Hywel Dda University Health Board

(2020 – ongoing)

Health spending has the potential to be a core economic driver in local economies, helping to mould the local economic architecture of places to address the social determinants of health and tackle some of the core drivers of avoidable demand into the health system. CLES, with Hywel Dda University Health Board (HDUHB), are exploring how a progressive health board can maximise the impact of its spending power for wellbeing in Wales.


  • Health spending has the potential to be a core economic driver in local economies. However, this has yet to be realised at scale by health institutions in the UK.
  • In England, many health institutions are keen to explore their role as local economic agents, but this can be hampered by a muddled national policy context and a tendency towards centralised systems.
  • In Wales, the national commitment to a wellbeing economy and the prioritisation of the everyday, foundational economy, provides a progressive policy frame within which the scope for health spending as a core economic driver can be fully explored.
  • CLES is supporting HDUHB, which provides healthcare services to a population of around 384,000 throughout Carmarthenshire, Ceredigion and Pembrokeshire, to pioneer this approach.

Health institutions are key local anchors

Unlike the configuration of health services in England, the Health Board as a single entity is responsible for both commissioning and delivery, providing significant opportunities for direct influence. HDUHB explicitly recognises, through its strategy and mission, that its role and influence extend beyond a direct focus on health services, with a broader role as an agent that can affect economic and social wellbeing by developing closer links between the economy, wealth creation and people.


HDUHB spends in the order of £1bn a year in revenue terms. While a proportion of this spending is not in the direct control of the Health Board, approximately three-quarters is potentially influenceable. Softer influence, through collaboration with other anchors with spending power across the HDUHB geographical footprint, could impact in the order of £2.5bn annual spending across this geography. The Health Board recognise that for areas of common spending, such as food procurement, collaborative working with other anchors can unlock additional opportunities to maximise local impact.

Whilst HDUHB has historically relied on nationally driven procurement, they are keen to develop a more locally focused approach, driven by community wealth building principles – developing a HDUHB procurement strategy to supplement the nationally led procurement approach through NWSSP.

The work will develop a whole health board approach to spending which maximises the opportunities to enhance public value across all pathways of spending – direct spend, contracted spend and procurement spend. Crucially, this will include focusing upstream in the commissioning process, for example, opportunities to explore alternative delivery models and link spending to business development opportunities in the local economy.

We will facilitate an action learning approach to support the operationalising of the new strategy and framework. This will involve (virtually) embedding a CLES procurement professional with the procurement and commissioning teams.