Second class citizens – in Wales?

Chris Smyth reports in the Times 15th April 2019: English hospitals begin to ban Welsh patients in funding row Thousands of Welsh patients could be banned from English hospitals as a funding row escalates.

Image result for second class cartoon

Conservatives have demanded that the Welsh government “pay up” while NHS insiders expressed frustration that politicians are “just throwing rocks at each other”.

Last week the Countess of Chester Hospital NHS Foundation Trust said that apart from emergency or maternity patients, it would no longer treat people from Wales because they did not bring in as much money as those living in England. The Welsh government said that the decision was unacceptable.

Hospitals are paid a fixed fee by the NHS for each patient they treat. In England the tariff was raised this month as part of a budget boost. Wales opted not to increase rates, widening a gap that means English hospitals get paid about 8 per cent less for treating patients referred from Wales.

This is a particular issue in Chester, a few minutes’ drive from the border, which gets a fifth of its patients from north Wales. Deficit-reduction targets set by NHS England have made the hospital more reluctant to take lower-funded patients.

Nigel Edwards, chief executive of the Nuffield Trust think tank, said: “This has been bubbling for some time. Wales was not felt to be paying its way . . . It seems [unclear] why one set of people should be subsidising another.”

Latest data shows Chester admitting or discharging 81 per cent of A&E patients within four hours, compared with 63 per cent in Glan Clwyd and 57 per cent in Wrexham Maelor, the two closest Welsh hospitals.

Mr Edwards said that the Welsh government had previously relied on the fact that English hospitals preferred a lower rate to no money. However, rising waiting lists have meant that Chester feels confident of filling its beds with higher-funded English patients.

As well as patients crossing the border to the closest hospital, those in Wales needing specialist treatment are often sent to Liverpool or Bristol. With four million patients on English waiting lists, other hospitals could also switch to more lucrative patients if Wales continues to pay less. “I suspect it could well escalate,” Mr Edwards said.

Darren Millar, acting health spokesman for the Welsh Conservatives, said that the Welsh government “should get out [its] wallet and pay up”, adding: “It’s astounding that for every pound spent [on the NHS] in England, Wales receives £1.20 — 20 per cent more — and yet it wants to spend less. It’s ridiculous.”

A Welsh government spokesman said: “The English tariff increases include costs previously covered fully within the English NHS system, and we take the view [they] are not chargeable to Welsh NHS organisations.”

NHS England said: “[We] have been speaking to the Welsh government about this issue, as there is no reason why NHS hospitals in England should run up debts in respect of treating unfunded Welsh patients.”

Amazing how England has been able to kid themselves there is an NHS – until now. Manchester’s health devolution: taking the national out of the NHS?

The four GP dispensations / jurisdictions. Nothing “national” about GP contracts.

This entry was posted in A Personal View on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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