Memorandum submitted by the Statistical Directorate,

Welsh Assembly Government (CBPS 80)

Background

The Welsh Affairs Select Committee requested information on health care statistics specifically relating to cross-border provision.

General points

Since devolution, the Welsh Assembly Government has set targets for the NHS in Wales. These targets are frequently different to those set for the NHS in England, so are often measured in a slightly different way.

This means that some statistics cannot be used to compare England and Wales. Some statistics published in England do not have an equivalent in Wales (and vice versa).

The coverage of data in England and Wales also varies slightly. Since the Welsh Assembly Government sets targets for all Welsh residents, data is collected on this basis. This means that people who are resident in England but registered with a GP in Wales are not necessarily recorded in Welsh waiting times data (though the health services in either country may take responsibility for these patients).

a. People registered with a GP across the border

There are no restrictions on cross-border registrations - Welsh residents can be registered with a GP in England, and vice versa.

The Statistical Directorate does not currently collate or publish figures for the number of GP registrations in England and Wales. However, some data has been collected internally within NHS Wales, and shared with the UK Department of Health.

In April 2007:

Source: NHS Wales Business Service Centres

These figures are produced by NHS Wales for internal management purposes, and should be considered as a guide only. However, this is the only source available that includes data on English residents registered with GPs in Wales.

The Welsh NHS Administrative Register database contains a more complete record of Welsh residents registered with English GPs, but not vice versa.

Source: Health Solutions Wales (1 May 2008)

b. People treated across the border

We can estimate the number of people treated across the English-Welsh border using information from the Patient Episode Database for Wales (PEDW). This counts the number of times that a new patient is admitted to a Trust for treatment (i.e. not including follow-up visits).

In 2006/2007, there were 48,944 Welsh residents admitted to English Trusts (6.4% of all admissions for Welsh residents).

In the same year, there were 12,671 English residents admitted to Welsh Trusts (1.7% of all patients treated in Wales).

The way this information is collected has changed since 1999/2000, so any direct comparison between years would be flawed. However, data for 2006/2007 has also been recalculated using the old methodology to allow for comparisons, as shown in the table below.

* calculated using the methodology used in 1999/2000 for comparative purposes only

Data on hospital admissions from 1999 to 2007 is available from Health Solutions Wales on their Internet site (http://www.wales.nhs.uk/hsw-healthstats). Figures for 2006/2007 were released on 22^nd April 2008.

c. Waiting times for Welsh people being treated in England

At the end of February 2008, there were 6,251 Welsh residents waiting for their first outpatient appointment at English Trusts. Of these, none have waited more than 36 weeks and 304 have waited more than 22 weeks (4.9%).

In February 2008, there were 3,159 Welsh residents waiting for inpatient and day-case admissions at English Trusts. Of these, one has waited more than 36 weeks and 310 have waited more than 22 weeks (9.8%).

The majority of these (around two-thirds) were referred from Local Health Boards in North Wales, with fewer from Mid and West Wales and South East Wales. There were no clear differences between the waiting times in each region.

The percentage of Welsh residents waiting more than 13 weeks for an out-patient appointment at an English Trust has fallen from 32% to 22% since April 2007.

Note that these figures include waits for consultant to consultant referrals as well as waits for referrals from GPs. In England, only GP referrals are monitored.

Data on waiting times for diagnostic tests for Welsh residents in English Trusts is not currently included in the monthly statistical collection. This collection is limited only to patients waiting for diagnostic tests in Welsh Trusts.

Targets for "referral to treatment" times have been set for March 2009 in Wales, and data is due to be released in 2008/2009 to monitor progress.

The StatsWales (http://www.statswales.wales.gov.uk) website has further information on waiting times, including cross-border issues. The site allows the user to design reports which can break down waiting times by Local Health Board and by month.

d. Waiting times for Welsh people being treated in Wales

At the end of February 2008, there were 146,446 Welsh residents waiting for first outpatient appointments at Welsh Trusts. Of these, none had waited more than 36 weeks and 5,261 had waited more than 22 weeks (3.6%).

In February 2008, there were 48,894 Welsh residents waiting for inpatient and day-case admissions at Welsh Trusts. Of these, none have waited more than 36 weeks and 2,686 have waited more than 22 weeks (5.5%).

The percentage of Welsh residents waiting more than 13 weeks for an out-patient appointment at Welsh Trusts has fallen from 31% to 22% since April 2007.

Note that these figures include waits for consultant to consultant referrals as well as waits for referrals from GPs. In England, only GP referrals are monitored.

In February 2008, there were 42,934 people waiting for the specific diagnostic tests that are monitored at Welsh Trusts. Of these, one has waited more than 36 weeks and 1,875 have waited more than 14 weeks (4.4%).

Targets for "referral to treatment" times have been set for March 2009 in Wales, and data is due to be released in 2008/2009 to monitor progress.

The StatsWales (http://www.statswales.wales.gov.uk) website has further information on waiting times, including cross-border issues. The site allows the user to design reports which can break down waiting times by Local Health Board and by month.

e. Waiting times for English residents

The Welsh Assembly Government does not generally collect information about English residents waiting for treatment in Wales. While English residents are included in the figures of those waiting for diagnostic tests in Welsh NHS Trusts, they are not separately identifiable.

f. Median Waiting Times

Median waiting times for patients admitted to hospital (through a waiting list or booked admission) were released for the first time in Wales on 22^nd April 2008. These are not calculated on the same basis as the earlier waiting times information, and are taken from the PEDW database for patients who already have been treated rather than those who are still waiting for treatment at the end of each month.

During 2006/2007, English residents had a median wait of 48 days before admission to Welsh Trusts. This compares to 45 days for all patients admitted to Welsh Trusts.

During 2006/2007, Welsh residents had a median wait of 44 days before admission to English Trusts. This compares to 45 days for all Welsh residents admitted to any Trusts.

g. The cost incurred by Local Health Boards for the treatment of Welsh patients in England

The Statistical Directorate do not collect any information on costs of health care across Wales. However, we are able to reproduce information from the 2006-2007 annual accounts of the Local Health Boards on the border between England and Wales.

Figures are only available for secondary and community health care (which are combined in the individual tables below). Although other Welsh Local Health Boards also incur costs for patients referred to English Trusts, the LHBs on the border incurred the largest part (£57.3 million) of the total amount spent on English Trusts by all LHBs in 2006-2007 (£74.5 million).

Flintshire Local Health Board

Expenditure to non-Welsh NHS Trusts

Countess of Chester - £16.6 M

Robert Jones and Agnes Hunt Orthopaedic - £2.0 M

Royal Liverpool and Broadgreen - £570,000

Wirral Hospitals - £430,000

Cheshire and Wirral Partnership - £340,000

Other non Welsh NHS trusts - £1.2 M

(all figures rounded)

Wrexham Local Health Board

Expenditure to non-Welsh NHS Trusts

Robert Jones and Agnes Hunt Orthopaedic - £4.6 M

Royal Liverpool and Broadgreen - £530,000

Countess of Chester - £400,000

Royal Shrewsbury - £340,000

Shropshire County - £340,000

Telford and Wrekin - £95,000

Liverpool Women's - £90,000

Other non Welsh NHS trusts - £600,000

(all figures rounded)

Powys Local Health Board

Expenditure to non-Welsh NHS Trusts

Royal Shrewsbury - £12.6 M

Hereford Hospital NHS Trust - £6.4 M

Robert Jones & Agnes Hunt Orthopaedic - £3.2 M

Shropshire County - £1.0 M

Other non Welsh NHS trusts - £1.3 M

(all figures rounded)

Monmouthshire Local Health Board

Expenditure to non-Welsh NHS Trusts

Gloucester Hospitals NHS Trust - £1.8 M

Hereford Hospital NHS Trust - £1.4 M

North Bristol NHS Trust - £590,000

Gloucester Partnerships NHS Trust - £210,000

United Bristol Hospital NHS Trust - £180,000

Other non Welsh NHS trusts - £490,000

(all figures rounded)

In 2007-2008, there is a funding agreement between the Department of Health and the Welsh Assembly Government to provide for patients living at one side of the border and accessing primary health care at the other side.

Since there were more English residents accessing primary health care in Wales than vice versa, the Department of Health provided an additional £5.56 million to the Welsh Assembly Government to reflect the net difference in primary health care provided across the border.

The Statistical Directorate cannot provide information about the costs incurred by English PCTs for the treatment of Welsh patients.

9 May 2008