Memorandum submitted by a group of retired people who have played a prominent role in the NHS and in public life in North Wales (CBPS 62)

The report entitled "Neurosurgery and Specialist Hospital Services for the People of North Wales" is submitted to the Welsh Affairs Committee for their consideration.

The report is set out in three parts:

Part 1 is a thorough review of neurosurgical services to the people of North Wales, together with a list of detailed objections to the proposal that elective neurosurgical cases should be redirected from The Walton Centre, Liverpool to Morriston Hospital, Swansea. We are firmly of the view that the proposal should be abandoned. The current arrangements should continue with all neurosurgical cases admitted to Walton, unless the patient and their relatives choose to go to another centre.

Part 2 sets out our concern that the proposal for neurosurgery is a model for other specialist hospital services, and there is an agenda that patients from North Wales requiring specialist acute hospital care will be redirected to Cardiff. We base our concern on actions and statements made by the Minister for Health. We consider this apparent shift of policy is not in the best interests of patients and their relatives and carers. Our view is that there should be a firm commitment to continue with the present pattern of referral to specialist hospitals in North West England.

Although we are sure Health Commission Wales undertake their role in a very professional manner, we consider that once the air is cleared over future policy, there should be a more positive approach to commissioning of services from specialist hospitals in North West England. This approach should involve Local Health Boards and NHS Trusts in North Wales more in the process. We believe that there are a number of improvements in services that could be achieved for patients in North Wales, without large additional expenditure

Part 3 raises the issue of the disparity between waiting times for patients from Wales compared to those from England, attending the same specialist hospitals in England. We state in our report that this issue came up relatively late in our review. We have written to three of the specialist hospitals asking for more precise information. None have replied. We can understand why this is so; the Trusts will not wish to jeopardize their working relationships with Health Commission Wales and the Welsh Assembly. We would, however, point out that managers in tertiary specialist hospitals in England stated they have a good working relationship with the staff of Health Commission Wales.

From our informal discussions it would appear that the discrepancies between waiting times for Welsh and English patients are considerable. We are not talking of a week or two. In some cases we were told the difference could be 15 to 20 weeks. We do not consider this is acceptable. These assertions need to be tested out.

It is public knowledge that maximum waiting time targets in Wales are longer than in England. For example, maximum time from referral from a GP to first appointment in Wales was 52 weeks in 2006, but was 18 weeks in England. Since then targets in Wales have been tightened. As at March 2008 the Welsh standard will be 22 weeks and by March 2009, 10 weeks. In Walton the waiting time is now 3 to 4 weeks for English patients. At Alder Hey the maximum wait target is 11 weeks and in 2008 will reduce to 5 weeks for English patients.

We fully accept maximum waiting times are not the most meaningful indicator [although they do present a comparative picture]. Mean, or average, waits for a patient from referral from a GP to first out-patient appointment, and then admission to hospital, present a more reliable measure.

The whole issue is complex and although we could pursue the matter further, requesting information under the Freedom of Information Act, we do not consider this approach will be fruitful.

We recommend that the Welsh Affairs Committee undertake their own investigation and commission an audit and a study by experts. A possible approach would be to compare waiting times at specialist hospitals for patients from North Wales compared with an area in England, say Cheshire.

Some of the information that would be helpful to obtain would be:

Health Commission Wales

- policy on waiting times for Welsh patients in specialist hospitals in England

- what are the detailed requirements in contracts?

- what is the cost per procedure, and is it the same for Welsh specialist hospitals as in England?

- are their disputes with English Trusts about payments?

English Trusts

We suggest the Committee concentrate on those English Trusts where there are a significant number of elective cases from Wales, e.g.

Alder Hey Children's Hospital

Broadgreen Cardio-Thoracic Centre

Manchester Royal Infirmary - cardiac centre

Robert Jones and Agnes Hunt, Gobowen - spinal injuries and specialist orthopaedics

The Walton Centre

The issues that need exploring include:

- what is the discrepancy between waiting times for patients from Wales compared with those from England, both for maximum and for mean waiting times?

- have they the capacity to reduce waiting times for Welsh patients to be the same as for English patients? If so what would be the cost?

- are there disputes with Health Commission Wales about payments?

The aim should be to identify the cost of first equalizing waiting times for out patient appointments, then for in-patient admission. Once the costs are known, then there can be an action plan introduced to achieve parity.

We do not consider these questions to be exhaustive, and as stated above, we recommend the Welsh Affairs Committee undertake their own investigation into a subject which we consider is very important. Much publicity is given to individual cases where a patient from Wales is denied treatment that would be available to a patient from England. This issue of disparity of waiting times is one that affects a much larger number of people.

28 March 2008