6 Cross-border engagement and
87. It is generally accepted that patients and the
public need to be enabled to play a greater role in the care they
receive and to engage effectively in health policy development.
In this section, we examine public awareness of the difference
in services they can expect to receive in England and Wales, and
public engagement in matters affecting health policy.
88. There is a lack of awareness and understanding
among patients and service users about devolution and healthcare.
A poll conducted by the BBC highlighted that less than half of
the population in Wales were aware that the NHS was the responsibility
of the Welsh Government.
The poll showed that 48% of the population knew Welsh Ministers
had responsibility for health while 43% thought it was the UK
89. During our public events in Newtown and Hereford,
we heard that many patients on both sides of the border were generally
unaware of the potential for divergence between the Welsh and
English health services. The Welsh NHS Confederation said that
patients were not aware that choosing a GP on one side of the
border might affect later referrals:
it is quite possible to have two people
living next door to each other in either Wales or England registered
as patients with two different practices and subject to two different
90. The Royal College of Physicians told us that
a lack of awareness about the different health systems meant that
clinicians often had to have "difficult" conversations
with patients, explaining why there was access to different treatment
or drugs in each respective nation.
91. Witnesses from both sides of the border called
for improved communication with cross-border patients, which needed
"to be standardised and consistent across the Department
of Health and the Welsh Government".
92. The Department of Health told us that information
regarding the different health systems was available on NHS England's
website, while the
BMA told us that they had had discussions with the Welsh Government
about a website for Welsh patients.
However, some witnesses had concerns about relying on the internet
to disseminate information, as many people living in the cross-border
areas had limited or no access at all to the internet.
Shropshire Clinical Commissioning Group told us that they encouraged
their GPs to explain the differences to their patients before
they were referred to secondary care "so that the patient
is making an informed decision" about the impact of GP registration.
93. Some patients
living on the border area of England and Wales choose their GP
based on proximity. We are concerned that patients are unaware
of the differences in services they can expect to receive in England
and Wales. Better information for patients must be made available,
particularly in immediate border areas, where the choice of a
Welsh or English GP might have implications for later care.
94. We recommend that the Department of Health
and the Welsh Government work together with medical practitioners,
particularly at a GP level, to ensure that patients are better
informed of the differences in healthcare policy between England
and Wales. Patients must also be made aware of the impact of choosing
a Welsh or English GP and the implications that this might have
for later care.
95. Healthcare policy on one side of the border can
have an impact on patients on the other. During our inquiry, we
received evidence that patients accessing health care services
on a cross-border basis felt that they were unable to contribute
to the development of the services which they and their families
96. As we have discussed, many patients in Wales
have no choice but to receive secondary care in England. For example,
Powys has no district general hospital and is served by the Royal
Shrewsbury Hospital and Princess Royal Hospital in Telford, among
others. The future of Shrewsbury's accident and emergency department
is currently being debated as part of the Future Fit programme.
97. During our public events, Welsh patients expressed
concern that they could be adversely affected if services were
moved eastwards, with them having to travel further to receive
care. Witnesses expressed concern that the changes could occur
without input from them, and without realisation of the impact
it could have for Welsh patients.
98. When we put these concerns to Shropshire Clinical
Commissioning Group, it told us that it had held a number of engagement
exercises with the population in Powys, including a number of
public meetings, a telephone survey, and a number of workshops
in August and September.
99. English residents who receive GP and hospital
care in Wales also expressed concern about their ability to affect
services in Wales. Healthwatch was established in England in April
2013 and is the new consumer champion for health and social care.
It aims to "give citizens and communities a stronger voice
to influence and challenge how health and social care services
are provided within their locality".
However, Action4OurCare told us that it had no remit in Wales,
while Welsh Community Health Councils could only represent Welsh
residents, and not those receiving treatment in Wales.
100. Both Governments agreed on the importance of
cross-border patient engagement and representation.
NHS England agreed that it was a "crucial principle"
that patient's interests were considered when designing and delivering
services, irrespective of whether someone was a Welsh or English
resident. The Welsh
Health Minister also noted that, while his primary responsibility
was to Welsh residents, he felt a responsibility to English residents
who accessed services in Wales.
101. We welcome
the commitment that exists to engage the public in service delivery.
However, we note that patients still feel disenfranchised from
any decision taken on those services, particularly when they are
provided across the border. The decision-making processes on each
side of the border need to be more co-ordinated, more coherent
102. We recommend that NHS Wales and NHS England
work together to improve patient engagement for cross-border services.
Engagement between Local Health
Board and CCGs
103. As well as care to individual patients, large-scale
service delivery by LHBs or CCGs can be affected by cross-border
activity. Health representatives told us that relationships between
LHBs and CCGs on the border were positive. Shropshire CCG told
us that Powys Health Board had a place on its programme board
and had a vote, as did Shropshire CCG and the Telford and Wrekin
CCG: "so its vote on that programme board is proportionate".
However, we heard concerns that changes to areas such as community
services and to community hospitals were not being communicated
to neighbouring healthcare providers across the border.
104. Shropshire CCG told us that changes to minor
injuries provision in Chirk had meant an increase in the number
of patients arriving at Oswestry. It told us that, "when
[decisions] have implications across the border for capacity and
for the planning of health services, it would be helpful to know
of them in advance".
105. The Welsh Government expressed concern that
English local authorities were sending Looked After Children (LAC),
some of whom have specialist or mental health needs, for placement
in Wales, without appropriate discussion and notification with
LHBs. The Welsh Government's Health Minister told us that this
had resource implications for LHBs, particularly in rural areas
where "services are not equipped to respond to very significant
and unexpected needs".
Although we do not examine this issue further in this inquiry,
the financial implications of such services being provided cross-border
may require further investigation in the next Parliament.
106. The Welsh NHS Confederation told us that it
would welcome formal protocols to be put in place to ensure formal
consultation between LHBs and CCGs when services impact on populations
across the border.
107. We are
encouraged by the positive evidence we have heard regarding hospitals
which have included a cross-border dimension in their management
structures. We believe that this model could and should be replicated
in all hospitals near the border which serve both English and
108. We are
concerned that there is a lack of communication regarding changes
to healthcare services which could have an impact across the border.
We recommend that formal protocols are put in place to ensure
consultation between LHBs and CCGs when changes to services impact
on populations across the border.
75 www.bbc.co.uk/news/uk-wales-politics-27739205 Back
Welsh NHS Confederation (CBH0016) Back
Royal College of Physicians (CBH0021) Back
Shropshire Council (CBH0050) Back
The Future Fit Programme has been set up to develop a clear vision
for hospital services to serve the population of Shropshire, Telford
& Wrekin and mid Wales. Back
Action4OurCare (CBH005) Back