Welsh Affairs Committee
Wednesday 11th November 2026
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Ruth Jones
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Ruth Jones
Thank you very much. Okay, let me ask first, Simon Evans and Rosalind Rich. So we've done a lot of work about you know obviously we're looking at it from the Welsh side. Can you describe to us the process of of a Welsh patient being referred to an English service? And tell us about the pathway and any potential barriers or difficulties and maybe good parts to it that would be really helpful. Shall I start with.
14:30
Speaker 2
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Speaker 2
Great. Thank you very much. So the nature of the referral ultimately is for patients who are in Wales who are going to a hospital that's either delivered in a. Services are delivered in England because their specialist services or because they're the nearest hospital to those patients. And the beginning of that pathway is largely the same for Welsh patients as it is for English patients. They will visit typically their primary care practitioner, their GP, and they will they will discuss their their issues with their practitioner. And the GP will make a decision there in terms of referral for specialist services, typically that are required by an acute hospital.
At that point, it starts to differ in terms of what happens for Welsh patients, as it does for English and for Welsh patients accessing English hospitals. They will use a referral system, which we call the referral Assessment Service. So that is a digital system. It will enable the GP to put the details of the referral into a system which will go through to a service that's hosted by Shrewsbury at STW ICB, and that is a service that was set up after the 2015 Select committee saying that we needed to standardise an approach for Welsh patients being referred into English hospitals, and that referral will then go through to the appropriate hospital in England.
And those specialist, typically consultants will review that referral, check that everything is there that's required in order to be able to then take that pathway forward for their patient, and the hospital will then process that patient's appointment. So they will contact the patient directly, they will book that within the hospital, and they will, if necessary, liaise with patient transport services in order to be able to get the patient through to the hospital. And from that point on, that acute hospital will look after that patient and the rest of their journey, ideally through to treatment and then discharge back.
At that point, it starts to differ in terms of what happens for Welsh patients, as it does for English and for Welsh patients accessing English hospitals. They will use a referral system, which we call the referral Assessment Service. So that is a digital system. It will enable the GP to put the details of the referral into a system which will go through to a service that's hosted by Shrewsbury at STW ICB, and that is a service that was set up after the 2015 Select committee saying that we needed to standardise an approach for Welsh patients being referred into English hospitals, and that referral will then go through to the appropriate hospital in England.
And those specialist, typically consultants will review that referral, check that everything is there that's required in order to be able to then take that pathway forward for their patient, and the hospital will then process that patient's appointment. So they will contact the patient directly, they will book that within the hospital, and they will, if necessary, liaise with patient transport services in order to be able to get the patient through to the hospital. And from that point on, that acute hospital will look after that patient and the rest of their journey, ideally through to treatment and then discharge back.
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Speaker 1
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Speaker 1
So I suppose one of the differences would be for specialised services, where it would be for a determination in terms of the Ipaf Ipaf panel runs within Wales within the Welsh Committee for Specialised Services. But then there is a referral process through to England for those specialised services. It is an area that we have said that we would be open to look with Welsh colleagues if there was an opportunity for us to mirror the same sort of approach that we have with Scotland, where there is a more formal agreement as to which of the specialised services would be accessed across our highly specialised services in particular.
So we think there's some learning there, because I think in some cases, colleagues do think that there are some areas where we could reduce the bureaucracy, but hopefully that's not focused or evident to the patient themselves. It's more a matter of streamlining the process as we go through. Once the decision has been made within Wales, that that is an appropriate referral for those highly specialised services.
So we think there's some learning there, because I think in some cases, colleagues do think that there are some areas where we could reduce the bureaucracy, but hopefully that's not focused or evident to the patient themselves. It's more a matter of streamlining the process as we go through. Once the decision has been made within Wales, that that is an appropriate referral for those highly specialised services.
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Henry Tufnell
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Henry Tufnell
Thank you chair. So my understanding you can correct me if I'm wrong. We've got long term agreements. Ltas in terms of the different pathways that patients can go down, prior approval or individual patient funding requests. So IPFS depending on whether you're in terms of specialist service for for long term agreements, prior approval in terms of a local treatment options being exhausted or in respect of ipfw's, where a new novel or developing treatment is available in in England that isn't in in Wales. So how confident are you that referring organisations in Wales and providers in England have a shared understanding of the referral criteria, the eligibility requirements and those commissioning arrangements?
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Speaker 1
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Speaker 1
I think certainly I mean, I'll talk particularly for the specialised services. I think colleagues are very clear about which of the services fit within those boundaries, both in terms of the IFR panels, etc.. Those very much set out in law those very clear parameters for those. And they sit very clearly within the joint committees within Wales and within England, and there's very good working relationships for those colleagues.
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Henry Tufnell
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Henry Tufnell
Can I break that down a little bit, though, because we had stats from an IAR in Bevan University Health Board. So. And they for the year 2425 they had four. And this is specifically for long term agreements that you've just set out is that we had 4500 referrals made under that long term agreement by the local health boards to seven local health boards in Wales, and then 850, well, just annoying Bevan being one of them. And then 854 referrals being commissioned by the NHS Wales Joint Commissioning Committee. So significantly more coming from the local health boards.
But there is a distinction there in terms of the the referring organisation and and and I guess the question as part of my question is whether there's a differential or in patient experience as a result of coming from those two those two different referral organisations.
But there is a distinction there in terms of the the referring organisation and and and I guess the question as part of my question is whether there's a differential or in patient experience as a result of coming from those two those two different referral organisations.
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Speaker 1
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Speaker 1
I think one response I would say is that those would be for different levels of service, depending on what went through to the joint committee versus what came directly through from from the local health board. Because if it was for a specialised service, it would sit within the remit of the of the joint committee. So I think they are two different levels of service that those patients would access. I would have to take away, I have to admit, because I'm very close to the specialised services, the question in relation to the the the numbers that you're talking about in terms of the health board, I don't know, Caroline, whether you've got any further clarity , because that's more your your health.
But it.
But it.
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Gill German
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Gill German
Poses the question for me as to whether the the larger number that you mentioned there, whether that would include some patients who would have been have gone through the referral assessment service that Simon described because and I am Bevan, the, the the commissioner then for that cohort of patients who live in England but have a Welsh registered GP. So that number may may be included within those figures that you have there, probably around about 600 or so a year are supported through that process.
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Henry Tufnell
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Henry Tufnell
But there's no difference. You're saying, in terms of the patient experience coming from a joint commissioning or from a local health board in terms of patient? I mean, we could go in terms of referrals. If you look at the if you've got 1000 coming from via the prior approval route and 98 via the IP route from local health boards. So there's different numbers depending on different referring organisation and therefore just understanding whether the providers in England understand there's a sufficient understanding of those criteria, eligibility criteria, commissioning and so forth.
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Gill German
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Gill German
I can only speak for providers in the Gloucestershire area but. But yes, they would understand the difference between an English resident with a Welsh GP and a Welsh resident who may access services at our acute trust as well. Those numbers would be relatively small, but they do sometimes come across to you, particularly some of the cancer services, so they would be aware that there's a different process in place for each of those. The patient I don't think would be aware and they wouldn't necessarily see anything different would be my view from a patient perspective. I don't think that the process would be very different at all.
But from the staffing perspective, as far as sort of whether prior approval is required or not, the trust would be very much aware of the the requirements there.
But from the staffing perspective, as far as sort of whether prior approval is required or not, the trust would be very much aware of the the requirements there.
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Speaker 2
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Speaker 2
The the vast majority of referral pathways will work almost seamlessly. So from an originating referral to the primary care practitioner, putting that through to the acute hospital, in reality, the time that that will take will be within days, the patient will be contacted really very quickly, and that appointment will be set within days. The actual time for the appointment will be dependent on the availability of capacity and the waiting times for that service, but the referral process itself will be actually a relatively slick operation, particularly now it's using this referral assessment service, which means the likelihood is it won't be redirected anywhere.
It will just go straight through to the right service from from the first offer.
It will just go straight through to the right service from from the first offer.
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Henry Tufnell
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Henry Tufnell
Do you have the sense that there's a sort of a lack of understanding about the nuances in respect of the Welsh system when it comes to these pathways that perhaps I'm I try to set them out, but perhaps you you don't understand the nuances of the bureaucracy that is faced in respect to some of these pathways. Is that fair?
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Henry Tufnell
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Henry Tufnell
In terms of breaking it down into these different routes from different organisations that are referring in. Yes. And that you're, you're you're seeming to suggest that it's straightforward, that it's a seamless process. And it doesn't matter which organisation refers into the patients being treated nonetheless in the correct manner through the correct pathway.
14:41
Speaker 2
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Speaker 2
So the referring organisation will be the primary care organization, not necessarily the health board. So the GP will make the referral in the vast majority of cases. Once that patient's been accepted, and they understand then the nature of that treatment, that may then move into a commissioning discussion about whether that is a treatment that can be provided.
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Henry Tufnell
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Henry Tufnell
Route into as to whether there's a whether there's a differential in terms of the patient experience as to whether whether the referring, whether the change in referring organisation has an impact on the patient experience. So whether it comes from the joint commissioning, whether it comes from the local health board.
14:41
Speaker 1
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Speaker 1
One of the distinctions would be that the the sort of services or the patients who would be considered within joint commissioning will be patients already on a consultant, a consultant provision as opposed to. So those are the specialist services as opposed to the general urgent or elective services that would come through from the primary care referral onto the secondary care provision. So it will be a different part of the pathway and a different discussion between the consultant. So patients will have already been. So I suppose they are different service areas and different conversations that are happening.
But in both of those contexts, the referring clinician, whether they are a primary care clinician, referring through RA and into secondary care within England, or a secondary care clinician working within Wales or within the initial referring organisation within England, they will understand the process and be able to articulate that with the patient, to understand how that decision is being made in terms of the Welsh decision, because it would be for Wales to make a decision in terms of the specialised services. So I suppose the distinction is the different parts of the pathway and the different consultants, depending on which of the pathways are.
But in both of those contexts, the referring clinician, whether they are a primary care clinician, referring through RA and into secondary care within England, or a secondary care clinician working within Wales or within the initial referring organisation within England, they will understand the process and be able to articulate that with the patient, to understand how that decision is being made in terms of the Welsh decision, because it would be for Wales to make a decision in terms of the specialised services. So I suppose the distinction is the different parts of the pathway and the different consultants, depending on which of the pathways are.
14:43
Henry Tufnell
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Henry Tufnell
Trying to understand, and forgive me for taking this, though, is that it's we've heard in evidence that it's okay when there's established relationship between consultants in England and Wales, because they have that relationship. Those those pathways are clear when it becomes unclear and difficult in respect to the patient experiences, when they're relying on the system that's in place, when there isn't that established relationship, when perhaps the system is more opaque, and then there becomes trouble in terms of the patient experience and the quality of the health care that they're receiving. And that's what I was trying to get into .
In respect of the question.
In respect of the question.
14:43
Speaker 1
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Speaker 1
Thank you. And I think that's one of the reasons why I raised this issue, particularly for more highly specialised services or for the specialised services, because generally for the established referral routes, whether that's cancer, cardiac, etcetera, musculoskeletal issues, etc., those established relationships are in place and very well embedded within the acute trusts across the border with the Welsh colleagues. The issue comes, and that will also be the case for very for the more common specialised services that that fall as well. The issue comes, I suppose, from a patient experience or understanding where there are the very highly specialised services.
So where we've only got, say, three centres, five centres in the whole of England who provide this particular services. And that's where very much we're clear about the process. Everybody is clear about which services those relate to because they're very clearly defined, but they may not have an established clinical relationships. And therefore that's where I was bringing the learning that we've had from Scotland that actually having whilst there is very good, there are very good relationships between the Joint Committee, specialised services and the English highly specialised commissioning teams, which will continue through the future, there are established relationships.
We do feel that's an area where we could probably have a much clearer framework between those two teams as we go through for which services and what those referrals, sorry, referral rates might be.
So where we've only got, say, three centres, five centres in the whole of England who provide this particular services. And that's where very much we're clear about the process. Everybody is clear about which services those relate to because they're very clearly defined, but they may not have an established clinical relationships. And therefore that's where I was bringing the learning that we've had from Scotland that actually having whilst there is very good, there are very good relationships between the Joint Committee, specialised services and the English highly specialised commissioning teams, which will continue through the future, there are established relationships.
We do feel that's an area where we could probably have a much clearer framework between those two teams as we go through for which services and what those referrals, sorry, referral rates might be.
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Steve Witherden
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Steve Witherden
Thank you. Chair. Good afternoon, Mr. Evans. In the whole of Powis there, there are no district hospitals, so my constituents in Montgomeryshire must go over the border to Gobowen, Shrewsbury, Telford for their surgeries and procedures. So. So when a Welsh patient is receiving care from an English NHS trust who is ultimately responsible for the coordination of that care, and also, is that responsibility always clear to clinicians and even more importantly, to patients?
14:45
Speaker 2
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Speaker 2
So where are patients been accepted into that English hospital? So if we describe that referral route and they have been seen, it is the responsibility of the English Hospital to coordinate that care through to the point of treatment. However, that's there are times when the acute hospitals will need to work with local provision, community services, primary care services, and that's when some of the communication challenges might start to appear. But in terms of the oversight, the acute hospital is responsible for looking after that patient from the point of accepting that referral through to the point of treatment and hopefully a safe discharge home at that point.
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Steve Witherden
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Steve Witherden
And so with different software and, you know, communication either side of, of Offa's Dyke, those, those that communication between Wales and England, in my instance, between Powis and Shropshire do, do clinicians on both sides of the border have to rely on informal relationships, you know, to communicate, you know, to, to, to, to resolve these, these coordinate coordination issues or not in your opinion.
14:47
Speaker 2
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Speaker 2
I think we see some of that informal relationships even within England itself. And that is part of the kind of networking and interface of acute hospitals, particularly with primary care, where in reality there are many, many different providers and many practices, it makes it quite challenging to be able to create sort of structured response to some of those. However, in in reality it is it is more challenging just probably because of the distance and because of the frequency of some of those referrals. English hospitals will see greater proportions of of English GP referrals coming through on a regular basis.
The digital. I think we will come on to later. We see slightly different levels of digital provision in terms of communication, depending on the maturity of each of our hospitals. So whether it be Robert Jones, Agnes Hunt, Specialist Services or Shrewsbury and Telford, they will have slightly different maturity and therefore differing levels of digital communication with patients. However, it is important that the acute hospitals still have a responsibility to communicate with the referring practitioner, either through letters or through electronic letters, and also with the patient in terms of summaries, discharge summaries, some of which may be electronic, some of which will still be paper.
The digital. I think we will come on to later. We see slightly different levels of digital provision in terms of communication, depending on the maturity of each of our hospitals. So whether it be Robert Jones, Agnes Hunt, Specialist Services or Shrewsbury and Telford, they will have slightly different maturity and therefore differing levels of digital communication with patients. However, it is important that the acute hospitals still have a responsibility to communicate with the referring practitioner, either through letters or through electronic letters, and also with the patient in terms of summaries, discharge summaries, some of which may be electronic, some of which will still be paper.
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Henry Tufnell
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Henry Tufnell
Thank you. Chair, can I just go on to arrangements you've got in place to ensure that patient experience is as a seamless service across organizational boundaries? And the reason why I ask this question is we've had written evidence as a committee to suggest that patient pathways are often fragmented. There's delays in communication, unclear clinical responsibility, and the administrative burden on GPS often inhibits this seamless cross-border workings with patients. So.
So the original question is what arrangements do you have in place to ensure patient experience is seamless? Service across organizational boundaries.
So the original question is what arrangements do you have in place to ensure patient experience is seamless? Service across organizational boundaries.
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Speaker 2
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Speaker 2
So I have described some of the sort of key interface points with patients that are through the acute hospital route, where care is transferred back into the community. It is still the responsibility of that of the acute hospital, essentially, to ensure that that the information is provided to the next point of care. We see some of that transfer of care issues that you've just described there within the English system, as we do with England and Wales, where the timeliness, perhaps, of some of those communication will become a barrier between seamless care. And also patients will sometimes see that in terms of any if there's any delays in communication and letters where they might see that they might be under the care of the hospital, but also perhaps under the care of a community provider.
As part of that, ultimately, the best way to manage that is to have a single interface with NHS services like the NHS app. But as we know that the NHS app doesn't necessarily run seamlessly between between Welsh and English services.
As part of that, ultimately, the best way to manage that is to have a single interface with NHS services like the NHS app. But as we know that the NHS app doesn't necessarily run seamlessly between between Welsh and English services.
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Speaker 1
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Speaker 1
To know? I'll just say, I mean, there's the individual patient experience, but at a at a broader level as well. One of the other mechanisms that we have absolutely committed to is that we can bring issues, and we have, through the cross border network, we have both lawyers representation, Healthwatch representation, etc. so if there are individual autorisé, recurring issues and themes that are coming through, we will have those mechanisms to be able to raise them, escalate them, and to make the right connections, to be able to enable people to both get learning of what works well, because we work across a number of organisations across, across the, the border.
But and the other aspect, I suppose, is there is still also the formal consultation and engagement mechanisms that are in place. And for example, in relation to the current Paris consultation at the moment, the mechanisms that are in place to ensure that both commissioners and providers from from England can contribute to those and vice versa if there are different service configuration issues. So the patient voice is absolutely critical in terms of our patient experience and understanding about how we can develop services at an individual level, but also in terms of how we think forward about how we plan services for the future.
And obviously, you know, we'll we'll be continued within the context of the the future changes in the NHS at the moment as well. But a lot of it, I mean, we will come on to digital issues as well. There are some some opportunities there where actually we can hopefully, as things move forward with digital systems, actually enable some of that better digital flow to enable patient engagement. Another issue which I know is of is of clear interest, is the ability for people to be able to engage in services in their own language and in the Welsh language and have that supported.
But and the other aspect, I suppose, is there is still also the formal consultation and engagement mechanisms that are in place. And for example, in relation to the current Paris consultation at the moment, the mechanisms that are in place to ensure that both commissioners and providers from from England can contribute to those and vice versa if there are different service configuration issues. So the patient voice is absolutely critical in terms of our patient experience and understanding about how we can develop services at an individual level, but also in terms of how we think forward about how we plan services for the future.
And obviously, you know, we'll we'll be continued within the context of the the future changes in the NHS at the moment as well. But a lot of it, I mean, we will come on to digital issues as well. There are some some opportunities there where actually we can hopefully, as things move forward with digital systems, actually enable some of that better digital flow to enable patient engagement. Another issue which I know is of is of clear interest, is the ability for people to be able to engage in services in their own language and in the Welsh language and have that supported.
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Henry Tufnell
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Henry Tufnell
Just quickly, before the chair takes the questioning on questioning off me, are you able just you set out earlier that in your question, in your answer, that there are similar issues in respect of coordination in England? So are you suggesting that these challenges remain in England? You know, it's the same in terms of people trying to access across the border as it would be in terms of trying to access different care across across England.
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Gill German
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Gill German
The only thing that I can really add from a Gloucestershire perspective, any of the patients that have been referred in through the referral assessment service, we do from time to time, run patient satisfaction surveys to understand what their experience of using that referral process is being, and they are usually very positive. I haven't got a percentage figures here to hand, but I can provide those to the committee if that would be helpful. They would only be for Gloucestershire patients and elsewhere along the border. They may run similar processes, but we do get very positive feedback generally.
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Gill German
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Gill German
From the pathway into care? So this is purely that referral assessment service, where the referral service will contact the patient and work through their their options, their choice that we have under the English system. So that was part of the rationale for setting up the referral service in the first place, was to enable English residents with Welsh GPS to have access into that, that choice, in the same way that any other Gloucestershire resident would. So so it is specifically about that referral process through. Rather than the actual care or appointment that that patient experience is gathered actually before they've usually gone through the process.
So they may not have had their appointment yet, but it is purely on that referral service. So we hear very positive feedback from patients about it. We also hear extremely positive feedback from our GP surgeries. We have seven practices that border Gloucestershire, that have that are Welsh practices that have English residents. They all have been using the some of them right from its inception and some from about 12 months afterwards. But they they all value that process.
So they may not have had their appointment yet, but it is purely on that referral service. So we hear very positive feedback from patients about it. We also hear extremely positive feedback from our GP surgeries. We have seven practices that border Gloucestershire, that have that are Welsh practices that have English residents. They all have been using the some of them right from its inception and some from about 12 months afterwards. But they they all value that process.
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14:55
David Chadwick
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David Chadwick
Thank you. This is a question for for Ross and for Simon. You'll both be very well aware of Paris Teaching Health Board's decisions, particularly the one to make its own patients wait longer for the treatment that they need. Despite making that decision last year, one year waits at Wye Valley NHS trust have increased by 75% and patient pathways waiting more than two years at Robert Jones and Agnes Hunt have increased by 370% since 2022. What impact is that decision having for your organizations and for those patients who are kept waiting?
14:55
Speaker 2
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Speaker 2
Yeah. So. Just to be really clear about those types of patients, our providers will separate the types of patients waiting for care into different groups. So for patients that are waiting for suspected cancer services or for those patients that are waiting for some direct diagnostics, those patients won't be in the cohorts that you've just described, those very long waits. And for those patients, they are given exactly the same kind of access as any English service. There's no differentiation for the for the acute providers there. So these are patients on the sort of non urgent non-emergency pathways that are waiting clearly substantially longer waits as you've described there.
And there are ultimately two systems at play in those organizations that are utilizing the capacity that they've got available in the English hospitals for two different cohorts. The the capacity that is bought by Welsh health boards is largely reserved or prioritised for that cohort of patients. And then for NHS England and the Icbs, who are now essentially purchasing a greater proportion of capacity. So more clinics, more theatres. Those patients in England are now waiting less and less over time. It is a differentiation and certainly for the services and the acute hospitals they find that are very difficult to be able to manage.
Two waiting lists and two priority systems essentially , as part of that. And a lot of their systems are not really designed to be able to operate a two, two systems like that, but they do make that work for those organizations. Now, there are some outside of for Gloucester as an example, I understand because the relatively small number of Welsh patients who access those services, they don't necessarily have a kind of secondary waiting system that they use. And but certainly for places like Robert Jones, Shrewsbury and Telford, they have to be able to create that in order to be able to respond to Powis requests.
And there are ultimately two systems at play in those organizations that are utilizing the capacity that they've got available in the English hospitals for two different cohorts. The the capacity that is bought by Welsh health boards is largely reserved or prioritised for that cohort of patients. And then for NHS England and the Icbs, who are now essentially purchasing a greater proportion of capacity. So more clinics, more theatres. Those patients in England are now waiting less and less over time. It is a differentiation and certainly for the services and the acute hospitals they find that are very difficult to be able to manage.
Two waiting lists and two priority systems essentially , as part of that. And a lot of their systems are not really designed to be able to operate a two, two systems like that, but they do make that work for those organizations. Now, there are some outside of for Gloucester as an example, I understand because the relatively small number of Welsh patients who access those services, they don't necessarily have a kind of secondary waiting system that they use. And but certainly for places like Robert Jones, Shrewsbury and Telford, they have to be able to create that in order to be able to respond to Powis requests.
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Speaker 2
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Speaker 2
There could be. What happens is as increase as providers are asked to increase their capacity. If that's done in a relatively short period of time, it becomes more expensive because they have to take additional actions that are probably not not within core contracts. So they might have to buy in some elements of service. They might also have to use elements of the independent sector so they can bring more capacity to bear. However, typically it becomes more expensive if that's done very quickly.
14:58
Speaker 1
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Speaker 1
Ross Simon is the chief operating officer for the region, so I defer absolutely to his position on this. What I would say, though, is that there is also significant work underway within the acute trusts within England in order to drive productivity improvements, as well as just respond to how we manage waiting lists. And those obviously have benefits for all patients, regardless of the commission levels of of waiting times. And at the end of the day, the trusts here are managing that complexity in the context where the legal response, where the responsibility for the commissioning of the standards that we have to respond to, the appropriate government positions and the constitutions, the commissioning requirements from our different Welsh and England positions.
14:59
14:59
Speaker 1
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Speaker 1
I think the concern clinically that's been raised, and I am not a clinician, therefore I'm only raising back the concerns that clinicians have raised is actually an increase in waiting times, actually leads to a deterioration in patients circumstances, and therefore probably leads to a greater degree of intervention that is needed later down the line.
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15:00
Speaker 1
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Speaker 1
The summer. It's obviously not something I'm currently on subject to consultation at the moment. I mean, generally the relationship at a network level is is reasonable when they are coming to our next cross border network on the 10th of December to present and to discuss and to their proposals and to enable engagement. And obviously, that formal ability for every party to contribute to that consultation is a really critical one, and it's one that our integrated care boards, in particular, as commissioners along as well as our providers, are very keen to engage in in order to express their views.
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15:01
Steve Witherden
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Steve Witherden
Thank you, chair. I hope you can indulge me in another very Montgomeryshire Powis into Shropshire focused question for Caroline Smith . From a patient perspective, is it sufficiently clear why two patients attending the same hospital might have different rights, different waiting time standards and different referral options?
15:01
Gill German
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Gill German
So I can't really comment about the area that you've asked about. I'm afraid, because that isn't part of my remit within within Gloucestershire. I think we, as Simon's already mentioned, our local acute hospital doesn't run two lists. So there isn't that differentiation between the the Welsh registered and and English residents. I think generally patients would not necessarily be comparing their wait with others. It's very much around your individual healthcare and looking at your, you know, your own individual experience. So I'm not sure that patients are aware in the way that you've described. Certainly not in my area of the country.
But I appreciate as I go further north of the border, there is more of a flow in different directions of patients, but I'm afraid I can't comment on that.
But I appreciate as I go further north of the border, there is more of a flow in different directions of patients, but I'm afraid I can't comment on that.
15:02
Steve Witherden
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Steve Witherden
But I would assume that you have, you know, Welsh patients from maybe southern Powis and Monmouthshire travelling cross border, and I and I wanted to ask you how, from your point of view then looking at the broader cross-border perspective, if not, you know, Montgomeryshire into Shropshire, how do you ensure that patients understand, you know, their rights? You know, their waiting time standards, treatment pathways that will apply to them when they're accessing your services in England.
15:03
Gill German
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Gill German
So actually, our patient flows are predominantly from Welsh registered patients, but patients who are already living in England. So we don't see a significant number of patients coming into Gloucestershire who live in Wales and are part of the Welsh health system in that sort of pure way. But certainly as a as an ICB, we have a very strong working relationship within our and Bevan University Health Board. They are one of our key stakeholders. They are identified through our impact assessment process as a as a stakeholder, that if we are changing services, we need to make sure that they are part of that consultation process, and I've personally made sure that the patients who live in that border area, we have held sessions where we've been changing services.
I mean, some time ago, my the example that immediately springs to my mind was when we were building a new hospital in the forest of Dean New Community Hospital, we made sure that we did hold patient events in those border areas. And we did actually go across quite unusually, but we did go across into Chepstow and that sort of area of Wales, because we do know that occasionally, particularly things like the minor injury and illness units, you may find that you get patient flows coming in that way. So we do work quite hard to ensure that the patient voice is heard and recognised even for that, that cohort, we have about 9000 Gloucestershire residents who are registered with Welsh GP practices.
So in the scheme of things, when you look at our whole population, quite small but not insignificant, and their voice is as important as anyone else's.
I mean, some time ago, my the example that immediately springs to my mind was when we were building a new hospital in the forest of Dean New Community Hospital, we made sure that we did hold patient events in those border areas. And we did actually go across quite unusually, but we did go across into Chepstow and that sort of area of Wales, because we do know that occasionally, particularly things like the minor injury and illness units, you may find that you get patient flows coming in that way. So we do work quite hard to ensure that the patient voice is heard and recognised even for that, that cohort, we have about 9000 Gloucestershire residents who are registered with Welsh GP practices.
So in the scheme of things, when you look at our whole population, quite small but not insignificant, and their voice is as important as anyone else's.
15:04
Steve Witherden
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Steve Witherden
And that does make sense, I think for hospitals, for surgeries, district hospitals in operations, it is much more concentrated, you know, in the north where in in in Paris, in Montgomeryshire, we're very, very dependent on Gobowen, Shrewsbury and Telford as a as I've said earlier. But one of the things this committee has done is, is, is sought feedback on this topic from Welsh patients accessing, you know, NHS care in England. And in relation to that, I was wondering, you know, what kind of feedback you receive from Welsh patients about consistency, you know, fairness, access, that sort of thing.
15:05
15:05
15:05
15:05
Gill German
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Gill German
Still do it. So they would still do it. Yes. Yeah, absolutely. So things like the friends and family test, for instance, is done on a patient basis, not, you know, so if a patient has experienced care in a setting, they would have the same opportunity to respond to the friends and family test as any other patient.
15:06
Speaker 1
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Speaker 1
Thank you. Can I, can I also sorry, chair, just also another mechanism is that we recently had recently undertaken a review and looked at the impact of of rural health within their feedback. They brought that and presented their findings within the cross-border network. So all of the icbs across the border were there to be able to hear, to receive and to take that informally on board. So there are also mechanisms where we can share some of that learning, and we are doing so because their representation, and we have Healthwatch colleagues also there who are able to share where they have identified issues, which they can then feed back to the health boards within the context of the network.
15:06
15:06
15:06
Andrew Ranger
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Andrew Ranger
Thank you. Chair. This one is to Simon Evans, if I may, and it's a bit of a follow on from the question, really flipping it around and, and I'd be really interested to know how confident you are that the clinical and administration staff understand the differences between NHS Wales and NHS England arrangements, and also what training, guidance and resources do you provide to them to help them with that?
15:07
Speaker 2
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Speaker 2
Thank you. So each hospital will respond to referrals in slightly different ways using different electronic systems. Unfortunately, we don't have a single electronic hospital system that is consistent across every every trust, so therefore each of them will develop their own training materials, guidance for clinicians and for administration staff. What what is developed is a way of being able to recognize patients who are on or under the Welsh Health Board commissioning scheme. So by at the point where they receive that referral, they'll be able to identify a patient who is who is essentially a Welsh patient.
At that point, they will use then their administration systems and their communication systems, according to their booking rules, is described, or the time, timings and access that are determined by the health board, i.e., how much capacity each hospital has for patients. And when communicating and communicating with those patients, they will go through scripts that will describe the level of access that they'll have, i.e., how long will it be for your first outpatient? How long is it typically for your treatment pathway? As part of that, each hospital will do that slightly differently, but ultimately they will run through that same mechanics of identifying waiting times and access.
At that point, they will use then their administration systems and their communication systems, according to their booking rules, is described, or the time, timings and access that are determined by the health board, i.e., how much capacity each hospital has for patients. And when communicating and communicating with those patients, they will go through scripts that will describe the level of access that they'll have, i.e., how long will it be for your first outpatient? How long is it typically for your treatment pathway? As part of that, each hospital will do that slightly differently, but ultimately they will run through that same mechanics of identifying waiting times and access.
15:08
Ann Davies
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Ann Davies
One of my biggest concerns, really with cross border healthcare, apart from the treatment and how things are working, but is how we look after our Welsh speaking patients, especially if the two ends of life, isn't it your very young patients, your children that perhaps come from Welsh medium families? And then at the other end, when you have very elderly patients who tend to go back to their first language and feel far more confident and able to communicate in their first languages. And what we've heard during this, this inquiry, is that any Welsh language or Welsh medium staff, it's a very ad hoc situation as to whether you have any Welsh medium staff on on these border hospitals, don't expect to have any in England, in in London, for example, but certainly in Gobowen or in Telford and Shrewsbury, if they should be, they should be staff there.
So I was just wondering what the systemic arrangements are. What arrangements have you got to support Welsh medium patients that come over the border and treated with you? So if I can ask Simon and Carolyn and then I've got another question for us, if that's okay with you.
So I was just wondering what the systemic arrangements are. What arrangements have you got to support Welsh medium patients that come over the border and treated with you? So if I can ask Simon and Carolyn and then I've got another question for us, if that's okay with you.
15:10
Gill German
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Gill German
So again, sort of from my own local experience, we do have translation and interpretation services available to all of our our patients in the acute hospitals and the community hospitals within Gloucestershire. We, we actually use a common provider across our primary care system, but also the local authority, the Acute hospital, and the Gloucestershire Health and Care, which provide mental health services and community nursing services. So that is a commission service through an organization, and they do have Welsh language interpretation available .
If patients require that.
If patients require that.
15:11
Gill German
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Gill German
It could be either. So they would typically we commission face to face service, a a video service, a telephone service which can be on demand or it can be pre-booked. So, you know, the on demand service obviously is available there for emergencies and urgent appointments. We try to encourage staff otherwise to, to make some sort of formal booking arrangements where appropriate, so that they would have that person available. And it largely depends on the nature of the conversation as to whether it's a face to face or whether it might be a telephone appointment. But certainly for people with more complex needs or where there's a particularly, you know, in some situations, I'm sure you can imagine where the delivering difficult news, they would then make sure that that a face to face appointment would be always requested there.
15:11
Speaker 2
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Speaker 2
So and that's a common approach across all hospitals. And indeed, it follows the expectation of, of multiple languages across England. Clearly in some, some of our cities we will have multiple languages and very large patient populations who are non-English speaking. So there is that sort of that same expectation. Clearly the proportion of Welsh speakers on the cases, it's more often used in places like Shrewsbury and Telford. But yes, exactly the same. And in particular, where there are vulnerable patients and where safeguarding or other issues that they will use face to face as part of an important message delivery.
As part of that.
As part of that.
15:12
15:13
Gill German
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Gill German
So ideally, that would be identified at the point of a secondary care booking being made. So the GP would normally hold that information on the patient's record. And I wouldn't say that it happens all the time, but the ideal world that information would be communicated to the patient, sorry, to the clinicians and the provider organizations at the time that the bookings made. What we also see in Gloucestershire is there is information that goes back out to a patient, and that tells them if they do have additional language requirements or any sort of accessibility requirements. The process that they can go through and who they need to contact at the trust in order to make sure that those arrangements are put in place for them.
15:13
15:13
Gill German
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Gill German
There is some a specific piece of it's a standard within the NHS in England around the Accessible Information standard, which is there to provide exactly that. So the requirement there is for a clinician to have that conversation with patients, carers to make sure that any, any sort of needs are met around communication. That's particularly for people who might have more of a of a disability that requires them to have a language interpreter there. But the same process is very much applied in practice to international language of any community language.
15:14
15:14
Gill German
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Gill German
It is. And I think that's where the the on demand service comes into its own. Because, you know, I I'm not saying there are patients who don't turn up for their appointment and there isn't an interpreter there provided for them. But we do have that on demand telephone service, which in my experience has been very robust. We carefully monitor that. It's it's quite instant. The connection times are around about a minute and a half to an interpreter. So it is quite instant. And whilst that isn't necessarily always as good as a face to face interpreter, it does provide the option to ensure that that communication takes place.
15:15
15:15
Speaker 1
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Speaker 1
I, I think that it having very clear standards that everyone needs to be able to apply to is absolutely core and that that is appropriate. I haven't got any evidence sitting where I am today about a systemic sort of issue, as opposed to individual circumstances, and therefore and the providers need to be able to force that to, to to follow that through. We've got a very clear statement of expectations, both in terms of our contractual positions and in terms of the statement of values and principles, which is agreed across England and Wales government. I think the what we need collectively to ensure is that that is a standard that is understood across all different parts of our commission services, whether that's primary care, whether that's community mental health services or acute.
And I think we also need to be conscious if we want to increase, for example, the range and breadth of different access provision or look at the workforce implication again, what's the cost value of that? And that's not that's not a judgment for me here. It's just saying that there are obviously there's a significant range of options that are made available. There's very clear expectations about communication. If we were to increase the standards associated with that, we'd have to understand the cost consequence and the workforce consequence, the training consequence, and also the value in the benefit that that will bring critically to patients.
And I think we also need to be conscious if we want to increase, for example, the range and breadth of different access provision or look at the workforce implication again, what's the cost value of that? And that's not that's not a judgment for me here. It's just saying that there are obviously there's a significant range of options that are made available. There's very clear expectations about communication. If we were to increase the standards associated with that, we'd have to understand the cost consequence and the workforce consequence, the training consequence, and also the value in the benefit that that will bring critically to patients.
15:16
15:16
15:16
David Chadwick
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David Chadwick
Thank you. This is a very important question. This one's for Ian. One of the major challenges that people in border areas face is making sure that their data travels with them back and forth over the border. Plenty of people in my constituency access treatment on the other side of the border in Hereford, but then can be discharged back. One thing that's been raised with me several times is that in some cases, for example, people who are discharged from Hereford to receive palliative care back on the Welsh side of the border, their data doesn't come with them, and their families often find that extremely distressing as they then end up having to explain to the hospital staff why their loved one is there and what's happened to their data.
What progress has NHS England made with NHS Wales to facilitate cross-border data sharing?
What progress has NHS England made with NHS Wales to facilitate cross-border data sharing?
15:17
Speaker 3
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Speaker 3
So I. This is a. Particularly in England and Wales. So every time someone interacts with a healthcare service, information is generated about that interaction, whether it's clinical information or whether it's appointments or referrals. But importantly, there is no single place for that. Of course, Simon touched on earlier, multiple different systems. So general practices, which are by far the largest collection of individual data, hold their own records. Hospitals hold their own records, mental health, community, other services will all hold their own records. So they are mostly digital, but typically they are operated in different systems. So it's not unusual for a large trust to have over 200 clinical systems across different things.
On the flip side of that, some trusts have single electronic patient records spanning the entirety of the services that they provide. They're often operated by different technology companies as well. So there are barriers in terms of that commercial element. The interoperability element is the kind of the key thing, which is about the data exchange across across the borders. So as, as, as some of the other services, this is not that this problem is solved in England by by any means. There are still issues in terms of accessing information from from hospitals or between different services.
General practice largely quite accessible, other areas less so. So in England we've made significant progress on some of that around our some of our National Care Record Service and exposing some of that through through our NHS app, which we'll come on to. Additionally, there's not just the actual physical exchange of the data, there's a need to understand how we make that understandable in the same way. So we've got consistent coding across, across the data that everyone can understand what the actual record means in order to use it, information governance arrangements and things like that, that kind of stand as some of the barriers for us.
Now, we work quite closely with our colleagues in Digital Health and Care for Wales. So we've established now a chief Digital information officer group across, in fact, all of the all of the for home countries , plus Ireland that meets at a strategic level every quarter. And we're establishing groups underneath that now to start to make some progress in terms of the kind of more working level in terms of the standards, the standards in particular are one, there already exists a standards working group, which is, again, across all the four home countries, but it's particularly active between England and Wales to develop some of the core common common standards that we'll need to begin to exchange this information.
So that's a messaging standards as well as terminology and coding standards as well. So those groups are meeting much more frequently now and are beginning to publish consistent standards that we will all adopt. It's a devolved power for in terms of standards adoption, but we've all agreed that actually will co-produce the materials, and then there'll be adopted by the various legislative powers in there. One of the ones that comes in, probably particularly for England, is the Data Use and Access Act, which for the first time gives us a power to mandate standards on system suppliers.
So that is an England only power. It amends the Health and Social Care Act, but the supplier base for many of these across England and Wales is the same. So actually, we're in discussion with our colleagues in Wales about how actually we might jointly support that as well. So I think most of the progress that we've made across some of the interoperability elements are probably in the initial stages. In terms of co-producing the standards. There are some elements at a very local level around access to, for example, the shared care records. So within England there are 47 shared care records, many across the border, and those shared care workers have made the information they hold accessible to some of the services in Wales.
Similarly, I know that within some of the Welsh border areas, access has been given to the English National Care Record Service so that some information can be accessed with the caveat there that there is. As I said, there is limited access to information from secondary care available. They're much more primary care, but some is available, particularly in appointments and referrals elements.
On the flip side of that, some trusts have single electronic patient records spanning the entirety of the services that they provide. They're often operated by different technology companies as well. So there are barriers in terms of that commercial element. The interoperability element is the kind of the key thing, which is about the data exchange across across the borders. So as, as, as some of the other services, this is not that this problem is solved in England by by any means. There are still issues in terms of accessing information from from hospitals or between different services.
General practice largely quite accessible, other areas less so. So in England we've made significant progress on some of that around our some of our National Care Record Service and exposing some of that through through our NHS app, which we'll come on to. Additionally, there's not just the actual physical exchange of the data, there's a need to understand how we make that understandable in the same way. So we've got consistent coding across, across the data that everyone can understand what the actual record means in order to use it, information governance arrangements and things like that, that kind of stand as some of the barriers for us.
Now, we work quite closely with our colleagues in Digital Health and Care for Wales. So we've established now a chief Digital information officer group across, in fact, all of the all of the for home countries , plus Ireland that meets at a strategic level every quarter. And we're establishing groups underneath that now to start to make some progress in terms of the kind of more working level in terms of the standards, the standards in particular are one, there already exists a standards working group, which is, again, across all the four home countries, but it's particularly active between England and Wales to develop some of the core common common standards that we'll need to begin to exchange this information.
So that's a messaging standards as well as terminology and coding standards as well. So those groups are meeting much more frequently now and are beginning to publish consistent standards that we will all adopt. It's a devolved power for in terms of standards adoption, but we've all agreed that actually will co-produce the materials, and then there'll be adopted by the various legislative powers in there. One of the ones that comes in, probably particularly for England, is the Data Use and Access Act, which for the first time gives us a power to mandate standards on system suppliers.
So that is an England only power. It amends the Health and Social Care Act, but the supplier base for many of these across England and Wales is the same. So actually, we're in discussion with our colleagues in Wales about how actually we might jointly support that as well. So I think most of the progress that we've made across some of the interoperability elements are probably in the initial stages. In terms of co-producing the standards. There are some elements at a very local level around access to, for example, the shared care records. So within England there are 47 shared care records, many across the border, and those shared care workers have made the information they hold accessible to some of the services in Wales.
Similarly, I know that within some of the Welsh border areas, access has been given to the English National Care Record Service so that some information can be accessed with the caveat there that there is. As I said, there is limited access to information from secondary care available. They're much more primary care, but some is available, particularly in appointments and referrals elements.
15:21
David Chadwick
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David Chadwick
Thank you very much. And please, could you just flesh this out a bit further in terms of the actual barriers that are technical or governance related to sharing the data from one system on one side to the other? You mentioned that there are 200 clinical systems, and you talk to at length as well about GP patient records. Can you just explain a bit further so that we've got it in writing? You know, what the actual technical and system based problems are?
15:22
15:22
Speaker 3
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Speaker 3
For general practices. Yeah. So in England there are three general practice system suppliers that operate in the market on a framework that is managed nationally in Wales. I think they've moved to one system supplier in across all of Wales. In general practice it increases much more in the in the secondary care. That's where the the kind of massively large number of systems exists both in hospitals and under supplier base as well. I think largely there is historically some of those suppliers reluctance to make that information available. It's kind of within their system that's changing through the through the new powers that will, will obtain.
So I think the technical barrier is largely probably around the implementation elements. So the standards exist already, but there's a need to drive the implementation. And it is our intention through our new powers , that that will be a real way for us to drive that implementation, because funding has not been in place before for systems suppliers, that will have to do so at a cost, but it will suddenly become a legal requirement for them, for them to do so. I think the other some of the other barriers, probably particularly around information governance, probably across those.
And again, that exists within England as well as across the border. And I wouldn't suggest that they're insurmountable, but there is a lot of work that could probably be done in that space as well, to make sure that we're enabling the right people to access information that they should be. For example, we operate different staff identity services across, across.
So I think the technical barrier is largely probably around the implementation elements. So the standards exist already, but there's a need to drive the implementation. And it is our intention through our new powers , that that will be a real way for us to drive that implementation, because funding has not been in place before for systems suppliers, that will have to do so at a cost, but it will suddenly become a legal requirement for them, for them to do so. I think the other some of the other barriers, probably particularly around information governance, probably across those.
And again, that exists within England as well as across the border. And I wouldn't suggest that they're insurmountable, but there is a lot of work that could probably be done in that space as well, to make sure that we're enabling the right people to access information that they should be. For example, we operate different staff identity services across, across.
15:24
Speaker 3
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Speaker 3
So I think probably now that the strategic group have the chief digital information officers across. So within the Department and within Welsh Government and within the Digital Health and Care for Wales have have a set of quarterly meetings that actually there is probably a need to drive that through that group to agree a set of common strategic priorities to be able to agree, and for all of the teams underneath to be able to work towards towards those, particularly where there might be some of them will be easier than others, obviously.
15:24
Ruth Jones
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Ruth Jones
Thank you. Interesting. Can I just double check though? Because what you're saying is there's a patchwork of different systems across England. And obviously with Wales, some of them interact and some of them don't. And you're now going to have quarterly meetings. Now, I will confess, as a physiotherapist working ten years ago in healthcare, we were talking about this then. I'm a little bit anxious that we've gone this far, but we haven't actually got anything that's actually going to join up.
15:25
Speaker 3
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Speaker 3
Yeah, I think there are. It is a it's some of those elements do join up. So some of the shared care record elements that are operated regionally do enable access. And there is an amount of access that's increasing from the national service as well. So there's been some elements of, of that. I think as I said, even within England, there is relatively limited access externally to data held within hospital trusts, easily accessible within a hospital trust, but not outside of it. So I think there's a problem that even in England hasn't been solved yet. But with the advent of some of the work on single patient record, for example, will probably drive a little bit more quickly.
I think there's much more of a push towards that now than there was even ten years ago.
I think there's much more of a push towards that now than there was even ten years ago.
15:25
15:25
Andrew Ranger
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Andrew Ranger
Thank you chair. Again it's for you Ian. So moving on to the digital services and the app for for patients point of view, the UK government has said that patients should be able to take advantage of digital healthcare advances, regardless of where they live. So I'd be really interested in how NHS England is working with NHS Wales to ensure that Welsh patients accessing healthcare across the border can use the digital services seamlessly. So I'm thinking about, you know, accessing records, appointments, prescriptions through the NHS Wales app. And just as an extra to that, are there any plans that you know of about addressing the issue around the lack of the Welsh language?
Log on to the NHS Wales app because they use the English log on don't they.
Log on to the NHS Wales app because they use the English log on don't they.
15:26
Speaker 3
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Speaker 3
Yeah. Yeah. No, absolutely. Yeah. So so there are two separate apps obviously just so the NHS app is the one that's built in England. It's been around for for some time. And then the NHS Wales app, which is in fact shares the code base. So it's based on the code that was written for England. And as you said, it uses some of the common services as well. After that point in time, the apps kind of begin to diverge because it was serving different, different populations. But the code base is the same. So where someone can access which app depends entirely on where their general practice is, not necessarily where they live or where they're receiving treatment.
It is solely based on the GP and has has a has a link into that. So at the moment it's only possible to have be registered to either NHS app or NHS Wales app. You can't have both. Now some of the services are, as I say, commonly the same. So I think in England, for example, there's comprehensive access to the GP information and some information on medications and allergies that's coming from that record. There is access to appointments and referral and some test results depending on where they're coming from. But as I said that even in England, that's not a we can view our full discharge summary and medical record within the app at this time.
So it's not that Welsh patients have been disadvantaged in that
It is solely based on the GP and has has a has a link into that. So at the moment it's only possible to have be registered to either NHS app or NHS Wales app. You can't have both. Now some of the services are, as I say, commonly the same. So I think in England, for example, there's comprehensive access to the GP information and some information on medications and allergies that's coming from that record. There is access to appointments and referral and some test results depending on where they're coming from. But as I said that even in England, that's not a we can view our full discharge summary and medical record within the app at this time.
So it's not that Welsh patients have been disadvantaged in that
15:28
Speaker 1
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Speaker 1
A full discharge summary and medical record within the app at this time. So it's not that Welsh patients have been disadvantaged in that way more so than English English patients, I think because those services are quite common and they're used across those it there was a possibility for us to understand actually, how do we enable, particularly with single patient record coming access through that route via an. interface to allow information to be drawn into either app, again, subject to the necessary things around identity, which actually would be easier for Wales and it would the other home countries because we use a shared NHS number service to, to, to pull that in as well.
So I think as that moves forward, that's probably the most useful area that we could possibly explore .
So I think as that moves forward, that's probably the most useful area that we could possibly explore .
15:28
15:28
Speaker 1
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Speaker 1
You talked about some good things there, but they're quite sort of piecemeal if that if that's fair. Yes. So so so so I'm not aware there's any any particular elements of discussion. I think that that will probably begin to surface through the group . That's that's meeting now in terms of, as you say, it should be a full. You can order prescriptions, for example, across your pharmacy might be across the border and all of those things. I think that's.
probably .
probably .
15:29
15:29
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15:29
Speaker 1
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Speaker 1
That that represents a potential for the future. Yeah. Thank you very much. Thank you. Sorry. You had a second question about sorry, the Welsh Language Act, which is a good news story. So as I said, there are different apps, but they use common services. So NHS login is a service that. verifies the identity of of a person when they register, and then provides the logon service to access the app to make sure that it is the person who should be accessing it. So obviously lots of advantages in that. It's a great element of collaboration. It was built for England as originally, so it is in English.
It's the only element that is not not currently available in Welsh. However, I know the team have just completed a proof of concept to. understand what, if that's possible to do, and they've completed the proof of concept so we can see the kind of storyboard that goes across that and the Welsh language support. And my understanding now is that there's discussion with NHS Wales on .
It's the only element that is not not currently available in Welsh. However, I know the team have just completed a proof of concept to. understand what, if that's possible to do, and they've completed the proof of concept so we can see the kind of storyboard that goes across that and the Welsh language support. And my understanding now is that there's discussion with NHS Wales on .
15:30
15:30
15:30
Gerald Jones
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Gerald Jones
To a more measured Gerald Jones please. Thank you. I was looking forward to be unmeasured, but there we go. I just wanted to ask a question around some of the structural changes that are happening in England. Obviously with NHS England going and the larger sort of. icbs being created, and whether you think it's going to be harder to maintain effective cross border healthcare arrangements and ensuring Welsh. patients remain a priority. So I suppose the question is for for all, all of you really is how do you expect the reforms to affect the commissioning and delivery of.
healthcare .
healthcare .
15:31
15:31
15:31
Llinos Medi
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Llinos Medi
In an English setting? I'd like to start off by all means. Yeah. Okay. Thank you. I suppose first to say is that we really recognise that the health bill is still going through the passage of, of, of consideration through, through the houses. So, so I'll come back to that in terms of, of the position. But obviously we we don't want to prejudge the outcome from legislative.
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15:31
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15:31
15:31
Llinos Medi
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Llinos Medi
50% reduction, and the. consolidation either in terms of of mergers in some areas or in terms of. clustering of the statutory. organisations and their arrangements. And that's very much as part of the commitment. And as a Commissioner, I fully support this of moving into becoming strategic commissioners, really doing the things that only they do are really understanding the detail of their. population needs, planning the services that are appropriate for them, ensuring that the right services are contracted and commissioned, and that we've got the right level of quality for those services, evaluating those, and then continuing to improve to meet the needs of local populations.
I think in relation to that does mean with the the scale that's come together, that that Icbs or ICB clusters now have a larger population than they did before. However, a lot of the really. significant work that underpins both the, the ten year plan for for National Health Service and in terms of the.
I think in relation to that does mean with the the scale that's come together, that that Icbs or ICB clusters now have a larger population than they did before. However, a lot of the really. significant work that underpins both the, the ten year plan for for National Health Service and in terms of the.
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Llinos Medi
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Llinos Medi
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Llinos Medi
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Llinos Medi
Really bringing with our voluntary sector partners, looking at cross border issues in terms of some of those management relationships. So I know certainly within the Midlands, where colleagues have got significant cross border flows, the integrated care boards within their new cluster arrangements have really considered what are the integrated what are the cross-border.
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Llinos Medi
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Llinos Medi
Making sure that the boards are brought in. The new boards are really aware of those, and Caroline obviously takes that that lead in terms of Gloucester. So there is. absolutely a clear. commitment that cross border healthcare is a clear. consideration within within the planning for the integrated care boards within the within the within England. There is. also a really clear. commitment from Department of Health and from NHS England, while we while we exist. And as we move into new arrangements for the future, that actually. The statement of values and principles that. Understanding about the cross border arrangements for Wales and other.
devolved countries absolutely remains a clear commitment and actually has also been factored into some of the. considerations with the health bill as well, not to prejudge the outcome there at all, but actually continues that explicit.
devolved countries absolutely remains a clear commitment and actually has also been factored into some of the. considerations with the health bill as well, not to prejudge the outcome there at all, but actually continues that explicit.
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Llinos Medi
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Llinos Medi
Whether that's across general practice and secondary care, or between between our secondary care providers or between mental health providers and community provision. So a lot of the structural. changes that we're facing, actually, you've still got. continuity because of the foundation of the of the of the. operational provision of health and care. And I think there are some some real. opportunities as well as we look forward to the the structural changes to come through about how the different discussions with our local authority arrangements, particularly within NHS England, the strengthening of the. relationship and understanding and engagement with voluntary sector continued conversations now with Healthwatch as well as lawyers, that we're really bringing those together as a strategic conversation about what are the priorities, how do we drive forward and making sure we've got those relationships in place?
There are other obviously established sort of relationships and partnership workings that also underpin that, whether we're looking at emergency planning and around how the local health resilience boards work and operate together and how they're incorporated in terms of some of those areas which are also embedded and are not subject to I mean, the people may change in the context of structural change and in terms of the changes and.
There are other obviously established sort of relationships and partnership workings that also underpin that, whether we're looking at emergency planning and around how the local health resilience boards work and operate together and how they're incorporated in terms of some of those areas which are also embedded and are not subject to I mean, the people may change in the context of structural change and in terms of the changes and.
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Speaker 3
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Speaker 3
Anybody else wants to know? I don't think there's much that I can add, but just as a lived example. So in Gloucestershire we're in a formal cluster at the moment with Bristol, North Somerset, South Gloucestershire. However, exactly as Ross has described, we. We have four places within our cluster, Gloucestershire being one of them, and within that. At the moment our. Our neighbourhood footprint is still very much mirroring our primary care networks that existed before. So we have a particular neighborhood that would cover that border area. And we've got very strong relationships within that neighbourhood. already for particularly voluntary sector.
organisations who who do support across the border and don't see such quite. defined areas in the same way that perhaps a statutory. organisation might. And our local authority obviously looks at their their the county as a whole rather than registered population necessarily. So some of that good. practice is already happening. And so we .
organisations who who do support across the border and don't see such quite. defined areas in the same way that perhaps a statutory. organisation might. And our local authority obviously looks at their their the county as a whole rather than registered population necessarily. So some of that good. practice is already happening. And so we .
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Gerald Jones
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Gerald Jones
Need to build on that. Obviously, as we continue to develop our neighbourhood model. Okay. So just one sort of follow up. I think you've given a reassurance in terms of the the neighbourhood level of engagement and those networks that are already in place and will continue. But in terms of the obviously, the ICB has been been quite large and serving wider. populations going forward or potentially given, you know, obviously what depending on what happens with the legislation, but are there any particular safeguards that are needed to ensure that the needs and priorities of Welsh patients are not, you know, don't become a lower priority in that sort of larger arrangement?
Or are you satisfied that the the. neighborhood level of. working will .
Or are you satisfied that the the. neighborhood level of. working will .
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Llinos Medi
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Llinos Medi
Be enough to, to sort of keep those. relationships and that that work? Well, I suppose the different. levels of safeguards arrangements is that the National Department of Health will still set the standards. We'll still hold the oversight of the statement of values and principles that are agreed between Welsh Government will still hold that policy, leadership.
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Llinos Medi
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Llinos Medi
And we will no intent on stopping the network arrangements that continue. I'm not saying that colleagues around the table may, and have over many years changed as to who holds, and every meeting we check if we got the right people around the table from all parties, etc. are there any arrangements that we need to put in place, etc. to make sure that we've got the appropriate handover arrangements? We've got the right people around the conversation. So at a at a networking level, we have that at a policy level, we will have continuity in terms of I don't know where within the operating model, but there is a commitment to that.
That will be a continued policy. consideration for the Department of Health and Care. And then in terms of the the regional role for the future, there will regions will have the and do have now the oversight.
That will be a continued policy. consideration for the Department of Health and Care. And then in terms of the the regional role for the future, there will regions will have the and do have now the oversight.
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Llinos Medi
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Llinos Medi
Both for providers and and ensuring that both our. providers within England and our integrated care boards fulfilling their. responsibilities fully. And that would. include how they're responding and engaging with their. stakeholders and how they're making sure that they're meeting the full needs of all of the. populations that they're responsible for. So we've still got those sort of oversight arrangements should we need them, and the discussions, the abilities to sort of come in and support.
conversations and facilitate. conversations .
conversations and facilitate. conversations .
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Ruth Jones
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Ruth Jones
Regulatory environments if we need them. Thank you very much. Thank you. I've got one final question. I suppose we've heard a lot today about how you're working together, you know, valiantly to get things working. We've had examples from MPs across Wales who have had issues with, you know, patients experiences. So I just I suppose the one question to all of you, if you had if if if it's working, okay, you can just say yes, it's fine.
But if there was one thing you could do to change or improve the.
But if there was one thing you could do to change or improve the.
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