Patients in Wales face cross-border specialist ops wait
Hospitals in England providing specialist care for Welsh patients have been told to delay some operations.
BBC Wales can reveal that health managers in Wales have threatened not to pay English trusts if they treat patients too quickly.
As part of a drive to save money, hospitals have been told to delay some operations, including heart surgery, until the end of March.
The Welsh government said all patients should be treated within set times.
The demand comes in a letter to the bosses of health trusts in England from the Welsh Health Specialised Services Committee (WHSSC), the body responsible for planning and commissioning specialised health services on behalf of Welsh health boards.
BBC Wales has obtained a copy of the letter which instructs English hospitals not to treat Welsh patients as quickly as they currently do until the end of the financial year.
They are also told to only undertake scheduled procedures if there is a risk that patients have to wait longer than 26 weeks.
Under Welsh government targets, only 5% of patients should spend more than 26 weeks on a waiting list.
But waiting time performance for Welsh patients being treated in England is typically ahead of the 26-week target. The NHS in England has a waiting time target of 18 weeks.
In the letter, WHSSC says it is implementing new controls in order to stay within "available resources".
"In order to ensure equity for Welsh patients we require that all providers to deliver activity both in line with the Welsh waiting times and within the available resources," it said.
"Routine elective (scheduled) activity between 17th of January 2013 and 31st of March 2013 should only be undertaken if it is required to avoid breaching the 26-week target."
The letter says that if cases are considered "clinically urgent" then English hospitals would need to obtain "prior approval" from WHSSC before proceeding with treatment.
It adds: "This is a significant initiative for NHS Wales and therefore failure to comply with the above will result in non-payment."
BBC Wales understands that the decision will affect a wide range of operations for Welsh patients undertaken by English hospitals. These could include heart surgery, neurosurgery and plastic surgery.
A senior doctor from the north west of England, who did not want to be named, said the decision could put patients at increased risk.
"I'll be prevented from operating on patients that I would otherwise have operated on," he said.
"Some patients get further problems and occasionally die while on waiting lists... so there's always a risk if they're waiting longer for an operation."
Conservative health spokesman Darren Millar called on Health Minister Lesley Griffiths to act.
"This advice is completely unacceptable and grossly unfair," said Mr Millar. "Any instruction which puts the health of Welsh patients on the backburner is unjust and should be stopped immediately.
"There is no reason why Welsh patients referred to a hospital over the border should be forced to remain in pain and discomfort on the whim of this committee and I urge the minister to take decisive action to overrule this advice."
The Welsh government says its position is that all patients should be treated within set waiting times.
A Welsh government spokesperson said: "The Welsh government expectations are unchanged - that all patients are to be seen within our waiting time target and in order of clinical importance.
"The minister requires all health boards and WHSSC to work on this basis."
Marcus Longley, director of the Welsh Institute for Health and Social Care at the University of Glamorgan, said: "People find it offensive with the health system appears to be putting money in front of clinical considerations.
"It is a high profile issue and emotive but it is fair to point out that the numbers involved are very small," he told BBC Radio Wales.
A WHSSC spokesperson said: "To ensure equity for all Welsh patients, action has been taken to align all elective care for specialised services which is delivered in England with Welsh waiting times standards.
"Providers of this care have also been informed that if there is any uncertainty regarding the urgency of treatment to contact the Welsh Health Specialised Services Committee to obtain prior approval.
"This affects all inpatient and outpatient appointments for specialised services which are provided by English organisations."
The instruction from WHSSC follows moves by Powys Health Board last year to delay treatment for its patients at hospitals across the border.
At the end of November, BBC Wales revealed that Powys Health Board had told English health trusts it would only pay for operations for the county's patients after they had waited between 32 and 36 weeks.
The health board insisted nobody would be at greater risk because of the decision.
Plaid Cymru health spokeswoman Elin Jones said it was a "worrying revelation".
"It shows how the Welsh government's failure to get to grips with NHS finances is affecting patients," she said.
"Most worryingly, it reveals that cancelling scheduled treatment is seen as an easy option for cutting costs by the Welsh government. We desperately need a new approach to the NHS in Wales."
Welsh Liberal Democrat leader Kirsty Williams said: "The Welsh Labour government only sees statistics and waiting times, they don't see the people suffering behind those statistics.
"I am really concerned that money saving 'initiatives' like this are happening all across the Welsh NHS to the detriment of Welsh patients."
All seven health boards in Wales are facing big financial pressures. In November the Wales Audit Office predicted health boards were likely to be £70m in deficit by the end of the financial year in March.
Later, Ms Griffiths announced £82m would be provided from the Welsh government to ease the pressure facing the NHS across the country.
The minister fiercely denied suggestions that the money amounted to a bail out.