The Welsh government announced in early June 2021 that it had offered a first dose of a vaccine against COVID-19 to all adults in Wales, the first of the UK nations to achieve this milestone. It also has the highest first dose vaccination rate per person, of any country in the world with a population of over a million, at over 70% by 14 June. 

Given these remarkable statistics, it is perhaps not surprising that Adrian Crompton, the Welsh Auditor General, has described the programme as a “phenomenal achievement” in Audit Wales’ recent report on the rollout of the COVID-19 vaccination programme in Wales. This report found that the NHS health boards have applied a variety of different delivery models tailored to the needs of the local areas and limited vaccine wastage to 0.4% of doses, compared to an estimated 1.8% in Scotland.

This is the fourth predominantly positive report Audit Wales have published on the Welsh Government and NHS’s response to the COVID-19 pandemic this calendar year. ICAEW reported on the overview of progress on the Test, Trace, Protect (TTP) programme which found that contact tracing had performed well and the Welsh government had effectively learnt lessons from earlier peaks.

Audit Wales also reported in January on governance in the NHS during the COVID-19 crisis and found that the bodies were able to maintain good governance as they adapted quickly to the crisis. Its April report on procuring and supplying PPE found that NHS Shared Services and other bodies overcame challenges to prevent Wales running out of stock. 

The report suggests that by working together and avoiding the use of a priority lane the Welsh government was able to achieve better value for money than the government in England. It estimates the Welsh government spent £300m on PPE compared to the £880m it received in Barnett formula funding calculated based on spending on PPE in England.

These positive reports have common themes including effective collaboration between the different bodies involved in the response. As examples, Audit Wales found that the Welsh government, NHS Shared Services, Public Health Wales and Life Sciences Hub Wales all worked collaboratively to identify and respond to potential PPE suppliers, while the different regional health boards operated an effective “mutual aid” system for testing to cope with local outbreaks.

Another common theme, particularly apparent in the report on governance, is how NHS Wales introduced structures to assist working at pace while maintaining good governance. For example, some boards made temporary changes to Schemes of Delegation to allow quicker decision making but kept clear arrangements for maintaining an audit trail for those decisions.

In all the reports, Audit Wales commented that the Welsh Government can learn from the successful aspects of the pandemic response highlighted in its reports and implement the best practice in its response to future challenges. 

One such challenge will be ensuring the long term financial sustainability of the Welsh NHS. Audit Wales have highlighted in a recent press release that four of the seven regional health boards have breached their statutory obligations to breakeven over a period of three years to March 2021 despite £1.7bn of additional health funding in 2020-21.

Oliver Simms, Manager, Public Sector Audit & Assurance for ICAEW, commented:

“Audit Wales’ findings about how well the different organisations have worked together and at pace, while maintaining effective governance, in response to the COVID-19 pandemic are reflected in real world outcomes. A higher proportion of the Welsh population have received their first dose of the vaccine compared to any other country with over a million people in the world, while the Welsh government managed to secure personal protective equipment at less than 40% of the equivalent costs borne by the government in England.

“Public sector organisations in all sectors across the four nations of the UK should consider whether they can learn lessons from the good practice in collaboration, speed and the Welsh NHS’s COVID-19 response identified by Audit Wales to improve the management of public services and the outcomes for the population.

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