SUPPLEMENTARY MEMORANDUM SUBMITTED BY BRECON AND RADNOR COMMUNITY HEALTH COUNCIL (CBPS 15A)

Notes of the Meeting with Yvonne Jones 29 April 2008.

Yvonne said there was a clear directive at one time to commission services in Wales and withdraw from England.

This has relaxed lately probably because HCW are more tied up with issues relating to reorganisation of Health Services in Wales but try and reduce services across the border.

There is a special need for some services to be accessed across the border - namely some orthopaedic work like spinal problems, cardiac provision and ENT provision, although these services (ENT) are being transferred to Worcester. There are difficulties of funding.

From a re-provision perspective in Wales - amongst the issues involved are:

1 Significant difficulties in lengthy travelling to access the services.

2 Differences in pricing systems in England, generally price is based upon the procedure - say hip replacement with universal cost - same for everyone, but in Wales the cost will be different say in Wrexham to Gwent to Bronglais, etc, etc, with substantial differences in some instances.

The usual and standard amount of time spent on the ward with relevant procedures, etc in England is built into the pricing mechanism based upon what is expected. However if there is an extension to the stay or services then additional costs can be incurred with extra bed days.

In Wales if the patient is in hospital 2 days or 20 the price is still the same.

Another issue associated to this of course is about effectiveness and efficiency. One hospital may be seeing 20 patients in a given time another 40 patients, prices should reflect this issue. (This is an issue that should be part of a policy debate at a high level).

The Powys LHB at present are responsible for 12% of the work at Shrewsbury DGH and 20% of the work at Hereford DGH.

At Hereford there are some difficulties where they are looking to introduce a local pricing system with inflation built in.

New contacts have been introduced across providers in Wales based upon the WH Circular WHC(2008)004.

The cross border arrangements have rolled on since 2005 WHC(2005)12 now WHC(2008)019.

Waiting Times

We are disadvantaged in Wales based upon the different waiting times in England to Wales.

In England from referral to treatment including outpatient, inpatient, etc a total time of 16 weeks.

Whilst in Wales it is 5 months (20 weeks) for inpatient treatment. This is a gross imbalance of provision.

The Powys LHB have been administering the waiting list for Powys patients. Although it now seems that the difficulties associated with this function seem to be problematic and the English DGH's are taking back this function and embracing the list into their common waiting pool. There are issues around this in as much as the English DGH's are looking to the Welsh contractors to buy into the English waiting times.

From the Robert Jones and Agnes Hunt Orthopaedic Hospital perspective, they are happy to take the inpatient list but leave the outpatient list to Powys.

Other Issues

1 A copy of the Maria Low report to be sent to Yvonne, Judith and Peter Meredith-Smith.

2 A report from the Mental Health Manager will be going to the LHB Board highlighting the limited resources of the Mental Health Advocacy Scheme and the need to increase the money available to the contract especially now the legal input has greatly reduced.

3 The All Wales information on IMCA statistics to be made available to Yvonne Jones/Cath Quarrell, Dawn Clarke and Mental Health Management Group

4 It was noted that Rebecca Richards is now responsible for the SLA contracting service.

2 June 2008