Cross-border Healthcare

Helen Morgan Excerpts

Tuesday 4th November 2025 Westminster Hall

[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.