Background to the inquiry

1.  Welsh life does not stop at the border with England. The Welsh and English populations move freely between the two nations, and the border's porous nature allows people to access public services on both sides of Offa's Dyke. Social networks, transport infrastructure and work patterns mean that Welsh people often gravitate in an east-west direction as opposed to looking north or south. As a consequence, access to public services by Welsh and English people has traditionally been characterised by a free flow of cross-border movement.

2.  Since the introduction of democratic devolution in 1999, members of the public, civic society and public service providers have voiced concern that policy makers in Cardiff and London are failing to consider the impact of diverging policy on the natural flow of people across the Welsh-English border. It has become clear to us that consideration needs to be given to the impact diverging policy has on individuals accessing and providing public services in both jurisdictions. Attention also needs to be paid to the ways in which administrations in England and Wales can work together more effectively to ensure equal access for all citizens to public services, regardless of residence.

Purpose of the interim Report

3.  In November 2007, the Welsh Affairs Committee announced its wide-ranging inquiry into the provision of cross-border public services for Wales. We announced our intention to explore the provision of health services in the first instance, followed by consideration of cross-border issues as they affect further and higher education and transport.

4.  This interim Report focuses on issues concerning the cross-border provision of health services. Our intention is to provide a timely contribution to the current discussions surrounding:

a)   the proposed protocol between the Department of Health and the Welsh Assembly Government on cross-border health provision;[1]

b)  the proposed restructuring of the NHS in Wales and its impact on cross-border health services;[2]

c)  Mr James Steers's review of neurosciences services for Welsh patients.[3]

5.  This interim Report therefore aims to summarise cross-border health issues highlighted so far in our inquiry. We begin by outlining the services that are currently used by Welsh patients on a cross-border basis. We then describe the policy divergence that has occurred between the English and Welsh NHS. The commissioning and funding of cross-border health services are considered, as are the current arrangements for the co-ordination of services. Each of these areas impact on patients who receive their treatment on a cross-border basis; consideration is given therefore to confusion and concern expressed by patients during the Committee's inquiry. We conclude by providing a set of criteria to which the health policies of the Department of Health and the Welsh Assembly Government ought to aspire and which ought to guide health bodies on both sides of the border in order to meet the needs and expectations of cross-border users of health services.

Next steps

6.  Following the conclusion of the Steers review, the response of the Welsh Assembly Government to the current consultation on the restructuring of the NHS in Wales, and the anticipated announcement of the establishment of a formal protocol on cross-border health services between the Department of Health and the Welsh Assembly Government, we will publish our full report which will draw on written evidence that we have received, and oral evidence sessions conducted between March and June 2008. The detail of the current reviews, consultations and draft protocols will also be considered, and will be measured against the criteria outlined in the final chapter of this interim Report. We would welcome further evidence from any interested parties on any of these issues by 30 September 2008.

7.  We thank all those who have taken the time to share their views with us to date, and welcome further relevant contributions to our inquiry. We would also like to thank our specialist adviser, Professor Marcus Longley, who has provided expert guidance and advice.

2   Welsh Assembly Government, Proposals to change the structure of the NHS in Wales: Consultation Paper, 2 April 2008  Back

3   The decision to establish an Independent Neurosurgery Task and Finish Group, chaired by Edinburgh-based neurosurgeon Mr James Steers, was announced in a Welsh Assembly Government decision report on 25 September 2007 http://wales.gov.uk/publications/accessinfo/drnewhomepage/healthdrs/healthdrs2007/1931940/?lang=en Back