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

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 understood it.

·  Unfairness: 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 other.

·  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 key staff.

·  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 to residents.

·  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 in English.

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 English residency.

·  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 work.

·  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.

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Prepared 12 March 2015