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

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)

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Prepared 12 March 2015