Memorandum submitted by the Royal College of Physicians (CBPS 33)

Provision of cross-border public services for Wales

We are pleased to submit evidence to the above Inquiry. The Royal College of Physicians (RCP) plays a leading role in the delivery of high quality patient care by setting standards of medical practice and promoting clinical excellence. We provide physicians in the United Kingdom and overseas with education, training and support throughout their careers. As an independent body representing over 20,000 Fellows and Members worldwide, we advise and work with government, the public, patients and other professions to improve health and healthcare.

The College has a Regional Adviser for Service in each region of England, Wales, and Northern Ireland. The geographical boundary for each region is normally co-terminus with that of the local Deanery although in some parts of the country there are exceptions to allow for local circumstances and practicality. Regional Advisers for Service are Fellows of the College, normally an NHS consultant in one of our "mainstream" specialties (as recognised by PMETB). They are elected initially to the Associate role, by Fellows within their region from candidates who are willing to devote time and energy on behalf of the College, and through that for the wider benefit of the NHS. For the purposes of this inquiry we have consulted with our Regional Advisers for Service in Wales and the bordering counties in England. We would like to make the following points:

The subject of the inquiry has certainly become an issue over the last few years. There are concerns in both directions. We are currently aware of problems for certain patients in Wales who have been unable due to boundary issues to access certain treatments (e.g. Enzyme replacement Therapy, Gender Reassignment Surgery). There are also patients from English Regions managed in Welsh Hospitals who are unhappy that they have to wait longer for treatments than friends from the same village who are managed in a neighbouring English Trust. Conversely, there are also patients from English Regions who go to Wales to receive free prescriptions.

The College believes it is important to identify the scope of the possible problems (medical, political and financial - in particular the tariffs under Payment by Results). We feel there should be further opportunities to highlight some of the more unfair differences, once the Select Committee has reported.

20 March 2008