One of England’s largest specialist providers is to take a stricter approach to accepting patients from Scotland, Wales and Northern Ireland, after struggling to secure payments from commissioners.

  • UCLH owed more than £2.3m for treating Scottish, Welsh and Northern Irish patients
  • Trust to review every patient from the devolved nations on its pathways
  • It hopes to agree a standardised approval process for funding

University College London Hospitals Foundation Trust said some commissioners outside England use a “burdensome” prior approval process, where a funding agreement is needed before each stage of treatment. The process can cause delays for patients as decisions often take two working days.

At the end of 2014-15 the trust was owed more than £2.3m for treating patients from Scotland, Wales and Northern Ireland. While debts from English commissioners remain within the same health system, the three other UK countries have devolved powers over the NHS.

The FT has decided to apply the rules more rigorously, and is now reviewing every patient from the devolved nations on its pathways to check that approval has been given.

It is also looking to work with other providers, the Department of Health and NHS England to simplify and standardise funding requirements.

HSJ sent freedom of information requests to a sample of 21 English providers, including major specialist trusts and those near borders. The responses suggested there was £21m of outstanding debt relating to patients from the devolved nations treated in the last three years, against total invoicing of £315m.

Of the outstanding debt, £5m was from 2012-13 and 2013-14, according to the responses.

A senior clinician at one of the organisations said trusts would have to start following the process more thoroughly to ensure their costs are met, but warned this could cause treatment delays.

A spokesman for UCLH, which is owed £700,000 from 2012-13 and 2013-14, said it would “review existing patients from the devolved administrations… to assess if prior approval is currently in place for these patients”.

He added: “Administering the requirements of the devolved administrations is burdensome and not aligned with the standard administrative processes that we operate as an organisation.

“It introduces significant risk of non-payment for trusts. The aim is to work with the Department of Health and NHS England to identify a way to simplify the current requirements of the devolved administrations.”

UCLH hopes to use a standardised approval process to cover a patient’s pathway, rather than needing approval before each stage, as required by some commissioners in Scotland.

Moorfields Eye Hospital FT said it already requires a full funding agreement for “any and all treatment” in advance of accepting referrals. However, the trust is still owed more than £600,000 for treatments in the last three years, against invoices totalling just over £1m. It is in “ongoing dialogue” with commissioners about the money, a spokesman said.

National Services Scotland, which handles the commissioning of specialised services, said: “In some treatment pathways we require prior approval before each stage in a patient’s treatment, depending on the nature of the illness; and the possibility of patients obtaining specialist diagnosis and advice on management at an English trust and then returning to a local hospital in Scotland for ongoing care. In some conditions we approve for the whole pathway.”

It said payments are prompt for cases approved in advance, but it could not comment on cases involving routine care, as these are commissioned by local health boards.

Stuart Davies, finance director of Welsh Health Specialised Services, said the vast proportion of its patients treated in English hospitals are covered by a £100m contract, but a small number of complex cases would need prior approval. He would not speak for commissioners of routine care, but said he had no ongoing disputes with English trusts, or outstanding debt from before 2014-15.