I’d like to thank Angela Burns for introducing our debate and the issue so well today. Matters of healthcare have dominated my inbox and my postbag since becoming an AM, but I suspect that’s the case for Members across the Chamber. But, because of the cross-border elements in my own constituency, the issue is all the more dominant, and in my contribution today, I would like to highlight some of the issues that my constituents face in accessing cross-border health services.

Now, of course, the county of Powys is the most sparsely populated and the largest geographical county in Wales. And of course, that brings us unique challenges. Powys has no district general hospital. Residents are served generally by the Royal Shrewsbury Hospital, the Princess Royal Hospital in Telford, or by Gobowen. Residents in the west of Montgomeryshire are served by Bronglais, but 80 per cent of my constituents are served by hospital services over the border, and this means, of course, for my constituents, they have to travel huge distances to access healthcare services. The differences in policy between England and Wales have a direct impact on the access to, the consistency of and the quality of care for patients in my constituency. Many patients suffer from a postcode lottery when it comes to waiting times, funding decisions and different treatment priorities. This means that mid-Wales patients often fall between the administrative cracks when accessing care. This is an issue that is the biggest in my postbag, perhaps more so than other AMs. I’m dealing with those administration issues of people falling between two different systems.

I’ll give a few examples here. One of my constituents—I’ll call him Mr L—requires a transcatheter aortic valve implantation—I hope I’ve pronounced that correctly—at Stoke university hospital, but funding has been declined twice. If Mr L was a resident in England, he would have had the operation without even the need for a funding request in the first place. Mr L, of course, is informed by consultants of the situation, because they are frustrated as well; consultants are frustrated that they have to operate a two-tier system; they’re frustrated that they have to give less of a service, as they see it, to Welsh patients.

Mrs E and Mr M need a total knee operation and a complete left hip respectively. Both are waiting 26 weeks for an operation in Gobowen, instead of 18 weeks if they were resident in England. The different waiting times, also—. The different targets, I suppose, that both hospitals have to work with in regards to two sets of targets is, of course, an issue here. Hospitals are facilitating a two-tier system when it comes to supporting Welsh and English patients. I’m forever getting this issue raised with me, where a patient will be told, ‘Ah, Mrs Jones, you’re going to have to wait 18 weeks’, and then as the consultation continues, ‘Oh, hang on, I notice you’re from Wales, it’s 26 weeks’. That’s a regular occurrence. That perhaps wouldn’t happen if a patient lived in Wales and went to hospital in Wales. The consultants are normally used to seeing English patients, so this is one of the issues that comes about.

A number of constituents have also expressed a big concern about PET scans, where normally only one PET scan would be allowed. But, of course, in England, two PET scans are allowed—usually one before the operation and one post-operation. So, the confusion regarding waiting times, funding arrangements and treatment priorities is rife, and my message to the Welsh Government, and the UK Government for that matter, is: work together to break down these barriers and provide clarity for patients and clinicians.

I strongly agree with the Welsh NHS Confederation, which has said that there needs to be greater cross-border citizen engagement to raise awareness of devolution and the differences in treatment availability. Again, this is one that fills my postbag. I’m forever replying to constituents saying, ‘This is my advice for how you deal with your particular request, and I’ll make representation on your behalf’. Then I’m going on to give them a lesson in devolution, because often one of the issues that is raised is, ‘I’m a taxpayer, we’re supposed to have a national health service, what’s gone wrong here?’ And, of course, then I’m answering, ‘Well, actually, you’re wrong; we have no longer got a national health service, we’ve got two different Governments with different priorities’. I’m forever answering that, perhaps on a weekly basis.

The Welsh Affairs Select Committee—