News / Wales consults on ending its internal market

The Welsh Assembly Government has announced proposals to dismantle the internal market in Wales and cut the current 22 local health boards (LHBs) to just eight.

The proposals were unveiled at the beginning of April as part of a three-month consultation on changes to the way the NHS operates in Wales.

Health minister Edwina Hart (pictured) said the proposals made good on a pledge included in the One Wales document, which sets out the coalition agreement between Labour and Plaid Cymru. ‘Ending the internal market is part of a wider Assembly government drive to encourage cooperation rather than competition in delivering public services,’ she added.

Under the proposals, funding for NHS trusts would no longer flow through LHBs but come either directly from the Assembly government or via a separate national board. Rather than commissioning, larger LHBs would focus on delivering primary care and potentially take over community services. No details of a funding mechanism are given, although there are existing proposals to pilot activity-based funding for a range of healthcare resource groups this year.

A background paper issued with the consultation document suggested that the internal market had led to an increase in the cost base in many localities. It suggested this was due to ‘a shared but inadequately described responsibility for cost control’ between trusts and LHBs. ‘Managing overspends and efficiency savings targets have proved problematical,’ the paper said. The proposals aim to address this concern.


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