Cross-border Healthcare

Karin Smyth Excerpts

Tuesday 4th November 2025 Westminster Hall

[The Minister for Secondary Care (Karin Smyth)]

It is a pleasure to serve under your chairmanship, Mr Dowd. I am grateful to the hon. Member for Brecon, Radnor and Cwm Tawe (David Chadwick) for securing this important debate. I knew that hon. Members from across the United Kingdom would come here for it, and so it has proved. There are no end of technicalities that devolution has brought us, but we respect devolution and difference while recognising that we are all citizens of the United Kingdom. On the initial point made by the hon. Member, I gently remind him that an extra £1.5 billion has been allocated by the Welsh Government to public services in Wales, to put Wales on a path back to growth, undoing the damage of the last 14 years. That money includes an extra £600 million for health and care, which was voted against by the Welsh Conservatives and by Plaid Cymru. That is the difference made by having a Labour Government at one end of the M4 and a Labour Senedd at the other. Let us hope that arrangement can continue into next year so that we can get on with resolving those issues for the people of Wales.

I am very proud of my Irish heritage, with family on both sides of the Irish border, and I represent a city just across the Severn from Wales, so I am no stranger to the issues that arise from sharing a border. I spent many years in the British-Irish Parliamentary Assembly and on the Public Administration and Constitutional Affairs Committee, looking at constitutional issues across the United Kingdom. As my hon. Friend the Member for North Northumberland (David Smith) said, given the reality of people’s lives across our borders, we need to be better at joining those dots, and—as my hon. Friend the Member for Carlisle (Ms Minns) said—at remembering those people who live at the edge of some people’s maps.

To assure everybody, with my hon. Friend the Member for Aberafan Maesteg (Stephen Kinnock) as the Minister for Care and with my hon. Friend the Member for Glasgow South West (Dr Ahmed) as the Minister for Health Innovation and Safety, on whose behalf I am speaking, we in the Department of Health and Social Care are well served by all voices in the United Kingdom. I reaffirm our commitment to ensuring that all patients on both sides of borders can access timely, high-quality care. Healthcare is devolved but patients cannot be left to navigate a fragmented system or face delays just because of where they live.

I assure hon. Members, in response to points made by the Opposition spokesperson, the hon. Member for East Grinstead and Uckfield (Mims Davies), that officials meet regularly. That co-operation is happening, and they will continue to meet. My colleagues and I also meet members of those Governments. However, I will come on to that at the end when discussing the requests for my colleague, the Minister for Health Innovation and Safety, to meet with hon. Members.

The spiritual home of the NHS is Tredegar. This Government will not leave anyone behind, not least patients in Welsh border communities who rely on services in England—the point of the debate. My hon. Friend the Member for Montgomeryshire and Glyndŵr (Steve Witherden) raised problems with data sharing and patient record transfer, confusing and inconsistent referral pathways and some of the disputes across borders. However, as we have heard, such disputes sometimes happen within countries and over more local borders. As we heard from the hon. Member for Berwickshire, Roxburgh and Selkirk (John Lamont), they happen internally as well, so let us not underestimate how hard it is to resolve such disputes.

Around 30,000 people who live in England have a GP in Wales, and vice versa. That is why the statement of values and principles for cross-border healthcare was published in 2018. That statement remains the foundation for our approach. It sets out clear expectations that patients living in defined border areas, whether they are registered with a GP in England or in Wales, should receive care without delay or administrative burden. Emergency care is available to all patients, regardless of residency or GP registration. We expect both integrated care boards in England and local health boards in Wales to consider the impact of commissioning decisions on cross-border communities.

The hon. Member for Brecon, Radnor and Cwm Tawe raised the issue of waiting times for residents in Powys who seek treatment in England. Waiting times on both sides of the border are falling. Whenever I appear in the media or speak in a debate, I hear people still saying, even to their television, “Well, where’s my appointment?” Nevertheless, it is the case that waiting times are falling, which is helped by the allocation of money from the Welsh Government to reduce waiting lists.

[David Chadwick]

Will the Minister give way?

[Karin Smyth]

I will get through all the points, if I can, because I know there are lots of issues to address.

As I was about to say, too many people are still waiting, but we are committed to working with the Welsh Government to keep the cross-border arrangements fair, transparent and patient-centred.

Patients also face challenges in accessing specialist services. NHS England commissions a number of these services on behalf of the devolved nations and we are willing to explore further contract arrangements with NHS Wales to improve access to them.

As we have heard this afternoon, travel to appointments can be a barrier. In England, patients referred for specialist NHS treatment may be eligible to claim a refund of reasonable travel costs under the healthcare travel costs scheme, and a similar scheme exists in Wales. I join my hon. Friend the Member for Shrewsbury (Julia Buckley) in welcoming the tremendous changes that we are seeing at Shrewsbury and Telford hospital, which are starting to benefit not only her constituents but people travelling from Wales. That is really good to see. It is a long way for people from Wales to travel, but we are still very pleased to see those changes being made.

The hon. Member for Brecon, Radnor and Cwm Tawe also raised the issue of digital interoperability. Again, I wish I could say that that was only a problem for hospitals on the border between England and Wales, but I am afraid that it is an issue for trusts across the country and across each country. It does not help that, after 14 years of under-investment, IT in the NHS lags behind IT in the private sector by at least a decade. That is why this Government are investing £10 billion into improving how patients access services through technology. My hon. Friend the Minister of State for Science, Innovation, Research and Nuclear, Lord Vallance, is currently giving the NHS the biggest digital makeover in its history as part of our 10-year plan.

I can also tell the hon. Member for Brecon, Radnor and Cwm Tawe that NHS England is working with NHS Wales to improve interoperability, especially through the shared care record and technical collaboration on the so-called fast healthcare interoperability resources, or FHIR for short, which allows systems from different manufacturers to exchange messages and data, regardless of the setting that care is delivered in. I commend my hon. Friend the Member for Montgomeryshire and Glyndŵr on meeting leaders in the local cross-border system to understand that issue better. However, I gently say to him that we cannot get very far without the private sector working with us, not only across genomics and future healthcare but in IT and the way that we develop some of these services.

In October, the chief information officers across all four nations agreed to start looking at digital architecture and standards. They are exploring what we can do to improve how we use shared systems, common standards for better communication, which was raised by nearly everyone this afternoon, and the potential of future alignment. This work should lead to some progress in the short term, ahead of our long-term ambition of building a single patient record.

We are also making cross-border billing arrangements easier. Although the NHS payment scheme applies only to services in England, we sat down with the Welsh Government and agreed that Welsh commissioners will pay English tariff prices for Welsh patients who are treated in England. For English patients who are treated in Wales, local agreements are in place and we are open to making those agreements more efficient through the provision of clearer guidance.

As for our constructive co-operation with devolved Governments, the Government were elected on a manifesto to reset our relationship with the devolved Governments, and from day one that is what we have been doing. In that spirit, and without downplaying many of the issues that the hon. Member for Brecon, Radnor and Cwm Tawe and others, including the hon. Member for Ynys Môn (Llinos Medi), have raised today, I will highlight some of the positive examples of collaboration between our healthcare systems.

In many areas along the border, NHS staff in England and Wales are showing the rest of the UK how joined-up care is done. For example, patients in south Wales regularly access paediatric intensive care services in my home city of Bristol, and there are long-standing arrangements for cancer care, renal services and mental health support that cross the border seamlessly. Such partnerships are a testament to the professionalism and dedication of our NHS workforce, but cross-border healthcare is just one part of our partnership.

First, we have seen immense progress through the Interministerial Group for Health and Social Care, which met last September. Such meetings are really important. They bring together all four nations to find common ground on key priorities, such as elective recovery for those on waiting lists, innovation and health reform, and we look forward to continuing these discussions at the next meeting in December.

Secondly, all four nations are working to protect our kids through the Tobacco and Vapes Bill, which is UK-wide in scope but tailored to the specific needs of each nation. If the representative of the Opposition, the hon. Member for East Grinstead and Uckfield, could indeed talk to her colleagues in the House of Lords, who are battling very hard to get some of this legislation through, we could start making this generation the first smoke-free generation and support kids with this public health measure.

Thirdly, the Mental Health Bill that applies to England and Wales has been a masterclass in constructive engagement between compatriots who want to put their differences aside and get stuff done. May I echo the words of the hon. Member for Strangford (Jim Shannon) and add my support to the hon. Member for South Antrim (Robin Swann) in his efforts to ensure progress on that often forgotten part of the Good Friday/Belfast agreement that deals with healthcare? It is not easy. If they can do it over there, it is not beyond the rest of us to do it in Scotland, Wales and England. I was so grateful when my own mother was being cared for at Altnagelvin hospital during the covid crisis in 2021 to see the co-operation across the border and staff just getting on with treating the patients wherever they came from. We have a lot to learn from our colleagues in Northern Ireland.

In conclusion, I want to assure colleagues that the UK Government remain committed to supporting cross-border healthcare arrangements that work for patients. I will not offer hon. Members lots of individual meetings, but what I have heard today is that there is a lot of good work going on among officials. People here have issues to raise, including things from the past. I will take that up and share that more widely. I will also endeavour to write to the hon. Member for Strangford on the issue he raised to do with university students.

We are building bridges with Wales to work through our issues in the national interest, but I am afraid to say that although waiting lists are falling in England and Wales, in Scotland they are rising, which is a great shame. My friend Anas Sarwar, a former NHS dentist, is committed to resolving that. The NHS is in his DNA, given his own professional work. Getting waiting lists down will be his No. 1 priority, should Labour be successful in Scotland next year. It is a shame for Scottish people to see waiting lists rising while we make progress in England and Wales.

The greatest Welshman in history, Nye Bevan, founded our national health service. The hon. Member for Brecon, Radnor and Cwm Tawe might want to dispute that and give the title to Lloyd George—we will politely disagree on that one. But the serious point is that Bevan’s vision was for a health service where no one was left behind, not least in his own country of birth. Working in partnership, we will fix the NHS across the United Kingdom and make it fit for the future.