Annex: Summary of public events in Newtown
and Hereford |
Key themes from Newtown meeting
· Lack of clarity: The
cross-border protocol, boundaries, and even the fact that health
had been devolved was not clear to patients. The confusion about
where patients could go, what treatments they could receive, and
to whom they could complain to caused frustration for patients
and even delays in treatment, as not even practitioners fully
Some Welsh patients felt like they were treated as second-class
citizens by the English NHS. Attendees said that they were pushed
down waiting lists by English hospitals and could not get referrals
to specialists. They also felt that it was unfair that some cancer
drugs could be obtained on one side of the border but not the
· Unhappiness with funding for Powys:
Attendees felt that Powys was neglected by the Welsh Government
and did not receive enough healthcare funding. They felt this
was exacerbated by its position on the border, as they had to
rely on English hospitals that did not take their needs into account.
· Lack of consultation: English
hospitals and CCGs were not doing enough to consult Welsh patients
on changes to their services, despite relying on Welsh patients
for funding. Attendees felt that they were being ignored and that
services that they relied on were being moved out of reach.
· Wider issues for healthcare in Powys:
Cross-border issues are part of the larger
challenges of providing a large rural area like Powys with healthcare,
including the lack of transport, ambulance times, the difficulty
of making hospitals and services viable, and the recruitment of
· GPs and key staff:
It was difficult to recruit GPs, nurses, and specialists to rural
areas like Powys and difficult to retain them. At the same time,
more GPs were going part time, reducing the levels of care available
· Lack of communication:
Attendees identified poor communication and co-operation between
health services on either side of the border as a major barrier
to patients receiving care. In particular, records and notes were
often lost or not transferred between hospitals in time.
· Welsh language:
There were issues for people for whom Welsh was their first language
being understood in English hospitals, particularly to healthcare
workers recruited from abroad on the basis of their proficiency
Summary: Attendees wanted
a National [their emphasis] Health Service and to be treated
fairly and equally to English people.
Key themes from Hereford meeting
· English GPs for English residents:
There were not enough English GPs for attendees to register with.
This meant that some patients were forced to register with Welsh
GPs, removing them from the English NHS. For many patients, this
was a key issue that they felt strongly about.
· Loss of rights and the principle of
choice: English attendees frequently said
that they felt that they were being denied access to the English
NHS and were being deprived of their rights under the NHS constitution.
In particular, they emphasised that they did not have any choice
when it came to GPs and are being forced into the Welsh NHS. Attendees
believed that access to the English NHS should be guaranteed by
· More cooperation and clearer agreements
needed: There had been disputes over payments
between Powys and the trusts it contracts. Information was not
shared as well as it could be. There was a need to integrate care
better in order for cross-border health to work. Attendees suggested
that the protocol might need to be re-written and contracts and
agreements made clearer in order for cross-border healthcare to
· Poor communication within NHS:
Welsh health boards were failing to communicate with their English
counterparts, making co-operation and effective cross-border care
difficult. In particular, unclear agreements between health boards
and English hospitals made it difficult for English hospitals
to plan and budget for Welsh patients. Incompatible IT systems
and the difficulties of transferring records and notes also make
it difficult for patients to cross the border and receive treatment.
· Poor communication with
patients: Attendees felt that they had not been kept adequately
informed of policy changes and were not informed of the consequences
of devolution or of registering with a Welsh GP. The absence of
information meant that they were often unable to make an informed
choice: this had led to a loss of trust in the NHS.
· Unnecessary barriers:
The devolution of health had led to unnecessary duplication and
difference in standards, making integrated care and referrals
more difficult. This included additional registration requirements
for GPs, waiting lists, and available treatments and drugs.
Summary: English residents
should be able to use the English NHS and should have choice.
Failing that, cross-border co-operation and information sharing
must be improved.