The Welsh Assembly Government provide local health boards with funding to meet the needs of the local population, and the Health Commission Wales (HCW) with funding to meet the needs of those requiring specialised care in Wales. The funding is allocated directly to these organisations to provide services based upon the principle of ensuring that patients receive the most appropriate level of care irrespective of where it is provided. Consequently, there is no specific funding allocated for patients requiring specialised treatment in hospitals in England that is not available in Wales.
Revenue is provided to local health boards (LHBs) and the HCW annually to purchase the necessary care (specialist and non-specialist) for the residents of Wales. LHBs and the HCW have contracts with both Welsh and English providers to service the needs of the population. The way in which the money is spent is no different in either country—that is, in general, services are provided by block or cost and volume contracts for that care. Where there are requirements outside the block or cost and volume contract, individual patient contracts are used (with English providers requiring prior authorisation from Welsh LHBs).
For instance, patients from north Wales who require cardiac surgery will have it carried out in the cardiothoracic centre in Liverpool, but it is paid for by the Health Commission Wales as part of the overall contract that the HCW has with the various providers in England.
It is important to reiterate the key principle: there is no difference in the way the money is spent, irrespective of which side of the border, Wales or England, it is delivered. It is based on patient need and the most appropriate place for that to be met.