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.

Letters in Shropshire Star

I had a letter published in the Shropshire Star the other day:

Easy way of saving NHS cash in England

With all the talk of cutting services at the Princess Royal Hospital, it is worth bearing in mind a few things. Firstly, the English NHS has been underspending for the last few years by a considerable amount.

Spending on the Scottish, Welsh and Northern Irish NHS has increased considerably. Secondly, the Welsh government refuses to pay the going rate to English hospitals for treating Welsh patients - something that costs the NHS in Shropshire approximately £2m per year.

Thirdly, the Welsh are terrible payers - Oswestry hospital threatened to refuse to treate patients from Powys earlier this year because they wouldn't pay their bills. A hospital in Bristol actually went as far as cancelling surgery for Welsh patients this year for the same reason.

The Welsh get free prescriptions and free hospital car parking yet we in England still subsidise their health service thanks to the Barnett Formula.

Why do our MPs allow £20bn a year flow over the border to subsidise spending in the rest of the UK? Shropshire's hospitals could raise well over £2m a year by charging Welsh health boards the amount for treating their patients and penalising for overdue payments.

Stuart Parr
Telford

Tonight they printed a reply from another reader ...

Rules for English are unfair

I agree with Stuart Parr's letter (Shropshire Star, October 2). We English are very unfairly treated under the Barnett formula to the advantage of the other countries in the so-called United Kingdom.

Over the last few years this has become the "dis-united kingdom". He asks why our MPs allow this disparity and all I can do is point out again that our Government is heavily Scottish-dominated. The other countries in the UK all have their own assemblies, but not the English.

The Scottish-dominated government will not even stop the Scottish, Welsh and Ulster MPs from voting on English-only matters in Westminster.

All this is very unfair to the English and even Barnett has stated so, but with the majority of English MPs being Conservative our current government is not going to change anything,

We can only hope to achieve parity after the next election and have our own parliament, or better still get rid of the other money-wasting and expense claiming assemblies.

Graham Burns
Newport

Agree with every word right up until the second half of the last sentence.

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.

Welsh patients pushed down waiting list at Shropshire hospital

I was told last night on very good authority that the Robert Jones and Agnes Hunt hospital in Gobowen (also known as Oswestry Opthopaedic) is bumping English patients up the waiting lists in protest at the Welsh government's refusal to pay the going rate for treatment.

The three main hospitals in Shropshire all lose money treating Welsh patients because the Welsh government doesn't pay the same amount for treatments as the British government does. More Welsh patients have to be treated to achieve the same income as they would receive if treating only English patients.

Added to this is the problem of the Welsh not paying their bills on time which resulted in at least two hospitals - Oswestry here in Shropshire and one in Bristol - threatening to refuse treatment to Welsh patients if they didn't hand over the cash.

An English patient's recent conversation with a consultant at Oswestry went something like ...

Patient: So when am I likely to get my operation?
Consultant: Probably around November unless you live in Wales
Patient: Why, what difference would it make if I lived in
Wales?
Consultant: Well, with all the free prescriptions and free parking
they get and they don't pay us us enough for treatment, Welsh patients get
pushed down the waiting list

I'm not sure if this is official hospital policy or an unofficial protest by consultants but I expect it will annoy the Welsh immensely, especially given the number of letters recently in the Shropshire Star trying to defend the special treatment the Welsh are getting (including putting Welsh signs in Oswestry hospital). There is a simple solution if the Welsh do start getting shirty over being pushed down the waiting lists - they could spend some of the multi-billion pound annual subsidy they get from the English taxpayer building some of their own hospitals.

Shropshire man falls foul of the Nationality Lottery

A Shropshire man has fallen foul of the nationality lottery after Telford & Wrekin NHS Trust refused to treat him with Lucentis to try and save his sight.

Allan Farley has punctate inner choroidopathy and two consultants have told him that Lucentis will help to save the sight in his right eye. He is already blind in his left.

But the NHS Trust, acting on guidelines issued by the increasingly inaccurately named National Institute for Clinical Excellence (NICE), have refused to fund a course of Lucentis. Honestly, someone really should complain to Trading Standards - they are neither "national" nor "nice".

Two years worth of Lucentis will cost about £18k, pocket money compared to the cost of paying benefits and providing services to a blind man and his family for the next 50 or 60 years. If you'll excuse the pun, the decision is more than a little short sighted.

Mr Farley says he's being refused Lucentis because of the cost. Yes, it's an expensive drug and the NHS Trust probably doesn't have £18k stuffed down the back of the Chief Exec's sofa to pay for it but finding the money for the drug is a secondary issue and the NHS Trust does have the money if it wants to spend it.

The real reason why Mr Farley is being refused Lucentis is because he lives in England. If he lived in Scotland he would have been treated by now and the sight of his left eye might have been saved. The Scottish Medical Consortium - the equivalent body to NICE north of the border - allows Lucentis to be provided on the NHS in Scotland, along with a host of other drugs such as cancer and alzheimers treatments that are unavailable to English people.

MP tells of Welsh woe

This article appeared in the Shropshire Star the other day ...

MP tells of Welsh woe

Tory MP Daniel Kawczynski has professed that he loves Wales, but he had plenty of complaints about the principality during a debate in the House of Commons.

The Shrewsbury & Atcham MP questioned Wales’s role in health services in Shropshire, flooding, tuberculosis in cattle, and “unfair and uncompetitive” grants to businesses given by the Welsh Assembly.

“The Welsh Assembly creates huge difficulties for English border towns,” he told MPs.

Mr Kawczynski said the Royal Shrewsbury Hospital was losing £2 million a year as a result of the way the assembly paid for treatment across the border.

“We have patients coming from Wales to the hospital who get life-saving medication to which my constituents in Shrewsbury are not entitled,” he told the Commons.

“I have to fight tooth and nail to secure life-saving treatments for my constituents that people from Wales get automatically in our hospital.

“That causes huge frustration and anger and divides our two communities.”

The Conservative MP said 40,000 cows had to be killed in England last year as a result of bovine TB.

“It is such a shame that there is not more co-operation between our parliament here in London and the Welsh Assembly over the issue, which transcends our borders,” he said.

“There should be far more co-operation in dealing with such major issues.”

Mr Kawczynski said flooding caused “tremendous misery” along the length of the River Severn with Shrewsbury flooding repeatedly.

“The way to resolve the problem is not to have little barriers in each town, but to have a wet washland scheme across the border in Wales,” he said.

“This would flood a large piece of agricultural land, which would become a marsh in the summer, encouraging wildlife, and a lake in winter.”

The Conservative MP said it was unacceptable that a Government minister had intervened to block the idea.

By London Editor John Hipwood

The Shropshire branch of the CEP has been plugging away at all five of the county's MPs, including Daniel. He is nominally supportive of some form of better representation for England and, having sat on a devolution committee, is quite aware of the discrimination England faces.

Co-incidently, I received an email from the Shrewsbury and Telford Hospital NHS Trust which covers the Princess Royal Hospital in Telford, the Royal Shrewsbury Hospital in Shrewsbury and the Robert Jones & Agnes Hunt in Oswestry. Prompted by an announcement by the Welsh Government that Welsh patients would be entitled to a new kidney cancer wonder-drug free of charge on the NHS, I had asked them ...

Will Welsh patients treated in the RSH also get these drugs paid for by the Welsh Assembly? Will it be possible for an English and Welsh patient being treated at the RSH for the same thing and for the English patient to be refused the drugs that the Welsh patient will be getting?

The reply was long-winded but, in a nutshell, the answer was "yes". The question is, what does Daniel propose to do about it? The Tory policy of English Pauses for English Clauses won't resolve the issue, only an English Parliament will by putting English health priorities in the hands of politicians elected to represent English interests.

Click the icon below to view a copy of the letter from the NHS Trust.

CEP rally - 18th October at Shrewsbury

The Shropshire branch of the CEP is holding a rally on Saturday the 18th of October in Shrewsbury.

We'll be meeting somewhere central - probably Pride Hill or near the hideous Market Hall - at around 10am and hand out leaflets.

The theme of the rally will be the NHS.  Just over the border in Wales they have free prescriptions and free hospital parking.  The Welsh government doesn't even pay the going rate for their treatment in English hospitals, costing the hospitals in Shrewsbury, Oswestry & Telford over £1m per year in lost revenues.  In Scotland they will all be entitled to free prescriptions from April next year and in Northern Ireland prescriptions will be only £3 next year and free for all from 2010.

Please get in touch for more details.

NHS Constitution

Read this then read the letter I just sent to my turncoat Liebour MP.

Dear David,

Your Prime Minister has somehow, against all the odds, managed to make me
even more annoyed today than he has since he was appointed as your
leader.

I was pretty incensed when he announced that his priorities as Prime
Minister would be the English education system, the English health system and
the English housing system even though he has no mandate over any of them.
Today I see that in return for the health system that we are paying for through
our taxes, your Prime Minister has decided that we must have
“responsibilities”. But only in England.

The medical treatment which the English will be entitled to will still
be inferior to the medical treatment his own Scottish constituents are entitled
to and they will continue to receive their superior service without the
“responsibilities” that the English must have.

David, YOU have a responsibility. Your responsibility is to your
constituents, NOT your party. Gordon Brown was not given a mandate by his
Scottish constituents to tell English people what they must do to receive
medical treatment. I assume you do understand that none of your Prime
Minister’s proclamations on health, education, housing, etc. affect his own
constituents - he has no more right to tell your constituents what medical
treatment they can and can’t receive than you have to tell his constituents what
medical treatment they can and can’t receive.

I cannot adequately express in polite terms how disappointed I am that you
condone this unconstitutional, undemocratic and immoral system of
apartheid. How can you continue to support your party when it is doing
everything it can to maintain the system that allows the Scottish ruling
elite to make decisions in your constituency when neither they, nor you, can
make the same decisions in their constituency?

If you play a part in breaking our health, education
and housing systems I can - and will - vote for someone else who won’t
do the same. Gordon Brown’s constituents won’t care what he does to the
English NHS or schools - they’re more likely to vote for him if they can see
that he’s screwing the English over!

Poll after poll has shown that English people are fed up with your Scottish
MPs interfering in English-only legislation. Poll after poll has shown
that English people want their own government like the one your party gave to
Scotland. It’s time you started doing your job David - represent your
constituents, not your party.

Stuart