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The Welsh NHS Confederation response to the Equality and Social Justice Committee inquiry on post-legislative scrutiny of the Well-being of Future Generations (Wales) Act. |
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Contact |
Haleema Khan, Policy and Public Affairs Officer, Welsh NHS Confederation |
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Date |
18 June 2025 |
Senedd Cymru | Welsh Parliament
Y Pwyllgor Cydraddoldeb a Chyfiawnder Cymdeithasol| Equality and Social Justice Committee
Ymateb gan: Conffederasiwn GIG Cymru | Evidence from: Welsh NHS Confederation
1. The Welsh NHS Confederation welcomes the opportunity to respond to the Equality and Social Justice Committee inquiry on post-legislative scrutiny of the Well-being of Future Generations (Wales) Act.
2. The Welsh NHS Confederation is the only membership body representing all the organisations making up the NHS in Wales: the seven local health boards, three NHS trusts (Velindre University NHS Trust, Welsh Ambulance Services University NHS Trust and Public Health Wales NHS Trust) and two special health authorities (Digital Health and Care Wales and Health Education and Improvement Wales). We also host NHS Wales Employers and are part of the NHS Confederation.
3. Regarding how far the intended objective of the Act is being achieved, our members believe the Well-being of Future Generations (Wales) Act has been successful in fostering a shared language and focus on sustainable development and well-being goals across public sector organisations. This common ground, reflected in Public Service Board’s Well-being Plans, enables stronger partnership working across different sectors and aligns well with the vision and the aims of the Act.
4. In relation to cross sector working, the Act has provided the NHS, and specifically the Welsh NHS Confederation, with the legislative framework to work in partnership with a range of organisations to support the prevention and well-being agenda. For example, in September 2017, the Welsh NHS Confederation and the Arts Council of Wales signed our first Memorandum of Understanding (MOU) to support both the NHS and the arts to further embed the five ways of working within the Act. We have been working in partnership with the Arts Council of Wales to develop joint areas of work in furtherance of the shared goal of improving the awareness of the benefits that the arts can bring to health and well-being and creating a more equal, cultural and more sustainable Wales as required within the legislation.
5. NHS Wales organisations recognise that implementing the Act is a key part of core business, both on an organisational level and an individual level. Since the Act was introduced, NHS organisations have been working to deliver innovative care models which help to create long-lasting and positive change to current and future generations.
6. Our members have highlighted some actions that could be taken to improve the effectiveness of the Act and its implementation.
7. The key challenge remains the tension between the Act’s long-term strategic vision and the immediate operational and fiscal pressures facing public sector bodies. This disconnect often limits the capacity of organisations to fully align with the Act, particularly in high-pressure environments where current acute demand on services necessitates a fundamental shift from a reactive, illness-focused model to a proactive one centred on prevention and early intervention.
8. However, while our members are currently responding to significant demand on services, they do support the focus on prevention and the need to shift thinking to prevention and the longer-term as set out in the recently published Well-being of Future Generations Report 2025. The report advocates for ringfenced prevention budgets and a transition to long-term funding arrangements, focusing on proactive measures which can mitigate future health crises and reduce long-term costs. It also highlights the importance of addressing socio-economic determinants of health and encourages public bodies to adopt a long-term perspective by developing 50-year strategies to promote sustainable development and inter-generational fairness. Many of the recommendations within the Future Generations Report 2025 align with our calls for the Senedd election.
9. Following a survey of 95 NHS leaders, we published a report, Building the health and well-being of the nation, which outlines the key areas for political parties' to consider ahead of the 2026 Senedd election. The report sets out our mission, developed with NHS leaders, to “build the health and well-being of the nation, supported by high-quality health and social care services and a partnership-led approach to population health and well-being that embraces the public, private and third sectors”. To achieve this mission, we have called on the next Welsh Government to deliver a cross-government national strategy to improve health and well-being and reduce inequalities. This will shift the focus from simply treating illness to promoting health and well-being, reducing inequalities and tackling the wider determinants of health, boosting economic growth and supporting people to be active partners in their own health and well-being. We have also called for changes to performance and financial frameworks by publishing a joint health and social care performance and financial framework for seamless care and support. This framework would support an emphasis on prevention, effective treatment and timely support for individuals.
10. Our members state that while the guidance provided by the Act and the Commissioner’s office offers a valuable framework for consistent, evidence-based planning, its effectiveness is significantly hampered by several factors, including competing priorities and limited workforce capacity hindering the effective implementation of associated plans.
11. Recently Audit Wales observed that the Act has not yet driven the intended system-wide change, noting inconsistent application across public bodies, particularly within the health sector. This inconsistency is further compounded by the proliferation of partnership bodies and reporting requirements, which have created a complex governance landscape that can impede the effective achievement of the Act's objectives.
12. The Welsh NHS Confederation welcomed the Audit Wales and Future Generations Commissioner for Wales reports, agreeing with their emphasis on growing population needs, long-term planning, prevention, and the wider determinants of health. While acknowledging that the health system still has work to do in implementing the Well-being of Future Generations Act, more extensive cross-sectoral action and long-term financial and delivery approaches are needed to scale up good examples.
13. Public bodies frequently face limitations in capacity and resources, making it difficult to always fully apply the Act's principles. Their immediate, short-term needs often overshadow the investment and capacity required for long-term, preventive strategies. Furthermore, the existing complex governance structure, characterised by numerous partnership bodies (including Public Services Boards and Regional Partnership Boards) and extensive reporting demands, potentially jeopardises the Act's effective implementation.
14. Ultimately, achieving the Act's ambitious goals necessitates a significant cultural shift within public institutions, including within the Government and election cycles. This requires prioritising long-term well-being over immediate gains, a transformation that may prove challenging without targeted leadership, dedicated training initiatives and additional resources.
15. Our members have stated that the collaborative relationship between the NHS and the Commissioner’s Office/ the Welsh Government is characterised by its constructive and open nature, with a preference for addressing issues through early engagement rather than through enforcement. However, members are concerned that making the Act more legally enforceable could inadvertently lead to negative consequences, potentially disrupting this collaborative approach. This highlights a desire to continue fostering a spirit of cooperation as Wales strives for a healthier and more sustainable future.
16. Our members emphasise that the Act offers substantial long-term value for Wales, fostering a more sustainable public sector model. Its core strength lies in its ability to embed shared values and working practices across various sectors.
17. However, the challenge is system redesign: aligning daily operations and services with the Act’s longer-term goals. Without the Act, this work would be significantly more difficult, and our members highlight that the continued support by the Commissioner’s office and the Welsh Government should be commended.
18. In relation to the Welsh NHS Confederation, over the last couple of years we have increasingly worked in partnership with the Office of the Future Generations Commissioner, including monthly meetings on areas of joint work and participating in, and speaking at, our respective events. This has ensured the Commissioner is aware of the key challenges for NHS leaders and improved our understanding of the Commissioner’s priority areas of influence and how the legislation is being implemented across the public sector in Wales.
19. In conclusion, the Well-being of Future Generations Act is at the cornerstone of work for our members. As a key partner across Public Service Boards, NHS bodies, collaborate with communities, environmental, educational, healthcare, social services, and economic systems to shape the conditions for the population. Creating healthy environments, strong public health infrastructure, and social equity are essential for preventing ill-health, reducing health inequalities, and promoting longer, better-quality lives.
20. The Welsh NHS Confederation is committed to the Act and works with our members to evidence how NHS organisations in Wales are implementing the Act. Since the Act's implementation, NHS organisations in Wales have been developing innovative care models to create lasting positive change for both current and future generations. We published resources, such as Implementing the Well-being of Future Generations Act in Wales, highlighting various projects and initiatives undertaken by NHS organisations as part of their journey to adopt the Act's principles. These efforts involve starting with minor adjustments and progressing towards more substantial transformations.
21. Moreover, our members have emphasised that the Act had introduced five core principles that fundamentally change how Welsh health and care services operate to meet community needs.
- The Voice and Control principle enshrines local accountability, democratisation, and accessibility, ensuring communities have a direct say in service management, engagement, and oversight.
- The Prevention and Early Intervention drives a crucial "shift left" by focusing on addressing the root causes of ill-health and complex social problems, aiming to prevent negative long-term outcomes and improve well-being.
- The Well-being principle broadens the focus beyond physical health to include mental well-being, quality of life, community connections, and cultural identity, fostering a holistic view of health.
- Co-production commits to building systems and services collaboratively with the communities that will use them, harnessing local energy and innovation alongside professional expertise.
- Finally, Multi-agency Working creates a legal duty for organisations to collaborate across silos, sharing information and skills to meet the complex, multi-factorial needs of communities, recognising that collective action leads to more comprehensive solutions.
22. Through these principles, the Act empowers Welsh health and care services to collaborate more effectively, intervene earlier, and work directly with communities to build a healthier, fairer, safer, and stronger future for all.
23. For example, across Gwent a comprehensive policy environment, encompassing rules, regulations, strategies, and support programs, is in place to ensure equitable opportunities for health, productivity, and happiness for all residents, regardless of their location or background. While significant progress has been made, there remains a critical need to address persistent inequalities in opportunities and outcomes that have affected past generations and continue to impact many within the community today. It is an imperative to improve these conditions and collaborate more effectively with communities, viewing this as a duty to both present and future generations, demanding immediate action. The Act is central to this effort, enabling a focus on preventative approaches, upholding its five key principles, prioritising outcomes that matter to individuals and families, and emphasising the fundamental conditions that foster good health and well-being.
24. In today's challenging environment of increased service demands, rising population health needs, and global economic turbulence, the Well-being of Future Generations Act offers crucial and widely applicable support. Our members highlight that the goal is to build upon existing efforts and consolidate them to empower local communities.
25. Leveraging both the Marmot framework and the enabling power of the Act to combat health inequalities, embed prevention, foster community resilience, and encourage ownership of health and well-being initiatives is integral to create a healthier, fairer, safer, and stronger region for everyone. By working together to deliver the ambitions of the Act, the current generation can strive to be the last to lament missed opportunities in addressing inequalities, thereby building a better future for those who will inherit Wales.