Cross-border Healthcare

Jamie Stone Excerpts

Tuesday 4th November 2025 Westminster Hall

[David Chadwick]

My hon. Friend makes a valid point, and I am sure her constituents will be pleased to hear her make it. The 2018 cross-border statement of values and principles promised that no patient would face delay or disadvantage because of which side of the border they live on, but my constituents know that those principles are not being applied in practice.

The clearest recent example of what has gone wrong is the new waiting list policy introduced by Powys teaching health board this summer. From 1 July, the board instructed English hospitals treating Powys residents to deliberately and artificially extend their waiting times, bringing them into line with the longer averages elsewhere in Wales. Until now, Powys patients had been treated in hospitals, such as Hereford and Shrewsbury, in exactly the same way as English patients, but from this summer they have been asked to wait up to twice as long.

We are told that hospitals in Herefordshire and Shropshire are treating Welsh patients “too quickly” and that Powys’s budget does not allow for the current number of people being treated each year, so patients have to be spread out over more years. How appalling it is to say that a patient can be treated “too quickly”. Swift treatment should be an objective, not a problem.

Worse still, this supposed cost-cutting exercise may not save a penny, because both the Wye Valley NHS trust and the Shrewsbury and Telford hospital trust believe that it could cost Powys more, because they will have to bill Powys teaching health board for the administrative cost of running two parallel waiting list systems. That is before we consider the hidden costs: the human and financial price of patients deteriorating while they wait longer, needing emergency admissions, extended rehabilitation and, in some cases, never recovering the quality of life they once had.

My constituents are not just numbers on a spreadsheet; their lives are on hold. Those months are months of agony, of lost work, of isolation, and of watching opportunities and life slip away while waiting for operations that should already have happened. Agnes is a patient from Llandrindod with Parkinson’s disease. She has been told that she must wait another 52 weeks for a knee replacement after already waiting a full year. That means a total of two years waiting for surgery. The delay has made it increasingly difficult for her to stay active, even though regular exercise is vital to managing Parkinson’s symptoms. The prolonged wait is worsening her mobility and pain, and it is undermining her ability to live independently.

Hazel, from Builth Wells, is awaiting spinal surgery in Hereford. Her expected waiting time has doubled to 104 weeks. She has been unable to work during this period due to numbness in her legs and feet, and she now fears losing her job. Once financially independent, she now relies on family support—an experience she describes as “degrading and unfair”—through no fault of her own.

Kelly was diagnosed with serious spinal disc problems in September 2024. She was given a surgery date for December, then March, but both were cancelled. Even though her pre-operative assessment had been completed, she later discovered—on her own—that her operation had been postponed by at least another year under the new policy. This is despite her being classed as an urgent P3 case and being told that existing bookings would not be affected. The delay has left Kelly in constant pain, which has taken a serious toll on her mental health and has contributed to her losing her job.

Those stories are not isolated; they speak for hundreds of others who are being quietly told to wait, not because of capacity or clinical need but because of budgetary decisions. Behind every statistic is a person whose life is being diminished while they wait for care that should already have been delivered.

What makes this even worse is that patients are sometimes not being told that their treatment has been delayed. Many have found out only through news reports or by doing their own investigations. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work, yet this policy, which Ministers could stop tomorrow, does the exact opposite. The health board and senior Welsh Labour politicians call it “fairness” that Powys residents should wait no less than anyone else in Wales. However, fairness and ambition should mean lifting standards everywhere, not dragging Powys down to the lowest common denominator.

It is not equality; it is equal punishment for the Welsh Government’s failure to fix the NHS after 25 years in power. The response from Ministers thus far, particularly in Cardiff Bay, has been nothing short of disgraceful. The Health Minister, Jeremy Miles, could not appear more uninterested if he tried—no action, no intervention and no urgency from the one man who has the power to stop the policy and to get people out of pain and back to their lives. Several constituents have told me that they have written personally to him and have received no response at all. That is despite the fact that it is his Government who are forcing Powys teaching health board to make significant cuts to its budget.

As for the First Minister—who, I remind the House, represents Powys in the Senedd, as well as being a Member of the House of Lords—she brushed off my constituents’ concerns, saying that she thinks it is just “smoke and mirrors”. I invite her to say that directly to Kelly, Agnes and Hazel, because months or even years of their lives have been stolen and spent living in pain.

The decision institutionalises inequality between Wales and England. If the waiting list policy exposes a failure of funding, the digital infrastructure of cross-border healthcare exposes a long-term failure of systems. Despite 25 years of devolution, we still have national health services across our four nations that cannot share data efficiently. Both NHS England and NHS Wales still operate separate digital systems that do not talk to each other. When a Powys GP refers a patient to Hereford or Shrewsbury, information often travels by post, fax or unsecured email. Discharge summaries arrive late or not at all. Test results are duplicated because clinicians cannot see each other’s records, wasting time and often causing distress for patients.

Even in emergencies, A&E doctors in England cannot automatically view a Welsh GP’s records, and vice versa. To paint the picture more vividly, one Powys resident told me that he was admitted to Shrewsbury hospital with a serious heart condition, yet staff could not access his medical records. Because it was a Sunday, they could not even reach his GP by phone.

That should not be happening in 2025. It puts lives at risk across our border regions. The lack of interoperability affects anyone moving between the four nations of the United Kingdom, as their health records tend not to move with them. The Welsh Affairs Committee has been calling for change since 2015, yet a decade later, nothing has happened. The Welsh Government alone do not have the funding to overhaul their systems, which is why we have called on Westminster to step in, as obviously this is a consequence of devolution. For a fraction of the cost of other Government digital projects, modernising NHS IT across the UK would directly improve patient safety, continuity of care and confidence in the system. Every week that remains unresolved, more patients are put at risk, which is a failure of politics, not just technology.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I can bring a Scottish context to the subject. A doctor in my constituency had a cataract problem and was told that the waiting list was ages. In the end, because she knew how to do it, she found out about an operation that was available in the north of England. She paid for the travel and paid to go private. The point is that if the database that my hon. Friend is talking about could show patients where to look in other parts of the UK, saying, “This is on offer, if you are willing to travel”, it could make such a difference to health services across the four nations.

[David Chadwick]

My hon. Friend is right to say that these system failures are putting extra responsibility, extra stress and often extra cost on individuals, which is why the system needs to be improved. Beyond the funding and IT problems, our systemic weaknesses make cross-border care even harder. Many Powys residents are registered with GPs in England simply because of geography—they might be closer—while others just across the border stay with Welsh practices. GPs who want to work in both nations must register twice, fill out the same forms twice and follow two sets of rules, which wastes time and discourages flexibility.

A constituent of mine in mid-Wales with a rare artery condition needed ongoing treatment from Hereford hospital. Because the two NHS systems do not share results, they had to collect their own blood tests and email them to their consultant each month. Prescriptions issued in England were not approved in Wales, causing months of delay. That is the daily reality of an unco-ordinated system.

At the governance level, the 2018 cross-border statement of values and principles remains voluntary and unenforceable. Each Welsh health board negotiates its own arrangements with English trusts. There is no single tariff, no unified billing system and no consistent data reporting. Audit Wales has warned for years that this patchwork leaves patients in limbo, between two systems that both claim to care for them, but neither fully owns responsibility when things go wrong.

Those problems did not appear by accident. Powys residents do not mind which NHS logo is printed on their appointment letter; they care that their care arrives on time, that their doctors can speak to one another, and that they are treated fairly. The border should not be a barrier to treatment, data or fairness. I say to the Minister that although several of these issues fall within devolved areas, they are of direct concern to the UK Government because they are also directly influenced by NHS England and by decisions taken here in Westminster.

My asks are simple. First, convene a meeting with counterparts in the devolved nations to finally address these cross-border challenges, and invite border MPs to that discussion. Those of us who represent border communities see these failures at first hand and know where the solutions are needed. Secondly, provide the funding required to make NHS IT systems interoperable across the United Kingdom, so that clinicians can share patient information safely and instantly wherever care is delivered. Thirdly, work with devolved Governments to give the cross-border statement of values and principles legal force, turning it from a voluntary pledge into a real, accountable framework that protects people in border communities like Powys.

We owe it to the people of Powys, and to every border community, to end this quiet injustice and to build a system that treats them not as second-class citizens but as equals who are entitled to the same care, dignity and chance to live free from pain. Labour Governments at both ends of the M4 talk about driving down waiting lists and getting people back into work. However, this policy, which Ministers could stop tomorrow, does the exact opposite. I look forward to the Minister’s response and the contributions from other Members.

--- Later in debate ---

[Robin Swann (South Antrim) (UUP)]

It is a pleasure to serve under your chairship, Mr Dowd. I congratulate the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) on securing a debate on cross-border healthcare, because we in Northern Ireland know only too well that health outcomes are not, and should not be, defined by borders—whether an internal UK border or one with an entirely separate sovereign jurisdiction. Sickness does not discriminate.

In fact, as the only part of the United Kingdom to share a land boundary with another nation, the issue of cross-border healthcare is something on which every Northern Irish MP, I am sure, will have an opinion. Despite our constitutional sensitivities, I for one have absolutely no hesitation in saying that I am deeply proud of the progress we have made in cross-border healthcare in both Northern Ireland and the Republic of Ireland. The progress in recent decades has shown what can be achieved when we actually work together with a shared purpose.

I take note of what other hon. Members have said about the challenges across an internal UK border, which I believe we should not have in healthcare. Despite that, in Northern Ireland we need only to look at the success of the radiotherapy unit at our hospital in Altnagelvin, and more widely the north-west cancer centre based in Londonderry. Those services demonstrate the tangible benefits of co-operation for patients and communities from both sides of the border.

When I was Health Minister in 2021, I was pleased to come together with the Governments of Ireland and the United States of America to sign a new memorandum of understanding to reinvigorate the Ireland-Northern Ireland-US National Cancer Institute cancer consortium, which is an often forgotten and unsung part of the negotiations of the ’98 Belfast agreement. When it comes to cancer, we should leave no stone unturned. There are undoubtedly people on both sides of the border who are alive today because of that practical and sensible co-operation. By continuing to refine that service level agreement, expanding areas such as skin cancer treatment, and deepening our joint research in clinical trials, Northern Ireland will once again be strengthening cancer services and helping to advance the fight against rare and specialist cancers across the island.

The same collaborative spirit is exemplified in paediatric cardiac care. Our all-island congenital heart disease network—an issue to which my family is as close as we can be—has ensured that children with complex needs can access world-class treatment without unnecessary delay or travel. I have seen at first hand that such cross-border co-operation works. Our youngest son was eight months old when he needed his first open-heart surgery, and that was conducted at Birmingham children’s hospital. He was 10 years old when he needed his pacemaker replaced, but that was done in the children’s hospital in Dublin because of that cross-border work. We in Northern Ireland know all too well about our reliance on the working relationships that we have across borders, should that be across the UK or with our partners in the Republic of Ireland.

[Jamie Stone]

The hon. Gentleman may know that I have family living in the north, in Armagh and Antrim, and a daughter living in Donegal. What he says is absolutely correct—I can vouch for that, and it is an example for us all. When somebody is sick and we are worried about what will happen next, we do not care about lines on maps. The point I want to make is this: it strikes me that this is an easy issue for the present Government, because it need not cost lots of money. Often, we ask for stuff and there is a huge bill attached, but just knocking heads together and saying, “Get real. Get the computer system online. Talk to each other,” is doable, and it would make such a difference for people even up as far north as where I represent.

[Robin Swann]

I thank the hon. Member for raising a valid point that comes to the crux of this debate and of what has been said by every Member so far. It is about putting the “national” back in our national health service, and doing so across borders without the unnecessary bureaucracy that often comes with how we look after our patients.

There is still more to do on this issue, and no system is perfect. I know from engaging with our current Health Minister in Northern Ireland, my party colleague, that there is potential for further north-south co-operation in other specialist paediatric services that lend themselves to an all-island approach, including the hugely emotive and sensitive issue of perinatal and paediatric pathology. Northern Ireland has been without a paediatric pathologist for some time, so an all-island solution should be looked at.

As the hon. Member said, ambulances in Northern Ireland regularly cross the border in both directions to save lives. Our two ambulance services have an agreement in place to provide mutual aid, with personnel from either service able to cross the border to assist in emergencies.

I believe that the future of healthcare will be defined by the digital innovation that has been referred to, and it will be a great step forward when we can get the national health services talking to each other—it is only recently that we have been able to get our five trusts in Northern Ireland sharing digital information. The will is there if the finance and support are there on genomic medicine, workforce planning and the interoperability of electronic health records. By collaborating on the genomics of rare disease and planning jointly for a workforce that can identify and close future gaps in work, we can ensure that the entire island—and islands—benefit from technological and medical advances.

Our co-operation should not just be practical; it should actually improve outcomes. It is proof that where health is concerned, cross-border partnerships really work. I encourage the Minister to take forward the recommendations made in this debate today.