Cross-border Health Care (England and Wales)

Debate between Jim Shannon and Jesse Norman

Tuesday 25th June 2013 Commons Chamber

[Jesse Norman]

It is interesting to have the parallel case, and I thank my hon. Friend for bringing it to the attention of the House.

Let us look at the issues in more detail. The relevant NHS regulations state that legal responsibility for these patients remains with the relevant clinical commissioning groups in England, but that local health boards in Wales take day-to-day responsibility for their care. The English and Welsh NHS take their guidance from the protocol for cross-border health care services, the latest version of which was agreed by Welsh and English Ministers in April this year. However, it appears that the protocol does not give full effect to the law. Specifically, point 14 of the current protocol implies that patients from England who are treated in Wales are to be seen and treated within the maximum waiting time targets of the NHS in Wales, which are of course rather different from those of the NHS in England. Why does this matter? It matters for three particular reasons.

First, as we have seen, these South Herefordshire patients struggle to get referred to the hospital of their choice. The Welsh Assembly Government Minister for Health and Social Services has openly stated that choice is not the basis of the health system in Wales.

[Jim Shannon (Strangford) (DUP)]

The hon. Gentleman will be well aware of the land border between the Republic of Ireland and the United Kingdom of Great Britain and Northern Ireland. There is co-operation, although it is not full blooded, between the health service in Northern Ireland and the health service in the Republic. Perhaps the Minister should look at that to see how it can work for the situation on the border between England and Wales.

[Jesse Norman]

I am grateful to the hon. Gentleman for that intervention. There is co-operation at the moment between England and Wales, but I think that it would absolutely benefit from further examination of the situation he describes between Northern Ireland and Eire.

The fact that the Welsh Assembly Government Minister for Health and Social Services does not believe that choice is the basis of the health system in Wales means that my constituents do not have the choice of health care, hospitals or consultants that is their proper legal right.

Secondly, the Welsh NHS’s performance in meeting its own waiting time targets continues to deteriorate. In England the waiting time target is 18 weeks, but in Wales it is 26 weeks, and that is regularly missed. Some patients are not even treated within 36 weeks. For example, some 4% of patients are not treated within 36 weeks at Cardiff and Vale hospital, according to recent Welsh Government statistics for April this year.

Thirdly, the current set-up is giving rise to serious clinical concerns. Earlier this year, in evidence to the Silk commission on devolution in Wales, the Royal College of Surgeons, the British Medical Association and the Royal College of Nursing made the following submission:

“The Panel... acknowledged that increasing policy divergence between health services in Wales and England was a challenge, especially in regards to cross-border services. The Panel added that there was a need to strengthen commissioning arrangements to improve current delays for processing individual cases... It was also agreed that it made sense for some specialist facilities to be shared by both England and Wales; and to work together to deliver economies of scale and efficiency savings, including cross border sharing of procurement and use of high-tech equipment.”

However, as I have mentioned, that ban on hospital access for those patients is not merely grossly unfair to them but places further financial pressure on Hereford hospital.

Sheltered Accommodation

Debate between Jim Shannon and Jesse Norman

Wednesday 17th November 2010 Westminster Hall

[Jesse Norman (Hereford and South Herefordshire) (Con)]

I congratulate my hon. Friend the Member for Stourbridge (Margot James) on securing this debate on an important national topic. It is important not merely because of the low level of building in this country, but because there is a serious issue about whether residents in sheltered accommodation are being cared for properly. The cases that have been described in this debate illustrate that issue.

The problem is perhaps not as acute in Herefordshire as in some other parts of the country, but it is serious and growing. We have a large elderly population that is increasing as a share of the population, and it includes an increasing number of frail people. Most of those in sheltered accommodation are cared for by Herefordshire Housing, which, after a difficult period a few years ago, has made great progress under its new leadership and reconstituted board. But all too often, sheltered accommodation is used for families who do not require it and to accommodate people with mental illness, who would be better accommodated in specialist dwellings designed for their needs.

The removal of the warden service from sheltered accommodation is a serious local issue, on which I have campaigned for three years. I associate myself with the comments of my hon. Friends on that issue. The warden service is vital, not only for its early-warning service, but for the human touch that it provides for those in sheltered accommodation. There has been more than one case in which a resident has been discovered several days after they have passed away because of the lack of a regular on-site warden.

When the housing stock was transferred from the council to Herefordshire Housing, residents were given strong assurances that their rights, and specifically the warden service, would be protected. There is a general duty of care, under which the warden service is provided. Residents were therefore appalled to discover a couple of years ago that the warden service was being removed.

A very good local campaigning group was set up, called the sheltered housing tenants umbrella group. With my assistance, several members of SHTUG took Herefordshire Housing to court over the removal of the warden service. In particular, I mention Shirley Baldwin, who ran SHTUG at the time, Lil Jones and Nancy Evans, in whose name the group received legal aid to pursue the case. I am sorry to tell hon. Members that the case failed because of a technicality. A statute of limitations, which was very short at some six months, had elapsed and they had neglected to register their concern, in part because they were notified in a modest, non-public way. They had not realised that they had only six months to register their concern, and it was some time before the impact of the withdrawal of the service became clear. Although the lawsuit reached the stage of taking the advice of a silk in London, it did not go through. I am sorry to report that, because those people deserve a better deal than they are getting.

What can be done? Hon. Members have made many good suggestions in this debate and I associate myself with those. I wish to emphasise three aspects. First, there should be more vigorous enforcement of tenants’ rights by statutory agencies. Tenants should not be notified in a letter that arrives among a lot of other correspondence that such rights are being ended without proper negotiation and consultation. Such rights should not be ended in any case because of the commitments that were made at the time of the stock transfer. Tenants deserve better than to have to obtain legal aid, which does not even exist in Herefordshire for such cases. The nearest place from which legal aid can be obtained, and where I found it, is Birmingham.

Secondly, there should be proper treatment of those with mental illness. I have residents who are being driven mad by the difficult behaviour of people who require proper treatment and care. Such people should not be left in sheltered accommodation, but they are because of the general crisis in housing.

[Jim Shannon]

Last week, my right hon. Friend the Member for Belfast North (Mr Dodds) introduced the First Reading of a Bill to protect elderly people and those in care, and to ensure that their rights are preserved. Like the hon. Gentleman, I represent an area with a large proportion of people who are coming up to retirement age—I am probably heading that way myself. Will he look at that Bill, which would go a long way towards providing the protection that he speaks about for the vulnerable people who need it?

[Jesse Norman]

I welcome the hon. Gentleman’s intervention, and I shall look at the proposed legislation with great interest.

My final point is that sheltered housing should be an integral part of a wider attempt to get more housing built in this country. In the past decade, there has been an enormous amount of talk about housing targets, and yet there has been the lowest rate of new housing creation in living memory. The large and increasing number of people who require sheltered accommodation are the losers in that much wider national problem.