Evidence submitted by the Department of Health and NHS England (CBH 30)

ACRONYMS USED

A&E              accident and emergency

CCG              clinical commissioning group

LHB              local health board

NHS              the National Health Service

Introduction

1. This evidence for the Welsh Affairs Select Committee has been prepared by the Department of Health, with input from NHS England.[1]

Summary

2. The evidence explains that:

• The National Health Service (NHS) in England and the NHS in Wales are separate entities.  The UK Government is accountable for the first, and the Welsh Government[2] for the second.

• People resident in Wales are able to access primary care services in England on the same basis as English residents.

• The NHS in Wales is also able to refer Welsh residents to secondary care providers in England.

• There are arrangements in place for discussing cross-border issues and to encourage co-operation where desirable between bodies in the two NHSs.  People resident in Wales and receiving health services in England count as part of the group of “local people” whose views the relevant local Healthwatch is responsible for representing.

3. On the six specific topics identified by the Committee, the evidence notes that:

• Impact of policy divergences in the health systems of England and Wales As is to be expected under devolution, policy divergences have developed over the years.  Clearly it is for Welsh Ministers to decide on policies for the NHS in Wales.  UK Government Ministers believe that choice benefits patients and would therefore like all patients – including those in Wales – to have choice over where, when and from whom they receive services.

• Experience of patients who are reliant on the use of healthcare services on the other side of the border Local bodies (both commissioners, providers and bodies representing patients and the public) are best placed to monitor patient experience and to use their findings to inform local service decisions.  The Department of Health and NHS England are aware of some cases where Welsh residents would like to receive secondary care in England, but are referred by the Welsh NHS to Welsh services. 

• The case for greater sharing of resources and facilities between the healthcare systems The Department of Health agrees that the NHS in England and the NHS in Wales should consider sharing resources and facilities where it is desirable to do so.  The costs involved should be shared equitably.  Examples of where such sharing already takes place include the organ donor register operated by NHS Blood and Transplant.

• The protocol for cross-border healthcare, agreed between the Welsh Government and NHS England, is currently under review by NHS England, working closely with the Department of Health, the Wales Office, the Welsh Government and bodies in both England and Wales.  The aim is to complete the review by the end of this calendar year.

• The Silk Commission has recommended the development of individual protocols between each border Local Health Board (LHB) in Wales and NHS providers in England, and a co-operative and coherent approach to joint delivery of health services.  The UK Government is considering these recommendations alongside the other recommendations made by the Silk Commission in its second report.

• Lessons from other cross-border health arrangements For historical and geographical reasons, the NHS in England has a closer relationship with the NHS in Wales than with health services in other parts of the UK or in the Republic of Ireland.  Nevertheless, the Department of Health and the devolved administrations work together closely where there is a strong case for arrangements to cover the whole of the UK.

Structure and scope of the evidence

4. The next section of this evidence provides an overview of legislation and other arrangements relevant to cross-border healthcare. 

5. The remainder of the evidence then addresses each of the six topics identified by the Committee in turn.

6. The evidence concentrates on:

-          matters for which the Department of Health and NHS England are responsible.  Where necessary to provide context, we have included information about matters that are the responsibility of the Welsh Government; but clearly the Welsh Government is best placed to describe its own policies and arrangements;

-          the NHS, as we understand that this is the prime focus of the Committee’s inquiry.  There are some health functions (for example, professional regulation, medicines licensing) that have not been devolved to the National Assembly for Wales or the Welsh Government.  If the Committee would like further information on those functions, the Department of Health would be happy to provide it.

Overview

Health is devolved

7. The NHS in England and the NHS in Wales are separate entities, each with its own legislation.   The UK Government is accountable for the NHS in England, while under the Government of Wales Act 2006 the Welsh Government is accountable for the NHS in Wales.

8. The NHS in England exists to benefit the people of England, and the NHS in Wales to benefit the people of Wales.[3]

9. Consistently with that:

• No English NHS body has statutory responsibility for commissioning services for people resident in Wales.[4]

• Funding for health services in Wales is included in the allocation made by the Treasury to the Welsh Government.  It is for the Welsh Government to decide how much of its total allocation to spend on the NHS in Wales.

There are arrangements for working together

Between Governments

10. The UK Government and the Welsh Government have both undertaken to act in accordance with the Memorandum of Understanding agreed between the UK Government and all three devolved administrations, most recently updated in October 2013.[5]

11. In addition:

• a concordat on health and social care is in place between the Department of Health and the Welsh Government, last updated in 2011;[6] and

• Department of Health and Welsh Ministers agreed a set of principles to inform policy making on cross-border healthcare in March 2013.[7]

Primary care

12. NHS England is responsible for commissioning primary care throughout England.  This means that it holds contracts with GP practices, dental practices, optical providers and pharmacies.  GP practices provide primary medical services for their registered patients; each GP practice has geographical boundaries, agreed with NHS England, and patients registered with the practice normally live within the practice boundaries.[8]  Other primary care practitioners in contract with NHS England do not have a defined practice area, or registered patients, in the same way.

13. English NHS arrangements allow people resident in Wales to obtain primary care services in England on the same terms as people resident in England:

• Welsh residents are able to register with GP practices – and to use the services of dental practices, optical providers and pharmacies – in contract with NHS England.[9]

• Pharmacies and optical providers in England are able to provide a service whether the patient’s prescription/optical voucher has been issued in England or in Wales.[10]

• When using primary care services in England, Welsh residents receive free prescriptions, free sight tests and help towards the cost of glasses if they meet the criteria in English regulations.  They pay charges (for prescriptions and dentistry) on the same basis as English residents.[11]

14. The information we have on the extent to which Welsh residents make use of English primary care services is as follows:

• Around 15,000 people resident in Wales are registered with GP practices in contract with NHS England.  Most of these are registered with practices in the areas of West Cheshire CCG or Shropshire CCG.[12] 

• Between April 2013 and March 2014, 47,655 courses of dental treatments were delivered in England for patients from Wales (0.12% of the total for England).[13]

15. The following arrangements between the two NHSs underpin the services for patients described above:

• The NHS in England pays the primary care contractors concerned for the services they provide, regardless of whether those services are provided to English or Welsh residents; and we understand the NHS in Wales does the same with its contractors. 

• No transfer is made between the two health systems in relation to the costs of primary care for each other’s residents (or in relation to the charges received from them). 

Emergency care

16. In England, under section 3(1C) of the NHS Act 2006, each CCG is responsible for commissioning services or facilities for emergency care for every person present in its area.[14]   

17. In practice, patients who call for an ambulance are taken to the nearest accident and emergency (A&E) department.  Patients who make their own way to A&E decide which A&E department to attend, and are not turned away on the basis that their problem “started on the other side of the border”.  Welsh residents accounted for just under 50,000 (0.27%) of the 18.3 million A&E attendances recorded in Hospital Episode Statistics for English hospitals in 2012/13.

Secondary care

18. Within the arrangements described in paragraphs 7-9 above, Welsh residents can and do access English NHS services as NHS patients, where the relevant Welsh NHS budget-holder[15] agrees to pay for them to do so (and where the English provider has capacity to accept them).  The Department of Health generally does not hold details of the arrangements that Welsh NHS budget-holders have with English NHS providers, but:

• In 2012/13, nearly 56,000 (0.37%) of the 15.1 million inpatient finished admission episodes, and around 268,000 (0.36%) of the 75.5 million outpatient attendances, recorded in Hospital Episode Statistics for English hospitals were for Welsh residents.

• By agreement with the Welsh Government, NHS England commissions certain highly specialised services[16] for Welsh residents.

Arrangements between NHS bodies in England and in Wales may take the form of an NHS contract.[17]  NHS contracts are subject to special arrangements for dispute determination, rather than being litigable in the courts. 

Offender Health Services

19. In the case of people detained in the justice system, there are considerable issues that can arise when prisoners move cross border, either to different establishments, or when being released back home from a prison over the border. Continuity of treatment, particularly for mental health and substance misuse, is crucial to support health and wellbeing and reducing reoffending. Similar problems can arise in relation to residing in Approved Premises or bail addresses whilst moving through the criminal justice system.

20. A Welsh Health & Justice Partnership Board has been convened which is co-chaired by the National Offender Management Service in Wales and the Welsh Government, and part of its remit is to work through these kinds of issues (as well as broader shared agendas around offender health). The Welsh Government are also members of the English Health and Justice Partnership Board, so that best practice can be shared.

21. In addition, the introduction of Transforming Rehabilitation[18] later this year will mean more support for offenders to access the services they need upon release. This includes a resettlement plan for each prisoner and new probation statutory offender management provision for a minimum of 12 months following release, (currently only those sentenced to over 12 months custody get statutory support on release).

England and Wales Special Health Authorities

22. The Secretary of State for Health and the National Assembly for Wales jointly established two Special Health Authorities in October 2005.  These bodies are accountable to both the Secretary of State and to Welsh Ministers. 

23. NHS Blood and Transplant provides services in relation to blood, tissues and organs for transplant in England.  It also provides services in relation to tissues and organs for the whole of Wales and services in relation to blood for North Wales.[19]  The Welsh Government has announced its intention of creating an All Wales Blood Service by 2016 and so of ceasing to use NHS Blood and Transplant for blood services in North Wales.

24. The Human Transplantation (Wales) Act 2013, passed by the National Assembly for Wales, is expected to come into force on 1 December 2015 and in Wales will replace the opt-in system for deceased organ and tissue donation that currently applies throughout the UK with a “soft opt-out system”.[20]  The Department of Health and NHS Blood and Transplant are working closely with the Welsh Government and the NHS in Wales to ensure that NHS Blood and Transplant’s organ donor register, currently being re-developed, will support Welsh legislation on opt-out.  The redevelopment will also enable residents across the UK to record their wishes in respect of organ donation and enable better partner working, such as compatibility with social media. In this way, the new register will be able to support the needs of both England and Wales and also of other parts of the UK.

25. The NHS Business Services Authority provides a range of support services for the NHSs in England and in Wales.  These include, for both England and Wales:

• management of the NHS pension scheme and the NHS injury benefit scheme;
• payments relating to the NHS dental contract, and the provision of management information (costs and trends) in prescribing and dental care;
• managing the outsourced contract for NHS supply chain;
• provision of NHS counter-fraud and security management (“NHS Protect”).

The Authority also, for England only, operates the prescription payment system and manages the NHS Student Bursary scheme.  In addition, it administers the European Health Insurance Card scheme for the whole UK, on behalf of the UK Government.

Duties to co-operate or to have regard

26. English and Welsh NHS bodies are under a duty to co-operate with each other in exercising their functions.[21] 

27. Section 14Z4 of the NHS Act 2006 provides a power to make regulations allowing any prescribed function of a clinical commissioning group (CCG) to be exercised jointly with a LHB.  Regulations may also make provision for any such functions to be exercised by a joint committee of the CCG and the LHB.  Welsh Ministers have not made regulations under this power, but regulations made by the Department of Health came into force on 1 April 2013.[22]

28. There is a duty on NHS England to have regard to the likely impact of its decisions on the provision of health services to persons who reside in an area of Wales that is close to the border.[23]  In practice, this is likely to be most relevant to NHS England’s decisions about commissioning primary care. The majority of secondary care services in England are commissioned by CCGs, who are not under a duty equivalent to that in section 13O.

29. There is currently no provision in Welsh NHS legislation equivalent to that in section 13O of the NHS Act 2006.  However, the protocol agreed between the Welsh Government and NHS England says:

“Despite the absence of a similar provision on the Welsh side at present, the NHS in Wales will be expected to operate on the same basis in relation to actions affecting persons who reside in an area of England that is close to the border with Wales, until there is an opportunity to legislate to introduce the same provision in Wales.”

Patient voice and public involvement

30. There are a number of ways in which the NHS in England takes account of the views of service users resident in Wales:

• people resident in Wales and receiving health services in England count as part of the group of “local people” whose views the relevant local Healthwatch is responsible for representing.
• In a previous report, the Welsh Affairs Committee commended Foundation Trusts for their engagement with their catchment populations.[24]  The legislation governing Foundation Trusts has since been strengthened (by the Health and Social Care Act 2012) and now requires Foundation Trusts, in deciding on their membership, to “have regard to the need for those eligible for such membership to be representative of those to whom the trust provides services” and to “take steps to secure that (taken as a whole) the actual membership of any public constituency and (if there is one) of the patients' constituency is representative of those eligible for such membership.”  Over half of all NHS provider trusts in England are now NHS foundation trusts. 
• The Welsh complaints regulations, unlike those for England, introduce the concept of redress, and place an obligation on a Welsh NHS body to consider, when it is notified of a concern that alleges harm has or may have been caused, whether or not there is a qualifying liability.  They also place a duty on an English NHS body that receives notification of a concern or a complaint about a service that it has provided (or arranged for the provision of) under arrangements with a Welsh NHS body, to consider, when investigating the complaint or concern, whether or not a qualifying liability exists or may exist.  If it does, it is for the Welsh NHS body to consider whether redress should be paid.

Impact of the increasing policy divergence in the health systems of England and Wales on cross-border healthcare services, and on medical practitioners and patients in border regions in England and Wales

31. Although the NHSs in England and Wales both have the aim of securing improvements in the physical and mental health of their peoples and in the prevention, diagnosis and treatment of illness, there are differences in the policies through which the UK Government and the Welsh Government work to achieve that. 

32. The existence of such differences is entirely consistent with the policy of devolution, which aims to allow:

• the Welsh Government to decide what policies are appropriate in the specific circumstances faced by the NHS in Wales; and
• the people of Wales, through the National Assembly for Wales, to hold the Welsh Government to account for those decisions.

33. Several divergences have developed over the years.  For example:

• In England, prescription charges continue to raise valuable revenue of around £450 million each year, which helps the NHS to maintain vital services for patients.  There are extensive exemption arrangements in place, including for those on low incomes, which mean that around 90% of all prescription items are dispensed free of charge in England.  In Wales, prescription charges were abolished in 2007.

• In England, there is a clear distinction between the commissioners of services (CCGs and NHS England) and the providers of services.  In 2007, the Welsh Government’s publication One Wales: a progressive agenda for the government of Wales included a commitment to “move purposefully to end the internal market”.  Consistently with that, we understand that in Wales since 1 October 2009 seven LHBs are responsible for delivering all healthcare services within a geographical area.[25]

• In England, commissioners can decide which provider (NHS or independent sector, including for example, independent sector treatment centres, other private providers, and voluntary sector organisations) will best meet the needs of the people they serve.  In Wales, the 2007 publication   One Wales included a commitment to “eliminate the use of private sector hospitals by the NHS in Wales by 2011.” 
• In England, legislation on the NHS Constitution came into force in 2010.  The Constitution publicises the rights available to both patients and staff of the NHS.   The Welsh Government has not adopted an equivalent policy.
• In England, a cancer drugs fund was created in 2010, and now stands at £200 million a year.  We understand there is no equivalent in Wales.
• In England, the Government has protected the NHS budget and ensured that it will go up by around £12.7 billion in cash terms over this Parliament.  This has resulted in around £1.6 billion extra funding for the Welsh Government – but in Wales the health budget is being cut by 8%.
• In general, legislation on handling complaints about NHS services is broadly similar in England and in Wales (with some detailed differences, for example in relation to timescales).  However, in Wales the concept of “redress” was introduced in 2011.[26]  In this context, “redress” means financial compensation, paid by a health body, for injury or harm done to a complainant.

• In England a number of changes to health service structures came into effect on 1 April 2013 which are not paralleled in Wales.  For example:
• Department of Health Ministers have carefully defined powers in relation to NHS bodies which need to be used in transparent ways.  (For example, the UK Government’s expectations of NHS England are set out annually, in the mandate, which must be laid before Parliament).  In Wales we understand that Welsh Ministers retain wide powers of direction over NHS bodies. 
• In England, certain functions previously carried out by NHS bodies (such as the commissioning of addiction services) are now commissioned by local authorities.
• There are differences between England and Wales in the approach to eHealth.  For example, in England the aim is to give patients online access to their summary care record by March 2015.  Wales has developed a similar service (the Individual Health Record), but we understand that a target date for patient access to it has not yet been set in Wales.

34. However, the policy divergence which appears to have had particular impact on patients and medical practitioners in border areas in recent months relates to choice of provider.  In England, patients have the right to make choices about the services commissioned by NHS bodies, and to information to support those choices.[27]  We understand that in Wales the policies of both the Welsh Government and Welsh NHS bodies put an emphasis on the provision of care within Wales. 

35. For example, in November 2011 the Welsh Government published Together for Health: A Five Year Vision for Health Services in Wales.[28]  This document does not specifically mention referrals outside Wales, but its vision for 2016 includes:

“a greater range of local services [which] will mean less need to travel”.

An emphasis on buying services within Wales is also implied by the statement that:

“[Welsh] NHS bodies will also use their enormous power as employers, property owners, and purchasers of goods and services to help create safe, confident, prosperous and sustainable communities and tackle poverty, working through Local Service Boards and initiatives like Communities First, in the knowledge that in some instances small changes in health provision can also assist other public services in achieving their goals”.

36. Consistently with this, we understand that at least one LHB has introduced a policy that aims to minimise referrals out of the LHB’s area or outside Wales.  It describes the aim of the policy as being that:

“the Health Board is the primary provider of secondary care services for the registered/resident population of Gwent […]

Where this cannot be provided by the Health Board’s own services for reasons such as resources, expertise or capacity, then the Health Board will look to plan and secure the necessary services with other NHS Providers in Wales through its agreed care pathways.  Where the services cannot be provided by the Health board or with other Welsh providers, the Health Board will plan and secure services from other appropriate providers.”[29]

37. The Department of Health is aware that this policy has been a cause of concern, at least in some cases, to both medical practitioners and to patients.  For example, a rheumatologist expressed concern that patients resident in Monmouthshire who had long been treated at Wye Valley NHS Trust were finding that their treatment was being transferred to providers in Wales because of a change in the policy of their LHB, not because of a change in their clinical needs.  Welsh MPs drew attention to the impact of the policy on their constituents.[30] 

38. It is clearly for Welsh Ministers to decide on policies for the Welsh NHS.  UK Government Ministers believe that choice benefits patients and would therefore like all patients – including those in Wales – to have choice over where they receive services.

The experience of patients in England and Wales who are reliant on the use of healthcare services on the other side of the border

39. The Department of Health and NHS England do not collect comprehensive information about patient experience in border areas: as a general rule, local commissioners and providers, and local bodies such as Healthwatch organisations in England and Community Health Councils in Wales, are best placed both to do this, and to use the results to inform decisions about services.  NHS England examines patients’ experience of general practice services through the GP survey.

40. However, the Department and NHS England are aware, from contacts with MPs, members of the public and NHS bodies, that some residents in Welsh border areas would like to be referred to English providers for certain kinds of secondary care. 

The case for greater sharing of resources and facilities between the English and Welsh healthcare systems, for example in relation to procurement and use of high-tech equipment

41. The Department of Health agrees that the NHS in Wales and the NHS in England should consider sharing resources and facilities where it is desirable to do so.  The costs involved in doing so should be shared equitably. 

42. Examples of where such sharing is already happening are provided by the arrangements for commissioning specialised services and the joint Special Health Authorities described in paragraphs 18-22 above. 

The impact of the protocol for cross-border healthcare services agreed by NHS Wales and NHS  England, implemented in April 2013, and whether it is meeting its objectives

43. The protocol for cross-border healthcare that is currently in place came into force in April 2013 and was agreed between the chief executives of the NHS in Wales and of NHS England.[31]  It replaces a protocol that was originally agreed between the Welsh Government and the Department of Health in 2005, which was renewed, generally at yearly intervals, until replaced by the April 2013 protocol. 

44. In the form it took from 2005/06 to 2012/13, the protocol was concerned, not with the generality of people resident near the border between Wales and England, but with two particular groups: people resident in Wales who are registered with an English GP; and people resident in England who are registered with a Welsh GP.  Arrangements for these groups remain the main focus of the April 2013 protocol.

45. Concerns about this aspect of the protocol have been raised, from May 2013, by people resident in parts of Herefordshire and Gloucestershire bordering on the area of Aneurin Bevan Health Board.  Their concern was that the protocol, combined with the out of area referral policy adopted by the LHB, meant that they were unable to access secondary care services in England.[32]  The Minister for Public Health has therefore asked NHS England to review the protocol.  It is working closely with the Department of Health, the Wales Office, the Welsh Government and both Welsh and English bodies and stakeholders to do so and aims to complete its work by the end of this calendar year.  Until that review is complete, it would be premature to say if the protocol is meeting its objectives.

46. The April 2013 protocol also covers some other aspects of cross-border care.  In particular, it says that there should be “arrangements on each side of the border to ensure that local NHS bodies work together to: ensure arrangements are in place so that bodies engage populations across the border in discussions on quality and changes to services provided”.  Accordingly, an informal cross-border group of NHS bodies from both sides of the border meets several times a year.  The meetings are chaired on a rotating basis by LHBs and NHS England Area Teams with responsibilities for border areas.  NHS England’s national support centre, CCGs and providers also attend from time to time.

The Silk Commission Part II recommendations on cross-border health, particularly the proposal to develop individual protocols between each border Local Health Board in Wales and neighbouring NHS Trust in England

47. The Silk Commission was established by the UK Government to make recommendations on devolution in Wales.  The Commission published its second report on 3 March 2014,[33] and recommendation 37 in that is:

“There should be equitable cross-border access for patients and a strategic approach to joint delivery of health services.  This should be delivered through:

a)      Regular and frequent review by the Welsh Intergovernmental Committee of the UK Government and Welsh Government protocol on cross-border healthcare;

b)      Individual protocols developed between each border Local Health Board in Wales and neighbouring NHS Trusts in England;

c)       A cooperative and coherent approach to joint delivery of health services, particularly highly specialist facilities, and joint efficiency savings.”

48. The UK Government is considering these recommendations alongside the other recommendations made by the Commission in its second report. 

Any lessons that can be learned from other cross-border health arrangements, such as between England and Scotland or Northern Ireland and the Republic of Ireland.

Arrangements within the UK

49. The NHS in England has had a closer relationship with the NHS in Wales than with the NHS in other parts of the UK.  The reasons for this are partly historical (linked to the separate legal systems that exist in Scotland and in Northern Ireland), and partly geographical.  For example, Scotland, like Wales and unlike Northern Ireland, shares a border with England; but there is less movement of patients across the Scottish/English border.  (Whereas patients resident in Wales account for less than 0.4% of the total inpatient, outpatient and A&E activity recorded in England, patients resident in Scotland account for less than 0.11%, and patients resident in Northern Ireland for less than 0.02%).  It has therefore not been thought necessary to put in place principles agreed between Ministers, or a protocol on cross-border healthcare, for Scotland or Northern Ireland.

50. Particular points worth noting are that:

• Originally there was a single NHS for England and Wales.  The NHS Act 1946 provided for “the establishment of a comprehensive health service for England and Wales”.  Scotland and Northern Ireland had, and still have, their own, separate and free-standing, legislation.[34]

• In 1969 the NHS in Wales became the responsibility of the Secretary of State for Wales, and from 1999 executive functions in what was by then the NHS Act 1977 were devolved from the Secretary of State to the National Assembly for Wales.  However, the same primary legislation continued to deal with services in both England and Wales – although sometimes making one set of provisions for England and another for Wales.

• It was only with the passing of the NHS Act 2006 and the NHS (Wales) Act 2006 that the primary legislation was put in two separate Acts, the first dealing predominantly with England and the second with Wales.  The NHS Act 2006 nevertheless continues to contain provisions that are of relevance in Wales as well as in England, notably the duty in section 72 on NHS bodies to co-operate in the exercise of their functions and the power in section 14Z4 to make regulations allowing for the joint exercise of CCG functions by CCGs and LHBs.

• There are some provisions in legislation that are relevant to health services in all four parts of the UK.  (For example, it is possible for a health body in any part of the UK to agree an NHS contract with a health body in another part of the UK).

• However, there are more duties of co-operation between NHS bodies in England and in Wales than between bodies in England and in Scotland or Northern Ireland.  For example:

• the duty in the NHS Act 2006 on NHS bodies to co-operate with each other applies only to bodies in England and Wales. 
• there is no power for CCGs to exercise functions jointly with their equivalents in Scotland or Northern Ireland. 
• the duty on NHS England in section 13O of the NHS Act 2006 to have regard to the impact of its commissioning decisions on the provision of health services to people resident in an area of Wales or Scotland close to the border with England does not apply in relation to Northern Ireland.

51. Nevertheless, where there is a strong case for arrangements to cover the whole of the UK, the Department of Health and the devolved administrations have worked together to ensure that such arrangements are in place.  Perhaps the clearest example of this is NHS Blood and Transplant, the body that manages allocation of organs in the UK:

• Legislatively, it is an England and Wales special health authority, established under NHS legislation (and therefore subject to direction by the Secretary of State as regards England and by Welsh Ministers as regards Wales).

• But health ministers in the devolved administrations responsible for Scotland and for Northern Ireland have chosen to contract with it for it to provide a similar service to their parts of the UK.

This UK-wide role is reflected in the Secretary of State’s 2005 directions to NHS Blood and Transplant.  (For example, article 3(2)-(4) makes specific reference to Scotland, Wales and Northern Ireland).  NHS Blood and Transplant’s framework agreement with the Department of Health reflects the need for it to maintain a relationship with the health services in all four parts of the UK, and it is working closely with all four parts of the UK to ensure that its organ donor register meets the needs of all four countries.

52. In addition, where an individual devolved administration wishes, the Department is willing to consider additional arrangements.  For example, all three devolved administrations have abolished prescription charges, but English residents who present an English prescription in Scotland or Wales continue to pay a prescription charge (unless exempt).  However, at the request of the Department of Health, Social Services and Public Safety in Northern Ireland, an arrangement is in place under which prescription charges do not apply to residents of Northern Ireland who present in England a prescription issued in Northern Ireland, or to residents of England who present in Northern Ireland a prescription issued in England.  The numbers of such prescriptions is small, but the arrangement is valued by the Northern Ireland authorities for the administrative convenience it brings.

Arrangements with the Republic of Ireland

53. The Committee also asked about arrangements with the Republic of Ireland.  Health services in the Republic do not have their origins in NHS legislation (which was introduced in all parts of the UK in the 1940s, some twenty years after the partition of Ireland).  Because the UK and the Republic of Ireland are both EU member states, residents of England who travel to, or who reside in certain circumstances in, the Republic, and vice versa, are treated in accordance with the requirements of the EU Social Security Coordination Regulations (which include healthcare) and the EU Patient Mobility Directive.  Individual health bodies in the two separate states sometimes decide to work together.  For example, the Republic of Ireland has a contractual agreement with NHS Blood and Transplant to audit and analyse the results of all organ transplants in the Republic of Ireland; and the Irish health system also commissions specialist care from some NHS providers in England.

26 August 2014

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