Committee publication · Correspondence · 4 June 2026
Correspondence to and from Robert Jones and Agnes Hunt Orthopaedic Hospital, following the 22 April evidence session on Cross-border healthcare arrangements between England and Wales
From: Welsh Affairs Committee
Inquiry: Cross-border healthcare arrangements between England and Wales
Summary
Correspondence between Ruth Jones MP (Chair, Welsh Affairs Committee) and Stacey Keegan (Chief Executive, Robert Jones and Agnes Hunt Orthopaedic Hospital) following an evidence session on cross-border healthcare. The hospital provides detailed written answers to four questions about spinal referral increases, specialised commissioning improvements, discharge processes for Welsh patients after complex surgery, and delays caused by cross-border arrangements.
Key findings
- Spinal disorder referrals increased 85.2% between 2019/20 and 2024/25; current levels remain 43.9% above baseline despite recent reductions, attributed to limited specialist clinician capacity rather than clinical demand alone.
- Hospital identifies systemic lack of clarity around responsibility between Welsh specialised commissioning functions and English provider Trusts, creating uncertainty over funding approvals and service development decisions.
- Welsh discharge processes require 'Discharge to Assess' (D2A) model with duplicative paperwork and delays (social worker assessments often exceed two weeks), whereas English patients receive assessments at the hospital before discharge to final residence.
- Hospital recommends improved integration of health and social care, better data transparency, clearer discharge policies for complex patients, demand-capacity reviews, and involvement of specialised commissioners in discharge meetings.
- Cross-border healthcare delays are driven by procedural duplication, lengthy social work assessment waits, and therapy team travel time constraints affecting ward-based care delivery.
Tone
ProceduralTopics
Key actors
Ruth Jones MP, Stacey Keegan, Robert Jones and Agnes Hunt Orthopaedic Hospital, Welsh Affairs Committee, Welsh Health Boards, Welsh specialised commissioning, NHS England
Notable line
“English patients will get their DST and CHC assessment at RJAH so will go to their final new residence upon being discharged.”
Key Quotes
“Spinal Disorder referrals between the 2019/20 baseline and 2024/25 saw an 85.2% increase, and whilst referrals have reduced in the most recent year, this is still 43.9% higher than 2019/20.”
“For English Trusts providing highly specialised care to Welsh patients, there is often a lack of clarity around where responsibility sits between national Welsh specialised commissioning functions and individual Welsh Health Boards.”
“Welsh providers insist on the Discharge To Assess (D2A) model, meaning patients need repatriating before the final discharge process to the permanent place of residence for our patients can be commenced”
“There is often lengthy waits for Social Workers to attend wards to complete patient assessments, which can often take more than two weeks.”
“Thank you for appearing before the Welsh Affairs Committee on Wednesday 22 April and giving oral evidence on our inquiry into Cross-border healthcare arrangements between England and Wales.”
Source · parliament.uk record ↗