How well is Wales?

Victoria Winckler looks at health – as reported by its residents – in Wales and asks if health policy has the right focus.

This winter we can expect that the NHS will once again be in the spotlight.  If you looked only at the queues of ambulances outside A&E or the patients on trolleys in corridors you might be forgiven for thinking that the population of Wales is sick.

In fact, most people are in good health

The latest findings from the National Survey for Wales suggest that around 70% of Wales’ population say that their health is good or very good. Although the proportion saying this has declined slightly in the last few years, it is still good news.  Only minority – around 1 in 10 – say that their health is bad or very bad.

The challenge of ageing

One of the big drivers of demand for health care is thought to be age.  The Welsh NHS Confederation, for example, points out that:

An ageing population, combined with more people having increasingly complex needs, means that demand for health and social care services is predicted to grow rapidly in coming years.

Similarly, Public Health Wales says that:

Increases in the ageing population of Wales will result in increasing numbers of age related conditions such as dementia

Older people certainly report poorer health than younger people. Reported poor health increases steadily with advancing years, so that by the age of 75 and over, people are nearly three times more likely to say their health is bad or very bad than 25-44 year olds.

But ageing isn’t the only factor.

The data from the National Survey for Wales show that deprivation has a larger association with ill-health than age  Twenty-two percent of people in deprived households report bad or very bad health, compared with seventeen percent of people aged 75 and over.  The impact of household deprivation is also greater than area deprivation or local authority of residence.

Even worse, age, deprivation and place come together in social housing. In our council estates and social housing complexes across Wales, an astonishing quarter of tenants say their health is bad or very bad.

At a very simple level, this association between deprivation, housing tenure and health suggests that social landlords and health professionals could do much more to reach what are essentially large communities of pretty ill people. Yet many council estates are devoid of a GP practice or pharmacy, and have poor transport connections to other primary care services.

When policy-makers talk about reconfiguring health services, they usually mean centralising secondary care. Very rarely does reconfiguration relate to bringing services closer to the people that need them. Maybe it is time that that debate changed.

Victoria Winckler is Director of the Bevan Foundation. A fuller analysis is available in our State of Wales briefing on health status, which is available to organisations on subscription for just £260 plus VAT a year. Subscribe here.