That this House has considered cross-border healthcare.
It is an honour to serve under your chairmanship, Mr Dowd. Last year, hopes were raised that two Labour Governments working together would put an end to conflict between Cardiff Bay and Westminster, yet few issues trouble my constituents more than the daily reality of cross-border healthcare between England and Wales. Powys is a beautiful county, but it is also the largest in Wales, with no district general hospital of its own. Nearly 40% of the health board’s budget is spent commissioning services across the border in Herefordshire and Shropshire, because that is where the nearest hospitals are. When co-ordination between the Welsh and UK Government fails, it is Powys patients who feel it first and hardest.
My hon. Friend is making a point about the border between England and Wales, but I represent a constituent who lives in a spot equidistant between two hospitals in Exeter and Taunton. Only one hospital could provide the treatment she needed, but the consultant there recommended rehabilitation at a third hospital across the border in Tiverton. After a lengthy back and forth, she was allowed treatment on the grounds of extenuating circumstances. Will my hon. Friend join me in pressing for a clear, binding system to allow seamless cross-border referrals where clinically appropriate?
My hon. Friend makes a valid point, and I am sure her constituents will be pleased to hear her make it. The 2018 cross-border statement of values and principles promised that no patient would face delay or disadvantage because of which side of the border they live on, but my constituents know that those principles are not being applied in practice.
The clearest recent example of what has gone wrong is the new waiting list policy introduced by Powys teaching health board this summer. From 1 July, the board instructed English hospitals treating Powys residents to deliberately and artificially extend their waiting times, bringing them into line with the longer averages elsewhere in Wales. Until now, Powys patients had been treated in hospitals, such as Hereford and Shrewsbury, in exactly the same way as English patients, but from this summer they have been asked to wait up to twice as long.
We are told that hospitals in Herefordshire and Shropshire are treating Welsh patients “too quickly” and that Powys’s budget does not allow for the current number of people being treated each year, so patients have to be spread out over more years. How appalling it is to say that a patient can be treated “too quickly”. Swift treatment should be an objective, not a problem.
Worse still, this supposed cost-cutting exercise may not save a penny, because both the Wye Valley NHS trust and the Shrewsbury and Telford hospital trust believe that it could cost Powys more, because they will have to bill Powys teaching health board for the administrative cost of running two parallel waiting list systems. That is before we consider the hidden costs: the human and financial price of patients deteriorating while they wait longer, needing emergency admissions, extended rehabilitation and, in some cases, never recovering the quality of life they once had.
My constituents are not just numbers on a spreadsheet; their lives are on hold. Those months are months of agony, of lost work, of isolation, and of watching opportunities and life slip away while waiting for operations that should already have happened. Agnes is a patient from Llandrindod with Parkinson’s disease. She has been told that she must wait another 52 weeks for a knee replacement after already waiting a full year. That means a total of two years waiting for surgery. The delay has made it increasingly difficult for her to stay active, even though regular exercise is vital to managing Parkinson’s symptoms. The prolonged wait is worsening her mobility and pain, and it is undermining her ability to live independently.
I can bring a Scottish context to the subject. A doctor in my constituency had a cataract problem and was told that the waiting list was ages. In the end, because she knew how to do it, she found out about an operation that was available in the north of England. She paid for the travel and paid to go private. The point is that if the database that my hon. Friend is talking about could show patients where to look in other parts of the UK, saying, “This is on offer, if you are willing to travel”, it could make such a difference to health services across the four nations.
My hon. Friend is right to say that these system failures are putting extra responsibility, extra stress and often extra cost on individuals, which is why the system needs to be improved. Beyond the funding and IT problems, our systemic weaknesses make cross-border care even harder. Many Powys residents are registered with GPs in England simply because of geography—they might be closer—while others just across the border stay with Welsh practices. GPs who want to work in both nations must register twice, fill out the same forms twice and follow two sets of rules, which wastes time and discourages flexibility.
A constituent of mine in mid-Wales with a rare artery condition needed ongoing treatment from Hereford hospital. Because the two NHS systems do not share results, they had to collect their own blood tests and email them to their consultant each month. Prescriptions issued in England were not approved in Wales, causing months of delay. That is the daily reality of an unco-ordinated system.
At the governance level, the 2018 cross-border statement of values and principles remains voluntary and unenforceable. Each Welsh health board negotiates its own arrangements with English trusts. There is no single tariff, no unified billing system and no consistent data reporting. Audit Wales has warned for years that this patchwork leaves patients in limbo, between two systems that both claim to care for them, but neither fully owns responsibility when things go wrong.
Those problems did not appear by accident. Powys residents do not mind which NHS logo is printed on their appointment letter; they care that their care arrives on time, that their doctors can speak to one another, and that they are treated fairly. The border should not be a barrier to treatment, data or fairness. I say to the Minister that although several of these issues fall within devolved areas, they are of direct concern to the UK Government because they are also directly influenced by NHS England and by decisions taken here in Westminster.
It is a pleasure to serve under your chairmanship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate—one that is very important to my constituents in North Northumberland.
A constituent of mine recently visited friends in the north of the county, near the border with Scotland, and sadly suddenly collapsed with a brain tumour. He was taken across the border to a Scottish hospital. But this hospital, as we have heard, could not diagnose him because it could not access English medical records. Imagine the scene: this constituent’s wife is now filling in her husband’s records from scratch, over the phone, while he waits and waits for an MRI that he cannot get in Scotland because he is under the care of Northumberland healthcare trust.
I am alarmed to realise that our country seems to have several invisible lines running through it. If someone has a stroke, heart failure or even a nasty cold on the wrong side of those lines, their illness and treatment come with strings attached. That is bad for my constituents and bad for our country. My constituents, like so many, live cross-border lives—that is just their reality. They move across the border all the time to see friends, to go shopping and to seek medical treatment. But as we have seen, if they take ill on the wrong side of the border, they will receive substandard treatment at times. That is not because there is anything wrong with the service of Scottish nurses or doctors—they are superb—but because they have no access to English medical records. There is no joined-up thinking.
Northumbria NHS foundation trust recently tried to offer the services of a new infirmary in Berwick to patients on the Scottish side of the invisible line, but up to now there has been a lack of take-up or interest from NHS Borders—something I hope to see change. The primary-secondary care link is in a bit of a black box. Patients have no idea where they will be referred by their GP. Will it be Melrose, Cramlington or Newcastle? Who arranges the appointment determines which organisation provides the referral.
It is a pleasure to serve with you in the Chair, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing the debate. I am going to give a Scottish perspective, similar to that of the hon. Member for North Northumberland (David Smith) but from the Scottish side of the border.
My constituency runs along the border between Scotland and England, touching both northern English counties of Northumberland and Cumbria. To the east of my constituency, many of the people living in the southern Berwickshire towns and villages of Eyemouth, Hutton, Paxton, Burnmouth, Chirnside, Foulden and Lamberton look to Berwick-upon-Tweed as their economic centre for shopping, work and other services—I am pleased that the hon. Member for North Northumberland is taking part in the debate. To the far south of my constituency, residents of Newcastleton and Hermitage are drawn to Carlisle—similarly, I am pleased to see the hon. Member for Carlisle (Ms Minns) in her place.
For generations before devolution, and certainly long before the SNP took control of the Scottish Government, patients from those areas were able to obtain NHS treatment in Northumberland and Cumbria without any difficulty—not because it was necessarily any better or different, but because it was more convenient. It was a reflection of the transport links that cross the border between those communities: the bus links, shorter car journeys and community ties. The border between Scotland and England is, for those communities, simply a line on the map.
This is absolutely not a criticism of the quality of care provided by NHS Borders—quite the opposite. We have first-class NHS provision at Borders general hospital and across the Scottish Borders, provided by hard-working and dedicated health professionals, to whom I pay tribute. It is not about tearing up the devolution settlement. The NHS in the Borders is absolutely the responsibility of the Scottish Government, and no one is suggesting a retreat from the Scotland Act 1998 or taking powers away from the Scottish Parliament. But it is about recognising the day-to-day challenges that people face in terms of public transport links and fitting medical appointments around work and family life.
It is a pleasure to serve under your chairship Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing this important debate.
As the Member of Parliament for Carlisle and north Cumbria, I represent a region where the realities of geography often challenge the neat lines that we find on maps, and those drawn by policy and practice. For example, earlier this year, during a prolonged power cut that affected the village of Kershopefoot, to the north-east of Carlisle, staff at ScottishPower Energy Networks were somewhat surprised to discover, after I contacted them, that they served customers in England who had a Scottish postcode.
When it comes to health, my constituents quite often face more serious issues. For some, their nearest GP might be in Scotland, but the nearest hospital is in England—in my case, the Cumberland infirmary. This can and does lead to issues.
I acknowledge the Government’s excellent work to improve healthcare access across the UK and in my constituency. In Carlisle and north Cumbria we have seen real progress: waiting lists have been cut and the urgent dental centre that opened last year is beginning to address many of the challenges we experience with NHS dental care. Those meaningful steps forward were made possible by this Government, but progress must be matched by policy that works for everyone, and especially those who live on the edge of systems, maps and borders.
One of my constituents, who lives in the northernmost part of the constituency, found himself facing a deeply troubling situation when he became very ill. He is geographically closer to Scotland and therefore registered with a Scottish GP. However, when he needed hospital care he was told he could not be treated at his local hospital in England—in Carlisle—because he was registered with a Scottish GP. Instead, he was advised to travel to Glasgow, a round trip of over 200 miles, rather than take the 40-mile trip to Carlisle.
It is a pleasure to serve under your chairship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing a debate on cross-border healthcare, because we in Northern Ireland know only too well that health outcomes are not, and should not be, defined by borders—whether an internal UK border or one with an entirely separate sovereign jurisdiction. Sickness does not discriminate.
In fact, as the only part of the United Kingdom to share a land boundary with another nation, the issue of cross-border healthcare is something on which every Northern Irish MP, I am sure, will have an opinion. Despite our constitutional sensitivities, I for one have absolutely no hesitation in saying that I am deeply proud of the progress we have made in cross-border healthcare in both Northern Ireland and the Republic of Ireland. The progress in recent decades has shown what can be achieved when we actually work together with a shared purpose.
I take note of what other hon. Members have said about the challenges across an internal UK border, which I believe we should not have in healthcare. Despite that, in Northern Ireland we need only to look at the success of the radiotherapy unit at our hospital in Altnagelvin, and more widely the north-west cancer centre based in Londonderry. Those services demonstrate the tangible benefits of co-operation for patients and communities from both sides of the border.
When I was Health Minister in 2021, I was pleased to come together with the Governments of Ireland and the United States of America to sign a new memorandum of understanding to reinvigorate the Ireland-Northern Ireland-US National Cancer Institute cancer consortium, which is an often forgotten and unsung part of the negotiations of the ’98 Belfast agreement. When it comes to cancer, we should leave no stone unturned. There are undoubtedly people on both sides of the border who are alive today because of that practical and sensible co-operation. By continuing to refine that service level agreement, expanding areas such as skin cancer treatment, and deepening our joint research in clinical trials, Northern Ireland will once again be strengthening cancer services and helping to advance the fight against rare and specialist cancers across the island.
The hon. Gentleman may know that I have family living in the north, in Armagh and Antrim, and a daughter living in Donegal. What he says is absolutely correct—I can vouch for that, and it is an example for us all. When somebody is sick and we are worried about what will happen next, we do not care about lines on maps. The point I want to make is this: it strikes me that this is an easy issue for the present Government, because it need not cost lots of money. Often, we ask for stuff and there is a huge bill attached, but just knocking heads together and saying, “Get real. Get the computer system online. Talk to each other,” is doable, and it would make such a difference for people even up as far north as where I represent.
I thank the hon. Member for raising a valid point that comes to the crux of this debate and of what has been said by every Member so far. It is about putting the “national” back in our national health service, and doing so across borders without the unnecessary bureaucracy that often comes with how we look after our patients.
There is still more to do on this issue, and no system is perfect. I know from engaging with our current Health Minister in Northern Ireland, my party colleague, that there is potential for further north-south co-operation in other specialist paediatric services that lend themselves to an all-island approach, including the hugely emotive and sensitive issue of perinatal and paediatric pathology. Northern Ireland has been without a paediatric pathologist for some time, so an all-island solution should be looked at.
As the hon. Member said, ambulances in Northern Ireland regularly cross the border in both directions to save lives. Our two ambulance services have an agreement in place to provide mutual aid, with personnel from either service able to cross the border to assist in emergencies.
I believe that the future of healthcare will be defined by the digital innovation that has been referred to, and it will be a great step forward when we can get the national health services talking to each other—it is only recently that we have been able to get our five trusts in Northern Ireland sharing digital information. The will is there if the finance and support are there on genomic medicine, workforce planning and the interoperability of electronic health records. By collaborating on the genomics of rare disease and planning jointly for a workforce that can identify and close future gaps in work, we can ensure that the entire island—and islands—benefit from technological and medical advances.
Our co-operation should not just be practical; it should actually improve outcomes. It is proof that where health is concerned, cross-border partnerships really work. I encourage the Minister to take forward the recommendations made in this debate today.
Several hon. Members rose—
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Hazel, from Builth Wells, is awaiting spinal surgery in Hereford. Her expected waiting time has doubled to 104 weeks. She has been unable to work during this period due to numbness in her legs and feet, and she now fears losing her job. Once financially independent, she now relies on family support—an experience she describes as “degrading and unfair”—through no fault of her own.
Kelly was diagnosed with serious spinal disc problems in September 2024. She was given a surgery date for December, then March, but both were cancelled. Even though her pre-operative assessment had been completed, she later discovered—on her own—that her operation had been postponed by at least another year under the new policy. This is despite her being classed as an urgent P3 case and being told that existing bookings would not be affected. The delay has left Kelly in constant pain, which has taken a serious toll on her mental health and has contributed to her losing her job.
Those stories are not isolated; they speak for hundreds of others who are being quietly told to wait, not because of capacity or clinical need but because of budgetary decisions. Behind every statistic is a person whose life is being diminished while they wait for care that should already have been delivered.
What makes this even worse is that patients are sometimes not being told that their treatment has been delayed. Many have found out only through news reports or by doing their own investigations. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work, yet this policy, which Ministers could stop tomorrow, does the exact opposite. The health board and senior Welsh Labour politicians call it “fairness” that Powys residents should wait no less than anyone else in Wales. However, fairness and ambition should mean lifting standards everywhere, not dragging Powys down to the lowest common denominator.
It is not equality; it is equal punishment for the Welsh Government’s failure to fix the NHS after 25 years in power. The response from Ministers thus far, particularly in Cardiff Bay, has been nothing short of disgraceful. The Health Minister, Jeremy Miles, could not appear more uninterested if he tried—no action, no intervention and no urgency from the one man who has the power to stop the policy and to get people out of pain and back to their lives. Several constituents have told me that they have written personally to him and have received no response at all. That is despite the fact that it is his Government who are forcing Powys teaching health board to make significant cuts to its budget.
As for the First Minister—who, I remind the House, represents Powys in the Senedd, as well as being a Member of the House of Lords—she brushed off my constituents’ concerns, saying that she thinks it is just “smoke and mirrors”. I invite her to say that directly to Kelly, Agnes and Hazel, because months or even years of their lives have been stolen and spent living in pain.
The decision institutionalises inequality between Wales and England. If the waiting list policy exposes a failure of funding, the digital infrastructure of cross-border healthcare exposes a long-term failure of systems. Despite 25 years of devolution, we still have national health services across our four nations that cannot share data efficiently. Both NHS England and NHS Wales still operate separate digital systems that do not talk to each other. When a Powys GP refers a patient to Hereford or Shrewsbury, information often travels by post, fax or unsecured email. Discharge summaries arrive late or not at all. Test results are duplicated because clinicians cannot see each other’s records, wasting time and often causing distress for patients.
Even in emergencies, A&E doctors in England cannot automatically view a Welsh GP’s records, and vice versa. To paint the picture more vividly, one Powys resident told me that he was admitted to Shrewsbury hospital with a serious heart condition, yet staff could not access his medical records. Because it was a Sunday, they could not even reach his GP by phone.
That should not be happening in 2025. It puts lives at risk across our border regions. The lack of interoperability affects anyone moving between the four nations of the United Kingdom, as their health records tend not to move with them. The Welsh Affairs Committee has been calling for change since 2015, yet a decade later, nothing has happened. The Welsh Government alone do not have the funding to overhaul their systems, which is why we have called on Westminster to step in, as obviously this is a consequence of devolution. For a fraction of the cost of other Government digital projects, modernising NHS IT across the UK would directly improve patient safety, continuity of care and confidence in the system. Every week that remains unresolved, more patients are put at risk, which is a failure of politics, not just technology.
My asks are simple. First, convene a meeting with counterparts in the devolved nations to finally address these cross-border challenges, and invite border MPs to that discussion. Those of us who represent border communities see these failures at first hand and know where the solutions are needed. Secondly, provide the funding required to make NHS IT systems interoperable across the United Kingdom, so that clinicians can share patient information safely and instantly wherever care is delivered. Thirdly, work with devolved Governments to give the cross-border statement of values and principles legal force, turning it from a voluntary pledge into a real, accountable framework that protects people in border communities like Powys.
We owe it to the people of Powys, and to every border community, to end this quiet injustice and to build a system that treats them not as second-class citizens but as equals who are entitled to the same care, dignity and chance to live free from pain. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work. However, this policy, which Ministers could stop tomorrow, does the exact opposite. I look forward to the Minister’s response and the contributions from other Members.
It does not have to be this way. The technical solutions clearly exist, as we heard from the hon. Member for Brecon, Radnor and Cwm Tawe, but the SNP Government in Edinburgh frankly have no incentive to make cross-border care work. I am sad to see no SNP Members here today. They are ideologically opposed to the choices that could lead to a cross-border, British healthcare system that serves all British people equally.
It is worse than that. I was recently contacted by a young constituent who lives in North Northumberland, in the north of England, and works in the Scottish Ambulance Service. They hope to take up further training in Scotland so that they can continue employment, but the Scottish funding support will not cover them because they are not Scottish, and the English support will not cover them because they want to study in Scotland. A British student who wants to study at a British university in order to save British lives cannot do so. That is a farcical situation.
This is the reality for many of my constituents. We must get better at joining the dots and realising that real people live holistically in the geography of where they are, which should not be determined by what are, in British terms, invisible lines on the map. If that is the situation now, imagine the mess for healthcare if the SNP were successful in its policy of independence. Because of bad cross-border healthcare my constituents are suffering, and the Union that so many of us cherish is suffering too.
It is also about highlighting the fact that since the SNP came to power in Holyrood, the real-life experience of many people in the Borders is that the option of cross-border healthcare has been diminished. It is about reaffirming that we are still part of one United Kingdom, and that the NHS is rightly an institution that we should be able to use regardless of which side of the border we live on.
The easiest way to describe the challenges that people face in my constituency is to share some of the stories that have been told to me in recent weeks. Margaret Merry said:
“I live in Eyemouth. Once I had to take a full day off work and 4 buses to travel to the Borders General Hospital for an x-ray, when I was working in Berwick, a 5 minute walk from where I could have had it done and only taken maybe 15 minutes out of my working day. It is ridiculous.”
Pauline Hutton said:
“I am currently under the care of BGH for cancer treatment and have to travel from Ladykirk to BGH daily for chemo. The treatment is excellent and I can’t praise the staff enough…but a simple thing like giving a blood sample means a 40 mile journey as I can’t give blood at our local surgery in Norham (1/2 mile away) because it’s in England and Borders General Hospital can’t access my results cross border. In this day of technology I can’t fathom out why medical records are all computerised yet one NHS trust can’t have access to patients medical records from another trust.”
Dennis McKeen said:
“Some patients in Newcastleton would also prefer to go to Carlisle rather than a 90 mile plus round trip to the Borders General Hospital...it’s ridiculous”.
Brenda Walker said:
“I am currently travelling from the east coast 3 times per week for dialysis at Borders General Hospital thanks to their transport system getting picked up at 6.40 am. The nurses do a brilliant job looking after us”.
Trixie Collin said:
“Currently I live in Scotland but was told that if I moved to England I would no longer be able to be seen by the consultant at Western General who had been treating me for 10 years.”
The Brucegate dental practice in Berwick-upon-Tweed said:
“As a healthcare provider in England it’s a daily problem on both sides of the border. I get rejections of referrals from both England and Scotland based on postcodes. Thanks for standing up for common sense.”
Kirsty Jamieson from Berwick-upon-Tweed said:
“We campaigned hard for reciprocal care between people living in the Borders and North Northumberland, during the 2018 A Better Hospital for Berwick campaign. No joined up thinking whatsoever.”
Lastly, Kate Tulloch highlighted the fact that this is not just a Scotland-England problem. Kate lives in Cockburnspath, which is Berwickshire in Scotland. Her GP is in Dunbar, which is also in Scotland, but Kate cannot get NHS Borders results because the two health boards, despite both being in Scotland, do not communicate. So this is not just a cross-border issue for Scotland and England; it is an issue of different health boards in Scotland not communicating properly.
All these stories clearly demonstrate the difficulties that my constituents face in accessing treatment across the border. I appreciate that this is not the Minister’s direct responsibility, but I would be grateful if she could relay my asks to her colleagues. First, will the Minister meet me to discuss how we can address the challenges that some of my constituents face when it comes to cross-border healthcare? Secondly, does the Minister recognise that we need to find a solution, and can she commit to working with the Scottish Government to overcome the perceived challenges that they are putting in place?
This is not just about extra money or funding; it is about putting in place common-sense solutions. NHS Northumberland has indicated that it is more than willing to accept patients from the Scottish Borders and other parts of Scotland, and NHS Cumbria has indicated similarly and is, I think, currently doing that for some patients. We must break through the ideological barrier that many of us believe the Scottish National party Government have put in place to stop what has happened for many years—people accessing NHS treatment on either side of the border.
This is a man who lives in England, pays his taxes here and has his bins collected by an English local authority, and whose nearest hospital is in England, but he was told to travel to Glasgow for care—not because of clinical need or even capacity, but because of outdated guidance. Thankfully, after the intervention of his GP and other dedicated health professionals, he was able to receive the treatment that he needed locally, but his case should not have required such extraordinary effort. It should never have required the negotiation it took and should not have required escalation. It should have been common sense.
The English guidance does not adequately cover cross-border scenarios, and I am told the Scottish guidance predates the creation of the integrated care boards altogether. I am very grateful to the Minister for Care for giving me his time a few weeks ago to discuss this issue. I know he recognises that this needs to be urgently resolved. I would welcome any update that I can share from the Minister today on whether the guidance is now to be reviewed and improvements are under way. We must ensure that all relevant healthcare providers are equipped with clear, up-to-date information, because we all want the same thing: a system that works for patients, wherever they live.
This is not a question of politics, as we can see from the cross-party presence at this debate—although the absence of the SNP is notable. I am pleased to see my constituency neighbour, the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont), in his place. This is a question of practicality, compassion and, as the hon. Gentleman said, common sense. We must ensure that our healthcare system reflects the lived realities of our constituents, and not the lines on a map. I urge the Minister to take this issue forward with urgency. I stand ready to support any efforts to improve cross-border healthcare.
The same collaborative spirit is exemplified in paediatric cardiac care. Our all-island congenital heart disease network—an issue to which my family is as close as we can be—has ensured that children with complex needs can access world-class treatment without unnecessary delay or travel. I have seen at first hand that such cross-border co-operation works. Our youngest son was eight months old when he needed his first open-heart surgery, and that was conducted at Birmingham children’s hospital. He was 10 years old when he needed his pacemaker replaced, but that was done in the children’s hospital in Dublin because of that cross-border work. We in Northern Ireland know all too well about our reliance on the working relationships that we have across borders, should that be across the UK or with our partners in the Republic of Ireland.