I don’t understand why border politics should come into it at all. Access to health facilities shouldn’t be determined by what are, after all, arbitrary administrative boundaries.

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What rot. Powys Health Board doesn’t pay for a general hospital in Powys, it pays for patients who can’t be treated at facilities in Mid Wales to be treated in hospitals in Shropshire instead. Powys Health Board pays a percentage of the costs of running the hospitals as part of the agreement to let them use our hospitals. The percentage of the run cost of the hospitals they pay is slightly under the percentage of patients that Powys residents constitute which suggests that they’re paying their fair share but in reality, the patients that are treated in Shropshire are more complex (and therefore more expensive) than the average English case because they are only treated in Shropshire if they don’t have facilities in Powys.

The underpayment is around £2m per year according to the hospital trust a couple of years ago. That’s £2m that could be spent on services for Shropshire people in our own hospitals. The amount that Powys Health Board pays into the teaching side of things is an irrelevance, they are contributing towards the provision of services for their own county – it’s part of the running costs they are contracted to pay a share of. They can’t spend the teaching money on their own hospital because they haven’t got one so they pay towards training the medical staff that are treating their patients. It’s not a favour they’re doing us!

The argument that “border politics” shouldn’t come into it is wrong. Although it’s usually referred to as “the NHS” in the press, it is the English NHS and Welsh NHS we are talking about here. Since 1997, the Welsh have had their own government with its own health budget and control over its own health service. It is the responsibility of the Welsh NHS to provide hospital services to people in Powys via the Powys Health Board. It is the responsibility of the British government (we aren’t allowed our own government in England) to provide hospital services to people in Shropshire via the NHS Trust in Shropshire. Powys people have no basic right to use hospitals in Shropshire, the same as Staffordshire people or anyone from any other county in any part of the UK or beyond (EU rules notwithstanding). More so for Powys people because they’re in a different country. It is simply a commercial agreement between the two health authorities that allows them to be treated in a different county in a different country by a different health service.

It works in our favour in Shropshire to have this agreement with Powys Health Board because it means we have enough patients going through our hospitals to sustain services that would otherwise not be viable but that doesn’t change the fact that it is us in Shropshire doing Powys a favour, not the other way round. Without this commercial agreement, there is no obligation other than a moral imperative to treat patients from Powys.

I would not suggest we cut off our neighbours and refuse to treat them at our hospitals because that would be cutting our nose off to spite our face and besides which I would consider it quite immoral. But we should get the full cost of that treatment, not a reduced amount. It also doesn’t mean that people in Powys should be able to unduly interfere in the way services are provided in Shropshire. The PRH and RSH are Shropshire hospitals built with English money for Shropshire’s benefit. The reconfiguration of services was, we are told, the best way to configure services for Shropshire. It has meant an extra 10 miles being added to the journey of some Powys residents and that’s regretful but it’s no more than the 10 miles half the county the hospitals belong to that also have to drive. I buy my shopping at Tesco but I wouldn’t expect to be able to dictate to them where they put the biscuit aisle or whether I have to go to the Tesco store in Wellington or Telford town centre to buy electrical goods. That’s how it works when you’re a customer, you take what you’re offered or you go elsewhere.

The decision has been made now on how services are going to be provided at Shropshire’s hospitals. If those changes are unacceptable to people in Powys then they need to stop complaining at us in Shropshire and start complaining to their Welsh Assembly members about the lack of adequate medical provision in their own county. If every Welsh person donated the price of one English prescription on the 1st of April (it’s going up to £7.40 per item on the 1st, the same day the Scots abolish their charges) they’d raise £22.2m towards the cost of a new Powys General Hospital.

Finally, a clarification on who pays what. The only country in the UK that pays more into the UK Treasury than it gets back is England. Under the Barnett Formula, England subsidises the rest of the UK in perpetuity. Currently that subsidy is £20bn and that’s how the Scots, Welsh and Northern Irish can afford to abolish prescription charges and hospital parking charges and why we in England apparently can’t. It would cost £350m to abolish prescription charges in England – just 1.75% of the English tax money the British Chancellor gives away to our neighbours every year. So yes, we are disadvantaged both democratically because we aren’t allowed the same self-government that Scotland, Wales and Northern Ireland get and financially because we are expected to pay for the perks the rest of the UK enjoys that we aren’t allowed. We are most definitely not all in this together as David Cameron likes to say and like this author says. We in England are paying the lions share of the cuts and I will happily show the author of this article the hard facts if she’s not too precious to be corrected.

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So “we are all in it together” are we? Some of us are more ‘in it’ than others. With regard to health services we, in England, are taxed to the tune of £7.40 for each prescription, free in Wales. The British Government that rules us spends less on health services for us in England than the Welsh Assembly Government pays for those in Wales. Political correctness! Are you saying that it is not politically correct for the English who are more heavily taxed than the rest of the UK to complain about the way the Barnett formula is more generous to the rest of the UK, that we do not have national government etc etc.

Are we simply to pay up and shut up? Sorry those days are gone!

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