Page last updated at 15:16 GMT, Tuesday, 18 March 2008

NHS trust's '2m Welsh subsidy'

Doctors and nurses performing an operation
Some Welsh patients are waiting longer than English equivalents

An NHS trust in England is subsidising patients from Wales by 2m a year, MPs have been told.

Shrewsbury and Telford NHS Trust chief executive Tom Taylor said he was paid less for treating patients from Wales than their counterparts in England.

MPs are investigating differences in public services in border areas of the two countries.

The Welsh Assembly Government said it had an agreement with the UK Government to ensure hospitals were paid fairly.

Mr Taylor told MPs on the Welsh affairs select committee: "I am not getting a fair deal to the tune of 2m."

Patients from Wales can also wait longer for the same treatment in non-urgent cases, he said.

His trust, which borders mid Wales, has a contract with Powys worth 15m a year.

If...all Welsh patients must be treated in Wales I think there would be serious clinical issues around that
Tom Taylor, Shrewsbury and Telford NHS Trust

The 2m gap is due to different ways of paying for treatment between Wales and England.

The difference along the whole Wales/England border could take tens of millions of pounds to resolve, Mr Taylor said.

But Mr Taylor said there was also some cross-subsidy.

If he were to lose that contract, he said he would be unable to recover it from English providers, leading to job losses and cuts in services.

"Yes, you can say 2m worth of subsidy but look at the other side," he said.

"If it wasn't there what would I do if I had that total loss of income?"

Mr Taylor warned against treating patients from Wales only in Wales.

"I don't think it would be clinically safe, no," he said.

"If there was a complete repatriation and all Welsh patients must be treated in Wales I think there would be serious clinical issues around that, particularly because of the travel distances," Mr Taylor added.

Plaid Cymru MP Hywel Williams asked him if anybody was seriously suggesting the repatriation of all services.

Mr Taylor replied: "There have been statements attributed to ministers in the Welsh assembly that says that will happen."

Ability to pay

Mr Taylor denied that the trust prioritised English patients, although he said previous management at the trust had done so.

He said clinical priority was the number one issue, despite different maximum waiting times in the contracts.

"If there are reasons why a patient doesn't need to be seen urgently clinically then yes, it will take longer for them to be seen if they are a Welsh commissioner because that's what the Welsh contract says."

Asked whether waiting times should be uniform or at least comparable throughout the UK, Mr Taylor said: "Yes, I'm very clear."

He said he didn't see why the principle of patients being treated on the basis of need, not ability to pay should be different in different countries.

In response, the Welsh Assembly Government said its aim "has long been to provide services as close to the patient as possible where it can be delivered safely and sustainably".

The statement added: "While the (Welsh) health minister wants to provide services for patients within Wales where possible, there will always be instances where patients will have to travel to England for highly specialised treatment that may only be on offer at a few centres in the UK.

"Our main aim is that patients have access to the most appropriate treatment when they need it.

"We have an agreement in place with the Department of Health (in England) in relation to the funding of Welsh patients treated at English hospitals, and English patients receiving treatment at Welsh hospitals, to ensure that hospitals are fairly paid for the treatment they provide."

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