, the Auditor General issued a separate qualified regularity opinion for the health board because one senior officer had been paid above remuneration levels set by the Welsh Government.

All three NHS trusts met their three-year break-even duty.

The two special health authorities, Health Education and Improvement Wales and Digital Health and Care Wales, are required to break even annually and both did so.

Agency spending falls sharply

Audit Wales highlighted a significant reduction in spending on agency staff.

Agency expenditure fell to £128 million in 2025-26, representing a 61% reduction compared with its peak in 2022-23.

Around 73% of agency spending was used to cover staff vacancies, while approximately 15% supported additional activity aimed at meeting demand for services.

NHS bodies reported making £256 million in savings during the year, just £3 million more than in 2024-25.

However, Audit Wales warned that recurring savings had fallen and had been outweighed by increased reliance on one-off measures.

One-off savings can include delaying projects or expenditure, while recurring savings result from permanent changes such as more efficient working practices or securing goods and services at lower prices.

The watchdog said the NHS remained too dependent on savings that could not be repeated in future years.

It warned that the current savings profile was not enough to stem the tide of rising demand and other cost pressures, including staff pay.

Most health boards unable to produce balanced plans

Health boards and NHS trusts are also required to prepare Welsh Government-approved three-year plans setting out how they will deliver services within the funding available.

Only one health board, Cwm Taf Morgannwg, had its plan approved, doing so for the second consecutive year.

All three NHS trusts also secured approval for their plans.

Audit Wales said the inability of most health boards to produce financially balanced plans meant the overall NHS deficit was unlikely to improve in the near future.

It warned that continuing financial pressure could push NHS organisations towards short-term decisions aimed at managing the immediate annual position rather than delivering longer-term reform.

The watchdog called for greater emphasis on prevention, whole-system change and long-term planning to safeguard the financial future of the health service.

Auditor General Adrian Crompton said the accounts showed financial pressure within the NHS was continuing despite repeated increases in cash funding.

He said: “The picture painted by those accounts is of financial pressure on the NHS that is not being contained, let alone reversed.

“That has been a persistent pattern during my eight-year term, compounded by the effects of the COVID-19 pandemic and rising demand.

“As I have pointed out previously, this is despite the Senedd passing the NHS Finance (Wales) Act 2014, more than a decade ago, to set the financial and planning duties that NHS bodies are expected to meet.

“Turning the tide on NHS spending will not be easy, but turn it must.

“For the NHS, as for public services in general, a much sharper and relentless focus on the delivery of value for money is needed, alongside a mindset shift to one focused on prevention and the longer term.”

Audit Wales has also published an updated NHS Wales Finances Data Tool containing further details about the financial performance of individual NHS organisations.

THE FIRST Minister has been challenged to provide a clear date for when two-year NHS waiting lists will be eliminated in Wales.

During the final Senedd plenary session before the eight-week summer recess, opposition leader Dan Thomas accused Rhun ap Iorwerth of failing to “do the detail” on health, transport, and childcare.

Reform’s Mr Thomas questioned why different cabinet ministers had provided conflicting timescales for tackling the backlog.

He said: “During the election campaign, the First Minister said that two-year waits would be eradicated within a matter of months, and then his new health minister said that they would be eradicated by the end of the four-year term. I then asked the First Minister who was right, and in a very long-winded answer, he said that he was.

“But then, just a couple of weeks ago, his finance minister, on BBC Walescast, said that two-year waits would be gone in 12 months – so, in other words, a year. Now, a year is a lot longer than a matter of months.

“So, can the First Minister finally give us some more detail: by which month will two-year waits be finally eradicated in Wales, as they are in England?”

Mr ap Iorwerth dismissed the row over the timeline as a “philosophical debate” and insisted his administration was actively delivering results.

He said: “The actions that government is taking are aligned with bringing down those two-year waits as quickly as we can. We want to do it in months.

“That is precisely what we set out to do before coming in to government, and what we are actively delivering now in government.”

Mr Thomas also pressed the Mr ap Iorwerth on the cost of Plaid Cymru’s flagship childcare policy – and accused the First Minister of failing to “do the detail”.

“We know this figure is somewhere in Plaid Cymru HQ,” said Mr Thomas. “What are the initial costings of Plaid Cymru’s childcare offer?”

Mr ap Iorwerth clarified that £55 million had been allocated in the supplementary budget to fund the first phase of the rollout, which will complete the 12.5 hours offer for two-year-olds within this financial year.

“Now, that is what is being done. I literally cannot give you more detail than that. It’s the money, it’s the timescale, and it’s going to be done within this financial year.”

Delays averaged 17 a day as MS demands targets, hospital-level figures and a timetable for improvement

MORE than 500 ambulance handovers at hospitals run by Hywel Dda University Health Board took longer than an hour during a single month, newly disclosed figures have revealed.

A total of 528 handovers exceeded 60 minutes in October 2025, equivalent to an average of around 17 lengthy delays every day.

Each delayed handover can leave a patient waiting in an ambulance outside hospital while the crew remains unavailable to respond to another emergency.

Even using one hour as the minimum, the 528 incidents represent more than 528 ambulance-hours spent on lengthy hospital handovers. The true figure will have been higher because every handover included in the total exceeded the hour mark.

However, the information released does not show which hospitals recorded the most delays, how long the worst handover lasted or how many ambulance hours were lost beyond the normal handover period.

It also provides no indication of whether performance improved or deteriorated in the months following October.

Claire Archibald, Reform UK Member of the Senedd for Ceredigion Penfro, obtained the figure after submitting a written question to the Welsh Government.

She has challenged ministers to publish a measurable recovery plan for West Wales, including targets for reducing delays and regular health-board-level performance figures.

The disclosure comes against a backdrop of sustained pressure throughout the Welsh emergency care system.

Official figures show that almost 96,800 people attended emergency departments across Wales in October 2025. Only 66 per cent were admitted, transferred or discharged within four hours, against a national target of 95 per cent.

A further 10,499 patients spent 12 hours or more in emergency departments during the month, an increase of 414 compared with September.

Problems moving patients out of hospital were also evident. On the day discharge data was collected in October, nearly 1,500 patients who were medically ready to leave hospital were still waiting for care, support or suitable accommodation.

Those patients had accumulated more than 64,100 days of delayed hospital stays between them.

Delayed discharges reduce the number of available hospital beds. This can leave patients waiting in emergency departments for admission and, in turn, prevent ambulance crews from handing over new arrivals promptly.

The latest Welsh Government figures suggest that pressure has continued well beyond October.

In May 2026, 11,066 people waited 12 hours or more in Welsh emergency departments, while only 64.4 per cent were admitted, transferred or discharged within four hours.

There were also more than 1,300 recorded delayed discharges, involving almost 57,200 accumulated days of delay.

The median response to the most serious red-category ambulance emergencies was nine minutes and 12 seconds, outside the target range of six to eight minutes.

Ms Archibald said: “More than 500 ambulance handovers taking over an hour in a single month is deeply concerning.

“Behind every one of those figures is a patient waiting for care and an ambulance crew unable to respond to another emergency.

“The Welsh Government’s response contains many of the same general assurances we have heard before, but it does not provide a deadline, a measurable target or explain what specific action is being taken within Hywel Dda.

“Ambulance crews and hospital staff are working incredibly hard, but they are being let down by a system that is struggling to move patients safely through hospitals and back into the community.”

In its written response, the Welsh Government said it was working with Hywel Dda University Health Board, the Welsh Ambulance Service and other partners to improve patient flow, timely discharge and same-day emergency care.

Ms Archibald said the answer did not include a reduction target, timetable or detailed health-board-specific action plan.

She added: “People across Pembrokeshire and Ceredigion need to know when these delays will be reduced and how progress will be measured.

“I will continue pressing the Welsh Government for a clear and accountable plan to ensure patients receive urgent care when they need it.”

The figures leave a number of important questions unanswered, including how the 528 delayed handovers were divided between individual hospitals, the longest time any patient waited, the total operational hours lost and whether any patient-harm incidents were associated with the delays.

Ms Archibald has called for monthly handover figures to be published for each health board, alongside clear targets showing when ministers expect the number of hour-long delays to fall.