Healthcare pathways for patients have always crossed the Welsh and English borders. Before devolution, this was not a problem as there was a single NHS. The NHS Act of 1946 provided for the establishment of a comprehensive health service for England and Wales. The United Kingdom Government was responsible for services in both countries, although from 1969 the NHS in Wales became the responsibility of the Secretary of State for Wales. Now, with the advent of devolution, responsibility lies with the Welsh Government. However, since half of the Welsh population live within a 15-minute drive by bus, car or ambulance to the border, movement across it to access health care is routine. Around 55,000, as Angela just said, Welsh residents are admitted to hospitals in England each year. Welsh hospitals admit some 10,500 people resident in England. There are just under 21,000 English residents registered with GP practices in contract with the Welsh NHS. The figure for Welsh residents registered with GPs in England is somewhere between 15,000 and 16,000.

We all want to see people get the treatment they need in the best place for them. Clearly, sometimes those services will be across the border. The Welsh Affairs Committee, in their report, found concern about difficulties and delays accessing secondary and specialist services on a cross-border basis. In particular, patients were worried about a perceived move towards in-country commissioning on the part of the Welsh Government. They believed the ultimate aim was to treat all Welsh patients within Wales irrespective of whether it was in their best interests. In some cases, patients living in south-east Wales receiving treatment at Hereford or Bristol were told that Aneurin Bevan Local Health Board would no longer fund their treatment. Aneurin Bevan Local Health Board introduced a policy in September 2012 of minimising referrals outside of Wales. They said, and their quote is:

‘the Health Board is the primary provider of secondary care services for the resident population of…Gwent…Where this cannot be provided by the Health Board’s own services…then the Health Board will look to plan and secure the necessary services with other NHS Providers in Wales through its agreed care pathways.’

Quote closed. Only if a Welsh health board could not provide the appropriate services would Aneurin Bevan health board look across the border. Although they changed this policy in 2013 for English residents with a Welsh GP, they did not do so for Welsh residents. As a result, prior approval is still required before a Welsh patient in Gwent can be referred to an English provider for treatment.

Many specialist services are simply not available in Wales, Deputy Presiding Officer. Specialised services are commissioned on a national basis by the Welsh Health Specialised Services Committee. Concerns have been expressed that it is not always possible to formalise service level agreements between Wales and England due to key differences in the contract documents. Key differences cited include differences in access criteria, waiting time targets and the fact that Wales does not operate a patient choice scheme. Different IT programmes in use in the healthcare services in Wales and England also make it difficult for primary, secondary and tertiary systems to communicate with each other across the border. Deputy Presiding Officer, cross-border movements to access healthcare have existed for many years. For many residents of border areas the nearest health provider may not be in their country of residence. It is vital, therefore, that the border does not become a barrier to accessing the best healthcare. If we promote the innovative use of cross-border healthcare, we can deliver the improved patient outcomes we all wish to see in Wales.

Finally, I would like to ask, Minister: the waiting list and the cancellation of patients in Wales are really, really at crisis point. I know that, for some of my own constituents, at least half a dozen times, their operation was cancelled after waiting two and a half years. And after that—the sixth time—the operation was cancelled. What a disaster in the NHS. We should use our own family to operate, within not only an 18-month wait but before an 18-month wait, and let these waiting lists be shortened as soon as possible in Wales. Thank you.