As someone who has spent years in public service, I continue to observe the evolution of our health systems with a mixture of hope, scrutiny, and concern.

In 2025, the NHS across the UK is no longer a monolith—it is a patchwork shaped by devolved governance, local pressures, and uneven reform. Nowhere is this more evident than in the contrasting trajectories of NHS Wales, Scotland, and Northern Ireland.

Wales: Recovery and Digital Reach

Wales has taken bold steps to tackle the long-standing backlog in planned care. In June 2025, the Welsh Government announced a £120 million recovery package aimed at:

• Eliminating all two-year waits
• Reducing diagnostic delays to under 8 weeks by March 2026
• Cutting the overall waiting list by 200,000 patients

Health Secretary Jeremy Miles reported that long waits have already fallen by two-thirds—a claim supported by BBC Wales reporting.

Meanwhile, mental health services have embraced digital innovation. One online CBT platform, managed by Powys Teaching Health Board, has now received over 41,000 referrals. Originally trialled in 2018 and expanded during the pandemic, it now offers direct access across Wales to those in rural or underserved communities.

Cancer care, however, remains under pressure. Performance against waiting time targets continues to lag—reminding us that timely diagnosis is not merely clinical, but ethical.

Northern Ireland: Pay Disputes and Political Paralysis

In stark contrast, staff in Northern Ireland—under the Health and Social Care (HSC) system—face a deepening crisis over pay inequality. Despite the Pay Review Body’s recommendation of a 3.6% uplift (already implemented in England and Wales), HSC staff have yet to receive it.

Health Minister Mike Nesbitt signed off on the award in May, but the decision remains stalled within the Northern Ireland Executive. As a result, nurses and allied health professionals remain among the lowest paid in the UK public sector.

The Royal College of Nursing (RCN) has warned that strike action is imminent, with a formal ballot underway. Other unions—NIPSA, UNISON, and Unite—have echoed these concerns, citing:

• Chronic staff shortages
• A “toxic environment” created by cuts and underfunding
• Erosion of morale and retention across the HSC system

Minister Nesbitt has acknowledged the urgency but pointed to budgetary constraints and the absence of additional Westminster funding as barriers to resolution.

Scotland: Ambition and Access

Scotland, meanwhile, is pursuing a different path. At the SNP conference in Aberdeen, First Minister John Swinney announced a network of 15 walk-in GP centres to be opened across the country within a year. These centres—staffed by GPs and nurses—will operate seven days a week from noon to 8pm, aiming to end the “8am rush” for appointments and deliver one million additional consultations annually.

Swinney also pledged that the Scottish Government would become a visa sponsor for overseas social care workers, stepping in after the UK Government curtailed the skilled worker route. “Scotland’s older people must not pay the price for Westminster’s prejudice,” he declared.

Reflections on Divergence

The contrast between Wales, Scotland, and Northern Ireland is not just administrative—it is philosophical. Wales, for all its challenges, is investing in recovery and digital access. Northern Ireland is paralysed by political delay, leaving frontline staff demoralised and underpaid. Scotland has plans; time will tell if they deliver.

I cannot help but think we are better together. The NHS should be joined up across the whole United Kingdom, with each nation learning from the others to build a stronger, fairer, and more resilient health service.

Sources

1.     Welsh Government: £120m Planned Care Recovery Plan

2.     BBC Wales: Waiting Times Cut by Two-Thirds

3.     Powys Teaching Health Board: SilverCloud CBT Milestone

4.     Wales Cancer Network: Performance Reports

5.     Betsi Cadwaladr UHB: Hospice Closure Announcement

6.     Betsi Cadwaladr UHB: Staff Recognition News

7.     Betsi Cadwaladr UHB: Surgical Theatre Open Day

8.     RCN – Pay Award Signed Off by Minister

9.     NIPSA – NHS Pay in Northern Ireland: Parity Broken Again

10.   UNISON NI – Update on Agenda for Change Pay

11.   RCN Northern Ireland – Strike Ballot Announcement

12.   Unite the Union – Pay Must Keep Pace with Rest of NHS

13.   UNISON NI – Staff Environment Statement

14.   NIPSA – Retention and Morale Report

15.   Statement by Health Minister Mike Nesbitt

16.   SNP Conference – Walk-In GP Centres Announcement

17.   Scottish Government – Visa Sponsorship for Social Care Workers