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

6  Cross-border engagement and co-ordination

Cross-border patient engagement

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.[75] The poll showed that 48% of the population knew Welsh Ministers had responsibility for health while 43% thought it was the UK Government.

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 health policies.[76]

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.[77]

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".[78]

92. The Department of Health told us that information regarding the different health systems was available on NHS England's website,[79] while the BMA told us that they had had discussions with the Welsh Government about a website for Welsh patients.[80] 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.[81] 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.[82]

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 use.

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.[83]

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.[84]

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".[85] 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.[86]

100. Both Governments agreed on the importance of cross-border patient engagement and representation.[87] 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.[88] 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.[89]

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 and transparent.

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".[90] 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".[91]

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".[92] 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.[93]

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 Welsh patients.

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 Back

76   Welsh NHS Confederation (CBH0016) Back

77   Royal College of Physicians (CBH0021) Back

78   Q6  Back

79   Q293 Back

80   Q192 Back

81   Shropshire Council (CBH0050)  Back

82   Q101 Back

83   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

84   Q114 Back

85  Back

86   Action4OurCare (CBH005) Back

87   Q39 Back

88   Q290 Back

89   Q381 Back

90   Q118 Back

91   Q116 Back

92   Q351 Back

93   Q39


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© Parliamentary copyright 2015
Prepared 12 March 2015