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The man driving the ban on patients from Wales accessing the Countess of Chester hospital is Margaret Thatcher’s former permanent health secretary and England’s first NHS chief executive.

Sir Duncan Nicol, knighted for his services to the NHS, now chairs the Countess of Chester Hospital (CoCH) Foundation Trust. It’s unilaterally decided to ban new outpatient referrals and urgent suspected cancer cases for patients from Wales due, it says, to a long-standing dispute over funding between NHS Wales and NHS England. Admissions for existing outpatients, maternity and A&E are being permitted.
Despite negotiations between the two bodies continuing, the CoCH has taken the unprecedented step of banning patients from care despite the Countess being the nearest hospital to thousands of patients in Flintshire, just over the Welsh border. In fact, the Countess relies on funding from Wales to ensure it’s viable because a fifth of all its patients are based there.
The ban is thought to affect about 8,000 Welsh patients a year, who will have to be accommodated in nearby Ysbyty Glan Clwyd and Wrexham Maelor hospitals by the north Wales health board, Betsi Cadwaladr University Health Board.
We understand that the dispute is over a sum of £2 million a year – which amounts to 1% of the CoCH budget. It’s also a fraction of the £12m overspend the Foundation Trust is expected to make this year. BCUHB pays CoCH about £25 million a year for services.
In trying to understand the motivation for the unilateral ban, it’s worth explaining that the internal market in England’s NHS, where there is a distinct division between commissioners of care and providers of care, does not exist in Wales. Health boards in Wales both commission and provide care and there is no unnecessary bureaucracy surrounding delivery of service.
The wrangle over finances turns around the need for the Welsh NHS to pay an extra 8% for services provided through that internal market.
He and another CoCH director, Christine Hannah, were described as the NHS “dream team” and, despite now being in his late 70s, he is still driving the ideological agenda. How else can we explain that 50 other English hospitals take patients from Wales but his won’t?
Health experts in the field say Nicol in particular and CoCH in general are expert at playing “the Welsh card” to distract from any little local difficulty. It’s regularly played but now the stakes have been upped. We can only wonder why… It’s believed this is the first time that patients from a neighbouring country within the UK have been banned from accessing a hospital.

At the time of writing, patients from north Wales have more rights via their EHIC card to treatment within the EU than at their local hospital.

Although the prize for the Countess may be relatively small at £2m a year, there is a bigger prize if all patients from Wales accessing services in English hospitals have to pay an extra 8%.
It also helps with a Conservative political narrative to attack Labour’s handling of the NHS in Wales. Labour First Minister Mark Drakeford has made it clear that he “won’t be blackmailed” into backing down in the ongoing negotiations.
So it looks like thousands of patients will be used as little more than bargaining chips in a complex cross-border political game that shows no sign of ending. A Plaid Cymru petition demanding an end to the ban while negotiations are ongoing is gathering traction locally but it remains to be seen if unelected bureaucrats such as Sir Duncan are actually listening.

• Please sign the petition and send a message to Sir Duncan.