Cross-border Healthcare

Debate between Rachel Gilmour and David Chadwick

Tuesday 4th November 2025 Westminster Hall

[David Chadwick (Brecon, Radnor and Cwm Tawe) (LD)]

I beg to move,

That this House has considered cross-border healthcare.

It is an honour to serve under your chairmanship, Mr Dowd. Last year, hopes were raised that two Labour Governments working together would put an end to conflict between Cardiff Bay and Westminster, yet few issues trouble my constituents more than the daily reality of cross-border healthcare between England and Wales. Powys is a beautiful county, but it is also the largest in Wales, with no district general hospital of its own. Nearly 40% of the health board’s budget is spent commissioning services across the border in Herefordshire and Shropshire, because that is where the nearest hospitals are. When co-ordination between the Welsh and UK Government fails, it is Powys patients who feel it first and hardest.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

My hon. Friend is making a point about the border between England and Wales, but I represent a constituent who lives in a spot equidistant between two hospitals in Exeter and Taunton. Only one hospital could provide the treatment she needed, but the consultant there recommended rehabilitation at a third hospital across the border in Tiverton. After a lengthy back and forth, she was allowed treatment on the grounds of extenuating circumstances. Will my hon. Friend join me in pressing for a clear, binding system to allow seamless cross-border referrals where clinically appropriate?

[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.

Pensions: Expatriates

Debate between Rachel Gilmour and David Chadwick

Tuesday 20th May 2025 Westminster Hall

[David Chadwick (Brecon, Radnor and Cwm Tawe) (LD)]

I am grateful for the opportunity to speak in this debate, Mr Dowd. I refer hon. Members to my entry in the Register of Members’ Financial Interests. I thank the hon. Member for Farnham and Bordon (Gregory Stafford) for securing this important debate.

Nearly half a million UK pensioners living overseas are being penalised, not because they did not pay into the system but because of where they now live. They are our citizens—our veterans, carers, former teachers and nurses. They worked all their lives, paid into the national insurance system and are now denied the annual uprating of their state pension. Their pensions have been frozen, sometimes for decades, based purely on whether the UK happens to have a reciprocal agreement with their country of residence. As we have heard, it cannot be fair that a pensioner in the US sees their pension rise each year, while a pensioner in Australia does not.

The Liberal Democrats have long campaigned for an end to that injustice. We have already heard about Lord German’s sterling work, and I would like to highlight the policy research by Liberal Democrats Overseas, which has proposed a fair and affordable five-year plan to restore full uprating, starting with those who have lost out the most. Campaigners acknowledge the cost of their demands, and are even willing to accept partial uprating as a first step. However, as we have heard, previous Governments have refused to act and, worse, have turned down repeated offers from countries such as Australia and Canada to negotiate new agreements. This Government can take a fairer approach.

It is interesting that the Welsh Affairs Committee is looking into how we can engage the Welsh diaspora in promoting brand Wales overseas. A new settlement for British pensioners living overseas strikes me as a good way to engage with the British diaspora, particularly as we strike new agreements with countries all over the world. We Liberal Democrats call on the Government to stop hiding behind outdated excuses and to start treating all UK pensioners with fairness and dignity.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

People who receive a pension income have worked throughout their careers for that money, and they deserve to be able to access it fairly and with the proper information, lest we see a repeat of the WASPI scandal. Does my hon. Friend therefore agree that, for people receiving a UK pension, uprating should not be a lottery of land borders, and that His Majesty’s Government should redouble their efforts to find reciprocal arrangements with countries currently without an agreement with the UK?

[David Chadwick]

David Lloyd George created the social contract on which our pension scheme still runs, and I am sure he would be proud to hear my hon. Friend calling for that social contract to be adhered to.

Several hon. Members have drawn attention to the fact that we now have many constituents living abroad who have the right to vote. To better represent their needs and make more progress, the Government might wish to consider the idea of overseas constituencies. That would give one or two hon. Members the opportunity to represent the needs of people living abroad who certainly warrant their full pensions.

Groceries Code Adjudicator

Debate between Rachel Gilmour and David Chadwick

Tuesday 25th February 2025 Westminster Hall

[David Chadwick (Brecon, Radnor and Cwm Tawe) (LD)]

I beg to move,

That this House has considered the Groceries Code Adjudicator.

It is a pleasure to serve under your chairmanship, Mr Twigg.

There is a deep unfairness at the heart of our food system. That unfairness stems from the power imbalance between producers and retailers. At one end, the retailers we buy our food from are making huge profits. Last year, the big four supermarkets saw a 97% increase in their profits: Tesco made £2.3 billion, Asda made £1.1 billion and Sainsbury’s made £701 million. That is enough to convince anyone that there is enough money in the till to go around.

As we know, food prices have soared since 2022, yet Welsh farming incomes are actually falling. That is a sign of a food system that generates huge profits for the supermarkets and the big retailers, while the producers at the other end suffer what they must. Farmers and growers carry the risks of food production but do not receive a fair share of the rewards. The people who grow our food deserve to earn a decent living. That is why the Liberal Democrats will keep campaigning to level the metaphorical playing field for farmers.

[Rachel Gilmour (Tiverton and Minehead) (LD)]

The Groceries Code Adjudicator was established by my party, the Liberal Democrats, during that sad time in Government. It was an extremely important achievement designed to protect the interests of farmers and food producers. Some hon. Members will know of my background as a director of the National Farmers Union, and my constituency of Tiverton and Minehead is home to some 1,600 farmers. In recognising that farmers are the lifeblood of the rural economy, would my hon. Friend agree that the GCA’s resources and scope must be expended to ensure it can exercise its investigative powers and correct the imbalance between our farmers and the big supermarket chains?

[David Chadwick]

I thank my hon. Friend for highlighting the achievements of the Liberal Democrats in power, particularly the fact that we have a long record of standing up for rural communities. The physical hills that Welsh farmers have to climb are getting steeper. Energy and fertiliser costs are rising, subsidy schemes are changing and farm incomes are falling. To make matters worse, the Government’s family farm tax threatens to further strain their livelihoods. Those are just a few of the battles that farmers face. Their industry deserves a fair market, and it is for that reason that the Liberal Democrats introduced the Groceries Code Adjudicator during the coalition years.