The way the NHS in Wales performs against significant measures such as spending, patient care and hospital waiting lists compared to other UK nations has been laid bare in a stark new report published today.

Independent research by the Nuffield Trust and the Health Foundation compared health service data in all four nations since devolution.

It highlighted significant issues with “disproportionately” lengthening waiting times in Wales, with patients waiting on average around 170 days for a hip or knee replacement compared to around 70 days in England and Scotland.

It also said that while spending had slowed in response to austerity in all countries, Wales was the only nation with an annual reduction in rates of growth in cash terms between 2010 and 2013.

During those three years, the annual rates of growth in cash terms were 2% in Northern Ireland, 1% in England and Scotland and a fall of 1% in Wales.

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In highlighting waiting times in Wales, the report said the decision to cut rather than maintain NHS spending may have had an impact, prompting warnings that the increase should “set alarm bells ringing” for policy-makers when considering the impact of austerity on healthcare.

But it concluded that, despite devolution, there was “little sign” that one country is moving ahead of others in terms of overall performance measures.

Andy McKeon, senior policy fellow at the Nuffield Trust, said: “Our study period coincided with the biggest sustained injection of cash the four health systems have ever seen, so it’s perhaps unsurprising that staff numbers have increased and performance has improved. But what is interesting is that, despite hotly-contested policy differences in structure, targets, competition, patient choice and the use of non-NHS providers, no one country is emerging as a consistent front-runner on health system performance.

“Only time will tell if the four countries’ progress made to-date will be sustained as austerity starts to bite. But Wales’ lengthening waiting times should set alarm bells ringing amongst policy makers when considering its possible impacts.”

The report found that the resources in all four countries increased significantly over the period.

Since 2000, England has increased spending on health by 115% , followed by 99% in Scotland, 98% in Wales and 92% in Northern Ireland.

In terms of staffing levels, in 2011, the headcount of GPs per 1,000 population stood at 0.7 in England and 0.6 in Wales and Northern Ireland.

Meanwhile, between 1996 and 2011, the rate of nurses per 1,000 population increased the most in Wales with a 21% rise, followed by 14% in Scotland, 13% in England and 5% in Northern Ireland.

In 2011, the rate of nurses per 1,000 population stood at 7.1 in Wales, 7.5 in Northern Ireland and 7.9 in Scotland and 5.8 in England.

In terms of hospital waiting times, Wales fared less favourably.

In England, more than 97% of outpatients were seen and more than 92% of patients were admitted to hospital within 18 weeks.

In Wales, 91.5% and 98.6% of patients were admitted to hospital or seen in outpatients within 26 and 36 weeks. In terms of satisfaction rates on the way the NHS is run and the way the NHS’ local doctors or GPs run, the proportion of people in Wales who said they were ‘very satisfied’ and ‘quite satisfied’ stood at 62% and 78% respectively.

In England, this stood at 53% and 76% respectively and 55% and 68% in Scotland.

The findings follow recent attacks by members of the UK Government on the performance of the Welsh NHS, with the Welsh Government hitting back, accusing them of attempting to “drag the Welsh NHS through the mud.”

Members of the Labour Party said the report’s findings discredited claims the Welsh NHS was worse than England.

Andy Burnham, Labour’s Shadow Health Secretary, said: “This important study shows the NHS made great strides under the Labour Government and those who seek to run it down would do well to study its conclusions carefully.”

Health Minister Mark Drakeford said: “The Nuffield Trust report, while acknowledging the problems of comparing different health services, is clear there have been improvements in all four countries since devolution.

“In some important areas covered by the report, Wales does well.

“While the report points out that spending on health has not increased in the devolved nations to the same extent as in England, it remains the case that England has the lowest spend on health per head of population.

“The standard waiting time for orthopaedic surgery in February is 15 weeks in Wales – 11 weeks lower than the 26-week target.

“We have invested £65m in orthopaedic services over the last three years and patients are also offered a range of therapies and pain management.”

But Shadow Health Minister Darren Millar said the report highlighted “damning differences” between the Welsh NHS and other health systems.

He said: “It’s no wonder our NHS is falling behind and it’s no wonder Welsh patients are getting a raw deal. While frontline staff get a boost in investment elsewhere in the UK, Wales is burdened by a decrease.”

Plaid Cymru’s health spokeswoman, Elin Jones, said: “This comprehensive study shows just how much more needs to be done to ensure Wales catches up with the rest of the UK.

“While Scotland has successfully closed the gap on waiting lists, Wales remains bottom of the league on many measures.”

Kirsty Williams, leader of the Welsh Liberal Democrats, said: “This independent report shows that we’re still lagging way behind the other nations of the UK in terms of some of the most fundamental indicators of the health service.

“Patients are waiting almost twice as long for the most common treatments such as knee and hip replacements, often waiting months in pain.”

But director of the Welsh NHS Confederation Helen Birtwhistle said the report showed how difficult it was to compare health service performance between the nations.

She said: “The overwhelming message from this report is how difficult it is to compare health services in each of the four countries.

“This means that the debate on how the different health systems are performing can easily become too narrowly focused on waiting times.

“While the NHS in Wales would be the first to acknowledge that there is work to be done to reduce waits for patients, it is important to note that waiting times capture only one part of what the NHS does.”