Cross-border health arrangements between England and Wales - Welsh Affairs Contents

5  Waiting times

77. As we noted earlier, one of the areas in which health policy in England and Wales has diverged is in the targets set for waiting times. In England, the maximum waiting time target is 18 weeks from referral to start of treatment. In Wales, there is a longer maximum waiting time target of 26 weeks from referral to start of treatment.

78. In addition, different arrangements apply to the treatment of patients from across the border in England and Wales. Welsh providers are required to work to the standards and targets set out by the Welsh Government for all patients whom they see and treat, whether they are patients registered in Wales or patients treated in Wales from any other part of the UK. English providers are required to work to the standards and targets set out by the Department of Health for patients who are the responsibility of English commissioners. Services accessed in England by patients registered in Wales are commissioned by Welsh commissioners to meet Welsh Government performance targets.

Dealing with different targets

79. Witnesses told us that the existence of different waiting time targets in the Welsh and English NHS caused significant problems for clinicians, administrators and ultimately patients.[67]

80. The BMA told us that longer waiting times caused problems to Welsh GPs and their workload:

    We are having to see those patients more regularly; we are writing expedite letters on a daily basis, which takes up GP and secretarial time. From time to time, patients ask 'Were I an English resident registered with an English GP, would the wait be different?[68]

81. A number of English providers referred to the additional administrative burden of differentiating between waiting times as an area of difficulty. Shropshire Clinical Commissioning Group highlighted the difficulties of treating Welsh patients in line with Welsh targets:

    In reality this means […] English hospitals on the border are running with two sets of targets English and Welsh. This can lead to communication issues with patients as some consultants have said directly to them that Welsh patients aren't managed to the same targets because they as a provider are not paid to do so.[69]

82. Anecdotal evidence we received from patients showed that it was possible for a Welsh patient to wait longer for treatment at an English hospital than an English patient with a similar complaint, due to the difference in waiting time targets between the two administrations.[70] The BMA stated that this did not "sit easily" with clinicians.[71]

83. It is important to note that this difference only affects elective treatment. There was no suggestion that Wales-registered patients would ever wait longer than English-registered patients for clinically urgent treatments. However, the Committee received representation that the differential in waiting times was unfair. Powys Teaching Health Board commented that patients saw waiting times as a 'two-tier service' where there was a level of guarantee that treatment would be sooner for English patients treated in England.[72]

84. Patients argued that they were paying the same taxes, irrespective of which side of the border they lived, and should therefore be treated equally. The BMA called for waiting time standards to be the same on both sides of the border:

    We treat people in the same way, so it would be helpful to us to have things the same. To have two different standards when you are doing one thing is not that helpful ...[73]

85. Jane Ellison told us that hospitals in England were acting to targets set by the Welsh Government, and that they were not treating Welsh-registered patients as second-class citizens:

    No one is saying "The Welshman can wait a bit longer" […] The Welsh have set a 26-week waiting time standard. The Welsh Government can decide to set a different waiting time standard. In England, we have set it […] at 18 weeks. That is a decision for the Welsh Government.[74]

86. Many Clinical Commissioning Groups operate two waiting lists, which differentiate between patients on whether they are 'Welsh' patients or 'English' patients. It is our view that providers should not be in this position; the procedures that English hospitals need to operate in this situation are a matter for the Welsh Government and the Department of Health to resolve.

67   Welsh NHS Confederation (CBH0016) Back

68   Q178 Back

69   Shropshire Clinical Commissioning Group (CBH0011) Back

70   Q137 Back

71   Q193 Back

72   Powys Teaching Health Board (CBH0026) Back

73   Q194 Back

74   Q278 Back

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© Parliamentary copyright 2015
Prepared 12 March 2015