Thank you, Deputy Presiding Officer. I would like to thank Members for tabling a debate on this topic, so we can discuss the reality of cross-border treatment for patients between England and Wales. The Welsh Government, of course, has been keen to ensure that the approach to cross-border patient flows is sensible and pragmatic and to focus on providing the best care for all of those who need it. That has been the primary focus of the cross-border protocol.

The Welsh Government’s aim is to ensure that all patients receive high-quality healthcare at the right time and in the right place. Sometimes, services provided across the border in England will be what is best for Welsh patients. There have, as has been discussed today, long-established patient flows into England for hospital-based care. Local health boards have the flexibility to refer patients out of their area for treatment, where a patient’s clinical need and circumstances justify it, or where services are not provided in Wales.

There is, though, the reality of the party political approach that has been taken to describing NHS Wales, which has unfortunately got in the way of some of the debate. The Offa’s Dyke comment was not particularly helpful, and has still not really been undone. But, to be fair, and to Angela Burns’s credit, she has not taken that partisan approach to talking about cross-border healthcare and what we actually need to do about it. [Interruption.] Suggestions that NHS Wales don’t pay on time were previously made in the past by English organisations in suggesting that NHS services in Wales weren’t paying upfront for Welsh patients. That simply isn’t true. That was really disappointing and actually damaged relations at one point in time between different organisations that were having to treat Welsh patients. Indeed, it is right—and many people in this Chamber have made this comment before—that those services over the border do rely on Welsh patient flows to make those services sustainable. So, there is a need to have a genuine and sensible conversation about how patients get treatment and where they get it.

And, of course, it isn’t just the standard secondary care treatment because, of course, there are specialist services, where people do need to go over into England. Hannah Blythyn described some of those in her comments. Of course, north Wales has a link to the trauma centre in Stoke. Now, that has actually improved outcomes. People travelling further geographically to go to the right centre in England has actually made a real difference for them in improving outcomes. That’s a good example of commissioning the right care, at the right time and in the right place to the benefit of patients in north Wales.

But of course, there are not just patient flows out of Wales and into England because Morriston Hospital in Swansea serves as a specialist burns centre for Wales and south-west England, and Velindre Cancer Centre in Cardiff provides specialist cancer services for Wales as well as treating a number of patients who are referred in from England. We do know that there are challenges in some settings in England where Welsh health boards commission care normally—Powys and Betsi in particular. Services in the Wye valley, Gloucester and Shropshire clinical commissioning group, for example, have been—or still are—in special measures. It is a matter that I discuss regularly when I meet people from Powys Teaching Local Health Board—how they are safeguarding their own assurance about not just the quality of care, but the timeliness of that care, and to make sure, as has been suggested in some of the comments, that Welsh patients aren’t treated in a less favourable manner, and that they’re getting the care that they’re actually commissioning. So, it is a regular part of the conversation at a performance level as well as at a more strategic one.

We also know, unfortunately, that some of the specialist gender identity service in Charing Cross clinic will be discontinued, and that brings us back to the challenge, I guess, at the start of this—how do we ensure that the right care is delivered at the right time and in the right place for the public that we are here to serve?

I note the findings of the Silk Commission, and I’m happy to inform Members that the Welsh Government is in ongoing discussions with NHS England concerning healthcare provision along our border. These discussions more recently focused on GP referral arrangements, and we will be taking account of the wider needs of border patients who will benefit from a more formal agreement being put in place. Because as has been recognised, there is more cross-border flow of primary care patients into Wales than out. Over 20,800 English residents are registered with a Welsh GP, compared to 14,700 Welsh residents registered with an English GP.

As a Government, we would not look to instigate or prevent individual protocols between local health boards and clinical commissioning groups, as any formal arrangements between those organisations are best undertaken at a local level, by those organisations that are best placed to assess and deliver on individual patient need.

I have looked at the findings of the Welsh Affairs Committee inquiry into cross-border healthcare, and I recognise that many of the conclusions and recommendations highlighted within their report were already being actioned at the time of the report’s publication. Since the committee’s inquiry, the Welsh Government continues to work with the Department of Health in England, and to an even greater extent with NHS England, to help the Department of Health address its issues with non-compliance with its legislation—the legislation in respect of English residents registered with a Welsh GP who require secondary care. This does highlight that some of the challenges here are about different systems, and about the way that NHS England now sets out in an apparent constitution apparent legal rights, so it’s difficult to see how those are enforced. But it doesn’t have a practical impact, I think, on performance, which you know is a real challenge, and meeting some of their waiting time targets. The language in the legislation hasn’t changed that. But there is that real practical conversation to be had about how we get through some of those challenges.

Of course there are real challenges about how some treatments are provided to English residents who see Welsh residents getting a better service. Many of the examples given in the debate today have been the other way around, with people saying, ‘Actually, we’d like to have what England has’, but on a range of issues, for example, Sativex, we understand that that’s a challenge in England, where it hasn’t been available at the same period of time. Ironing out the wrinkles is a two-way process in the way that we talk to each other.

Indeed, I’ve heard the conversation—again, Eluned Morgan’s point—about cross-border healthcare and the way it’s planned. We were previously concerned that conversations were taking place on NHS Future Fit across our border that weren’t properly taking account of the patient flows from Wales in making that choice. Now, we’re encouraged that a choice has been made today, but it does clearly need to go to clinical commissioning groups in England, so we still need to make sure. Those conversations are not yet complete, the decision isn’t yet finalised, and we need to be part of the conversation. Actually, since the start of that, Powys health board are now engaged properly as part of the programme board to understand what is happening in the way those decisions are being made.

We recognise that collaborative working does continue at a local level on the cross-border network. Healthcare commissioners and providers, including GPs, do come together on a quarterly basis to discuss local issues affecting cross-border healthcare. I want to address here the issue of the single performers list, because we won’t be supporting the amendment. We would be happy to see a single performers list, but the Department of Health in England are the issue. They’re not keen to see that happen. We’ve done all we can do to make sure that GPs can be performers on both lists in Wales and in England. We’ve done all that we could do to make that an easier and simpler process. It really does matter in areas across the border. But we want the Department of Health to come and talk to us and actually agree a way forward. We’re not in a position to require them to act in the way that we would wish them to, and that I know Members in this Chamber would wish today. It’s been a helpful discussion on that point, actually, because I simply can’t give guarantees for the English system.

We will continue to make changes that improve NHS Wales, but we can’t be held back by a UK Government refusal to do the same thing either at the same pace or in the same direction. There’s the reality of having differing systems between the borders. I’m keen, though, to do what we could do and should do, and including on the point raised by Angela Burns on sharing patient information. There’s an issue there about the quality of care that people receive.

The challenge isn’t what we do now. The challenge is what we can do to further improve on what we have. I’m happy to work with NHS England to improve outcomes, but it does, of course, require a willing partner and a level of trust. I’m happy to work in that manner now and in the future for the benefit of patients in Wales and England.