HEALTH Secretary Jeremy Hunt used a visit to Hereford County Hospital (HCH) to take the latest shot in his cross-border standoff with NHS Wales.

Mr Hunt cited Wye Valley NHS Trust (WVT) being put into special measures as an example of the “honesty” NHS Wales and the Welsh government should be showing to  patients.

Putting hospitals into special measures acknowledged problems and allowed for solutions – the approach NHS Wales should be taking to what its own statistics show, he said.

The Welsh health minister Mark Drakeford AM has spoken of his "serious concern" at the rating of HCH as "inadequate" given the number of Welsh patients routinely receiving care and treatment there.

During an allotted five-minute interview slot, Mr Hunt had been asked whether, in his opinion, NHS Wales and the Welsh Assembly should be doing more to assist WVT over its issues with Welsh patients.

The Welsh NHS has been criticised in a series of reports revealing problems with patient care and waiting list times.

In October last year, Mr Hunt branded the NHS in Wales as “second class”  during a Commons debate with Tory MPs claiming English hospitals were being put under pressure with Welsh patients crossing the border to use.

Welsh politicians launched a scathing attack in reply, accusing the government of conducting a cynical campaign to run down the Welsh NHS.

Prime Minister David Cameron subsequently agreed to “look very carefully” at the specific pressure Welsh patients put on HCH.

In July last year, the Hereford Times revealed that WVT has to find around £12 million a year to cover the cost of Welsh patients who can’t go home because care packages aren’t in place.

North Herefordshire MP Bill Wiggin raised in the issue at Parliament saying Welsh patients were taking addresses in England  to access the likes of cancer drugs not available through NHS Wales.

In response, the PM acknowledged pressures posed by Welsh patients and a need for “continued improvements” at the hospital with Wye Valley NHS Trust now in special measures.

He said: “Obviously, we want to see continued improvements at the Hereford hospital. There are pressures from people from Wales crossing the border and wanting to use services in England. That is why it is so important that the Welsh NHS has the improvements that we have been talking about.

In November, Welsh First Minister Carwyn Jones told TVs Question Time that HCH wouldn’t function without the number of Welsh patients using it.

That comment set up a clash with Hereford & South Herefordshire MP Jesse Norman who accused Mr Jones of “playing politics” with the future of HCH when he should “start fixing” NHS Wales.

“Problems arise when the Welsh NHS does not pay the full cost of the healthcare provided, or pays it late.  And that's before you consider the 3.500 people in my constituency who have been forced to use the Welsh NHS in violation of their rights under the English NHS constitution,”  said Mr Norman.

At any one time, WVT  can be caring for up to a dozen patients transferred out of NHS Wales and waiting for struggling health and social services across the border to put care packages in place before they can be discharged.

The trust can claim back the care cost - an annual average of £12 million - through a tariff system that pays per person.

But such claims don’t come back quickly and the trust faces a £15 million deficit of its own without financial support.

The trust acknowledges a number of beds are blocked at Hereford County Hospital as delays in repatriating Welsh patients continue.

Trust chief executive Richard Beeken has written to NHS Wales highlighting the plight of Welsh patients at the hospital.

Some of the Welsh patients have been transferred to community hospitals to improve patient flow through the hospital.

A Welsh Government spokesperson said the Welsh Health Minister was "seriously concerned" at the rating of HCH as "inadequate" given the number of Welsh patients routinely receiving care and treatment at the hospital.

Responding to Mr Hunt's reference to "honesty" the spokesman said:" The NHS in Wales and the Welsh Government are both open and transparent – useful information about health services is readily available on the My Local Health Service website.”

Every year, thousands of English patients are treated in Wales and thousands of Welsh patients are treated in England.

Welsh patients, especially those who live close to the English border, will find it easier and quicker to access routine NHS hospital services in England because they  are closer to their homes than facilities in Wales.

Many patients living in North and Mid Wales also receive specialist hospital care in England, for example, people in North Wales will go to Liverpool or Manchester for cardiac surgery and Gobowen for orthopaedic surgery, just as many patients living in South West England receive specialist burns care in Wales.

Previously, the Hereford Times had previously highlighted the “postcode lottery” that pushed NHS patients on the Herefordshire side of the border into NHS Wales for treatment - the row went all the way to parliament.

The “postcode lottery” was taken up by MP Jesse Norman and the Aneurin Bevan Health Board (ABHB), which covers much of mid and south Wales, announced policy changes that made it easier for border patients to use the hospital of their choice.

Some 3,500 Herefordshire patients are registered with Welsh GPs.  

The ABHB adopted a policy in September 2012 which attempted to keep these patients in Welsh hospitals wherever possible, effectively denying them their choice to come to hospitals in England.

A review of access to NHS services for patients on the English side of the border was ordered at ministerial level.

The ABHB subsequently resolved to allow English residents registered with a Welsh GP to access hospitals in England without prior approval and work with GPs and health commissioners along the border to improve access in the longer term.

As a result, the Welsh Affairs Committee inquiry into cross-border health care came to Hereford in November taking evidence from patients, medical professionals and social care practitioners.

The five years since the committee last examined the issue in 2009 have seen an  increasing divergence between the healthcare systems of England and Wales, which has implications for patients in border areas.

NHS Wales and the NHS Commissioning Board (CB) England agreed a protocol for cross-border healthcare services  but it is not clear how well this has been functioning to date.

The Silk Commission also made recommendations to improve cross-border health delivery identifying issues as:

* The impact of the increasing policy divergence in the health systems of England and Wales on cross-border healthcare services, and on medical practitioners and patients in border regions in England and Wales.

* The experience of patients in England and Wales who are reliant on the use of healthcare services on the other side of the border.

* The case for greater sharing of resources and facilities between the English and Welsh healthcare systems, for example in relation to procurement and use of high-tech equipment.

* The impact of the Protocol for Cross-border Healthcare Services agreed by NHS Wales and NHS CB England, implemented in April 2013, and whether it is meeting its objectives.

* The Silk Commission Part II recommendations on cross-border health, particularly the proposal to develop individual protocols between each border Local Health Board in Wales and neighbouring NHS Trust in England.

* Any lessons that can be learned from other cross-border health arrangements, such as between England and Scotland or Northern Ireland and the Republic of Ireland.

 During his visit Mr Hunt also said trusts as relatively small as WVT “absolutely” had a future in the NHS where their emphasis could be put on quality of care.

He praised Mr Norman’s work in cutting some £5 million from costs related the PFI contract that got the hospital built, but stopped short of outlining any prospect of direct government intervention in the application of the present contract or influence on its future application.