Cross-border Healthcare

Tuesday 4th November 2025 Westminster Hall

[Peter Dowd in the Chair]

[Relevant document: Oral evidence taken before the Welsh Affairs Committee on 22 January, on cross-border healthcare, HC 606.]

14:30

[David Chadwick (Brecon, Radnor and Cwm Tawe) (LD)]

I beg to move,

That this House has considered cross-border healthcare.

It is an honour to serve under your chairmanship, Mr Dowd. Last year, hopes were raised that two Labour Governments working together would put an end to conflict between Cardiff Bay and Westminster, yet few issues trouble my constituents more than the daily reality of cross-border healthcare between England and Wales. Powys is a beautiful county, but it is also the largest in Wales, with no district general hospital of its own. Nearly 40% of the health board’s budget is spent commissioning services across the border in Herefordshire and Shropshire, because that is where the nearest hospitals are. When co-ordination between the Welsh and UK Government fails, it is Powys patients who feel it first and hardest.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

My hon. Friend is making a point about the border between England and Wales, but I represent a constituent who lives in a spot equidistant between two hospitals in Exeter and Taunton. Only one hospital could provide the treatment she needed, but the consultant there recommended rehabilitation at a third hospital across the border in Tiverton. After a lengthy back and forth, she was allowed treatment on the grounds of extenuating circumstances. Will my hon. Friend join me in pressing for a clear, binding system to allow seamless cross-border referrals where clinically appropriate?

[David Chadwick]

My hon. Friend makes a valid point, and I am sure her constituents will be pleased to hear her make it. The 2018 cross-border statement of values and principles promised that no patient would face delay or disadvantage because of which side of the border they live on, but my constituents know that those principles are not being applied in practice.

The clearest recent example of what has gone wrong is the new waiting list policy introduced by Powys teaching health board this summer. From 1 July, the board instructed English hospitals treating Powys residents to deliberately and artificially extend their waiting times, bringing them into line with the longer averages elsewhere in Wales. Until now, Powys patients had been treated in hospitals, such as Hereford and Shrewsbury, in exactly the same way as English patients, but from this summer they have been asked to wait up to twice as long.

We are told that hospitals in Herefordshire and Shropshire are treating Welsh patients “too quickly” and that Powys’s budget does not allow for the current number of people being treated each year, so patients have to be spread out over more years. How appalling it is to say that a patient can be treated “too quickly”. Swift treatment should be an objective, not a problem.

Worse still, this supposed cost-cutting exercise may not save a penny, because both the Wye Valley NHS trust and the Shrewsbury and Telford hospital trust believe that it could cost Powys more, because they will have to bill Powys teaching health board for the administrative cost of running two parallel waiting list systems. That is before we consider the hidden costs: the human and financial price of patients deteriorating while they wait longer, needing emergency admissions, extended rehabilitation and, in some cases, never recovering the quality of life they once had.

My constituents are not just numbers on a spreadsheet; their lives are on hold. Those months are months of agony, of lost work, of isolation, and of watching opportunities and life slip away while waiting for operations that should already have happened. Agnes is a patient from Llandrindod with Parkinson’s disease. She has been told that she must wait another 52 weeks for a knee replacement after already waiting a full year. That means a total of two years waiting for surgery. The delay has made it increasingly difficult for her to stay active, even though regular exercise is vital to managing Parkinson’s symptoms. The prolonged wait is worsening her mobility and pain, and it is undermining her ability to live independently.

Hazel, from Builth Wells, is awaiting spinal surgery in Hereford. Her expected waiting time has doubled to 104 weeks. She has been unable to work during this period due to numbness in her legs and feet, and she now fears losing her job. Once financially independent, she now relies on family support—an experience she describes as “degrading and unfair”—through no fault of her own.

Kelly was diagnosed with serious spinal disc problems in September 2024. She was given a surgery date for December, then March, but both were cancelled. Even though her pre-operative assessment had been completed, she later discovered—on her own—that her operation had been postponed by at least another year under the new policy. This is despite her being classed as an urgent P3 case and being told that existing bookings would not be affected. The delay has left Kelly in constant pain, which has taken a serious toll on her mental health and has contributed to her losing her job.

Those stories are not isolated; they speak for hundreds of others who are being quietly told to wait, not because of capacity or clinical need but because of budgetary decisions. Behind every statistic is a person whose life is being diminished while they wait for care that should already have been delivered.

What makes this even worse is that patients are sometimes not being told that their treatment has been delayed. Many have found out only through news reports or by doing their own investigations. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work, yet this policy, which Ministers could stop tomorrow, does the exact opposite. The health board and senior Welsh Labour politicians call it “fairness” that Powys residents should wait no less than anyone else in Wales. However, fairness and ambition should mean lifting standards everywhere, not dragging Powys down to the lowest common denominator.

It is not equality; it is equal punishment for the Welsh Government’s failure to fix the NHS after 25 years in power. The response from Ministers thus far, particularly in Cardiff Bay, has been nothing short of disgraceful. The Health Minister, Jeremy Miles, could not appear more uninterested if he tried—no action, no intervention and no urgency from the one man who has the power to stop the policy and to get people out of pain and back to their lives. Several constituents have told me that they have written personally to him and have received no response at all. That is despite the fact that it is his Government who are forcing Powys teaching health board to make significant cuts to its budget.

As for the First Minister—who, I remind the House, represents Powys in the Senedd, as well as being a Member of the House of Lords—she brushed off my constituents’ concerns, saying that she thinks it is just “smoke and mirrors”. I invite her to say that directly to Kelly, Agnes and Hazel, because months or even years of their lives have been stolen and spent living in pain.

The decision institutionalises inequality between Wales and England. If the waiting list policy exposes a failure of funding, the digital infrastructure of cross-border healthcare exposes a long-term failure of systems. Despite 25 years of devolution, we still have national health services across our four nations that cannot share data efficiently. Both NHS England and NHS Wales still operate separate digital systems that do not talk to each other. When a Powys GP refers a patient to Hereford or Shrewsbury, information often travels by post, fax or unsecured email. Discharge summaries arrive late or not at all. Test results are duplicated because clinicians cannot see each other’s records, wasting time and often causing distress for patients.

Even in emergencies, A&E doctors in England cannot automatically view a Welsh GP’s records, and vice versa. To paint the picture more vividly, one Powys resident told me that he was admitted to Shrewsbury hospital with a serious heart condition, yet staff could not access his medical records. Because it was a Sunday, they could not even reach his GP by phone.

That should not be happening in 2025. It puts lives at risk across our border regions. The lack of interoperability affects anyone moving between the four nations of the United Kingdom, as their health records tend not to move with them. The Welsh Affairs Committee has been calling for change since 2015, yet a decade later, nothing has happened. The Welsh Government alone do not have the funding to overhaul their systems, which is why we have called on Westminster to step in, as obviously this is a consequence of devolution. For a fraction of the cost of other Government digital projects, modernising NHS IT across the UK would directly improve patient safety, continuity of care and confidence in the system. Every week that remains unresolved, more patients are put at risk, which is a failure of politics, not just technology.

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

I can bring a Scottish context to the subject. A doctor in my constituency had a cataract problem and was told that the waiting list was ages. In the end, because she knew how to do it, she found out about an operation that was available in the north of England. She paid for the travel and paid to go private. The point is that if the database that my hon. Friend is talking about could show patients where to look in other parts of the UK, saying, “This is on offer, if you are willing to travel”, it could make such a difference to health services across the four nations.

[David Chadwick]

My hon. Friend is right to say that these system failures are putting extra responsibility, extra stress and often extra cost on individuals, which is why the system needs to be improved. Beyond the funding and IT problems, our systemic weaknesses make cross-border care even harder. Many Powys residents are registered with GPs in England simply because of geography—they might be closer—while others just across the border stay with Welsh practices. GPs who want to work in both nations must register twice, fill out the same forms twice and follow two sets of rules, which wastes time and discourages flexibility.

A constituent of mine in mid-Wales with a rare artery condition needed ongoing treatment from Hereford hospital. Because the two NHS systems do not share results, they had to collect their own blood tests and email them to their consultant each month. Prescriptions issued in England were not approved in Wales, causing months of delay. That is the daily reality of an unco-ordinated system.

At the governance level, the 2018 cross-border statement of values and principles remains voluntary and unenforceable. Each Welsh health board negotiates its own arrangements with English trusts. There is no single tariff, no unified billing system and no consistent data reporting. Audit Wales has warned for years that this patchwork leaves patients in limbo, between two systems that both claim to care for them, but neither fully owns responsibility when things go wrong.

Those problems did not appear by accident. Powys residents do not mind which NHS logo is printed on their appointment letter; they care that their care arrives on time, that their doctors can speak to one another, and that they are treated fairly. The border should not be a barrier to treatment, data or fairness. I say to the Minister that although several of these issues fall within devolved areas, they are of direct concern to the UK Government because they are also directly influenced by NHS England and by decisions taken here in Westminster.

My asks are simple. First, convene a meeting with counterparts in the devolved nations to finally address these cross-border challenges, and invite border MPs to that discussion. Those of us who represent border communities see these failures at first hand and know where the solutions are needed. Secondly, provide the funding required to make NHS IT systems interoperable across the United Kingdom, so that clinicians can share patient information safely and instantly wherever care is delivered. Thirdly, work with devolved Governments to give the cross-border statement of values and principles legal force, turning it from a voluntary pledge into a real, accountable framework that protects people in border communities like Powys.

We owe it to the people of Powys, and to every border community, to end this quiet injustice and to build a system that treats them not as second-class citizens but as equals who are entitled to the same care, dignity and chance to live free from pain. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work. However, this policy, which Ministers could stop tomorrow, does the exact opposite. I look forward to the Minister’s response and the contributions from other Members.

14:43

[David Smith (North Northumberland) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate—one that is very important to my constituents in North Northumberland.

A constituent of mine recently visited friends in the north of the county, near the border with Scotland, and sadly suddenly collapsed with a brain tumour. He was taken across the border to a Scottish hospital. But this hospital, as we have heard, could not diagnose him because it could not access English medical records. Imagine the scene: this constituent’s wife is now filling in her husband’s records from scratch, over the phone, while he waits and waits for an MRI that he cannot get in Scotland because he is under the care of Northumberland healthcare trust.

I am alarmed to realise that our country seems to have several invisible lines running through it. If someone has a stroke, heart failure or even a nasty cold on the wrong side of those lines, their illness and treatment come with strings attached. That is bad for my constituents and bad for our country. My constituents, like so many, live cross-border lives—that is just their reality. They move across the border all the time to see friends, to go shopping and to seek medical treatment. But as we have seen, if they take ill on the wrong side of the border, they will receive substandard treatment at times. That is not because there is anything wrong with the service of Scottish nurses or doctors—they are superb—but because they have no access to English medical records. There is no joined-up thinking.

Northumbria NHS foundation trust recently tried to offer the services of a new infirmary in Berwick to patients on the Scottish side of the invisible line, but up to now there has been a lack of take-up or interest from NHS Borders—something I hope to see change. The primary-secondary care link is in a bit of a black box. Patients have no idea where they will be referred by their GP. Will it be Melrose, Cramlington or Newcastle? Who arranges the appointment determines which organisation provides the referral.

It does not have to be this way. The technical solutions clearly exist, as we heard from the hon. Member for Brecon, Radnor and Cwm Tawe, but the SNP Government in Edinburgh frankly have no incentive to make cross-border care work. I am sad to see no SNP Members here today. They are ideologically opposed to the choices that could lead to a cross-border, British healthcare system that serves all British people equally.

It is worse than that. I was recently contacted by a young constituent who lives in North Northumberland, in the north of England, and works in the Scottish Ambulance Service. They hope to take up further training in Scotland so that they can continue employment, but the Scottish funding support will not cover them because they are not Scottish, and the English support will not cover them because they want to study in Scotland. A British student who wants to study at a British university in order to save British lives cannot do so. That is a farcical situation.

This is the reality for many of my constituents. We must get better at joining the dots and realising that real people live holistically in the geography of where they are, which should not be determined by what are, in British terms, invisible lines on the map. If that is the situation now, imagine the mess for healthcare if the SNP were successful in its policy of independence. Because of bad cross-border healthcare my constituents are suffering, and the Union that so many of us cherish is suffering too.

14:47

[John Lamont (Berwickshire, Roxburgh and Selkirk) (Con)]

It is a pleasure to serve with you in the Chair, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing the debate. I am going to give a Scottish perspective, similar to that of the hon. Member for North Northumberland (David Smith) but from the Scottish side of the border.

My constituency runs along the border between Scotland and England, touching both northern English counties of Northumberland and Cumbria. To the east of my constituency, many of the people living in the southern Berwickshire towns and villages of Eyemouth, Hutton, Paxton, Burnmouth, Chirnside, Foulden and Lamberton look to Berwick-upon-Tweed as their economic centre for shopping, work and other services—I am pleased that the hon. Member for North Northumberland is taking part in the debate. To the far south of my constituency, residents of Newcastleton and Hermitage are drawn to Carlisle—similarly, I am pleased to see the hon. Member for Carlisle (Ms Minns) in her place.

For generations before devolution, and certainly long before the SNP took control of the Scottish Government, patients from those areas were able to obtain NHS treatment in Northumberland and Cumbria without any difficulty—not because it was necessarily any better or different, but because it was more convenient. It was a reflection of the transport links that cross the border between those communities: the bus links, shorter car journeys and community ties. The border between Scotland and England is, for those communities, simply a line on the map.

This is absolutely not a criticism of the quality of care provided by NHS Borders—quite the opposite. We have first-class NHS provision at Borders general hospital and across the Scottish Borders, provided by hard-working and dedicated health professionals, to whom I pay tribute. It is not about tearing up the devolution settlement. The NHS in the Borders is absolutely the responsibility of the Scottish Government, and no one is suggesting a retreat from the Scotland Act 1998 or taking powers away from the Scottish Parliament. But it is about recognising the day-to-day challenges that people face in terms of public transport links and fitting medical appointments around work and family life.

It is also about highlighting the fact that since the SNP came to power in Holyrood, the real-life experience of many people in the Borders is that the option of cross-border healthcare has been diminished. It is about reaffirming that we are still part of one United Kingdom, and that the NHS is rightly an institution that we should be able to use regardless of which side of the border we live on.

The easiest way to describe the challenges that people face in my constituency is to share some of the stories that have been told to me in recent weeks. Margaret Merry said:

“I live in Eyemouth. Once I had to take a full day off work and 4 buses to travel to the Borders General Hospital for an x-ray, when I was working in Berwick, a 5 minute walk from where I could have had it done and only taken maybe 15 minutes out of my working day. It is ridiculous.”

Pauline Hutton said:

“I am currently under the care of BGH for cancer treatment and have to travel from Ladykirk to BGH daily for chemo. The treatment is excellent and I can’t praise the staff enough…but a simple thing like giving a blood sample means a 40 mile journey as I can’t give blood at our local surgery in Norham (1/2 mile away) because it’s in England and Borders General Hospital can’t access my results cross border. In this day of technology I can’t fathom out why medical records are all computerised yet one NHS trust can’t have access to patients medical records from another trust.”

Dennis McKeen said:

“Some patients in Newcastleton would also prefer to go to Carlisle rather than a 90 mile plus round trip to the Borders General Hospital...it’s ridiculous”.

Brenda Walker said:

“I am currently travelling from the east coast 3 times per week for dialysis at Borders General Hospital thanks to their transport system getting picked up at 6.40 am. The nurses do a brilliant job looking after us”.

Trixie Collin said:

“Currently I live in Scotland but was told that if I moved to England I would no longer be able to be seen by the consultant at Western General who had been treating me for 10 years.”

The Brucegate dental practice in Berwick-upon-Tweed said:

“As a healthcare provider in England it’s a daily problem on both sides of the border. I get rejections of referrals from both England and Scotland based on postcodes. Thanks for standing up for common sense.”

Kirsty Jamieson from Berwick-upon-Tweed said:

“We campaigned hard for reciprocal care between people living in the Borders and North Northumberland, during the 2018 A Better Hospital for Berwick campaign. No joined up thinking whatsoever.”

Lastly, Kate Tulloch highlighted the fact that this is not just a Scotland-England problem. Kate lives in Cockburnspath, which is Berwickshire in Scotland. Her GP is in Dunbar, which is also in Scotland, but Kate cannot get NHS Borders results because the two health boards, despite both being in Scotland, do not communicate. So this is not just a cross-border issue for Scotland and England; it is an issue of different health boards in Scotland not communicating properly.

All these stories clearly demonstrate the difficulties that my constituents face in accessing treatment across the border. I appreciate that this is not the Minister’s direct responsibility, but I would be grateful if she could relay my asks to her colleagues. First, will the Minister meet me to discuss how we can address the challenges that some of my constituents face when it comes to cross-border healthcare? Secondly, does the Minister recognise that we need to find a solution, and can she commit to working with the Scottish Government to overcome the perceived challenges that they are putting in place?

This is not just about extra money or funding; it is about putting in place common-sense solutions. NHS Northumberland has indicated that it is more than willing to accept patients from the Scottish Borders and other parts of Scotland, and NHS Cumbria has indicated similarly and is, I think, currently doing that for some patients. We must break through the ideological barrier that many of us believe the Scottish National party Government have put in place to stop what has happened for many years—people accessing NHS treatment on either side of the border.

14:54

[Ms Julie Minns (Carlisle) (Lab)]

It is a pleasure to serve under your chairship Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate.

As the Member of Parliament for Carlisle and north Cumbria, I represent a region where the realities of geography often challenge the neat lines that we find on maps, and those drawn by policy and practice. For example, earlier this year, during a prolonged power cut that affected the village of Kershopefoot, to the north-east of Carlisle, staff at ScottishPower Energy Networks were somewhat surprised to discover, after I contacted them, that they served customers in England who had a Scottish postcode.

When it comes to health, my constituents quite often face more serious issues. For some, their nearest GP might be in Scotland, but the nearest hospital is in England—in my case, the Cumberland infirmary. This can and does lead to issues.

I acknowledge the Government’s excellent work to improve healthcare access across the UK and in my constituency. In Carlisle and north Cumbria we have seen real progress: waiting lists have been cut and the urgent dental centre that opened last year is beginning to address many of the challenges we experience with NHS dental care. Those meaningful steps forward were made possible by this Government, but progress must be matched by policy that works for everyone, and especially those who live on the edge of systems, maps and borders.

One of my constituents, who lives in the northernmost part of the constituency, found himself facing a deeply troubling situation when he became very ill. He is geographically closer to Scotland and therefore registered with a Scottish GP. However, when he needed hospital care he was told he could not be treated at his local hospital in England—in Carlisle—because he was registered with a Scottish GP. Instead, he was advised to travel to Glasgow, a round trip of over 200 miles, rather than take the 40-mile trip to Carlisle.

This is a man who lives in England, pays his taxes here and has his bins collected by an English local authority, and whose nearest hospital is in England, but he was told to travel to Glasgow for care—not because of clinical need or even capacity, but because of outdated guidance. Thankfully, after the intervention of his GP and other dedicated health professionals, he was able to receive the treatment that he needed locally, but his case should not have required such extraordinary effort. It should never have required the negotiation it took and should not have required escalation. It should have been common sense.

The English guidance does not adequately cover cross-border scenarios, and I am told the Scottish guidance predates the creation of the integrated care boards altogether. I am very grateful to the Minister for Care for giving me his time a few weeks ago to discuss this issue. I know he recognises that this needs to be urgently resolved. I would welcome any update that I can share from the Minister today on whether the guidance is now to be reviewed and improvements are under way. We must ensure that all relevant healthcare providers are equipped with clear, up-to-date information, because we all want the same thing: a system that works for patients, wherever they live.

This is not a question of politics, as we can see from the cross-party presence at this debate—although the absence of the SNP is notable. I am pleased to see my constituency neighbour, the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont), in his place. This is a question of practicality, compassion and, as the hon. Gentleman said, common sense. We must ensure that our healthcare system reflects the lived realities of our constituents, and not the lines on a map. I urge the Minister to take this issue forward with urgency. I stand ready to support any efforts to improve cross-border healthcare.

14:58

[Robin Swann (South Antrim) (UUP)]

It is a pleasure to serve under your chairship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing a debate on cross-border healthcare, because we in Northern Ireland know only too well that health outcomes are not, and should not be, defined by borders—whether an internal UK border or one with an entirely separate sovereign jurisdiction. Sickness does not discriminate.

In fact, as the only part of the United Kingdom to share a land boundary with another nation, the issue of cross-border healthcare is something on which every Northern Irish MP, I am sure, will have an opinion. Despite our constitutional sensitivities, I for one have absolutely no hesitation in saying that I am deeply proud of the progress we have made in cross-border healthcare in both Northern Ireland and the Republic of Ireland. The progress in recent decades has shown what can be achieved when we actually work together with a shared purpose.

I take note of what other hon. Members have said about the challenges across an internal UK border, which I believe we should not have in healthcare. Despite that, in Northern Ireland we need only to look at the success of the radiotherapy unit at our hospital in Altnagelvin, and more widely the north-west cancer centre based in Londonderry. Those services demonstrate the tangible benefits of co-operation for patients and communities from both sides of the border.

When I was Health Minister in 2021, I was pleased to come together with the Governments of Ireland and the United States of America to sign a new memorandum of understanding to reinvigorate the Ireland-Northern Ireland-US National Cancer Institute cancer consortium, which is an often forgotten and unsung part of the negotiations of the ’98 Belfast agreement. When it comes to cancer, we should leave no stone unturned. There are undoubtedly people on both sides of the border who are alive today because of that practical and sensible co-operation. By continuing to refine that service level agreement, expanding areas such as skin cancer treatment, and deepening our joint research in clinical trials, Northern Ireland will once again be strengthening cancer services and helping to advance the fight against rare and specialist cancers across the island.

The same collaborative spirit is exemplified in paediatric cardiac care. Our all-island congenital heart disease network—an issue to which my family is as close as we can be—has ensured that children with complex needs can access world-class treatment without unnecessary delay or travel. I have seen at first hand that such cross-border co-operation works. Our youngest son was eight months old when he needed his first open-heart surgery, and that was conducted at Birmingham children’s hospital. He was 10 years old when he needed his pacemaker replaced, but that was done in the children’s hospital in Dublin because of that cross-border work. We in Northern Ireland know all too well about our reliance on the working relationships that we have across borders, should that be across the UK or with our partners in the Republic of Ireland.

[Jamie Stone]

The hon. Gentleman may know that I have family living in the north, in Armagh and Antrim, and a daughter living in Donegal. What he says is absolutely correct—I can vouch for that, and it is an example for us all. When somebody is sick and we are worried about what will happen next, we do not care about lines on maps. The point I want to make is this: it strikes me that this is an easy issue for the present Government, because it need not cost lots of money. Often, we ask for stuff and there is a huge bill attached, but just knocking heads together and saying, “Get real. Get the computer system online. Talk to each other,” is doable, and it would make such a difference for people even up as far north as where I represent.

[Robin Swann]

I thank the hon. Member for raising a valid point that comes to the crux of this debate and of what has been said by every Member so far. It is about putting the “national” back in our national health service, and doing so across borders without the unnecessary bureaucracy that often comes with how we look after our patients.

There is still more to do on this issue, and no system is perfect. I know from engaging with our current Health Minister in Northern Ireland, my party colleague, that there is potential for further north-south co-operation in other specialist paediatric services that lend themselves to an all-island approach, including the hugely emotive and sensitive issue of perinatal and paediatric pathology. Northern Ireland has been without a paediatric pathologist for some time, so an all-island solution should be looked at.

As the hon. Member said, ambulances in Northern Ireland regularly cross the border in both directions to save lives. Our two ambulance services have an agreement in place to provide mutual aid, with personnel from either service able to cross the border to assist in emergencies.

I believe that the future of healthcare will be defined by the digital innovation that has been referred to, and it will be a great step forward when we can get the national health services talking to each other—it is only recently that we have been able to get our five trusts in Northern Ireland sharing digital information. The will is there if the finance and support are there on genomic medicine, workforce planning and the interoperability of electronic health records. By collaborating on the genomics of rare disease and planning jointly for a workforce that can identify and close future gaps in work, we can ensure that the entire island—and islands—benefit from technological and medical advances.

Our co-operation should not just be practical; it should actually improve outcomes. It is proof that where health is concerned, cross-border partnerships really work. I encourage the Minister to take forward the recommendations made in this debate today.

[Several hon. Members rose—]

[Peter Dowd (in the Chair)]

Order. Although there is no time limit, four more Back Benchers wish to speak and we are going to move on to the Front Benchers at half-past 3, so I ask Members to bear that in mind.

15:06

[Julia Buckley (Shrewsbury) (Lab)]

It is an honour to serve under your chairship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate.

Cross-border healthcare affects us in Shropshire because our Shrewsbury and Telford hospital NHS trust serves not just 353,000 residents across Shropshire but a further 70,000 residents just over the border in Wales, including the hon. Member’s constituents in Powys. He will be aware that, for many years, the trust languished at the bottom of the national league tables. We had the worst waiting times for both elective care and emergency treatment, as well as for ambulance pick-ups. Worse still, when we finally got an ambulance, it would then spend many hours waiting outside A&E because there were not enough beds to treat urgent patients. Much of that was documented in the TV programme “Dispatches” two years ago, which was a blow to the morale of our hard-working NHS staff.

Since then, I am delighted to report, there have been radical changes at the Royal Shrewsbury hospital in my constituency. Thanks to a significant capital investment project of more than £320 million, we have been the recipient of a hospital transformation programme to improve health and care services across the piece for Shropshire, Telford and mid-Wales. We are now one year into that construction project, with more than half the structure completed—a four-storey building at the front entrance. I visited last week, and the whole area is unrecognisable from when I gave birth to my daughter there in a very old, outdated ward. The new infrastructure will provide much-needed modern facilities and clinical space to improve care for everyone, and it will interconnect with the refurbished existing hospital.

In September we opened the next phase of majors and resus as part of refurbishing the emergency department. This has seen the space in the old A&E transformed; we have doubled the number of bays, improved and upgraded “fit to sit” space and created a new ambulance assessment area. We will be opening two new wards this winter, providing new facilities for gastroenterology and colorectal services, and providing more joined-up and improved services between surgical and rehabilitation teams, often out in community hospitals. Following the delivery of a modular ward unit by the treatment centre entrance, on 8 December we will celebrate a new acute ward with 56 additional beds, which will have a major impact on flow out of the emergency department. That will be felt in shorter waiting times.

Since the first phase of improvements took place, the impact on our hospital has already been significant. Waiting times are down, and we have moved up more than 20 places from the bottom of the league tables. Staff morale is climbing and recruitment is buoyant. I am so proud of our hard-working NHS staff and, in particular, the hospital transformation programme led by Matt Neal and our new chief executive, Jo Williams.

I am incredibly grateful for the support of the Department of Health and Social Care and NHS England, whose investment is not just saving lives but improving lives across my constituency and beyond into Wales. I hope the Minister will visit the hospital to see it for herself when the project is completed. I have every confidence that the work to improve the Royal Shrewsbury will continue to transform the hospital, our community and health outcomes for all our residents. It is right that a major hospital serving cross-border communities be prioritised for investment in this way.

15:09

[Jim Shannon (Strangford) (DUP)]

It is a real pleasure to serve under your chairship, Mr Dowd, as always. On behalf of us all, I look forward to your deliberations. I thank the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick)—I think I pronounced that right—for securing this debate. [Interruption.] Did I get it wrong? My apologies; the Northern Ireland accent gives it away nearly every time. While we are one United Kingdom, it is always important to remember the differences that we have in devolved matters, and in healthcare specifically—especially in Northern Ireland, where we have witnessed major disparities. It is a pleasure to make a contribution on that.

I want to talk about a cross-border health scheme that was used in Northern Ireland some years ago before our official exit from the European Union—although it appears that we never exited—and when we were all in the United Kingdom. The scheme meant that patients in Northern Ireland who had been on health and social care waiting lists for two years or more could apply to receive private treatment in the Republic of Ireland and claim reimbursement from the Northern Ireland Department of Health. When I was a member of the Northern Ireland Assembly and in my early years here at Westminster, I saw numerous examples of hip replacements, knee replacements and cataract operations being done down south because the patients had waited two years. The payment for the scheme then came from us in Northern Ireland. There are systems that work.

I thank the hon. Member for South Antrim (Robin Swann) for his contribution. He will probably be embarrassed by this, but I want to put on record that he was a great Health Minister when he was in the Northern Ireland Assembly, and I thank him for that. I never heard anyone say a bad word about him—and I talk to plenty of people, by the way—so I would say that he is an example of a Minister who really worked hard.

I know of a couple of constituents who availed themselves of the scheme and to say that their surgery was life-changing is an understatement. The hon. Member for South Antrim referred to his son. One of my constituents had a hip replacement and one had knee surgery. They could have been waiting up to 10 years for that surgery in Northern Ireland if they had not been able to avail themselves of the scheme with the Republic of Ireland. Those are some examples of how strategies like these work; I listened to hon. Members’ examples of similar processes in their constituencies.

I want to talk briefly about the importance of medical records. I spoke to the Minister about that beforehand, and others have referred to it. Through working closely with universities, I have witnessed a few examples where a young person lives in Northern Ireland and goes to Scotland or England for university. When they come back to Northern Ireland three or four years later, healthcare professionals cannot access their information as there is no shared provision for medical records. I hope that the Minister will forgive me, but it seems illogical not to have a system that takes that on board.

One of my staff members who went to Chester to study was in that exact scenario around 10 years ago. She had to travel back to England and pay £50 for a printout of her records to take to her GP back home. We must not forget that £50 was a lot of money for a student 10 years ago. It might be expected that the cost has now gone way beyond that.

This debate is really important, so I want to make sure that other hon. Members get their five minutes as well. There are clear examples of where cross-border health initiatives work and are beneficial to supporting people who are faced with extensive waiting lists and serious conditions that alter their day-to-day life. I look to the Minister—as I always do, because she answers us and listens to our requests—for a commitment to ensuring that our constituents have access to the care that they need, whether it be cross-border or within our healthcare systems in England, Scotland, Wales and Northern Ireland. Furthermore, hon. Members have shared experiences of the medical records issue within our constituencies. When so many people travel to different parts of this nation to study, more must be done to ensure that their records can flow smoothly and without hassle. My goodness, Mr Dowd, a life without hassle—it would be a miracle.

15:14

[Steve Witherden (Montgomeryshire and Glyndŵr) (Lab)]

It is a pleasure to serve under your chairship, Mr Dowd. I thank the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick), with whom I share a health board, for securing this important debate.

Montgomeryshire and Glyndŵr is served by two of the three Welsh local health boards that directly border England—65% by Powys teaching health board in mid-Wales and 35% by Betsi Cadwaladr university health board in the north. Powys is unique: it is the largest county in Wales by area, yet it has no full-service hospital. As a result, many of my constituents in the Montgomeryshire area rely on hospitals in England for their secondary and specialist care.

Recently, Powys teaching health board asked NHS England to delay care for Welsh residents in order to meet its savings targets. English hospitals have pushed back, arguing that such measures increase clinical risk and undermine the trust on which the system depends. We cannot allow a two-tier system to develop, whereby Welsh patients become second-class citizens. Patient data is delayed or simply fails to cross the border, leading to unnecessary delays and confusion. To reduce cost or manage a scarce resource, services are centralised in one location, causing either significantly more travel in an already huge geographical area with poor public transport, or significant delays in an emergency, with ambulances commissioned to serve Wales being diverted to calls in Staffordshire.

Let me give two examples from my constituency that demonstrate how the system can fail those it is supposed to serve. First, one resident from Powys was for many years referred to the dermatology clinic in Shrewsbury. Following a reorganisation by the local integrated care board, diagnostic services were moved to Telford while treatment remained in Shrewsbury. The result was a 120-mile round trip for a single course of care. That is a heavy burden for any patient, especially those managing long-term conditions.

Secondly, a woman living close to the border, who was registered with a Shropshire GP, was diagnosed in September with breast cancer. She was told she would need to wait to be seen by the north Wales genetics clinic. Because of delays, she was advised to begin chemotherapy before surgery—a course that carries more side effects and lengthens recovery. A private consultant later questioned whether the chemotherapy had even been necessary. In the end she felt forced to pay privately, to receive timely treatment. That is simply unacceptable in a publicly funded health service.

We all know that we need effective care as close to home as possible, and a crucial part of co-operation must be data sharing. The solution is openness, communication and shared standards. I meet regularly with the NHS trusts and integrated care board that provide health care for my constituents. I have been impressed by their openness and frankness, and their desire to tackle the issues they face with practical enthusiasm. I am currently organising a meeting to understand the issues from their point of view and address cross-border issues.

I know that both Powys teaching health board and the English trusts ultimately want the same thing: to provide the best possible care for those who need it. I want patients to receive the best possible care as close to home as possible. I want clinicians to have the information, resources and support they need to treat people swiftly and safely. Finally, after years of austerity and underfunding, it is vital that we keep PFI and private interests out of our NHS. We must defend it as a truly public service, just as Nye Bevan, our great Welsh hero, intended.

15:19

[Llinos Medi (Ynys Môn) (PC)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I, too, congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate.

In January, the Welsh mental health charity Llais reported to the Welsh Affairs Committee that

“15-20% of people living in Wales use NHS services in England. In the border counties, this percentage is far higher and can be nearer 50%.”

Existing provisions aim to ensure that no patient’s treatment is denied or delayed due to differing rules or funding responsibilities across health systems on either side of the Wales-England border. None the less, the British Medical Association reports significant issues in how these provisions are offered. These systems can be complicated for patients, who are not always clear about who is responsible when their care and treatment cross the border. People living in Wales continue to face a range of challenges if they need care and treatment in England. Llais’s evidence referred to issues around announcements made by the UK media covering England-only stories. It is not clear whether the announcements apply for the people who live in Wales.

[Ann Davies (Caerfyrddin) (PC)]

My constituent Michael Riordan has asked his GP to refer him to a facility available to armed forces veterans located in Shropshire but, due to an issue with cross-border funding, the Welsh NHS will not fund that facility, despite his residence not being an issue when he volunteered for service to his country. This excellent facility is now unavailable to Michael. Does my hon. Friend agree that current issues in cross-border funding must be addressed for the sake of our constituents?

[Llinos Medi]

That is another example of what we have already heard, where cross-border work is not working for a timely patient outcome. I agree with my hon. Friend.

Ensuring that cross-border health is as seamless as possible means developing strong partnership, introducing effective ways of sharing information and learning, communicating well, and making advice and information easily available and accessible. Solving these issues needs co-operation between Governments on both sides of the border.

It is just over a year since Eluned Morgan, the First Minister of Wales, announced a cross-border health plan. The Secretary of State for Wales, the right hon. Member for Cardiff East (Jo Stevens), vowed to deliver “additional surgical procedures”. When asked to provide an update on that programme in the Senedd last month, and on how many more patients in Wales have been treated in England over the past 12 months, the First Minister’s answer was vague and non-committal. It is obvious that the bureaucratic problem in making cross-border referrals, as evidenced by the British Medical Association and by Powys health board, which has asked to reduce the number of patients sent for treatment due to financial constraints, is completely at odds with the promise made by the First Minister and the Secretary of State. It seems increasingly clear that this announcement has not led to the changes that we all, and our constituents, would like to see on our waiting lists. Those remain stubbornly high in Wales, with figures showing 794,500 to 796,000 patient pathways as of mid-2025.

We are all aware of the huge pressures being placed on the NHS in Wales by social care. In April, the Welsh Local Government Association warned that plans to reduce NHS waiting lists in Wales will fall short unless we see targeted investment in social care. This week, my Plaid Cymru colleagues in the Senedd will follow that advice by calling for the establishment of a national care service for Wales. That would be a serious step in the right direction.

The people of Wales deserve better than poorly planned announcements leading nowhere. I encourage the Minister to impress upon her Welsh Government colleagues to throw their support behind our plan to get to grips with the high waiting list blighting our health service. Diolch.

15:23

[Helen Morgan (North Shropshire) (LD)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I also thank my hon. Friend the Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing a debate that is really important along both the Welsh and Scottish borders.

It is always a pleasure to respond for the Liberal Democrats. This is an issue that my own constituents deal with daily, because North Shropshire has a very long and winding border with Wales. My office, as a result, has dealt with many upsetting pieces of healthcare casework that stem directly from the broken and disjointed system that serves our border counties and, critically, the lack of information that flows between them, as we have heard.

Take for example many of my constituents whose GP will be in Wales because that will be their closest GP, and who usually attend Wrexham Maelor hospital for investigations and procedures, because if they live in north-west Shropshire that is almost as close as the hospitals in Shrewsbury and Telford. It is certainly closer than Telford. In an emergency, because their address is in England, the ambulance that they are sent comes from the West Midlands ambulance service and it is most likely that they will be taken to Shrewsbury or Telford hospitals as a result. When they get there, those hospitals are unable to access their medical records, including any recent blood reports or clinical history. I think the Minister will agree that that is inherently dangerous for those patients, whose only “fault” is to live close to the border.

The 2018 cross-border statement promised that no patient would face delay or disadvantage because of which side of the border they lived on, but in reality that promise has not been kept. Another constituent of mine who is registered with a GP in Wales was unfortunately diagnosed with breast cancer about 18 months ago. Her GP in Wales was very good; her initial care was excellent, and she was set to have a mastectomy and reconstructive surgery in Telford, but a couple of days before the surgery she was told that the Welsh health board would not be paying for the reconstructive element of the surgery. Obviously she was distressed and very scared about her future, and worried about having to wait longer to have that vital surgery because the funding issue needed to be sorted out. Although my office resolved the issue fairly quickly, it should not be necessary for an MP to get involved in a funding flow across the border. That is not acceptable, and not how we should be dealing with cross-border care.

As my hon. Friend the Member for Brecon, Radnor and Cwm Tawe and the hon. Member for Montgomeryshire and Glyndŵr (Steve Witherden) have described, Powys teaching health board has set waiting times for elective surgery that are arbitrarily long and without reference to clinical need. That means that Shrewsbury and Telford hospital NHS trust, which treats my constituents, and the Robert Jones and Agnes Hunt orthopaedic hospital, which is in my constituency and provides the veterans centre that the hon. Member for Caerfyrddin (Ann Davies) mentioned, are being asked to prioritise waiting lists based not on need, but on nationality.

I am an accountant, not a medical expert, but how can clinicians at those trusts be expected to manage their lists if they must take into account nationality before clinical need? The teams in both trusts are working incredibly hard to bring down their own long waiting lists. They have ambitious targets to meet, but they are being instructed to leave some patients longer, for no obvious reason. It is clearly an untenable situation for those hospital trusts. The patients, who may be living with chronic pain, are being told to wait longer than necessary because they live in Wales. That is not fairness; it is failure. I ask the Minister to ensure that the Labour-led Welsh Government are working hand in hand with our English integrated care boards and hospital trusts to ensure that residents on the border—on the Welsh side and the English side—are provided with the care that they need and deserve.

Behind the problem with funding flows lies another problem—the data-sharing chaos. After 25 years of devolution, NHS England and NHS Wales still cannot share patient records properly. Although England uses the NHS e-RS, or e-referral service, Wales uses the Welsh clinical portal, I am reliably informed. Clinicians often need multiple logins to access cross-border data, and GP-to-GP digital record transfers do not work between nations, with referrals, test results and discharge letters still moving by post or fax, which is an absurd situation in 2025. As we have heard from our Scottish colleagues in today’s debate, there is a similar situation on the Scottish border.

A fundamental difference in national strategies has left those on the border torn between two healthcare systems and two sets of priorities. The pilot project between Powys and the Wye Valley is a glimmer of hope, but progress on that is too slow. This is leading to a situation in which it is harder to recruit GPs, referrals take longer and patients fall through the cracks, because the two systems do not talk to each other. Treatment pathways can be confusing and fragmented, as we heard from my constituent’s example. Patients are facing delays and disputes not because of medical need, but because of bureaucracy.

The 2018 “Statement of values and principles” has no legal force; it is a voluntary agreement that leaves patients powerless when things go wrong. What we really need is proper accountability, shared data and transparent funding, so that the border does not become a barrier to care. It should not decide how long people wait, what care they get and whether their doctor can access their records.

One of the communities hit hardest by these challenges is St Martin’s—the largest village in Shropshire and, of course, in North Shropshire. Its GP surgery was a branch of the medical practice over the border in Chirk and it was overseen by Betsi Cadwaladr university health board. In 2022 it was closed, despite strong opposition from me and the village residents.

The Betsi Cadwaladr university health board has no official responsibility for my constituents over the border in North Shropshire, but it does get funding from the Welsh NHS for each individual registered in Chirk. Shropshire, Telford and Wrekin ICB presumably cannot afford a new surgery for the village, despite its being Shropshire’s largest village—it is also rapidly expanding—which means that residents must travel into Wales to see their nearest GP, with all the complications that entails. The best interests of English patients were disregarded by Betsi Cadwaladr health board because it was not responsible for those patients’ outcomes. It is essential for the health and wellbeing of residents on both sides of the border that we move to a system that focuses on a smooth flow of information between the nations and, crucially, that prioritises patient outcomes.

Improvements should be built on existing systems and border projects, rather than attempting some kind of long-winded, full national integration. As a party, the Liberal Democrats believe that the best way to do it is by, for example: extending England’s secure nhs.net to Welsh GP practices to allow safe patient data exchange; expanding English clinicians’ access to the Welsh clinical portal, which is currently available just in Wye Valley, to improve safety and efficiency; implementing any further sensible measures integrating English, Welsh and Scottish secure email systems; broadening the Welsh clinical portal, including expanding the Powys teaching health board and Wye Valley trust data-sharing model to other border trusts; and investigating interoperability of the NHS app between countries to support patient communications.

In 2025, we should be in a place where the flow of information is smooth and patients in the UK need not worry where they are located or what nationality they are if they need healthcare. I call on the Minister to work with her colleagues in the Welsh Government to ensure that their health system works in harmony with ours. Devolution should not mean having a dysfunctional border region. It should help deliver the localised care that residents need. I look forward to the Minister’s response.

15:31

[Mims Davies (East Grinstead and Uckfield) (Con)]

May I take a moment to say how pleased and honoured I am to respond to this important debate—we have heard why it is important—on behalf of His Majesty’s loyal Opposition, as the shadow Secretary of State for Wales? It is a pleasure to serve under your chairmanship, Mr Dowd.

I sincerely thank the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing this incredibly timely debate examining cross-border health services, constituents’ experiences of them and the wider challenges across the health service in Wales and Scotland. Some formal points have been put on the record about Wales in particular. There have been passionate and concerned approaches from Members this afternoon, particularly the hon. Member for Montgomeryshire and Glyndŵr (Steve Witherden).

Today, the Chamber has heard pertinent and passionate contributions from across the political divide regarding disappointing healthcare affecting people, despite the best efforts of staff members, as has been drawn out in the comments today. These first-class, dedicated and hard-working teams are in essence grappling with the challenges of devolution. My hon. Friend the Member for Berwickshire, Roxburgh and Selkirk (John Lamont) rightly highlighted that before devolution, services were connected to people’s communities, places of convenience or connection and shorter car journeys. It led to services that actually worked for them, and that matters. The challenges of the reality facing our constituents and those we care for have been highlighted in today’s debate.

The hon. Member for Brecon, Radnor and Cwm Tawe rightly mentioned the ridiculousness of “too quickly” and how some constituents looking for hospital care were asked to give slower responses. How on earth can someone receive that message and be able to manage it? That affects not only the staff on the ground.

Lack of access and issues around medical records were raised today. The hon. Member for North Northumberland (David Smith) rightly talked about joined-up thinking. It is not clear where people will be sent and referred to, whether in Scotland or around the English border. We need a British healthcare system that works in the situations that people or their loved ones may find themselves in. Staff on the ground are putting in their very best efforts. It is simply not good enough to be still looking at this issue.

Since taking up this role, one of the things that has been front and centre when meeting and listening to people is their experiences across the NHS in Wales as a whole: how they worry about their families and their care, the disjointed nature of the process and, frankly, what feels like a lack of interest and joined-up approach from Ministers. I ask that the Secretary of State for Wales takes note of what is said in this Chamber this afternoon—and indeed the Secretary of State for Scotland. Similarly, I hope that the Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock) will take a similar interest, given that it is the Welsh NHS that delivers for his constituents.

We know too many people, whether our family or friends, who are waiting in pain and in vain. Given the changes in the NHS in England, they want this Government to be interested in what happens in Wales and Scotland, and that they are using the fabled two Governments. I know the need for this debate, which in parts has been strident. We are here to make sure that this challenge is taken up and pursued in the places where it exists, by both Labour Governments in Cardiff Bay and in Westminster.

Since I have taken on this role, I have continually pointed out that since 1999—yes, since Tony Blair was Prime Minister—the Labour Welsh Government have controlled the health service in Wales. Despite some pleasant colleagues from Plaid Cymru and the Liberal Democrats, it is important to remember that parties there have been backing the Labour Government in Wales, and there has been far too little change. I was particularly pleased to hear the hon. Member for Ynys Môn (Llinos Medi) taking the opportunity, rightly, to point out that for her constituents, change needs to happen. The people of Wales and those using cross-border health services will not accept it if this debate does not lead to change. The answer is simple. People should not be holding their breath to see a change in their experiences; they should be seeing different outcomes.

The Conservatives tried to take up this task, but as we heard today, the challenge around devolution has left it in a difficult state. During the last Parliament, the then Secretary of State for Health and Social Care, my right hon. Friend the Member for North East Cambridgeshire (Steve Barclay), reached out to the Health Minister in Wales—the now First Minister, Baroness Eluned Morgan —recognising the disparities. He asked that they bring officials together—as has been asked for again today—to see how all our UK nations could work together to reduce NHS waiting lists and support the people of Wales. It was bitterly disappointing to see that opportunity to engage not taken up. It was a vital and genuine offer, based on all the reasons that we have heard in the Chamber this afternoon. I would love to hear the Minister tell the House whether that decision is regretful. It seems short-sighted, especially given the ongoing messages in today’s debate.

Can the Minister reveal whether she would like to do the same thing and reach out and offer to assist Welsh Government Ministers, as my party did? We would all be assured by that, and we would all assist in any way to make this change. We also committed in last year’s general election to accelerate investment into new hospitals in Llandrindod Wells, Flint and Newtown to improve cross-border services. Can the Minister commit to an update on that, as it will make a real difference in people’s lives?

I was fascinated to hear from the hon. Member for South Antrim (Robin Swann), that where technology, co-operation and partnership is focused, it can change lives. That is the outcome we are looking for here. Despite the feeling that this issue is about funding, it feels more about delivering and making sure that cross-border services work, no matter what party someone belongs to or what part of the country they live in. Wales desperately needs more nurses and doctors, not more politicians in Cardiff Bay. My colleagues, the Welsh Conservatives, led a debate on this topic in July, making it clear that they felt some of the funding could and should have been redirected at cross-border waiting times.

I will conclude by asking the Minister—given the cross-border experiences discussed and what hon. Members have pleaded for on behalf of their constituents—whether she will work with the Wales Office to deliver an inquiry into the preventable deaths, particularly those under the Betsi Cadwaladr university health board. David Jones from Flintshire and many others want that inquiry to be delivered under the Inquiries Act 2005. I look forward to hearing from the Minister on how, by delivering on our commitment and listening to what has been said in this debate, she can take forward people’s experiences so that they are at the heart of what Parliament discussed this afternoon, and real change can be delivered.

15:40

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I am grateful to the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing this important debate. I knew that hon. Members from across the United Kingdom would come here for it, and so it has proved. There are no end of technicalities that devolution has brought us, but we respect devolution and difference while recognising that we are all citizens of the United Kingdom. On the initial point made by the hon. Member, I gently remind him that an extra £1.5 billion has been allocated by the Welsh Government to public services in Wales, to put Wales on a path back to growth, undoing the damage of the last 14 years. That money includes an extra £600 million for health and care, which was voted against by the Welsh Conservatives and by Plaid Cymru. That is the difference made by having a Labour Government at one end of the M4 and a Labour Senedd at the other. Let us hope that arrangement can continue into next year so that we can get on with resolving those issues for the people of Wales.

I am very proud of my Irish heritage, with family on both sides of the Irish border, and I represent a city just across the Severn from Wales, so I am no stranger to the issues that arise from sharing a border. I spent many years in the British-Irish Parliamentary Assembly and on the Public Administration and Constitutional Affairs Committee, looking at constitutional issues across the United Kingdom. As my hon. Friend the Member for North Northumberland (David Smith) said, given the reality of people’s lives across our borders, we need to be better at joining those dots, and—as my hon. Friend the Member for Carlisle (Ms Minns) said—at remembering those people who live at the edge of some people’s maps.

To assure everybody, with my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock) as the Minister for Care and with my hon. Friend the Member for Glasgow South West (Dr Ahmed) as the Minister for Health Innovation and Safety, on whose behalf I am speaking, we in the Department of Health and Social Care are well served by all voices in the United Kingdom. I reaffirm our commitment to ensuring that all patients on both sides of borders can access timely, high-quality care. Healthcare is devolved but patients cannot be left to navigate a fragmented system or face delays just because of where they live.

I assure hon. Members, in response to points made by the Opposition spokesperson, the hon. Member for East Grinstead and Uckfield (Mims Davies), that officials meet regularly. That co-operation is happening, and they will continue to meet. My colleagues and I also meet members of those Governments. However, I will come on to that at the end when discussing the requests for my colleague, the Minister for Health Innovation and Safety, to meet with hon. Members.

The spiritual home of the NHS is Tredegar. This Government will not leave anyone behind, not least patients in Welsh border communities who rely on services in England—the point of the debate. My hon. Friend the Member for Montgomeryshire and Glyndŵr (Steve Witherden) raised problems with data sharing and patient record transfer, confusing and inconsistent referral pathways and some of the disputes across borders. However, as we have heard, such disputes sometimes happen within countries and over more local borders. As we heard from the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont), they happen internally as well, so let us not underestimate how hard it is to resolve such disputes.

Around 30,000 people who live in England have a GP in Wales, and vice versa. That is why the statement of values and principles for cross-border healthcare was published in 2018. That statement remains the foundation for our approach. It sets out clear expectations that patients living in defined border areas, whether they are registered with a GP in England or in Wales, should receive care without delay or administrative burden. Emergency care is available to all patients, regardless of residency or GP registration. We expect both integrated care boards in England and local health boards in Wales to consider the impact of commissioning decisions on cross-border communities.

The hon. Member for Brecon, Radnor and Cwm Tawe raised the issue of waiting times for residents in Powys who seek treatment in England. Waiting times on both sides of the border are falling. Whenever I appear in the media or speak in a debate, I hear people still saying, even to their television, “Well, where’s my appointment?” Nevertheless, it is the case that waiting times are falling, which is helped by the allocation of money from the Welsh Government to reduce waiting lists.

[David Chadwick]

Will the Minister give way?

[Karin Smyth]

I will get through all the points, if I can, because I know there are lots of issues to address.

As I was about to say, too many people are still waiting, but we are committed to working with the Welsh Government to keep the cross-border arrangements fair, transparent and patient-centred.

Patients also face challenges in accessing specialist services. NHS England commissions a number of these services on behalf of the devolved nations and we are willing to explore further contract arrangements with NHS Wales to improve access to them.

As we have heard this afternoon, travel to appointments can be a barrier. In England, patients referred for specialist NHS treatment may be eligible to claim a refund of reasonable travel costs under the healthcare travel costs scheme, and a similar scheme exists in Wales. I join my hon. Friend the Member for Shrewsbury (Julia Buckley) in welcoming the tremendous changes that we are seeing at Shrewsbury and Telford hospital, which are starting to benefit not only her constituents but people travelling from Wales. That is really good to see. It is a long way for people from Wales to travel, but we are still very pleased to see those changes being made.

The hon. Member for Brecon, Radnor and Cwm Tawe also raised the issue of digital interoperability. Again, I wish I could say that that was only a problem for hospitals on the border between England and Wales, but I am afraid that it is an issue for trusts across the country and across each country. It does not help that, after 14 years of under-investment, IT in the NHS lags behind IT in the private sector by at least a decade. That is why this Government are investing £10 billion into improving how patients access services through technology. My hon. Friend the Minister of State for Science, Innovation, Research and Nuclear, Lord Vallance, is currently giving the NHS the biggest digital makeover in its history as part of our 10-year plan.

I can also tell the hon. Member for Brecon, Radnor and Cwm Tawe that NHS England is working with NHS Wales to improve interoperability, especially through the shared care record and technical collaboration on the so-called fast healthcare interoperability resources, or FHIR for short, which allows systems from different manufacturers to exchange messages and data, regardless of the setting that care is delivered in. I commend my hon. Friend the Member for Montgomeryshire and Glyndŵr on meeting leaders in the local cross-border system to understand that issue better. However, I gently say to him that we cannot get very far without the private sector working with us, not only across genomics and future healthcare but in IT and the way that we develop some of these services.

In October, the chief information officers across all four nations agreed to start looking at digital architecture and standards. They are exploring what we can do to improve how we use shared systems, common standards for better communication, which was raised by nearly everyone this afternoon, and the potential of future alignment. This work should lead to some progress in the short term, ahead of our long-term ambition of building a single patient record.

We are also making cross-border billing arrangements easier. Although the NHS payment scheme applies only to services in England, we sat down with the Welsh Government and agreed that Welsh commissioners will pay English tariff prices for Welsh patients who are treated in England. For English patients who are treated in Wales, local agreements are in place and we are open to making those agreements more efficient through the provision of clearer guidance.

As for our constructive co-operation with devolved Governments, the Government were elected on a manifesto to reset our relationship with the devolved Governments, and from day one that is what we have been doing. In that spirit, and without downplaying many of the issues that the hon. Member for Brecon, Radnor and Cwm Tawe and others, including the hon. Member for Ynys Môn (Llinos Medi), have raised today, I will highlight some of the positive examples of collaboration between our healthcare systems.

In many areas along the border, NHS staff in England and Wales are showing the rest of the UK how joined-up care is done. For example, patients in south Wales regularly access paediatric intensive care services in my home city of Bristol, and there are long-standing arrangements for cancer care, renal services and mental health support that cross the border seamlessly. Such partnerships are a testament to the professionalism and dedication of our NHS workforce, but cross-border healthcare is just one part of our partnership.

First, we have seen immense progress through the Interministerial Group for Health and Social Care, which met last September. Such meetings are really important. They bring together all four nations to find common ground on key priorities, such as elective recovery for those on waiting lists, innovation and health reform, and we look forward to continuing these discussions at the next meeting in December.

Secondly, all four nations are working to protect our kids through the Tobacco and Vapes Bill, which is UK-wide in scope but tailored to the specific needs of each nation. If the representative of the Opposition, the hon. Member for East Grinstead and Uckfield, could indeed talk to her colleagues in the House of Lords, who are battling very hard to get some of this legislation through, we could start making this generation the first smoke-free generation and support kids with this public health measure.

Thirdly, the Mental Health Bill that applies to England and Wales has been a masterclass in constructive engagement between compatriots who want to put their differences aside and get stuff done. May I echo the words of the hon. Member for Strangford (Jim Shannon) and add my support to the hon. Member for South Antrim (Robin Swann) in his efforts to ensure progress on that often forgotten part of the Good Friday/Belfast agreement that deals with healthcare? It is not easy. If they can do it over there, it is not beyond the rest of us to do it in Scotland, Wales and England. I was so grateful when my own mother was being cared for at Altnagelvin hospital during the covid crisis in 2021 to see the co-operation across the border and staff just getting on with treating the patients wherever they came from. We have a lot to learn from our colleagues in Northern Ireland.

In conclusion, I want to assure colleagues that the UK Government remain committed to supporting cross-border healthcare arrangements that work for patients. I will not offer hon. Members lots of individual meetings, but what I have heard today is that there is a lot of good work going on among officials. People here have issues to raise, including things from the past. I will take that up and share that more widely. I will also endeavour to write to the hon. Member for Strangford on the issue he raised to do with university students.

We are building bridges with Wales to work through our issues in the national interest, but I am afraid to say that although waiting lists are falling in England and Wales, in Scotland they are rising, which is a great shame. My friend Anas Sarwar, a former NHS dentist, is committed to resolving that. The NHS is in his DNA, given his own professional work. Getting waiting lists down will be his No. 1 priority, should Labour be successful in Scotland next year. It is a shame for Scottish people to see waiting lists rising while we make progress in England and Wales.

The greatest Welshman in history, Nye Bevan, founded our national health service. The hon. Member for Brecon, Radnor and Cwm Tawe might want to dispute that and give the title to Lloyd George—we will politely disagree on that one. But the serious point is that Bevan’s vision was for a health service where no one was left behind, not least in his own country of birth. Working in partnership, we will fix the NHS across the United Kingdom and make it fit for the future.

15:52

[David Chadwick]

First, NHS waiting lists in Wales are not falling; Wales has the highest waiting list in the United Kingdom. Nearly a third of our population are stuck on waiting lists. I wanted to intervene to make the Minister aware that I agree that extra funding is required to tackle the waiting list that we face in Wales. But when extra funding was announced for the Welsh NHS in June by the Welsh Government, it later transpired that none of that money could be spent on this issue because none of it could be spent on English commissioned services, which meant that the problem we are here today to discuss could not be solved. That is why it is so important to bake in a sort of border by design when designing national healthcare systems, because, as we have heard today from so many Members, it is often very typical and much easier for our constituents to cross borders to access their nearest hospital or their nearest GP practice; and it is important for our Union to facilitate that practice by making it easier and faster.

The hon. Member for Shrewsbury (Julia Buckley) talked of the progress being made in her constituency to bring down waiting times. Clearly, that is good news and shows what can be done—I know that my hon. Friend the Member for North Shropshire (Helen Morgan) has campaigned very hard for that. That is why it is so frustrating for my residents and constituents in Powys to know that access to faster healthcare is available just on the other side of the border, but their own Government and health board are preventing them accessing that treatment. Today we are calling on that to end.

What this debate has shown is that for too long, Powys residents have lived with a system that treats them as an afterthought. The waiting list policy introduced this summer has made that painfully clear. People are waiting longer not because of medical need or capacity, but because the funding simply is not there to pay for it. We have heard today that the problems run deeper than just funding alone. They are about systems that cannot talk to one another, Governments that will not work together, and patients who are left to navigate the gaps.

These are man-made problems, and they can be solved if there is political will. My message to Ministers in both Cardiff Bay and Westminster is simple: sit down together, bring in those of us who represent border areas, and fix this. Every week that passes without action means more people living in pain, more lives on hold and more families watching their loved ones deteriorate while they wait. This debate is about more than party politics; it is about people who simply want to be treated with the same respect and urgency as everyone else. We owe it to them to get this right. Diolch yn fawr.

Question put and agreed to.

Resolved,

That this House has considered cross-border healthcare.

15:55

Sitting suspended.