It is unreasonable to expect the NHS in Shropshire to configure services to suit Welsh people at the expense of people living in Shropshire

Shrewsbury and Telford Hospitals NHS Trust is currently consulting on the provision of services across the two general hospitals in the county.

Faced with real terms budget cuts from the British government, the Trust has to consolidate services at the two sites as it is no longer possible to fund the same services at both hospitals.

Consultation events are being held all over the county where Shropshire residents can have their say but not only are we in Shropshire being consulted, people in Wales are as well.

The Royal Shrewsbury Hospital is used by people in Wales where it is closer than their nearest Welsh hospital but it is not their hospital.  Health is devolved and the Welsh government is responsible for providing health services to Welsh people.  Welsh health boards pay English NHS Trusts to provide health services to Welsh people.  They are customers of the English NHS, they have no right to make decisions on how we provide our service this side of the border.

Of the eight consultations taking place, three are in Wales.  A lot of the arguments against moving services from Shrewsbury to Telford that have been reported from the consultation meetings already held revolve around the inconvenience to patients from Mid Wales.  Travelling the extra 10 miles to Telford could be the difference between life and death, they are saying.  Well yes, it could but then people from South Shropshire travelling the extra 10 miles to Shrewsbury could be the difference between life and death.

In Shropshire it is the responsibility of Shropshire County PCT, Telford & Wrekin PCT and the Shrewsbury and Telford Hospitals NHS Trust to provide health services to Shropshire people.  In Powys it is the responsibility of the Powys Health Board to provide health services to Powys people.  In Shropshire the funding comes from the British government, in Powys it comes from the Welsh government.

That there is a shortage of hospitals in Mid Wales is not in question but it is not the responsibility of English hospitals to fill that hole in health provision.  The Welsh government chooses to spend a big chunk of its health budget on free prescriptions and hospital parking rather than a general hospital for Powys.  That's their choice.  The NHS in Shropshire loses £2m per year treating Welsh patients because the Welsh government won't pay the same rate for treating Welsh patients as the British government pays for treating English patients.

The best thing for Shropshire is, of course, to keep a full range of services at both the Royal Shrewsbury Hospital and the Princess Royal Hospital but the British government won't let us have enough of our taxes back to pay for it so services have to be targeted at where they are needed.  Telford is the fastest growing town in Shropshire and has by far the largest population of any town in the county - more than twice the size of Shrewsbury and accounting for 35% of the population of the whole county.  If services have to be consolidated on one site then the site that can best serve the majority of Salopians is the Princess Royal Hospital in Telford.

If people in Powys are unhappy with the idea of travelling an extra 10 miles to access services in Telford then they can lobby their Welsh Assembly Member for a new hospital of their own.  It is unreasonable to expect the NHS in Shropshire to configure services to suit Welsh people at the expense of people living in Shropshire.  The Welsh can't have all the benefits of devolution without the responsibilities that go with it.

Shropshire NHS needs to start thinking like a business, not just acting like one

Today's meeting of the Shropshire NHS Trust was a bit of a shambles by all accounts - they didn't announce it properly so it wasn't a legal consultation - but the Park Inn in Telford was packed out (over 300 people) despite being held, yet again, during the working day.

Earlier this month I wrote on this blog that it is the Welsh government that needs to sort out the inadequate health provision in Mid Wales, not the NHS here in Shropshire and I stand by that. I suggested that the Welsh government should invest some of their substantial health budget in building a new hospital in Mid Wales so that the Welsh government can discharge its duty to provide adequate health care to Welsh people without unduly impinging on our health services here in Shropshire. Again, I stand by that comment.

However, it occurs to me that there is a better solution. It can be implemented in the next financial year and it will protect and possibly even improve health services in Shropshire. As the Royal Shrewsbury Hospital (RSH) is an integral part of the Welsh government's health provision for Mid Wales, the Welsh government can contribute part of its health budget towards the general running costs of the hospital.

The Welsh government doesn't provide hospital services to Mid Wales, which has a population of about 209,000. Instead it uses the RSH and other English and Welsh hospitals to provide those services. The RSH is the primary hospital for the county of Powys which has a population of approximately 132,000. The population of Shropshire is only around 283,000 (as of 2001). Almost a third of the people in the catchment area for the RSH are the responsibility of the Welsh government. It is only fair, therefore, that the Welsh government should contribute more than a fee per patient treated (at a discounted rate, inexplicably) and should instead contribute a proportionate amount of the actual running costs of the RSH.

The NHS in England is no longer run as a public service, it is run as a business and the NHS in Shropshire is in effect providing an outsourced health service to the Welsh government. Any outsourcing business that didn't either charge their client a share of the capital cost of running a shared service or a usage charge at an inflated price to recover a share of the capital costs would soon be out of business and deservedly so. If the NHS in Shropshire is going to act like an outsourcing business then it needs to start thinking like one.

The second attempt at today's consultation will be taking place at the Park Inn in Telford at 1pm this coming Monday. I hope to be there to put this argument across to the representatives of the Shropshire NHS.

It's not our job to fix the Welsh government's bad decisions

The NHS in Shropshire is proposing to cut A&E and acute paediatric services in Telford's Princess Royal Hospital to save money.

David Wright, the MP for the Telford constituency, has launched a "Say no to Shrewsbury" campaign calling for cuts to be made at Shrewsbury rather than Telford which has prompted Daniel Kawczynski, the MP for the Shrewsbury & Atcham constituency, to campaign for the cuts to be made at Telford instead. Daniel Kawczynski has even tried to enlist the help of Rhoddri Morgan, the First Minister of Wales, because patients from Mid Wales would be inconvenienced by cuts to the Royal Shrewsbury Hospital.

The suggestion that one hospital can cope with all A&E and acute paediatric referrals is ridiculous in itself but to suggest that they should be centralised in Shrewsbury when Telford has the largest and fastest growing population in the county is unbelievable.

What is best for Shropshire is for the services to stay at both hospitals or for a new hostpial to be built between Shrewsbury and Telford. But if there is a requirement to centralise services then they should be centralised in Telford, not in Shrewsbury.

The problem with this suggestion, though, is that it inconveniences patients from Mid Wales who don't have a local Welsh hospital. The NHS in Shropshire has cited this as a reason to keep services in Shrewsbury and the Daniel Kawczynski MP has also used it as an excuse to keep services at the hospital in his constituency.

And this is the problem with so-called English MPs - they aren't English MPs at all, they are British MPs. On balance, taking into account the interests of patients from Mid Wales, it makes most sense to keep services at Shrewsbury and it is the interests of those Welsh patients that Daniel Kawczynski is taking into account and using as leverage to save services at the Royal Shrewsbury Hospital.

But the people of Shrewsbury & Atcham elected Daniel to represent their interests, not the interests of Welsh people. In Wales they elect Welsh Assembly Members to deal with health as it's a devolved area and it is the Welsh government that has a responsibility to provide adequate health care in Wales, not the British government and not the NHS in Shropshire.

I'm not suggesting for a moment that someone from outside of Shropshire should be refused treatment at any of our Shropshire hospitals but there is a difference between treating someone from another English county, whose health provision is the responsibility of the same government that our own is in Shropshire and treating someone from another country whose health provision is the responsibility of another government - one that, crucially, is funded separately to the English NHS and given more money from the British Treasury to provide services.

This isn't a case of sour grapes or being anti-Welsh, it's simply that the provision of health services to Welsh people is the responsibility of the Welsh government and if services do need to be cut in Shropshire then those cuts should be made in such a way that it provides the least detriment to the people of Shropshire. If it leaves the Welsh with worse health provision then I'm afraid it is up to the Welsh people to petition the Welsh government to invest some of their health budget in building a hospital in Mid Wales.

The Welsh people asked for their own government and they got it. They have to live with the consequences of that decision and one of those consequences is that they can't keep relying on the English to pick up the pieces when their government makes the wrong decision. Not investing in health care in Mid Wales was a bad decision but fixing the consequences of that bad decision is up to the Welsh government, not the NHS in Shropshire.