The must-read stories and debate in health policy and leadership.

Cross border tension

Tensions have been fraying over who should pay what for Welsh patients receiving treatment in England.

Welsh health boards pay less than their English counterparts for treating patients (between 5 and 10 per cent depending on the treatment). The disparity is not new but the rates for the (English) 2019-20 national tariff payments have widened the gap. And, when Welsh patients move across the border for treatment, English trusts must accept less money for the same treatment based on the patient’s nationality.

This has left some border trusts with a potential financial shortfall. HSJ reported three trusts disclosing they would be millions of pounds out of pocket. There are almost certainly more in a similar position.

All trusts that responded to HSJ for the story have talked up the chance of a resolution. In past years, both Welsh health boards and NHS Improvement have, fully or partially, made up the shortfall.

However, Countess of Chester Hospital Foundation Trust was adequately alarmed this year to stop treating Welsh patients until the matter was resolved, a move the Welsh government said was “unacceptable”.

Resolving who pays for the gap is largely out of individual trusts’ hands, with talks ongoing at national level between NHS England/Improvement and the Welsh government.

Thus far, no other trust has said it will refuse treatment to Welsh patients but that may change if a solution is not found.

Thank you for your interest

Teeing up the leadership team for the merged Aintree University Hospital Trust and Royal Liverpool and Broadgreen University Hospitals Trust was always going to be a tall order. 

There was – or at least seemed – to be a clear cut choice for chair. After Royal’s chair Bill Griffiths stepped down earlier this year, Aintree’s Neil Goodwin looked a shoo in.

But according to minutes from a governors’ meeting last month, NHS Improvement was less impressed with this choice of chair, thanks to Aintree’s “requires improvement” Care Quality Commission rating

This view seems to have softened after joint regional leadership was established with NHS England, with Mr Goodwin applying and interviewing for the role. In fact, he was the only person interviewed after another candidate dropped out (Aintree said the role was advertised nationally).

But the interview panel decided not to recommend his appointment to the council of governors, so the recruitment process is back to square one with the role being re-advertised.

This may also have delayed interviews for the chief executive role, which had been due to take place earlier this month. Normally you would want the chair to be determined first.

Additionally, it could be a spanner in the works for the merger timeline. The trusts still insist this is planned for October 2019, but this seems ambitious, given the transaction still needs to go through the NHSI and Competition and Markets Authority approval processes.