Ministers strike deal to resolve cross-border row

29 May 2019 Seamus Ward

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The trust said in April it would no longer provide elective care for new Welsh patients as it was unable to agree funding with Betsi Cadwaladr University Health Board. The trust continued to take some patients, including maternity cases, patients waiting for treatment and those attending A&E.

Countess of Chester

The health board said the issue was over changes in the structure of the tariff system for 2019/20, making the care provided unaffordable. The tariff has risen, partly to cover the cost of the new Agenda for Change deal, which was funded through a separate funding stream in 2018/19.

It is understood the Department of Health and Social Care will provide funding to close the gap in 2019/20, with the Welsh government covering the cost in future years.

Welsh health and social services minister Vaughan Gething remained disappointed at the trust’s actions, which he said were taken while negotiations were ongoing. However, he hoped such disputes would be avoided in the future through closer Welsh involvement in tariff setting.

He said: ‘What is evident is that changes introduced to the tariff costs in England since 2017 have created a complex set of issues in relation to cross-border arrangements.

‘Wales will now have a seat on [England’s] tariff advisory group. We need to fully track policy developments in England that will potentially have an impact on the tariff in future to aid planning in the Welsh context.’

Countess of Chester chief executive Susan Gilby insisted that the trust was unaware of national negotiations on the matter when it took the decision on new referrals.

‘We were clearly informed that there were no ongoing negotiations to address the issue of contracting for cross-border secondary (as opposed to tertiary) care prior to our decision. Nor are there any existing protocols which would mandate that we continue to accept underfunded elective referrals at the expense of investments in patient safety.

‘Our focus remains the delivery of high-quality services to the population we serve.’