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Urgent Need for Sustainable Cost Savings in NHS Wales
Despite recent progress, the financial situation in NHS Wales remains precarious.
Adrian Crompton
Auditor General, Audit Wales
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NHS organisations achieve savings in a number of different ways. These include stopping certain activities, reducing expenditure, and reshaping services to deliver care more efficiently.
In 2023-24, NHS organisations in Wales delivered £210 million in savings – an increase of £70.3 million from the previous year, which equalled the highest level of savings since 2018-19. Notably, 59% of these savings were recurrent, compared to 40% in 2022-23 and 51% in 2021-22. Despite this progress and an additional £425 million in funding from the Welsh Government, NHS Wales ended the year with a collective deficit of £183 million, up from £150 million in 2022-23 and £47 million in 2021-22.
Preliminary figures for 2024-25 suggest further improvement, with £253 million in savings, 61% of which were recurrent. Despite this positive progress and a further additional £450 million in government support, the system still closed the year with a £124 million deficit, underscoring the ongoing financial challenges facing NHS Wales.
NHS organisations demonstrated a solid grasp of their primary cost drivers. Significant savings were achieved in the following high-expenditure areas:
- Staff pay: £87 million
- Medicines management: £31 million
- Non-pay costs (e.g., utilities and premises): £65 million
However, there is still potential to reduce NHS Wales costs further, particularly by transforming service delivery.
A major area for improvement is cutting down on the use of expensive agency staff, which cost £262 million in 2023-24.
While some organisations are using benchmarking data to identify savings opportunities, the application of this data is inconsistent. This limits their ability to fully realise potential savings. As a result, NHS bodies need to make more effective and consistent use of available data and insights to identify and act on cost-saving opportunities.
Although the proportion of non-recurrent (one-off) savings dropped from 60% in 2022-23 to 41% in 2023-24, many NHS organisations still rely heavily on these short-term measures. This approach is unsustainable and does not address underlying financial issues. A focus on recurrent savings, therefore, is important to ensure long-term financial stability.
Audit Wales found that clinical and frontline staff were not sufficiently involved in identifying cost-saving opportunities. Their engagement is crucial, as they are best positioned to understand the practical implications of service changes.
Additionally, NHS boards often lack clear updates on how savings are being achieved, which hampers oversight and strategic planning.
Despite recent progress, the financial situation in NHS Wales remains precarious.
We have identified several key actions that NHS organisations should take to strengthen their financial resilience:
- Focus on long-term, sustainable savings rather than short-term fixes.
- Apply benchmarking tools and data insights more consistently and effectively across all organisations.
- Enhance financial literacy and skills across the NHS workforce to support better decision-making.
- Involve clinical staff, operational teams, and service users in planning and implementing cost-saving measures.
- Embrace long-term strategies that focus on prevention, which can reduce future demand on services and improve public sector budgets.
A more strategic, long-term approach to financial planning in NHS Wales is critical if we want to have a positive impact on public sector budgets. Our reports on cancer services and the implementation of the Well-being of Future Generations Act highlight the benefits of preventive care and forward-thinking policies.
As healthcare demands continue to grow, NHS organisations and the Welsh Government must embed these principles into their planning to ensure financial sustainability and high-quality care for the future.
Further data and key findings from Audit Wales - Read more
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Our Historic Estate is Rethinking Farming for a Climate Conscious Era
Our goal is not just to achieve net zero, but to inspire others, farmers and consumers alike to think differently.
Maria Leijerstam
Owner, Llantrithyd Deer Park
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Established in the mid-17th century, Llantrithyd Deer Park has remained remarkably intact, with 100 acres of unspoilt parkland nestled just outside Cardiff in the Vale of Glamorgan.
For the past 25 years, this historic landscape has quietly championed a different kind of farming, one that puts the land, the animals, and the climate first.
As the second generation to care for the estate, I’m proud to share how we’re not only aiming for net zero carbon emissions this year, we’re also rethinking the role of meat in a sustainable future.
We hear every day how many UK farmers face relentless financial pressure. The reality is that to make ends meet, many are forced into intensive systems: more animals on less land, imported feeds, and ever-increasing transport miles. A recent episode of the hit TV show Clarkson’s Farm highlighted the crisis facing UK abattoirs: small abattoirs are closing at an alarming rate of about 10% per year, with only around 60 remaining by 2023 and warnings that they could disappear entirely within a decade.
It’s a treadmill that’s hard to step off, and it’s taking a toll on our countryside, our climate, animal welfare, consumer health, and the quality of our food.
At Llantrithyd Deer Park, we’ve chosen a different path, one that’s not always easy, but is deeply rewarding. We keep our deer herd small, ensuring every animal has an extremely high quality of life with ample space to roam & rest and the land is never overburdened.
Our deer roam freely across natural, unfertilised pastures, enriching the land as they go. Their dung is naturally spread and gently trodden in by their hooves, creating a self-sustaining cycle that nourishes the soil without the need for artificial fertilisers.
Because our deer graze across the entire park, no patch of grass is left to grow sour or overrun, keeping the land naturally balanced.
We produce all our own haylage for winter feeding, closing the loop and eliminating the carbon footprint of importing feed from elsewhere.
We’re practically off-grid, thanks to newly installed solar panels that power our operations. Our deer are born, live, and are humanely culled right here on the park. Soon, we hope to bring the entire butchering process on-site, too. That means our venison will be truly zero miles, produced and sold from the same place, with no lorry journeys or anonymous supply chains.
Every year, we plant new trees across the park, locking away more carbon and enriching the landscape for wildlife. Our ambition is to use every part of every animal: antlers for dog chews or décor, skins for rugs or drums, offal for dog food (our own dogs certainly approve!). We’re working towards being able to process and sell the whole animal, so nothing is wasted.
Here’s where we really stand apart: Llantrithyd Deer Park might be the only meat-producing farm in Britain actively encouraging people to eat less meat. We believe meat should be a treat, something special, not an everyday staple.
When you do eat it, choose the highest quality, least tampered-with, and least transported meat you can find.
Our venison fits that bill: it’s local, low-carbon, and as natural as it gets.
Venison is considered one of the healthiest meats to eat and is great for weight loss due to its very low fat content- just 1.6g of fat per 100g serving compared to 12.9g in beef topside, and high protein, which helps keep you fuller for longer. It’s also rich in iron, with 100g of venison providing around 4mg of iron, about 80% more than beef and covering up to 16% of a woman’s daily iron needs, making it especially beneficial for women. Additionally, our park venison is 100% traceable from estate to plate, unlike wild venison, and comes exclusively from animals less than two years old, ensuring tender meat with none of the strong, gamey flavours sometimes found in older wild venison.
We know this isn’t the easy path. It’s hard to make ends meet when you refuse to compromise on quality, animal welfare, or the environment.
Fortunately for us, venison is also the healthiest meat you can eat with the lowest fat content and highest levels of protein. The rewards are immense: a thriving landscape, healthy animals, and food you can truly trust.
After 25 years, Llantrithyd Deer Park stands as a testament to what’s possible when you put nature and ethics at the heart of farming. Our goal is not just to achieve net zero, but to inspire others, farmers and consumers alike to think differently.
Farming and nature can thrive together, and the choices we make at the table really do matter.
It is a beautiful lifestyle, and we are determined to prove that low-impact, carbon-friendly farming is not only possible, but essential for the future.
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AI Offers Wales a Once-in-a-Lifetime Opportunity to Punch Above its Weight in Tech
Our problem is cultural, not technical. Wales boasts a very generous support ecosystem - grants, hubs, incubators, yet that generosity too often breeds complacency.
Neil Cocker
Investor/Startup/Founder/CEO
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The numbers are still chastening. Just 47,727 people work in digital roles across Wales - a mere three per cent of our total workforce.
We lag behind the rest of the UK on everything from broadband take-up to basic online skills. Yet this very deficit could be our super-power.
Like sub-Saharan Africa, which skipped copper landlines and jumped straight to mobile phones, Wales can leapfrog the legacy stage and throw itself wholly at the new frontier: Artificial Intelligence. But, as in Africa and other such examples of technological leapfrogging, there needs to be institutional flexibility and support for the next stage.
Westminster can apparently see this opportunity. The Prime Minister’s new TechFirst programme, £187 million for schools plus a pledge to upskill 7.5 million workers by 2030, explicitly names AI literacy as Britain’s next competitive edge.
For a nation the size of Wales, that investment is an invitation to sprint while bigger regions are still lacing their trainers.
The tools are on our side. Low-code platforms such as Lovable, Bolt and Replit let founders spin up a web app frontend, a payments layer, and integrate an AI chatbot in a handful of hours.
OpenAI’s Sam Altman predicts “one person plus 10,000 GPUs” companies worth billions, insisting that tiny teams can now out-earn yesterday’s unicorns. In other words, scale has slipped from headcount to horsepower. And horsepower is cheap.
But there is a sting in that tail. When it costs pennies to build, the world will inevitably flood with pointless apps and sites. Validation - the discipline of proving a customer will pay before you write a single line of code, matters more than ever. I spent last year teaching over 300 Welsh founders to run customer discovery processes and tests that expose a bad idea within days, not months. The goal is ruthless: kill nine ideas that were never going to survive so the hundredth can live. And flourish.
Our problem is cultural, not technical. Wales boasts a very generous support ecosystem - grants, hubs, incubators - yet that generosity too often breeds complacency.
Because the support is kind, and ever-present, founders are able to cling to pet projects for years, drawing a pittance while their sunk-cost fallacy deepens.
A sharper challenge early on would free them to pivot faster, earn sooner and contribute more to the economy. I have seen it first-hand in London: the start-up that shelved three doomed prototypes inside a single accelerator cohort now turns over six figures after eight months. Here in Wales: “don’t worry, here’s another marketing workshop and a free desk”. All the while, no real challenge is forthcoming.
Happily, AI makes that path to real customer understanding much easier. A simple prototype created in a few hours, connected to a dummy data set can be demoed to a potential buyer the same afternoon. Indeed, after 4 months of fruitless conversations with clients about what they could theoretically do (“sounds interesting, come back when you have something to show us”), someone who built a prototype in one of my workshops was able to sell a trial with a customer the very next day.
And there is a deeper purpose. Better-paid digital work on home soil means fewer eighteen-year-olds forced to take the M4 east. Careers Wales already tracks soaring demand for AI-literate roles across energy, creative industries and healthcare. If we couple that demand with validation-obsessed, capital-efficient companies, we can keep the talent, and the tax base, right here.
So here is the challenge. To Cardiff Bay and Westminster: funnel a slice of TechFirst cash into rapid-validation-with-AI boot camps, not just coding classes. To incubators and grant panels: reward proof of demand, not prettiness of deck. To every would-be founder in Wales: your next prototype costs less than a night out - but the only applause that counts is a paying customer.
Get those pieces right and that bleak three-per-cent statistic becomes an irrelevance.
What will matter is the multiplier: how many global customers each Welsh job serves because a small, fearless team learned faster and built only what was worth building.
In the age of AI, that multiplier can be limitless, but only if we demand proof of value from day one. Punching above our weight starts with landing the punches that count.
Neil is currently running workshops about how to build prototypes, MVPs, and internal tools with AI - https://build-in-a-day-workshop.lovable.app/
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Breaking Barriers in Motorsport Engineering
Change is happening. Women now make up 10 per cent of the workforce in motorsport, and for the first time, we’ve achieved that same percentage on our motorsport programmes at UWTSD.
Abi Penny
Senior Lecturer in Motorsport Engineering, UWTSD
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Motorsport has been my passion for as long as I can remember, and I feel incredibly fortunate that it has also become my career. For the past 18 years, I’ve had the pleasure of lecturing in Motorsport Engineering at the University of Wales Trinity Saint David (UWTSD), and what a journey it has been.
During that time, the field has evolved dramatically. We’ve seen rapid and sometimes groundbreaking technological advances, from significant improvements in simulation techniques to the development of hybrid powertrains. The role of an engineer has expanded and diversified and it’s an incredibly exciting time to be part of this industry.
However, one thing that hasn’t changed enough is the number of women pursuing careers in motorsport engineering.
Over the years, I’ve seen some incredibly talented young women enrol on our courses, graduate, and go on to have fulfilling careers. But until recently their numbers have been small, about 5 per cent compared to the men. For many years, I was the only woman in our motorsport department. I’m happy to say there are now two of us, but the wider industry still has work to do.
This enduring imbalance raises an important question: why does the stereotype persist, and what can we do to change it?
The old image of engineers covered in grease and wearing overalls is largely outdated. Today, engineering roles are diverse, some still involve hands-on work, which appeals to many, but others focus on software, data analysis, and simulation. You can thrive in this industry and still wear heels and have great nails if you want to! Motorsport is global, offering opportunities to travel, build international careers, and work with world-leading teams. It’s an exciting, dynamic field with excellent pay, strong maternity benefits, and a real sense of camaraderie.
You don’t even have to be a “petrol head” to succeed, although an aptitude for maths certainly helps!
I was lucky. I grew up with a rally-mad father who was delighted when I chose motorsport, and an independent, feminist mother who constantly reminded me that “women can do anything.” Add to that a few brilliant maths teachers at Llangatwg Comprehensive and St John Baptist School, and I had the support I needed to achieve my A-levels and secure a place at university.
Since my school days, the curriculum has shifted to emphasise STEM subjects, helping to address the national skills shortage. But we can do more to support girls early on, encouraging them to stick with maths and science and helping them see engineering as an accessible and exciting career.
Fantastic initiatives like F1 in Schools and Green Power are inspiring young people to dream big. Here at UWTSD, we’re proud to support Girls on Track, Motorsport UK’s programme that introduces school-aged girls to the diverse world of motorsport, from pit stop challenges to media and presenting roles.
Change is happening. Women now make up 10 per cent of the workforce in motorsport and for the first time, we’ve achieved that same percentage on our motorsport programmes at UWTSD.
To celebrate, we’re running a series of activities to build a stronger community of female engineers, hoping to create a supportive network that encourages even more girls to consider this fantastic career.
Last year marked the 25th anniversary of our BEng Motorsport Engineering Degree Programme, the first of its kind in the world. Thanks to the vision of former lecturer Roger Dowden who started the course and guidance from the Motorsport Industry Association, our graduates have become valuable assets in motorsport and high-performance automotive industries worldwide. Many have gone on to work for prestigious companies like McLaren, Gordon Murray, Bentley, Ford, Arc, and Toyota Gazoo Racing.
Our close ties with industry advisors ensure that our course remains relevant, practical, and academically rigorous. This blend of theory and real-world application is our unique strength, and it makes our graduates stand out.
I believe we’re on the right track. By continuing to challenge stereotypes, build supportive communities, and celebrate the successes of women in motorsport, we can create a future where gender is no barrier to pursuing a thrilling, rewarding engineering career.
And to all the young girls out there dreaming big: believe me when I say that you can do anything.
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