Health Services: Cross-border Co-operation

Tuesday 16th April 2024 Westminster Hall

16:00

[Dame Caroline Dinenage (in the Chair)]

I will call Virginia Crosbie to move the motion and then I will call the Minister to respond. As is the convention for 30-minute debates, there will not be an opportunity for the Member in charge to wind up, or indeed for anyone else to make a speech, but there will potentially be opportunities to intervene.

[Virginia Crosbie (Ynys Môn) (Con)]

I beg to move,

That this House has considered cross-border cooperation on health services.

It is an honour to have you chairing this important debate on cross-border co-operation on the health service, Dame Caroline, and I thank you for the opportunity to hold it.

My constituents in Ynys Môn, like those of my colleagues here today, are served by the devolved Welsh NHS, which is managed and funded by the Welsh Government in Cardiff. Despite health having been devolved for 25 years, around a third of my most serious casework is for my constituents who are suffering, or perhaps even dying, because of failures in our local health board. I hear from patients, families and even members of staff who are deeply concerned about Betsi Cadwaladr University Health Board—BCUHB for short—and the effect that its failings are having on the people of north Wales. That is why my colleagues and I want the UK Government to help find a solution and why we desperately need the following: much better co-operation across borders on our health services; data that allows the direct comparison of performance across all health boards in the UK, regardless of whether they are devolved; a recognition that the UK Government have a moral, and arguably a legal, duty to take action where the wellbeing of their citizens is compromised; and a willingness to act on that duty where necessary.

I can best explain why we are so concerned by sharing the issues we face in north Wales. BCUHB is by far the largest health board in Wales; with a budget of £1.9 billion, it is responsible for a quarter of the Welsh population—more than 700,000 people spread across a huge area roughly four times the size of Greater London. BCUHB is currently in Welsh Government special measures for not the first but the second time; it has spent all of the last six years in special measures. Despite that, its performance seems to be getting worse, not better. It has been called “dysfunctional”, “chaotic” and a “basket case”. In February 2023, the Welsh Health Minister sacked its entire board. An audit of its 2021-22 accounts found £122 million unaccounted for, with senior executives accused of deliberately falsifying entries. It is now on its eighth chief executive in 11 years. All that is despite a devolution settlement that funds the Welsh Government with £1.20 per person for every £1 we spend here in England.

It is difficult to relate just how bad some of the stories I hear are: people discharged from hospital sicker than when they went in; hours spent waiting for ambulances, and hours spent waiting in ambulances outside A&E; errors in patient records; appointments lost; significant failures in the provision of medication; palliative patients dying in hospital because fast-tracking them home would take weeks; and medical appointments cancelled and rearranged for hospitals 60 miles away.

[Dr James Davies (Vale of Clwyd) (Con)]

I congratulate my hon. Friend on securing this important debate. Betsi Cadwaladr University Health Board has, over the last decade, received the 11th highest number of prevention of future death reports of any organisation in England and Wales. To put that in perspective, organisations with comparable numbers of such reports are generally whole United Kingdom Government Departments. Does my hon. Friend agree that that is a damning indictment of the poor state of health services in north Wales and further emphasises the serious concerns about the adequacy of those devolved services?

[Virginia Crosbie]

I thank my hon. Friend for his intervention, which gives me the opportunity to thank him for his hard work in fighting not only for his constituents, but for everyone across Wales. They deserve a better service than they are getting, and it is only by working together that we can get action, so I am delighted that he is here today. He is a doughty campaigner and a doughty champion for his constituency.

[Jim Shannon (Strangford) (DUP)]

The Northern Ireland-Republic of Ireland cross-border initiative was officially closed in December 2020 due to the withdrawal of EU funding. It was a scheme that many of my constituents bought into and did well out of, getting their operations down south before coming back to Northern Ireland, thereby skipping long waiting lists.

The hon. Lady is absolutely right to ask for better cross-border health co-operation between Wales and England, and I understand the reason that she does so, but I believe that there is an argument to be made for a scheme across the whole United Kingdom of Great Britain and Northern Ireland, because I think that there are cross-border opportunities that we can all take advantage of. Although she is asking specifically about Wales and England, the title of the debate, if she does not mind my saying so, is “Health Services: Cross-border Co-operation,” and that is something that we can all ask for.

[Virginia Crosbie]

I thank the hon. Member for his intervention, and in particular for that feedback on how cross-border co-operation actually works. Of course I am focusing on Wales, but he quite rightly highlights that this is the United Kingdom. By working together, we can solve these issues and provide a collaborative approach to healthcare for people across the UK.

I also wanted to add to my list of failures the near-collapse of local NHS dental services. I could honestly stand here and reel off story after story of lives drastically and sometimes irreversibly impacted by the failures of BCUHB. In Holyhead, the largest town in my constituency, two GP practices were merged during the pandemic into Hwb Iechyd Cybi, or Cybi Health Hub. That practice has suffered a series of problems, including twice facing the threat of having no GPs—and that is in Holyhead, the largest town in my constituency.

One of the main things that would make a difference to Hwb Iechyd Cybi and the people it serves would be to co-locate the two original practices. Proposals have been made for that and, in the longer term, for a state-of-the-art healthcare centre for Holyhead. The co-location project would deliver economies of scale that would vastly improve the service that the practices can deliver and, therefore, patient outcomes. The project was allegedly given the go-ahead two years ago, but it has stalled and stalled in BCUHB’s hands, and now it has completely stagnated. Likewise, the integrated health centre has been under discussion for years, but it remains under discussion, with no progress likely. Lack of funding is the problem that is generally cited.

Hwb Iechyd Cybi serves 9,000 patients, and there are around 15,000 people in its catchment area. Holyhead is not a minor backwater in north Wales; it is a large town, yet it has no integrated healthcare. It has an A&E that is 25 miles away across a bridge that closes in high winds, and it has a massive shortage of doctors. I have launched my own petition to raise awareness of this issue and to call on BCUHB to proceed with the co-location project, as well as starting work on the new health centre with urgency. I recognise that the NHS faces significant pressures across the UK, but people are actually moving out of my constituency to live in other parts of Britain because they are scared of becoming ill in north Wales.

There are too many stories of avoidable death and harm. Unfortunately, it is almost impossible to compare the situation across the devolved nations in order to see just how bad it really is, because the Welsh Government produce different data from that produced by the UK Government. That makes it almost impossible to compare patient outcomes across borders.

What we do know are facts like these. In 2023, over 22,000 paramedic hours were lost in Wales just waiting outside A&E. In January 2024, more than 3,000 people in north Wales waited for more than 12 hours to be discharged from A&E, and nearly 60,000 BCUHB patients had been waiting for more than 36 weeks to start treatment; six years earlier, that number was just under 10,000. Over 57,000 people across Wales have been waiting for more than a year to start treatment, with 24,000 patient pathways waiting more than two years. Since 2010-11, the Welsh Government have increased health spending by 30.6%, well short of the UK Government’s increase in England of 38.9%.

We have asked the UK Government for help on behalf of our constituents. Last year, the then Secretary of State for Health and Social Care, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), wrote to the Welsh Government to offer a right of access to NHS services in England for people in Wales. Unfortunately, the Welsh Health Minister claims not to have the additional budget to facilitate that proposal, despite the clear benefits it could offer our constituents. The Welsh Government can, however, find an estimated £100 million to increase the number of Senedd Members from 60 to 96; £4.25 million to buy a farm that it now cannot develop; and over £30 million to implement the much-derided default 20 mph speed limit.

The Welsh Government approach is also highly inconsistent. Take the covid pandemic. The Welsh Government seemed to be unaware that they would have to provide their own response to the threat, despite having been in charge of healthcare in Wales for years. They prevaricated and created different measures and responses, but they want to be part of the UK covid inquiry rather than holding their own. They seem to think they can pick and choose when they are accountable. It would be fantastic to see the Welsh Government prioritising health as the UK Government are doing, for example by enabling pharmacies in England to prescribe medication for common conditions such as earache and impetigo. It is challenging to be a UK MP in Wales when a matter such as health is devolved. Many people do not realise that it is devolved and blame Westminster for failings.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

The hon. Member is making an splendid speech, and my goodness, it rings a bell with me. I have a GP friend in Caithness who developed an aggressive cataract; within a very short space of time she was unable to drive and had to give up her practice. She put her name down with NHS Scotland. Shortly afterwards, she went private and got it dealt with. Fourteen months later, she got a message from the NHS to say she could have a consultation —not a treatment, but a consultation. She would have grabbed it with both hands if she could have got treatment across the border in England. There is a lot wrong with the NHS in Scotland. It is too bad that none of the nationalists are here. They should be pressing for cross-border co-operation as well. Let us hope we get it.

[Virginia Crosbie]

I thank the hon. Member for sharing some background information on the situation in Scotland and his friend’s story of waiting 14 months for a cataract consultation. He makes a very important point: there should be many more Members of Parliament here for the debate. We have the Minister here, and it is an important opportunity to share some of the some of the terrible stories that we hear.

Despite health in Wales not being our gig, it makes up a third of my postbag, and my colleagues and I cannot turn our backs on our constituents. We cannot ignore their problems and blame Wales, because these are life and death situations. We desperately need the UK Government to step in and up the ante on cross-border co-operation. We desperately need the UK Government to take this matter in hand and do something now to protect the wellbeing of British citizens. Will my right hon. Friend the Minister commit to visiting Ynys Môn and meeting my constituents who have suffered as a result of the BCUHB failures and those who desperately need an integrated medical centre in Holyhead?

16:13

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to see you in the Chair, Dame Caroline. I congratulate my hon. Friend the Member for Ynys Môn (Virginia Crosbie) on securing this debate on cross-border healthcare. I know the performance of health services across the United Kingdom is a subject close to her heart, as it is for my hon. Friend the Member for Vale of Clwyd (Dr Davies) and the hon. Members for Strangford (Jim Shannon) and for Caithness, Sutherland and Easter Ross (Jamie Stone), who have all made important contributions to the debate. My hon. Friend the Member for Ynys Môn works tirelessly on improving local health services in her constituency, including by campaigning for an integrated health centre in Holyhead and championing the importance of mental health by pushing for 100 members of the public to undergo a mental health training course in Anglesey.

Although my hon. Friend rightly said that healthcare in Wales has been devolved for 25 years, as a representative of the UK Government and a proud Unionist, I feel it is important that all four nations work together where that is of benefit to the people we represent. For that reason, within my first few weeks in post, I was pleased to visit Wales, Scotland and Northern Ireland to look at the different approaches being taken to the shared challenges that we face.

During my visit to Wales, I heard directly from some GPs in the constituency of my right hon. Friend the Member for Vale of Glamorgan (Alun Cairns) and met some of the pioneering Welsh life sciences companies whose innovations have so much to offer the NHS across the whole United Kingdom. I would, of course, be delighted to visit the constituency of my hon. Friend the Member for Ynys Môn to learn more about the challenges that she faces there.

Without doubt, one of the biggest challenges facing all four nations is dealing with the legacy of covid-19, which has left us with record waiting lists. Cutting waiting lists in England is one of the Government’s top priorities, and by delivering on the actions set out in the delivery plan for tackling the covid-19 backlog of elective care, we are making good progress on tackling the longest waits. Thanks to the incredible work of NHS staff, as of February this year the number of patients waiting over 18 months had been reduced by almost 90% in England, which is a far faster reduction than we have seen in Wales or Scotland.

A core part of that approach has been empowering patients to make decisions on their care by choosing their provider. Improved choice can not only lead to shorter waiting times for patients and incentivise providers to offer appointments, but have a positive impact on the overall patient experience. However, as the former Health Secretary, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), said last year, it is vital that the UK Government and devolved Administrations work together to ensure that no matter where they live, patients can access the care that they need when they need it.

As my hon. Friend the Member for Ynys Môn said, a genuine offer was made to the devolved Administrations, which remains open. We continue our commitment to working closer with the devolved Administrations on elective recovery and access to primary care, on top of the existing cross-border arrangements to allow patients who live in Scotland and Wales to access care in England under certain circumstances, which is paid for by the relevant Administration. That is important because when adjusted for data differences, the Welsh waiting list of 677,000 represents 21.6 patient pathways per 100 population compared with 13.3 per 100 in England. The magnitude of the difference between England and Wales cannot be accounted for by divergent definitions. That is why the current Secretary of State, my right hon. Friend the Member for Louth and Horncastle (Victoria Atkins), will be engaging with her counterparts as her predecessor did.

I am pleased to confirm that the next meeting of the inter-ministerial group for health and social care will take place on 24 April. Further, we have agreed to take forward those meetings quarterly. The inter-ministerial group includes Ministers from the UK Government and the devolved Governments who have health and adult social care matters in their portfolios. It provides a forum for strategic discussion between the portfolio Ministers on health and adult social care policy issues, enabling them to engage on areas of shared interest and, where possible, collaborate on policy development and address shared challenges. Moreover, officials have been working on sharing lessons and comparing approaches to demand management and supporting the patients who have been waiting the longest, including through the “Getting it right first time” programme. Those discussions have been constructive in highlighting the benefits of sharing approaches to elective recovery.

My hon. Friend the Member for Ynys Môn made some excellent points about how critical data is as a tool for improving health and tackling inequalities. This Government and the devolved Administrations have been doing important work to improve data comparability in the UK. Not only is it fundamental that citizens can scrutinise the performance of their health services, but a coherent picture of health across the UK is essential to policy evaluation so that we can provide robust challenge and support where it is needed, and build a deeper understanding of the health outcomes in the different parts of the United Kingdom. The Office for National Statistics has recently expanded its cross-Government work and partnered with health bodies in all four nations to ensure that data is coherent, accessible and meets users’ needs. Through that approach, we will enhance our collaborative working and ensure that health services work for every citizen, regardless of geography.

I pay tribute to my hon. Friend for the work that she has done to improve health services in Wales and promote the importance of cross-border health co-operation across the entire United Kingdom. She raises the concerns of her constituents with me and other Health Ministers week in, week out. Her constituents could wish for no better representative than her. I hope that what I have said today shows that we are committed to improving health services for everyone across the whole of our United Kingdom.

Question put and agreed to.

16:20

Sitting suspended.