Health: Funding

Earl Howe Excerpts

Tuesday 1st November 2011 Lords Chamber

[Lord Roberts of Llandudno]

To ask Her Majesty’s Government whether they will take action to ensure that there is no delay in funding medical treatment in hospitals in England for residents of Wales, Scotland and Northern Ireland.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, in the future it will be the role of the NHS Commissioning Board to act as the steward of NHS resources in England, including managing the structure of payments for NHS services. During the transition to the new NHS structure, officials from the Department of Health are working with colleagues from the devolved Administrations to understand and resolve any issues which are arising as the result of the devolution of the responsibility for healthcare.

[Lord Roberts of Llandudno]

I thank the Minister for that reply. Will he give us an assurance that no person needing medical attention, wherever they are in the United Kingdom, shall be denied the very best attention possible, and that in order to facilitate that—and I have some indication that this is already happening—there should be immediate discussions between the devolved health administrations and here to make sure that neither funding nor procedure nor anything else will prevent the best treatment for patients wherever they are in this kingdom?

[Earl Howe]

I fully agree with my noble friend that the same principles should apply across the United Kingdom as regards access to NHS treatment and facilities. The majority of cross-border flows occur in relation to Welsh patients coming in to England, and I am not aware that there are particular problems there. The Department of Health and the Welsh Government have agreed a protocol for cross-border healthcare commissioning, to define commissioning and payment arrangements for those living along the border. I believe that that is working well.

[Lord Wigley]

My Lords, is the Minister aware that there are numerous cross-border issues between the north Wales area and the Liverpool and Manchester area, where many people get their services and treatments? Is he aware that the NHS policy changes currently being pursued in England are estimated to have a knock-on negative effect of no less than £11.5 million on the Betsi Cadwaladr health board, which serves the north Wales area? In those circumstances, is it not imperative that the health departments in Wales and England work together very closely indeed so that our health board can plan safe and sustainable services for all the people living in north Wales?

[Earl Howe]

Yes, I agree with the noble Lord. It is important that officials from both Wales and England have a dialogue to ensure that problems do not arise of the kind that the noble Lord refers to. Having said which, I repeat that the protocol that currently exists, and the funding that we in England give to the Welsh Government to compensate for differences in prices between either side of the border, serve to ensure that patients are treated promptly and as they should be.

[Lord Jones]

Does the Minister fully comprehend that the border between England and Wales is over 200 miles long; that the bulk of the population of Wales is in the east; and that historically there has always been access—for example, from north-east Wales—to the great hospitals of Christie in Manchester, Broadgreen in Liverpool and Alder Hey in Wirral? Does he fully comprehend the current anxiety? It is the wish of the mass of the population that they should have access to these hospitals—hospitals of access and excellence—and that Ministers in England should take a generous and understanding attitude to the wishes of a population who have always had access to the excellence of these great hospitals, of which the people of north-east Wales are very fond.

[Earl Howe]

My Lords, I appreciate everything that the noble Lord has said. He may like to know that the protocol to which I have referred states as follows:

“The patient’s safety and well-being must be paramount at all times. No treatment must be refused or delayed due to uncertainty or ambiguity as to which”—

local health board or PCT—

“is responsible for funding the healthcare provision”.

I think that that should give patients in Wales every reassurance.

[Lord Elystan-Morgan]

My Lords, does the Minister accept that there is one very specific matter in relation to transborder matters in Wales, and that is in relation to Powys? Despite strategic policy decisions of many years ago, Powys has never had a district general hospital, with the result that there is a very considerable flow from north-east Powys to hospitals in the Shrewsbury and Telford area. Will he give an undertaking that, whatever happens, that system will continue?

[Earl Howe]

My Lords, nothing in the Government’s plans will impede the flow of Welsh patients into England. I can give the noble Lord that reassurance.

[Baroness Randerson]

The increased sensitivity to local needs which will be created by the reorganisation of the health service is to be welcomed, but in practice there will be more organisations involved which will need to co-operate. Does the Minister agree that this will need strong ministerial guidance for all affected organisations to follow if individual patients are not to suffer delays?

[Earl Howe]

I agree with my noble friend. The NHS Commissioning Board will have a duty to consider the likely impact of commissioning decisions on the provision of health services to people living close to the border with England, wherever they may be.

[Lord Foulkes of Cumnock]

Did I catch the Minister’s first answer right—did he say that it would be the new head of commissioning who would have this responsibility? Am I right in saying that this is the professor who was described by MPs as not having the experience necessary and not understanding the job of head of commissioning, and who was only approved by the committee in the House of Commons on the casting vote of the chairman? Is this the guy who is going to be responsible?

[Earl Howe]

My Lords, the chief executive-designate of the NHS Commissioning Board is Sir David Nicholson, who is currently chief executive of the NHS. He is not the gentleman to whom the noble Lord referred. He currently runs the NHS. Professor Malcolm Grant, to whom I think the noble Lord was referring, will be chairman of the NHS Commissioning Board Authority, in a non-executive capacity.

[Baroness Thornton]

My Lords, I think it is time that we brought Scotland, Wales and Northern Ireland into this Question, since they are actually part of the Question. So, on behalf of the rest of the UK, it is my understanding that essentially the same responsibilities and powers rest on the Secretary of State in England and the Ministers of Health in Scotland and in Wales. My question to the Minister is how do the Government intend to reconcile, manage and co-ordinate accountability to patients on cross-border concerns?

[Earl Howe]

My Lords, the accountability is currently, as the noble Baroness will know, fairly complicated. Patients who are resident in England are the responsibility of their local PCT and patients with a Welsh GP are the responsibility of the Welsh local health board. That leads to an anomaly where patients who are resident in England but who have a Welsh GP are the legal responsibility of two commissioners, while patients resident in Wales with an English GP are not the responsibility of any commissioner. The situation is much clearer in Scotland because patients resident in Scotland but registered with an English GP are the responsibility of Scotland, and that is very clear. None of that will change as a result of the Government’s reforms.