The Welsh Government recently issued a consultation document that provides a framework for establishing the correct body within the NHS in Wales responsible for securing healthcare for an individual.
As this consultation process concludes (responses were due by 30 September), a clearer understanding of the body responsible for funding care for a patient who moves to Wales may be obtainable.
Having recently advised two separate English NHS clients about their funding responsibilities when a patient moves to Wales, we have become aware of the uncertainty in the present system. In the two cases we have been asked to advise because the Welsh body has refused to pay.
The draft guidance sets out a framework for establishing the body responsible for securing secondary and tertiary health care for an individual, within the NHS in Wales.
The draft guidance clarifies that within Wales, it is the local health board, where an individual is usually resident, that is responsible for funding. Therefore, when a patient for whom an English PCT is funding a care package moves to Wales, funding responsibility for that package of services will transfer to the local health board for the area the patient is moving to. In the context of NHS continuing healthcare, the “placing PCT” exception that can apply to patients placed in care homes who move to another PCT’s area within England, does not apply in relation to placements into Wales. The Welsh local health board will become responsible for all elements of the individual’s care (including the costs of the NHS Continuing Healthcare package) when the individual becomes usually resident in Wales.
Where it is more convenient for residents to register with GPs across the Wales/England border, the DH and the Welsh Government have agreed an interim joint protocol that deals with the situation where a Welsh resident is registered with an English GP, and where an English resident is registered with a Welsh GP. The current protocol, which does not supersede the legal responsibility in such cases, can be accessed online.