Welsh NHS and schools underperforming, says think tank

Wales' health and education systems are underperforming compared with England despite significant increases in spending, according to a major think-tank.

A report from the Institute for Fiscal Studies (IFS) said that despite recent falls waiting lists remain far higher than before Covid struck, and school absences remain 50% higher than in 2019.

But it said that funding plans of funding from the UK government mean whoever wins the Senedd election would struggle to maintain, let alone improve, services.

The Welsh government said it was continuing "to work closely with health boards and local authorities to improve frontline public services at a time that costs are rising".

There have been improvements in examinations since 2024, it said, and the longest NHS waits "are coming down".

David Phillips of the IFS said the causes of poor performance in Welsh public services were "not fully clear" and more work was needed to diagnose the reasons.

He said funding levels "seem unlikely to be a major factor given spending in Wales is higher than comparable areas of England" and high levels of deprivation "can likely only explain part of it too".

"Instead, policies and the way services are delivered are likely to play a role. Average hospital stays are 40% longer in Wales than England, reducing the number of patients that can be admitted and treated.

"For schools, accountability for poor performance may be weaker – with less data available to both teachers and parents."

Overall and persistent absences from school remain far higher than before the pandemic, the IFS said, citing figures from 2024-25 when 9% of pupils in Wales were absent on any given day, up from less than 6% in 2019.

Performance in the internationally comparable PISA tests for 15 year olds fell by more in Wales than England post-pandemic - with the last figures published in 2023.

The IFS cited average waiting times for elective treatments in Wales of 19 weeks in December 2025, double the pre-pandemic level of 10.7 weeks and higher than the equivalent figure of 13.4 weeks.

A&E waiting times had worsened over the last two years, with 53% of patients waiting less than four hours in December 2025, compared to a target of 95%.

But it said health spending had increased by 17% per person in real terms since 2019-20, and spending per pupil had increased by 14% - similar to or higher than those seen in England over the same period of time.

The IFS said the next Welsh government "will struggle to maintain, let alone improve, services due to a slowdown in funding growth and the impact of recent budgeting decisions".

Health and social care spending is set to fall by 2% in real terms in the 2026-27 financial year starting in April, which the IFS says Welsh ministers will likely need to top-up.

If it wanted to match planned health spending in England in the following two years other services would face cuts around 5% a year, given current forecasts of UK government funding.

Headteachers union NAHT Cymru said PISA results can be useful but should not be over interpreted, suggesting it was a "simplistic" comparison "which may not capture the richness of children's learning".

But the organisation's Laura Doel added: "School leaders will be particularly interested to understand where the increased spending on education identified by the IFS has gone – because it has not reached the frontline."

The Welsh Conservatives' education spokesperson Natasha Asghar said: "Clearly this isn't a funding problem, it's a policy problem."

Plaid Cymru's Mabon ap Gwynfor said: "This report confirms what people across Wales already know – the state of our NHS and our schools is simply not good enough."

A Welsh Liberal Democrat spokesman said: "After 27 years in power, it is clear now more than ever that it is Welsh Labour's mismanagement that is holding Wales back."

A Green Party spokesperson said: "By now it's clear Labour won't get a handle on the state of our public services."

A spokesperson for the Welsh government said: "We continue to work closely with health boards and local authorities to improve frontline public services at a time when costs are rising.

"The NHS waiting list has fallen and the longest waits are coming down. We have set clear expectations for all health boards to reduce emergency department long stays and complete ambulance handovers within 45 minutes.

"Our education system is moving in the right direction thanks to the additional support we are providing to schools and the hard work of school staff.

"Our latest GCSE and A-level results show improvements in attainment since 2024. For younger learners we are seeing progress within reading and numeracy in personalised assessments."