Conclusions and recommendations
Funding and Commissioning
1. There is an unresolved
tension between the cross-border healthcare protocol and the Health
and Social Care Act 2012. English patients registered with Welsh
GPs or Welsh-registered GPs do not receive the same services as
if they were registered with an English GP, and for the majority
of people concerned, they will not have a choice of registering
with an English GP. (Paragraph 30)
2. The Department
of Health should investigate the problem of why some patients
living in England, currently being treated in the Welsh healthcare
system and wishing to be treated in the English healthcare system,
have been turned away by GP practices in England. This should
be considered in light of the legal rights of these residents
under the Health and Social Care Act 2012. (Paragraph 31)
3. We recommend that
the Welsh and UK Governments continue to work together to clarify
what an English patient registered with a Welsh GP and a Welsh-registered
GP, and a Welsh patient registered with an English GP and an English-registered
GP, can expect. (Paragraph 32)
4. We welcome the
good relationship between Local Health Boards in Wales and the
Clinical Commissioning Groups in England. The publication of the
financial accounts of such bodies will enable the public to see
whether value for money is being achieved. (Paragraph 42)
Cross-border problems
5. Cross-border movements
have been a fact of life for many years, and this is no less the
case for health services. For those residing in immediate border
areas, the nearest health provider may not be in their country
of residence. There is no practical or realistic prospect of diverting
these well-established cross-border flows, nor would it be desirable
to do so. (Paragraph 51)
6. We welcome the
commitment from the Welsh Government's Health Minister on patient
needs and his commitment not to allow the border to become a barrier.
We recognise that Welsh GPs will be mindful of a need to maintain
investment and capacity in Wales. Healthcare providers in England
and Wales need to maintain close links to ensure that patients
receive the treatment they need regardless of their country of
residence, particularly given the policy divergence that has emerged
as a result of devolution. (Paragraph 52)
7. Specialised services
are accessed by patients from all across Wales. It is unacceptable
that administrative issues lead to delays to patients seeking
specialised services. (Paragraph 61)
8. We recommend that
Welsh Local Health Boards must provide improved training for clinicians
on how to refer patients for tertiary care. (Paragraph 61)
9. The divergence
in policy since devolution can cause difficulties in cross-border
contracts. There must be improvements to service level agreements
(SLAs) between LHBs and CCGs. (Paragraph 62)
10. We recommend that
the Department of Health and the Welsh Government work together
to carry out a review of cross-border SLAs. (Paragraph 62)
11. Uncertainty in
the referral process can cause unnecessary worry to patients and
their families, particularly when they are their most vulnerable.
Decisions must be made in a timely manner. (Paragraph 63)
12. We recommend that
a 30-day limit be placed on decisions on referrals by WHSSC (Paragraph
63)
13. It is essential
that patient information is transferred between primary and secondary
and tertiary services as well as across borders in a timely and
consistent manner. It is clear that the existence of different
IT systems in England and Wales is having a detrimental impact
on patient care in both countries. While we welcome the efforts
being made to introduce consistent systems within each country,
there must be a commitment to work towards a solution to accommodate
the flow of patients across the Wales-England border. We welcome
the pilot project currently being run by the Welsh Government
in Powys. (Paragraph 69)
14. We recommend that
the UK Government and the Welsh Government work together to examine
how improvements can be made in the electronic transfer of information
between Wales and England. (Paragraph 70)
15. Wales is currently
facing recruitment challenges in relation to GPs. It is unacceptable
that the need for separate Performers Lists is acting as a deterrent
to GP recruitment and affecting the freedom of GPs to work cross-border.
We welcome the Welsh Government Minister's recognition of this
problem during our evidence session, and his commitment to finding
a solution. (Paragraph 75)
16. We recommend that
the Department of Health works with its counterparts in the devolved
administrations to establish a single Performers List for GPs
across the UK. (Paragraph 76)
Waiting times
17. 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. (Paragraph 86)
Cross-border engagement and co-ordination
18. 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. (Paragraph
93)
19. 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. (Paragraph 94)
20. 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. (Paragraph 101)
21. We recommend that
NHS Wales and NHS England work together to improve patient engagement
for cross-border services. (Paragraph 102)
22. 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.
(Paragraph 107)
23. We are concerned
that there is a lack of communication regarding changes to healthcare
services which could have an impact across the border. (Paragraph
108)
24. 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. (Paragraph 108)
| 
