Review of 2011: Border issues for health in Wales

Image caption The Welsh government is committed to eliminating the use of the private sector by the NHS

2011 has been a bit different for me - for several months I stepped out of my usual role in Wales, and went to work over the border.

My experience of the NHS in England confirmed what most people in Wales already know - that the UK's different health services are growing apart.

In fact, in 2011, England and Wales seemed to be heading in polar opposite directions.

The UK government's Health Bill published in January is centred around the principles of competition and choice, opening the doors to much greater use of the private sector.

Read the Welsh Labour manifesto - also published early in 2011 - and you see the proud boast that the Welsh government has managed to "eliminate the use of private sector hospitals in NHS Wales".

Competition had already gone out of the window in Wales in 2009 with the formation of big new health boards, and the word "choice" is not one many Welsh patients ever hear.

"It's become rather more obvious to us how England is going one way and Wales is going the other, and being on the border is rather uncomfortable," said Dr Alasdair Jacks, who works in Chepstow.

For him the differences have already created a tension as he's able to refer fewer patients with chronic conditions over the border to hospitals in Bath and Bristol.

"In Monmouthshire there are a lot of things we are severely discouraged from trying to send to England," Dr Jacks explained.

"If we wanted to send them east it would be an awful lot of bureaucratic form-filling and asking permission before you even get round to writing a letter to a consultant in England."

Despite those difficulties, Dr Jacks was adamant he preferred working in Wales to being part of the health reforms in England.

"I've always been uncomfortable putting money between the doctor and the patient," he said.

Hotly disputed

"In England I think that is becoming more and more of an everyday conflict of interest."

For patients living on the Wales-England border, the growing divergence brings both restrictions and rewards.

Michael Lenthall is one of many residents in Hewelsfield, Gloucestershire, who is registered with a Welsh GP surgery.

"The advantages of being in the Welsh system are the free prescriptions, free parking, and the situation where you get help with your rent for aged relatives in sheltered accommodation," he says.

But having spent most of 2011 on a waiting list for treatment, Mr Lenthall also feels frustrated by the lack of choice available in Wales.

"You are not free to have the hospital or the consultant of your choice without going through a tortuous system of financial approval at every stage," he explained.

"I find it very puzzling, we've all paid the same national insurance and tax on a basis for the country as a whole."

The different political approaches taken in England and Wales are in some ways both attempts to address the biggest challenge of 2011 - saving money.

It is claimed - though hotly disputed - that the reforms in England would save up to £5bn over the next four years.

In Wales, an approach of efficiency and thrift has been adopted to try and cope with a shrinking real terms budget in the future.

According to Professor Siobhan McClelland from the University of Glamorgan, they are two opposing approaches to the same problem.

"The health service has been described as a tanker whose direction is very difficult to change - all of these services are looking for incentives," she explains.

"In England, they seem to think the way to change services is to have a plurality of commissioners, to have competition - to have choice for patients.

"In Wales, Scotland and Northern Ireland there's a much more planned approach, a much more partner approach to doing that."

So who will get it right? It's such a loaded question I doubt the politicians would ever, but 2012 should at least start to provide us with some answers.

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