Thank you, Deputy Presiding Officer. I wish to move the motion before us today, tabled by the Welsh Conservative group, and, by doing so, highlight the innovations that cross-border healthcare can offer in improving the outcomes for patients on both sides of the border. We would also wish the Assembly to note the very sound recommendations made by the Silk commission, which are reflected also in the Welsh Affairs Select Committee report on cross-border health arrangements. We ask the Welsh Government to recognise the challenges that cross-border working brings.

Our motion today, Deputy Presiding Officer, will look at ways of improving patient outcomes for patients based on both sides of the border, will consider the recommendations made on this issue by the Silk commission, and will also use the evidence taken by the Welsh Affairs Select Committee to highlight a number of concerns raised by patients and other health organisations. We will also seek to make constructive suggestions for improving cross-border healthcare. The challenges of cross-border healthcare are unlikely to prey upon the minds of most of us, and yet it is an issue that impacts on every one of us living in Wales. It doesn’t matter whether you are one of the 50 per cent of Wales that lives within 25 miles of the English border, or any other user of the NHS, because we rely on being able to access services, from GPs to specialist care, from the English NHS. Yet many patients and organisations find that the system is often mired with confusion and uncertainty because they are not really aware of where they are getting their services from.

Over the years, very clear differences in health policy between Wales and England have developed. Devolution has enabled the respective Governments to promote policies that they see fit to reflect the needs of their own populations. However, it does mean that we need to be more alive to problems that this may generate, and find a more robust and constructive solution. These problems are not insignificant, given that some 56,000 Welsh patients are admitted to English hospitals every year. The Welsh Affairs Select Committee report says that there’s no practical or realistic prospect of diverting these well-established cross-border flows, nor would it be desirable to do so. So, we say that, whilst there is no way of altering this pattern, there must be ways that we can improve the situation so that patients on both sides of the border get fair access to health treatments.

Geography is not the only challenge that we face. The sparsity of our population gives us problems in equity of access to health services, and so it is a real positive that many rural communities in Wales are able to access health services by crossing the border to a centre closer to them rather than having to travel miles within Wales, particularly if they’re relying upon public transport.

Now, to try and address some of the challenges faced by the respective services, a cross-border protocol was introduced by both Governments, with the latest iteration being in 2013. This protocol sets out who is responsible for providing which services and to whom. However, the seven Welsh LHBs do remain responsible for Welsh patients. In turn, the English clinical commissioning groups remain responsible for English patients. Now, this can and does cause tensions, which can arise when different policies come into play on either side of the border, and we have a situation where one set of rules can apply to different patients at the same surgery, depending on where they live, or different rules even apply to neighbours, depending on which GP surgery they are registered at. Another tension comes over disparate policies between Wales and England concerning patients choosing their own location for treatment. If they’re in the English system, they can choose which hospital to go to. However, this freedom is frowned upon by the Welsh Government, who state that providing patients with more of a voice is important. Now, this debate isn’t about looking at that policy. The challenge of patient’s voice against patient’s choice means that those English patients receiving their treatment in Wales lose the rights that their countrymen have across the border. So, we’re seeking equity across the whole piece.

Waiting list targets are another issue that causes tension. Ninety-five per cent of English patients have a legal right to start treatment within 18 weeks of referral, and no-one is expected to wait over 36 weeks. However, in Wales, our ambitions are not set so high, with a 26-week target for starting treatment, but there is no legal right. According to figures from last month, almost 5 per cent of patients in Wales waited longer than 36 weeks from referral to treatment. Figures show that, even for routine procedures, waiting times can be as much as two and a half times longer in Wales as in England. This is a very confusing situation for those who live around the borders of our country. Worryingly, the Welsh Affairs Select Committee highlighted that many clinical commissioning groups operating along the English side of the border operate two waiting lists within the same surgery—a Welsh list and an English list. Now, can I and my colleagues here echo the views of the committee that the Welsh Government and the Department of Health need to resolve this problem, and as a matter of urgency? So, Cabinet Secretary, could you provide assurances that this will happen, and that you will address this as a matter of urgency? It seems to be highly unfair for one surgery to operate such a difference between whether you’re a Welsh or an English person.

The Welsh Affairs Select Committee report, which was published in March 2015, also stated that the then Welsh Minister had said he would move to amend the necessary regulations in Wales to remove barriers to GPs providing services on either side of the border. I think that’s a very welcome step forward.

Cabinet Secretary, I would be interested to know whether any progress has been made on this subject, and whether, in fact, this is an ambition that you would want to see happen. I understand that the protocol is subject to a three-year review. As I’ve already established, the last protocol was drawn up in 2013, so I believe I’d be correct in saying that we must be due another review before the end of this year. Cabinet Secretary, will you provide an update as to whether this review has taken place, and, if not, do you intend to review, and when might we see such a review?

The Silk commission, which reported in March 2014, goes further than the provisions of the 2013 protocol and argues that current arrangements should be strengthened by developing individual protocols between each border local health board in Wales and the neighbouring NHS Trust in England. I wonder if you’ve got any views on whether or not that should be moved forward.

Additionally, Silk called for English and Welsh health services to work more closely together to develop better joint strategies to maximise joint efficiency savings, but there’s a lack of clarity as to how far that has been moved forward. We need to make the cross-border situation more of a level playing field when compared to services other people in Wales can access. So, can I ask, Cabinet Secretary, that, when policies are introduced in health in this Assembly, they are automatically assured or looked at to ensure that they are suitably border-proofed so that Welsh people are not disadvantaged overly if they are going to an English GP? I appreciate it may only affect a relatively small number of people, but this needs to be done to provide greater consistency in healthcare and also fits into some of our discussions yesterday emanating from the chief medical officer’s report surrounding reducing health inequalities.

I know my colleagues will wish to speak more about individual areas on the border, but it’s worth touching on some of the key issues. Due to the free-prescription policy, patients from Wales being discharged from an English hospital sometimes are asked to pay for their own medicines and then have to try and claim back. Also, the policies pertaining to discharge to social care are different between the two countries, leading, quite often, to patients routinely facing delayed transfers of care. May I just add a quick rider here? This is not just stuff I’ve dug out of nowhere. This has come from the Silk commission report, from the Welsh Affairs Select Committee report, and from the NHS Confederation. So, these are all verifiable instances that are happening out there today.

Finally, the lack of co-ordination between IT systems on either side of the border is fast becoming a problem. Although I know there’s currently a study going on surrounding establishing an electronics referral system between Welsh GPs and English hospitals, I would like to know how this pilot is progressing and when we will learn of its outcome. I really feel the issue of IT services is important. If we can get this right, it may really help to streamline services and outcomes.

Evidence was given to the Welsh Affairs Select Committee from a doctor based at the Countess of Chester Hospital in England who deals with diabetes. He described how blood samples taken by Welsh GPs are sent to Wrexham Maelor, even though the patient is under him. Due to a lack of cross-border compatibility, he is unable to access the results and provide a full consultation. The Royal College of Physicians backed up this view and gave evidence as to how it was often easier to repeat blood tests rather than find results from across the border. This has just got to be a shocking waste of time and money. We need to be able to resolve this. The committee went on to detail how there is currently no joint programme of work between the English NHS and the Welsh Government around central IT arrangements.

I do recognise there’s a divergence of approach here, with England looking at improving interoperability for local IT services in England, and we want to develop a single national system. But I’m sure, Cabinet Secretary, you will agree about the importance of patient information being transferred effectively between primary, secondary and tertiary services, no matter which side of the border they’re on, and across the border. So, I wonder if you can tell us or give us some guarantees that this issue will be addressed as soon as possible. Would you also consider a short-term fix that may be given that would enable patients who are receiving cross-border care to have a hard copy or an electronic copy of their records to take with them to their appointments? I believe we can trust patients to take care of their own medical data.

The OECD report into the quality of the UK’s health service raised concerns over the whole area of cross-border and, whilst they found that there were good joint-working arrangements, they did propose that collaborations could help health boards deliver meaningful change by a range of initiatives, such as mentoring partnerships between health boards, staff exchanges and ensuring open comparison of results. I would be interested to learn from you, Cabinet Secretary, if you intend to take any of those OECD recommendations forward.

Cabinet Secretary, the Welsh Conservatives would like to see both national health services, and the relevant commissioning groups, and the Governments of the two countries, working together in a consensual way to ensure that patients on both sides of Offa’s Dyke get the best possible deal. With more cross-border co-operation, we may be able to better address the concerns that have been raised by many of the witnesses to the various committees. We may also find ourselves in a better position to tackle some of the staffing issues that currently face the Welsh NHS and reduce the ever-increasing reliance on bank and agency staff. And with the workforce pressures in mind, I would confirm that the Welsh Conservatives will be supporting the amendment put forward by UKIP. I trust, Cabinet Secretary, that you’ll take our observations forward, and I look forward to your answers to the questions I’ve raised.