§ Mr. MorganTo ask the Secretary of State for Wales what proposals he has for transitional arrangements for the period 1 April 1991 to 1 April 1993 for health authorities in respect of those hospitals and specialised wards in which a high proportion of the patients come from outside the boundaries of the health authorities.
§ Mr. GristFrom 1 April 1991 district health authorities will be funded to meet the needs of their resident populations rather than those of the wider catchment areas they serve. The services provided by hospitals will be paid for under service agreements negotiated with health authorities and GP fund-holding practices on behalf of their patients. Thus hospitals receiving patients from outside the district in which they are situated will in future receive funds from the district health authorities or, where appropriate, the general practitioner fund-holding practices, covering the respective patients' areas of residence.
In 1991–92, district health authorities will be funded to enable them to meet the costs of anticipated patient flows across boundaries. It is expected that these anticipated flows will broadly reflect the existing pattern of cross-boundary movements of patients and will in any case represent the agreements reached in the course of this year between health authorities, general practitioner fund-holding practices and the providing hospitals. We do not therefore expect to see patients disadvantaged, or individual hospitals or specialist services made unviable, simply because of the new funding arrangements that will be introduced next April.
In clue course, district health authorities' revenue funding will reflect their weighted population share of available resources—which may be more or less than the shares based on their residents' use of services which, as I have described, will be the basis of funding in 1991–92. There will be a process of transition to weighted capitation funding in order to allow authorities and hospitals time to adjust—either by considering new ways of providing services or by improving efficiency. It is not yet possible to say how long this period of transition will take since the starting point for transitional arrangements will not be determined until authorities produce data on anticipated cross-boundary flows and since the methodology for calculating weighting population shares will not be determined until authorities have been consulted. These matters will be resolved during the autumn and transitional arrangements will then be mapped out when the district health authorities' allocations for 1991–92 and their resource planning assumptions for subsequent years are published in December and January respectively.