Speeches by Tufnell.

“Is there any way that you could provide evidence to the Committee about why there is that massive differential?”

“I think I have taken this as far as I can, Chair.”

“I understand that bit, and I understand that happens with other health boards, like Betsi referring to the Wirral—I get that. I also get the IPFRs, which we will come to later in respect of high-cost medication. What I do not understand is where there is this third batch of patients, and how they are being referred for…”

“You mentioned Hywel Dda. They have 631 patients who go outside of their contractual relationships and outside of IPFRs to English providers. What is the JCC’s role in respect of those 631 patients? For instance, I represent Pembrokeshire, so some of those 631 patients will be my constituents. How are they accessing hea…”

“Those are the contracted relationships that I touched on before.”

“Why is there such a big differential between the approval rates in Wales and England? I think you said it was 5% approval in England, and you are at 79% in Wales.”

“Which are established through those contractual relationships that already exist. I understand that. Evidence that we have had before has shown that those are quite successful: there is quite a streamlined process because the relationships are established and that is quite smooth. The fear is that the IPFRs are quite c…”

“Can you explain the JCC’s role in interacting with that group of patients?”

“You won’t have a role in the contractual relationship.”

“It is quite big.”

“May I read something out quickly, before we move on, because it is important? It is about the statement of principles and values. One of them is: “The overriding principle of this statement is that no treatment will be refused or delayed due to uncertainty or ambiguity as to which body is responsible for funding an ind…”

“It does not feel very streamlined. From what you are describing, it feels a bit ad hoc and scattergun. Is that a fair assessment?”

“That is fine; we know that. We know about the IPFRs, and we know that you have a role in respect of that. But there is this third group of patients.”

“The evidence that we heard yesterday was: “there are times when a patient does not fit with the JCC or the contractual arrangements we have in the long-term agreements…in our health board”—this is Hywell Dda—“we have the prior approval process for that, and it equated to 631 patients last year where our patients would …”

“How are you working with NHS England to facilitate travel?”

“But you are saying that it is not your responsibility.”

“Is that the same experience for you both?”

“As a Welsh MP, I want to bring in this aspect around devolution. Keeping with controlled fires and prescribed burning, obviously you have different regimes. In Wales, we have a burning season. As Natural England, how do you interact with those devolved regimes, and how do you learn from them? What is that process like?”

“Do you think those values and principles should be legally binding?”

“We have talked about how there is clarity in situations where that relationship already exists, particularly within a specialty, but when you go down the individual patient funding request route, presumably that becomes an issue in terms of upholding that statement of values and principles—although I appreciate that yo…”