Committee publication · Correspondence · 4 June 2026
Correspondence to and from Llais, 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 the Welsh Affairs Committee and Llais (NHS Wales patient advocacy body) following an April 2026 evidence session on cross-border healthcare between England and Wales. Llais provides detailed written responses to committee questions about waiting list impacts on Welsh patients in England, and support mechanisms for those referred to private facilities, with additional evidence on cancer care fragmentation and Individual Patient Funding Request confusion.
Key findings
- Powys Teaching Health Board's July 2025 decision to deliberately extend waiting times for Welsh residents receiving NHS treatment in England has caused 'considerable concern and distress', with patients reporting feelings of being treated as 'second-class citizens' and experiencing discriminatory comments from English healthcare staff.
- Extended waiting times cause measurable harm: prolonged pain, anxiety, loss of independence, financial strain, and relationship disruption. The decision creates parallel administrative systems in cross-border hospitals, increasing complexity and potentially negating intended cost savings.
- Cancer patients receiving cross-border care report severe fragmentation: delays in referrals and diagnosis, poor coordination between systems, travel burden (especially in rural areas), and inadequate post-treatment support. Most Powys cancer patients receive majority treatment in England.
- Individual Patient Funding Requests (IPFR) create unexpected barriers and confusion in cross-border pathways, particularly for time-critical conditions like cancer. Patients often unaware of funding requirements until delays occur, reinforcing perception that system decisions prioritise constraints over individual need.
- Llais offers free complaints advocacy support for NHS-funded care at private English providers and can support patients in understanding waiting time standards and governance, but data gaps mean the full scale of impact from extended waiting times remains unmeasured.
Tone
CriticalTopics
Key actors
Alyson Thomas, Ruth Jones MP, Llais, Powys Teaching Health Board, NHS Wales, NHS England, Robert Jones and Agnes Hunt Hospital, Wye Valley Trust
Notable line
“… a decision that deliberately create longer waits feels not just inconvenient, but morally wrong.”
Key Quotes
“… for some, their treatment in England may take significantly longer than a person with the same clinical need and priority at the same hospital but who lives across the border in England.”
“Some people have reported their distress at being told directly by staff in an English healthcare setting that different waiting - time rules apply to them.”
“… people describe being told, on being identified as a Powys resident …”
“These interactions leave people feeling embarrassed, upset and unfairly treated. For many, they reinforce the sense of being treated differently or as "second - class citizens ," simply because of where they live, despite accessing the same NHS services.”
“Long waits are not experienced as abstract system pressures, but as prolonged pain, anxiety, deterioration in health, and disruption to everyday life.”
“… cross - border cancer care can deliver excellent specialist treatment, but too often at a personal cost. Delays, fragmented pathways, poor communication, and travel demands increase anxiety, fatigue, and pressure on families.”
“People are often unaware that a separate funding decision is required until a delay occurs or a recommended treatment cannot proceed. In cross - border pathways, this can feel like an unexpected barrier after referral, rather than a clearly signposted part of the care journey.”
Source · parliament.uk record ↗