Cross-border Health Care (England and Wales)

Bill Wiggin Excerpts

Tuesday 25th June 2013 Commons Chamber

[Jesse Norman]

I am grateful to the hon. Gentleman for that intervention. There is co-operation at the moment between England and Wales, but I think that it would absolutely benefit from further examination of the situation he describes between Northern Ireland and Eire.

The fact that the Welsh Assembly Government Minister for Health and Social Services does not believe that choice is the basis of the health system in Wales means that my constituents do not have the choice of health care, hospitals or consultants that is their proper legal right.

Secondly, the Welsh NHS’s performance in meeting its own waiting time targets continues to deteriorate. In England the waiting time target is 18 weeks, but in Wales it is 26 weeks, and that is regularly missed. Some patients are not even treated within 36 weeks. For example, some 4% of patients are not treated within 36 weeks at Cardiff and Vale hospital, according to recent Welsh Government statistics for April this year.

Thirdly, the current set-up is giving rise to serious clinical concerns. Earlier this year, in evidence to the Silk commission on devolution in Wales, the Royal College of Surgeons, the British Medical Association and the Royal College of Nursing made the following submission:

“The Panel... acknowledged that increasing policy divergence between health services in Wales and England was a challenge, especially in regards to cross-border services. The Panel added that there was a need to strengthen commissioning arrangements to improve current delays for processing individual cases... It was also agreed that it made sense for some specialist facilities to be shared by both England and Wales; and to work together to deliver economies of scale and efficiency savings, including cross border sharing of procurement and use of high-tech equipment.”

However, as I have mentioned, that ban on hospital access for those patients is not merely grossly unfair to them but places further financial pressure on Hereford hospital.

[Bill Wiggin (North Herefordshire) (Con)]

My hon. Friend and neighbour is making an important and powerful speech and should be congratulated on securing the debate. Does he agree that when one has a national border next to one’s county, it should be treated like a coastline, because it is not the Minister’s responsibility to control the health service in Wales? But if we do not have proper funding we will suffer as a result of not only our rurality but our sparsity, and once again people living in the marches will be at a disadvantage. We have the Barnett formula, but should we not have something similar for people on the Welsh border?

[Jesse Norman]

I am grateful to my hon. Friend and neighbour for that kind intervention. I share his view that the situation needs to be addressed, and it needs to be addressed in the spirit of amity and co-operation between the two sides.

In 2009-10 I commissioned an independent study of the funding of public services in Herefordshire relative to other suitable comparators across the country. I was only a parliamentary candidate at the time and such a study had never before been undertaken, but it seemed obvious to me that Herefordshire suffered from a serious shortfall in public funding and I was determined to get to the bottom of the matter. The results were astounding—even frightening. The study found that Herefordshire had been underfunded by no less than £175 million over the previous five years across all public services. In health care, the underfunding was £44 million, or roughly £9 million a year. It is no coincidence, I suggest, that Hereford hospital is currently running a deficit of almost exactly that amount. It is that deficit that is being worsened by the denial of choice to cross-border patients in my constituency and elsewhere.

Why did that funding shortfall occur? The reason is that the NHS funding formula is systematically skewed against areas that are highly rural and have a large population of older people, and systematically favours urban areas with younger populations. The formula does not recognise the relatively high cost of delivering services in sparsely populated areas, as my hon. Friend the Member for North Herefordshire (Bill Wiggin) indicated, and it does not adequately recognise the special costs imposed by caring for older people—particularly the over-85s, the very oldest in our society. Research by Professor Sheena Asthana at the university of Plymouth indicates that the areas of greatest health care need are those with the highest proportion of over-75s. However, the current funding formula is focused on deprivation rather than on need for health care. That means that less funding is available to treat older people with chronic diseases.

Nationally, 17% of people are aged 65 or over. In Herefordshire, the figure is already 22% and pensioners will make up a third of the population by 2030. In 2010-11, Herefordshire had the highest proportion of over-75s in the west midlands, and the most patients per 100,000 on the cancer register.  It also had the lowest cancer spend per cancer patient per year—a little over £5,000—and was in the lower half of the per capita allocations.

By contrast, the Heart of Birmingham PCT had the lowest proportion of over-75s in the region, and the fewest patients per 100,000 on the cancer register.  However, the spend per cancer patient per year there was not £5,000 but more than £10,000—nearly double that in Herefordshire. Thus the effect of the funding formula is that Heart of Birmingham has twice as much funding per cancer patient as Herefordshire, for a much lower incidence of cancer. That is not merely unfair; it is a monstrous injustice.

I conclude by asking the Minister three questions. First, will her Department amend the cross-border protocol and reintroduce patient choice for English residents registered with GPs in Wales? Secondly, will she acknowledge the strain that the protocol places on hospitals such as Hereford hospital? Thirdly, will she press her Department to make the case to NHS England for a fairer funding settlement, which will give older people—not merely in Herefordshire, but up and down the land—the funding for cancer and for other health care that they so richly deserve?

--- Later in debate ---

[Anna Soubry]

I am grateful for that intervention and for the wise words of the hon. Member for Strangford (Jim Shannon), who, as ever, brings a great depth of experience to these matters. Yes, we will certainly take that on board.

All this came about because of a meeting between me and my officials, the Welsh Secretary and my hon. Friend the Member for Forest of Dean (Mr Harper). As a result of that meeting, I have asked NHS England to work locally with GP practices in the border counties to review their practice boundaries with the aim of providing additional choice of GPs to those who do not currently have it. I am keen that all English patients are able to access an English GP if they wish or that they can register with a Welsh GP if that is their choice and they are aware of the impact of that decision. I have also asked NHS England to review the protocol as it currently stands.

I have asked the Welsh Government to review their policy on out-of-area treatments to consider an exception for English residents—specifically, that GPs operating from branch surgeries in England should be exempt from the requirement to seek prior approval for English resident patients to be referred to hospitals in England. These are all matters of concern not only to constituents of my hon. Friend the Member for Hereford and South Herefordshire but to others. We have heard about that from my hon. Friend the Member for City of Chester (Stephen Mosley) and my hon. Friend the Member for North Herefordshire (Bill Wiggin), and of course I know of the concerns of my hon. Friend the Member for Forest of Dean.

I am informed that since the meeting with the Welsh Secretary and my hon. Friend the Member for Forest of Dean, NHS England has had several further meetings with colleagues in the Welsh Government and local health boards based in Wales to discuss these concerns so that they can be addressed. There have been constructive discussions with Aneurin Bevan local health board, which has confirmed that it will undertake a review of the application of its policy on out-of-area treatment. I understand from NHS England that work will continue on this review over the next few months, and I will of course keep everybody fully informed and up to date on any progress.

[Bill Wiggin]

Will my hon. Friend give way?

[Anna Soubry]

Of course, but quickly.

[Bill Wiggin]

I am most grateful to my hon. Friend. I am really heartened by the positive things she has said, and I congratulate her on the work she has done. Will she also look at the impact of cross-border patient numbers on hospitals, which also badly affects us in Herefordshire?

[Anna Soubry]

Indeed. I will come to the effect on Hereford hospital, but I am more than happy to write to my hon. Friend about his specific point. The usual rules apply: if there are questions that I have not answered I will of course write to any hon. Member.

We have asked the Welsh Government to request that other local health boards along the border in Wales should similarly review the application of their own policies for out-of-area treatment affecting patients in the same circumstances. In many of those areas patient numbers are much smaller, but that does not matter; these are important issues for these individuals.

In the light of the further legal advice that NHS England is seeking, I am advised that it will review the protocol with the Welsh Government in view of my concerns and those of other hon. Members, the updated legal advice, the outcome of the local health boards’ reviews of the application of their policies on out-of-area treatment, and feedback that we have received from local NHS bodies on the operation of the protocol. The review will be undertaken in the autumn following completion of the reviews by the local health boards.

My hon. Friend the Member for Hereford and South Herefordshire is concerned that the policy of the Welsh Government that those who are registered with a Welsh GP must use Welsh NHS services will have a direct impact on the viability of Hereford hospital. I share his concern, but I understand that a number of other factors affect the viability of the hospital and the Wye Valley NHS Trust.

I was a bit concerned when I read the next part of my brief, because it has been worded in an interesting way by my very able officials. It states that those factors include

“the drop in the numbers of young people locally leading to a lack of activity in maternity services”.

I am not sure what “lack of activity” young people have been guilty of. I think that what is meant is that there are not as many young people in the area, because there is undoubtedly a higher proportion of retired elderly people in the population. It is obvious that if there are fewer young people, people are less likely to be having babies and are therefore less likely to use maternity services. I am sure that activity remains at a high level.

As my hon. Friend is aware, Wye Valley NHS Trust published a strategic outline case in March this year, setting out the options for its future form to create a clinically sustainable model for local people. I have been advised by the NHS Trust Development Authority that it has been working with the trust to develop a full business case, which it expects to receive for consideration by the end of this month. Again, I make it very clear that I am more than happy to revisit this issue with my hon. Friend and others following the outcome of that process.