Betsi Cadwaladr health board cuts private sector spending to £14 million

Betsi Cadwaladr University Health Board has significantly reduced its expenditure on outsourcing NHS treatments to private sector facilities over the last three years. Data obtained through a Freedom of Information request indicates that the health board spent around £14 million in three years to pay for NHS treatments at private facilities.

The decline in spending is reflected in year-on-year figures. In 2022/23, the health board paid £8.48m for 5,656 treatments. This expenditure dropped to £4.50m for 3,132 treatments during 2023/24, and decreased further to just over £1m for 1,000 treatments in 2024/25. The health board maintains that these payments do not constitute funding for private patient care, but rather reflect contracts with private providers to deliver NHS activity. The health board stated:

"We do not pay for private treatment of patients – all payments made are for NHS treatment. However, we do contract with private providers to provide NHS activity."

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The reduction in outsourcing was not uniform across all clinical departments. Ophthalmology services accounted for the majority of the health board's private outsourcing efforts. In 2022/23, eye clinics (ophthalmology) handled 4,445 treatments costing £4.92m; this dropped to 1,699 procedures in 2023/24 at a cost of around £1.88m, dropping again to 1,000 procedures in 2024/25 at a cost of just over £1m.

Other departments saw more drastic shifts. Skin treatments, or dermatology, went from 565 treatments in 2022/23, costing £148K, to 1,183 the next year, costing £280,000, but dropped to zero in 2024/25. Orthopaedics (bone and joint procedures) cost £3.41m for 646 treatments in 2022/23 and £2.34m for 250 treatments the year after, but also stopped completely in 2024/25, with no patients sent to private clinics.

These figures are incomplete regarding the total scale of NHS patient movement. The health board stated it could not provide data on patients sent to England or other regions within Wales, noting that gathering such information would be prohibitively expensive. They explained:

"We would have to carry out a specific exercise to collate this data by conducting a manual case note trawl of over 33,000 inpatient admissions."

Context of Waiting List Management

The Welsh government has allocated £50m to health boards to facilitate increased access to tests, treatments, and outpatient appointments. The government has set a target of providing 16,000 additional treatments by the end of March 2025, with the expectation that private capacity will be utilized where necessary to achieve these ends.

Political responses to the use of private sector capacity are mixed. Sam Rowlands, the Conservative Senedd shadow health minister, expressed support for the involvement of the private sector, describing it as a necessary form of cross-sector collaboration. Conversely, Mabon ap Gwynfor, health spokesman for Plaid Cymru, voiced concerns regarding the financial implications of this model. He told Bbc Wales:

"Of course we welcome steps to tackle the waiting lists and understand that extra capacity is required to do this but, once again, like with agency staff money that should be going to treat patients will be going to shareholders."

Plaid Cymru has recently advocated for fundamental governance changes within the Welsh NHS, calling for the removal of political influence over decisions such as placing health boards into special measures. The party’s stance on the structure of the health system has evolved, with Mabon ap Gwynfor stating that he no longer supports the break-up of the Betsi Cadwaladr health board, acknowledging that the challenges faced by the organization are not unique.