English: Speaking in the Welsh Conservative debate on cross-border issues here in May 2009, I stated: 'Cross-border movements in healthservices are a long-established fact of life, reflecting geographic and demographic realities.' I referred to the Welsh Affairs Committee report on cross-border services then, which concluded that there was a lack of effective communication between the Welsh Government and the Department of Health in England, and called for the two to work together to ensure that Welsh residents' rights to access English services are protected and vice versa. They considered that an improved Government-level protocol was essential to standardise and clarify funding arrangements and accountability mechanisms, stating that the result should be seamless care for patients based on clinical need. The Flintshire governors on the board of the Countess of Chester Hospital had stated that their hospitals of first choice are the Countess of Chester and the teaching hospitals of Liverpool, and orthopaedic patients had expressed their need for continued access to Gobowen hospital. They referred to the Welsh Affairs Select Committee's statement that citizen engagement should not stop at the border, and to Flintshire local health board's annual report the previous year, which said that more Flintshire patients were treated as out-patients, day cases or emergency cases at the Countess of Chester Hospital than at either Wrexham Maelor or Glan Clwyd hospitals. Although the Welsh Government health Minister, during the third Assembly, stated that her overriding aim was to secure as many services as could be safely provided within Wales's boundaries, and although the impartial Assembly Research Service told me in 2013 that they'd spoken to a Welsh Government official who confirmed that it was Welsh Government policy to repatriate Welsh patients presently served in English in-patient settings, the last Welsh health Minister wrote to me stating that this information is incorrect - there is no hidden policy to repatriate Welsh patients. However, in a meeting with the Countess of Chester Hospital in September 2013, I was told that Betsi Cadwaladr University Local Health Board was reducing or cancelling referrals and pulling activity back across the border, despite not having the capacity. As they said, the focus should be the patient and they wanted to contribute to the provision of quicker, better and more economic cross-border care. Early last year, the Welsh Government announced that it was commissioning pain management clinics from England, after waiting lists in Wales reached 78 weeks. I've been contacted by constituents in pain who'd always received their treatments at the Countess of Chester, but were now instead being added to long waiting lists in Wales. When I took this up with the health board, they acknowledged that there was a waiting time for this service, but said that they had not been able to secure additional NHS capacity in north-west England. So, I contacted the chief executive of the Countess of Chester who replied that Wales withdrew from their pain service two years previously, and as a consequence, they could no longer accept Welsh referrals. But he added: 'maybe this is something that you might discuss with the Welsh Government to see if there's a political will for us to be seen as part of the North Wales acute healthcare solution.' When I did this, however, the then health Minister simply passed the buck back to the health board. Although the Wales-England protocol for cross-border healthcare services was implemented in April 2013 to improve communication, the Welsh NHS Confederation states now that the decision-making process on each side of the border needs to be more co-ordinated, coherent and transparent. The 2016 Welsh Affairs Committee report on cross-border health arrangements between England and Wales expressed concern that there's a lack of communication regarding changes to healthcare services, which could have an impact across the border, and recommended that formal protocols are put in place to ensure consultation between Welsh local health boards and English clinical commissioning groups, when changes to services impact on populations across the border. As Dr Dai Lloyd said here in 2009: 'Mature nations work together across boundaries in historical time-honoured fashion for the better health provision of all of their people.' Excellently put. As I then said, we must avoid at all costs a slate curtain in services between these two British nations. Our long and porous border should be a cause for celebration and co-operation, rather than an obstacle to efficiency and effectiveness.
Welsh: Wrth siarad yn nadl y Ceidwadwyr Cymreig ar faterion trawsffiniol yma ym mis Mai 2009, nodais, 'mae symudiadau trawsffiniol mewn gwasanaethau iechyd yn ffaith hir sefydledig, yn adlewyrchu'r realiti daearyddol a demograffig.' Cyfeiriais at adroddiad y Pwyllgor Materion Cymreig ar wasanaethau trawsffiniol ar y pryd a ddaeth i'r casgliad fod diffyg cyfathrebu effeithiol rhwng Llywodraeth Cymru a'r Adran Iechyd yn Lloegr, a galwai ar y ddau i weithio gyda'i gilydd i sicrhau bod hawliau trigolion Cymru i ddefnyddio gwasanaethau yn Lloegr, a'r ffordd arall, yn cael eu diogelu. Roeddent o'r farn fod protocol gwell ar lefel Llywodraeth yn hanfodol i safoni ac egluro trefniadau ariannu a mecanweithiau atebolrwydd, gan ddweud mai'r canlyniad y dylid ei sicrhau yw gofal di-dor i gleifion ar sail angen clinigol. Roedd llywodraethwyr Sir y Fflint ar fwrdd Ysbyty Iarlles Caer wedi datgan mai eu dewis cyntaf o ysbytai yw Ysbyty Iarlles Caer ac ysbytai addysgu Lerpwl, ac roedd cleifion orthopedig wedi mynegi eu hangen i barhau i ddefnyddio ysbyty Gobowen. Roeddent yn cyfeirio at ddatganiad y Pwyllgor Dethol ar Faterion Cymreig na ddylai ymgysylltiad â dinasyddion ddod i ben ar y ffin, ac at adroddiad blynyddol bwrdd iechyd lleol Sir y Fflint y flwyddyn flaenorol, a oedd yn dweud bod mwy o gleifion Sir y Fflint yn cael eu trin fel cleifion allanol, achosion dydd neu achosion brys yn Ysbyty Iarlles Caer nag yn Ysbyty Maelor Wrecsam nac Ysbyty Glan Clwyd. Er bod Gweinidog Iechyd Llywodraeth Cymru, yn ystod y trydydd Cynulliad, wedi dweud mai ei phrif nod oedd sicrhau cymaint o wasanaethau ag y gellid eu darparu'n ddiogel o fewn ffiniau Cymru, ac er bod Gwasanaeth Ymchwil diduedd y Cynulliad wedi dweud wrthyf yn 2013 eu bod wedi siarad â swyddog o Lywodraeth Cymru a gadarnhaodd mai polisi Llywodraeth Cymru oedd dychwelyd cleifion o Gymru sy'n cael gwasanaeth ar hyn o bryd mewn sefydliadau cleifion mewnol yn Lloegr, ysgrifennodd Gweinidog Iechyd diwethaf Cymru ataf i ddatgan bod y wybodaeth hon yn anghywir - nid oes polisi cudd i ddychwelyd cleifion i Gymru. Fodd bynnag, mewn cyfarfod gydag Ysbyty Iarlles Caer ym mis Medi 2013, dywedwyd wrthyf fod Bwrdd Iechyd Prifysgol Betsi Cadwaladr yn lleihau neu'n canslo atgyfeiriadau ac yn tynnu gweithgarwch yn ôl dros y ffin, er nad oedd ganddynt gapasiti i wneud hynny. Fel y dywedasant, dylai'r ffocws fod ar y claf ac roeddent yn awyddus i gyfrannu at ddarparu gofal trawsffiniol cyflymach, gwell a mwy economaidd. Yn gynnar y llynedd, cyhoeddodd Llywodraeth Cymru ei bod yn comisiynu clinigau rheoli poen o Loegr ar ôl i restrau aros yng Nghymru gyrraedd 78 wythnos. Cysylltodd etholwyr â mi a oedd mewn poen ac a oedd bob amser wedi cael eu triniaeth yn Ysbyty Iarlles Caer, ond yn lle hynny roeddent bellach yn cael eu rhoi ar restrau aros hir yng Nghymru. Pan soniais wrth y bwrdd iechyd am hyn, roeddent yn cydnabod bod amser aros am y gwasanaeth hwn, ond nad oeddent wedi llwyddo i sicrhau capasiti GIG ychwanegol yng ngogledd-orllewin Lloegr. Felly, cysylltais â phrif weithredwr Ysbyty Iarlles Caer a atebodd fod Cymru wedi tynnu allan o'u gwasanaeth poen ddwy flynedd ynghynt ac o ganlyniad, ni allent dderbyn atgyfeiriadau o Gymru bellach. Ond ychwanegodd: efallai fod hyn yn rhywbeth y gallech ei drafod gyda Llywodraeth Cymru i weld a oes ewyllys gwleidyddol i ni gael ein gweld fel rhan o'r ateb gofal iechyd acíwt yng ngogledd Cymru. Pan wneuthum hyn, fodd bynnag, trosglwyddodd y Gweinidog iechyd ar y pryd y baich yn ôl i'r bwrdd iechyd. Er bod y protocol Cymru-Lloegr ar gyfer gwasanaethau gofal iechyd trawsffiniol wedi ei roi ar waith ym mis Ebrill 2013 i wella cyfathrebu, mae Cydffederasiwn GIG Cymru yn datgan yn awr fod angen i'r broses o wneud penderfyniadau ar y ddwy ochr i'r ffin fod yn fwy cydgysylltiedig, yn fwy cydlynus ac yn fwy tryloyw. Mynegwyd pryder yn adroddiad 2016 y Pwyllgor Dethol ar Faterion Cymreig ar drefniadau iechyd trawsffiniol rhwng Cymru a Lloegr fod yna ddiffyg cyfathrebu ynglŷn â newidiadau i wasanaethau gofal iechyd, a allai gael effaith ar draws y ffin, ac argymhellodd y dylid rhoi protocolau ffurfiol ar waith i sicrhau bod ymgynghori'n digwydd rhwng byrddau iechyd lleol Cymru a grwpiau comisiynu clinigol yn Lloegr pan fo newidiadau i wasanaethau'n effeithio ar boblogaethau ar draws y ffin. Fel y dywedodd Dr Dai Lloyd yma yn 2009: 'Mae cenhedloedd aeddfed yn cydweithio ar draws ffiniau mewn dull hanesyddol er lles iechyd eu holl bobloedd.' Dyna ffordd ragorol o'i roi. Fel y dywedais ar y pryd, rhaid i ni ar bob cyfrif osgoi llen lechi mewn gwasanaethau rhwng y ddwy genedl Brydeinig hyn. Dylai ein ffin hir a thyllog fod yn achos dathlu a chydweithredu, yn hytrach na rhwystr i effeithlonrwydd ac effeithiolrwydd.