Coalition’s NHS reforms stoke tension on Scottish border

NHS patients are facing a 'tartan curtain' caused by bickering health officials either side of the English-Scottish border.

The spat, which is being encouraged by the British government in Westminster, is forcing English patients to take lengthy bus journeys as far south as Newcastle upon Tyne instead of receiving treatment just over the border.

Scottish patients are now only being allowed access to English hospital services in exceptional circumstances after the Northumberland clinical commissioning group (CCG) suggested it feared lower standards north of the border.

Dr Alistair Blair, its chief clinical officer, told Berwick-upon-Tweed MP Sir Alan Beith in a letter seen by "Scottish providers are not governed by the same contractual arrangements as English providers and Northumberland CCG needs assurance that commissioned services are of high quality, locally sensitive and value for money."

He added that as a result GPs in Northumberland had been asked "not to routinely refer patients across the border".

Sir Alan blamed NHS managers' arguments over how much they pay each other for treating patients from the other side of the border for the dispute.

"It cuts across the whole tradition of the area where people access services across the border the whole time," he said.

"It seems extraordinary that this would happen after the referendum."

The Borders region voted two to one against Scottish independence but now faces what Scottish Conservative MSP John Lamont called a "massive inconvenience" which "could be putting patients' health at risk".

"Cross-border care is vital for thousands of Borders patients and despite assurances to the contrary, it appears Scottish patients are not getting the access they need to services south of the Border," he said.

"The Scottish government needs to intervene and work with both health boards to protect this arrangement, which currently benefits both Scottish and English patients."

A spokesperson for the Scottish government said it  was "very clear" that patients living in border regions should not be disadvantaged in their healthcare access and treatment.

"Should a Scottish patient who is registered with an GP in England require hospital care, their GP will refer them to the most appropriate service based on their clinical need,"

"Cross border treatment is carried out through established arrangements between Scottish NHS boards and English Trust Hospitals."

Sources on the eastern side of the border suggested this was exactly what happens. But on its western side, in Northumberland, the problems faced by Sir Alan's constituents are posing an ongoing problem.

The row has developed since NHS Borders health board became the prime provider of healthcare services for patients in the Borders area from July 1st this year.

But ministers in London remain defiant and are defending the right of the CCGs – which the coalition government controversially created – to reject Scottish health services.

Department of Health minister Jane Ellison told MPs it was up to Northumberland CCG to decide where to commission services from. When Sir Alan raised the issue in the Commons, she said:

To be clear, the CCG is free to commission services from Scottish providers if it wishes to do so. No one instructs a CCG on where to commission services from – that is a decision for the CCG and one of the strengths of the system. Convenience may not be the most important factor in making that decision, but CCGs need to be assured of quality and standards.

One victim of the cross-border tensions said ambulance crews had repeatedly tried to take him to an English hospital when his patient notes were kept at a Scottish one.

"There has been cross-border cooperation," Brian Woodcock, a 63-year-old parish councillor in Carham, told the Journal newspaper.

"I would just like to see them look at it again and see if it can be kept going."

UPDATE: Dr Graham Syers, Joint North Locality Director at Northumberland CCG, has this to say:

"NHS Northumberland Clinical Commissioning Group (CCG) plans and buys the healthcare services for the people living within Northumberland. We want to commission high quality, integrated care in the most efficient and sustainable way, by the most appropriate provider to meet the longer term needs of the people in Northumberland.

"We work with all providers to ensure that this is delivered and patients are offered choice. We have recently met with NHS Borders and shared with them our standard contract as all our providers must meet the standards required by the NHS standard contract.  Scottish providers are not governed by the same contractual arrangements as English providers and NHS Northumberland CCG needs assurance that commissioned services are of high quality, locally sensitive and value for money.

"When a patient is referred to a Scottish provider, different rules apply for the referral and treatment.  This can increase the waiting times and Northumberland CCG is working with all providers to ensure this does not adversely affect patient care. For example, we cannot guarantee a two-week wait for cancer."