Delivery before Headlines.

This post is for those of you interested in the consequences of devolution on the health care needs of the people of Mid Wales. And its background to why I responded negatively to comments made in the Welsh Affairs debate at Westminster last week by a political colleague. Its a complex story.

In the first few years after the National Assembly for Wales was established, there developed a poisonous atmosphere between the Powys Local Health Board, which commissioned treatment, and the NHS Hospital Trusts in England which delivered it - in particular at the Royal Shrewsbury Hospital and the Robert Jones and Agnes Hunt Orthopaedic Hospital at Gobowen. The root of the problems were the inability of the LHB to pay the same rates for treatment as was being paid in England. This led to serious differences in waiting times, and much resentment in Powys, as patients waited longer for treatment. Relationships were bitter, and cross border funding issues were being taken to arbitration to sort out. It sometimes seemed that the patient was a secondary consideration. At Shrewsbury, the position was worsened by the build up of huge debts, and serious problems amongst the senior management, all of which threatened major parts of the services offered.

Then along came a new Chair, Margaret Bamford, and a new Chief Executive, Tom Taylor, who took a different approach. There was a public acceptance that Mid Wales 'business' was vital to the future success of the Hospital, and an acceptance that the solution to the long-standing, cross-border funding problems would only be resolved by an agreement between the UK Government and the Assembly Government. Nothing whatsoever would be gained by sniping in the media. And generally speaking it has stopped - and there has been no need for politicians to make a song and dance to get something done.

Sometime last year, the Welsh Affairs Committee, took evidence and reported on this issue. In January the UK Government responded to that report. Here are a few extracts from the response.

"We have carefully considered the Welsh Affairs Committee's interim report on cross border health services. As a result of devolution, there are understandably some differences of emphasis between Governments in England and Wales. But we agree with the Committee that the border between England and Wales does not represent a barrier to providing health care, and believe that the core principles of the NHS apply across the UK"

"...to achieve clinical safety as close to home as possible, Welsh and English patients will receive treatment on the other side of the Wales-England border. This should be accepted by policy makers in England and Wales.

"We are working with the Welsh Assembly Government to secure a fair and long term solution. These negotiations are almost complete."

"Consideration is being given specifically to issues around funding arrangements for Welsh patients who use English hospitals and formal agreement is expected shortly."

I'm told that agreement could come as early as next month. It seems to me unwise in the extreme to try to return to megaphone diplomacy of old, when on the cusp of agreement.