MEMORANDUM SUBMITTED BY POWYS LOCAL HEALTH BOARD (CBPS 65)

1. Executive Summary

1.1 Powys Teaching Local Health Board commissions a significant range of health services from English NHS Trust providers.

1.2 Funding to English NHS Trust providers is based predominantly on historic baselines as the Health Service in Wales does not recognise English tariff.

1.3 The tLHB is content with the quality of services provided to its population from its English NHS Trust providers, but notes there are continued difficulties and tensions over the matter of tariff and differential waiting times.

2. Introduction (to Powys tLHB)

2.1 Powys Teaching Local Health Board (the tLHB) both commissions and provides a range of healthcare services to the population covered by the county borough of Powys. The county runs along the border between England and Wales.

2.2. The circa 120,000 population is of rural status and having no District General Hospital within its boundaries, is serviced from several English and Welsh District General Hospitals outside of the borough.

3. Extent to which Powys population accesses cross border health services

3.1 Whilst the largest element of expenditure on secondary healthcare by Powys tLHB is on its own provider function, the Powys population receives the majority of its acute care via District General Hospitals (DGHs) outside of boundaries of the county borough. The most significant English NHS Trusts providing these DGH services to Powys are Hereford Hospitals NHS Trust and Shrewsbury and Telford Hospitals NHS Trust

3.2. To put some context on the scale by which Powys tLHB commissions services from English NHS Trusts, of the total secondary care expenditure incurred by Powys tLHB, approximately 23% (just under £30million) is with 13 English NHS Trusts with the largest provider within this category being Shrewsbury and Telford Hospitals NHS Trust (12%).

4. Arrangements in place to co-ordinate cross-border service provision

4.1 Powys tLHB has NHS contracts in place with the majority of its English NHS Trust providers. The tLHB uses the template documentation issued by the Welsh Assembly Government as the basis for the majority of its contracts.

4.2 The contracts are agreed on an annual basis and are negotiated based on anticipated demand for services and applied inflationary increases.

4.3. Regular review meetings are held with providers to consider and agree the actual performance and corresponding funding against contracted baselines.

5. Funding and Quality of cross border services

5.1 The tLHB funds the services provided by English NHS Trusts based on the resource mapped funding provided to it on its establishment in 2003/04, adjusted annually for movements in activity and uplifted for inflationary increases.

5.2 The tLHB seldom receives complaints regarding the quality of services provided by English NHS Trusts and has no cause for concern regarding this matter.

6. The extent to which health policy has diverged across the UK since devolution

6.1 There are several differences between England and Wales in terms of the approach to securing healthcare services for their respective populations. The two which predominantly impact on the relationships between Powys tLHB and its English NHS Trust providers are:

Ø Implementation of tariff

Ø Differential waiting times targets

6.2. As noted in paragraph 5.1. above, the tLHB funds all providers based on historic funding baselines adjusted for movements in activity and uplifted for inflation / recognised pressures.

6.3. The implementation of Payments By Results or "tariff" would normally have meant Powys tLHB paying a higher price for the same level of service received by English NHS Trust providers. The tLHB has not received funding from the Welsh Assembly Government to recognise English tariff and has therefore received the support of the Welsh Assembly Government to only pay against historic funding baselines.

6.4. This has not however, prevented several providers still pursing the tLHB for additional funding.

6.5. The implementation of differential waiting times has also had an impact both on the management arrangements for meeting targets and on managing the population's expectation of services provided between England and Wales.

6.6. For example, with Hereford Hospitals NHS Trust, the tLHB has taken on the management of the waiting list because the Trust has refused to operate differential waiting lists between English and Welsh commissioners. This has placed an administrative burden on the tLHB as we now manage the waiting list both for ourselves and that of Monmouthshire LHB.

6.7. Similarly, the English providers who have continued to operate differential waiting times between English and Welsh commissioners have had additional administrative burden placed upon them.

6.8. In addition, the tLHB has to manage both patient and clinician perception of operating differential waiting times between England and Wales which has resulted in letters of complaint due to the confusion over the differences.

7. Mechanisms for identifying and resolving cross border deficiencies

7.1. As outlined above, the tLHB maintains regular contact with its English providers and any issues requiring resolution are, where possible resolved locally.

7.2. However, the issue of price has in the past and still today caused tensions with English providers. The tLHB has already been through arbitration over this matter and it is possible that this will occur again.

7.3. The process for resolving this type of dispute is through an arbitration process via the relevant Strategic Health Authority and the Welsh Assembly Government.

8. Recommendation

8.1. Powys Teaching Local Health Board has no specific recommendations to make to the Committee, but asks the Committee to note the contents of this memorandum.

31 March 2008