11th June 2015
Healthcare continues to be thrust into the spotlight on the back of the Scottish referendum last year. Along the border with England, people on both sides feared a yes vote could potentially bring an end to the journeys they regularly made across the divide to access what are often their nearest GPs and hospitals. Following the resulting ‘no’ to independence, many breathed a sigh of relief in the knowledge they could continue accessing their nearest healthcare services regardless of where they fell across the border. On closer inspection however, there have been instances of GPs close to the borders being encouraged not to refer them to hospitals across the divide, even with patients in both England and Scotland. More worryingly, alleged situations have come to light of ambulances not taking patients or attending callouts on the opposite side of the boundary.
Union Brae Surgery, close to the borders English side – where most patients live closer to Scotland’s Borders General Hospital than Northumberland’s Wansbeck General – issued a telling statement on its webpage:
“Although last year’s referendum left Scotland and England united, the health services in the two countries have moved further apart than ever. Northumberland CCG has decided that for patients living in England it is not possible to be referred to Edinburgh for any condition whatsoever. Referrals to the Borders General Hospital are not possible for Ophthalmology, Orthopaedics or for suspected cancer cases, except in exceptional circumstances. Referrals for other specialities are possible but discouraged. For patients living in Scotland, Borders Health Board has decreed that all referrals for x-rays, physiotherapy and to hospital specialities must be to the Borders General Hospital, except by prior arrangement with the health board.”
The practice issued this guidance following the increasing number of its patients querying the situation. One GP with three decades’ experience called it ‘an irony’, remarking that “patients used to be able to go to Edinburgh or Newcastle”, and that the reason for the dispute is a lack of a fixed contract between health authorities in England and Scotland. “They are effectively becoming further and further apart. It was all free; there were no problems 30 years ago. It was all one big NHS.” The story is emphatic of wider issues in the profession, with the workload crisis and increased divergence between practices creating concern amongst the public.
Newly-elected Berwick MP Anne-Marie Trevelyan has taken aboard concerns, the subject of a series of letters to health minister Jeremy Hunt and the Northumberland CCG. “I am aware of this apparent breakdown in cross-border cooperation. A lot of people have raised these concerns, both in terms of access to Border General Hospital and ambulances being diverted south.” Northumberland CCG said GPs can make referrals across the border “in some circumstances” but that “it’s not something that happens routinely.” North locality director Dr Graham Syers commented:
“NHS Northumberland Clinical Commissioning Group plans and buys healthcare services for people living in Northumberland. We work to commission high quality, integrated care in the most efficient and sustainable way, by the most appropriate provider. Healthcare north of the border is the responsibility of the Scottish government, which means that Scottish healthcare providers are governed by different contractual arrangements. NHS Northumberland CCG needs assurance that any services we commission are of the right quality and value for money to meet local people’s needs. If a patient is referred to a Scottish provider, different rules apply for referral and treatment.”
NHS Borders has been similarly militant about the situation, with a spokesperson confirming it too ‘prefers to keep patients within its boundaries.’ It did however say emergency cases should be taken to the nearest hospital regardless of locale. Director of nursing and midwifery and interim director of acute services Evelyn Rodger said “NHS Borders is responsible for providing health care services to the residents of the Borders... [But] in emergency situations, all patients should be taken as quickly as possible to the closest A&E department whether this is Borders General Hospital, Edinburgh or the North of England. NHS Borders remains happy to accept referrals from other health boards or trusts including Lothian and Northumberland... [it] cannot comment on Northumberland clinical commission group’s policy around cross-border referrals.”