NHS cross-border care between Wales and England: 2024
Data covering GP registrations, Referral To Treatment (RTT) waiting lists and hospital treatment.
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In this page
Introduction
This statistical release has been produced using data from NHS Wales, Digital Health and Care Wales (DHCW) and NHS England. It provides a summary of NHS cross-border care activity between Wales and England covering GP registrations, Referral To Treatment (RTT) waiting lists and hospital admissions.
Information about how cross-border care is commissioned and funded is provided in the arrangements for cross-border care section below and in the background information.
Main points
- Mutual arrangements are in place to manage and fund healthcare for patients resident in one country but registered with a GP practice or receiving NHS treatment in the other.
- In April 2024 there were 13,300 Welsh residents registered with GPs in England and 21,100 English residents registered with GPs in Wales.
- In March 2024 there were almost 27,000 open RTT pathways for patients resident in Wales and on RTT waiting lists in England, more than twice as many as there were in 2011. No data is available for English residents waiting for treatment in Wales.
- In 2023-24 there were 60,700 finished consultant episodes (FCEs) of Welsh residents, where the episode involved an admission at an English NHS hospital.
- In 2023-24 there were 7,300 FCEs of English residents, where the episode involved an admission at a Welsh NHS hospital.
Arrangements for cross-border care
Mutual arrangements are in place to manage and fund healthcare for patients resident in one country but registered with a GP practice or waiting for NHS treatment in the other. These arrangements ensure that each country ultimately covers the costs of the services required by its residents, wherever those services are provided.
Arrangements for cross border health care between Wales and England are based on the principle that no treatment will be refused or delayed due to uncertainty or ambiguity as to which body is responsible for funding an individual’s healthcare, or due to differing rules as to the level of services available under each country’s health system. Further information is provided in the background information section below.
General practice (GP) registrations
Figure 1: Number of English residents registered at Welsh GP practices and Welsh residents registered at English GP practices, January 2020 to April 2024 [Note 1]
Description of Figure 1: A line chart showing there are more English residents registered at Welsh GP practices than Welsh residents registered at English GP practice. Both series have remained stable over time.
Source: NHS Wales Shared Services Partnership
Patients Registered at a GP Practice - NHS England Digital
[Note 1]Data are not available for April 2022.
Latest data for April 2024, show there were 13,300 Welsh residents registered with GPs in England and 21,100 English residents registered with GPs in Wales. There has been very little change in this series since January 2020, the earliest available data point.
Patients waiting for secondary care treatment
An RTT pathway covers the time waiting from referral until the pathway is closed, either because treatment has started or it has been determined that treatment won’t be needed. This includes time spent waiting for any hospital appointments, tests, scans or other procedures before treatment begins.
Some or all of a Welsh resident’s RTT pathway may be carried out in England. Data in this section of the article relate to open pathways for Welsh residents on English RTT pathways. Data are not available for English residents on open RTT pathways provided in Wales.
A summary of the cross-UK comparability of NHS planned care waiting time statistics is published on the ONS website: NHS planned care waiting times across the UKK (ONS).
Figure 2: Number of Welsh residents on Referral To Treatment (RTT) waiting lists with NHS providers in England, September 2011 to March 2024
Description of Figure 2: A line chart showing the number of Welsh residents on RTT waiting lists in England. Numbers waiting increased steadily from 2011 to 2020, and then sharply into 2021 following the onset of the coronavirus (COVID-19) pandemic. By 2024, there were more than twice as many patients waiting when compared to 2011.
Source: Referral to treatment times, Digital Health and Care Wales
In March 2024 there were almost 27,000 open RTT pathways for patients resident in Wales and on RTT waiting lists in England, almost three times more than the lowest point in March 2012. The long term trend is similar to the trend in total RTT waiting lists, which is explored in our Trends in NHS planned care report. No data is available for English residents waiting for treatment in Wales.
Patients treated at NHS hospitals
The inpatient activity data used in this section of the article is based on finished consultant episodes (FCEs) where patients spend time in hospital under the care of a consultant (an admission). This includes in-patient, day case and maternity/other consultant episodes. More information relating to outpatient and inpatient activity is available at DHCWs secondary care page and NHS Digital's Hospital Episode Statistics (HES) page. Data has been sourced from Wales’ Admitted Patient Care (APC) dataa (DHCW) and England’s Hospital Episode Statistics (HES) (NHS Digital).
Figure 3: Number of finished consultant episodes (FCEs) with admissions of cross border patients, 2014-15 to 2023-24
Description of Figure 3: a line chart showing there are around eight times as many FCE admissions for Welsh residents in English hospitals as there are for English residents in Welsh hospitals. The long-term trends for both series are relatively flat, though there were significant falls in 2020-21 when hospital activity reduced during the COVID-19 pandemic.
Sources: English residents treated at Welsh NHS providers: Admitted patient care (APC) dataset, DHCW and Welsh residents treated at English NHS providers: HES, NHS England (NHSE)
In 2023-24 there were 60,700 FCE admissions for Welsh residents at English NHS hospitals and 7,300 admissions for English residents at Welsh NHS hospitals. The difference between these figures was relatively stable pre-pandemic. However, the impact of the pandemic has been greater for English residents treated at Welsh NHS providers than for Welsh residents treated at English NHS providers, with activity in 2023-24 down 14% and 3% respectively compared to their pre-pandemic levels.
Some Welsh Local Health Boards (LHB) and English Integrated Care Boards (ICB) routinely commission services in the other nation. This happens, for example, where a regional centre for a particular service covers parts of Wales and England, or where services in general are more readily available in the other nation. The difference between the number of Wales residents receiving treatment in England and England residents receiving treatment in Wales at least partially reflects the fact that more planned care services are available in England.
Figure 4: Proportion of finished consultant episodes (FCEs) with admissions of cross border patients by type of admission, 2023-24
Description of Figure 4: a bar chart showing that elective daycases were the most common type of FCE admission for Welsh residents in English hospitals and emergency admissions were the most common reason for English residents receiving treatment at Welsh hospitals in 2023-24.
Sources: English residents treated at Welsh NHS providers: Admitted patient care (APC) dataset, DHCW and Welsh residents treated at English NHS providers: HES, NHSE
There are differences in the types of FCE admissions of English residents receiving treatment in Wales compared with Welsh residents receiving treatment in England. In 2023-24, almost three quarters of admissions of English residents in Welsh hospitals were emergency admissions. But for Welsh residents admitted in English hospitals, almost 60% were for elective treatment and just over a third were emergency admissions.
Background information
Mutual arrangements are in place to manage and fund healthcare for patients resident in one country but registered with a GP practice or waiting for NHS treatment in the other.
Each country initially pays for all secondary care undertaken in that country, regardless of where patients are resident. For patients who live in Wales but are registered with a GP practice in England, the English ICB that includes their GP practice commissions and pays for health services on behalf of the Welsh LHB. The same applies for residents in England who are registered with a GP practice in Wales, with the relevant Welsh LHB commissioning and paying for services for those patients on the English ICB’s behalf.
In April 2024 there were 13,300 Welsh residents registered with English GPs and 21,100 English residents registered with Welsh GPs. A transfer of funds from England to Wales is made annually, which notionally relates to the cost of care for the net additional English residents registered with Welsh GPs. The settlement figure for 2023-24 was around £6m. This is based on a methodology which takes into account the net difference in cross border GP registrations and average costs of secondary care per capita in both countries.
In addition, where Welsh LHBs commission secondary care directly to English providers, LHBs pay the providers for those services using the NHS Payment Scheme.
Arrangements for cross border health care between Wales and England are based on the principle that no treatment will be refused or delayed due to uncertainty or ambiguity as to which body is responsible for funding an individual’s healthcare, or due to differing rules as to the level of services available under each country’s health system. Further information is available at the following:
Quality and methodology information
Statement of compliance with the Code of Practice for Statistics
This statistical article combines data sourced and published by more than one government department and with different types of statistical designation. Principles of the Code of Practice for Statistics have been applied were possible in developing this release.
Data for GP registrations and patients treated at hospital are Management Information (Office for Statistics Regulation (OSR)). However, data relating to patients waiting for secondary care treatment, sourced from the RTT dataset, DHCW, are Accredited Official Statistics (OSR).
Statement of compliance with the Code of Practice for Statistics
Our statistical practice is regulated by the OSR. OSR sets the standards of trustworthiness, quality and value in the Code of Practice for Statistics that all producers of official statistics should adhere to.
All of our statistics are produced and published in accordance with a number of statements and protocols to enhance trustworthiness, quality and value. These are set out in the Welsh Government’s Statement of Compliance.
Management information are not classed as official statistics. However, we have applied the principles of the Code of Practice as far as possible during development and have published these data at the earliest possible opportunity to assist users in understanding patterns of NHS cross-border care activity between Wales and England.
We have applied the Code of Practice for Statistics (UK Statistics Authority) to the accredited official statistics on RTT waiting lists as follows.
Trustworthiness
These statistics are compiled from administrative data systems in use across the NHS in Wales and England. In Wales, data are collected by the Welsh LHBs and provided to DHCW to enable them to be collated at a national level. DHCW separately collects data from NHSE providers regarding Welsh residents on RTT pathways in England.
The Welsh data collections are overseen by the Welsh Information Standards Board (WISB) (DHCW)), which is the custodian of the Information Standards Assurance Process. WISB mandates data collections through the NHS and LHBs, appraises information standards and provides assurance on matters related to confidentiality and consent.
The published figures are compiled by professional analysts using the latest available data and applying methods using their professional judgement and analytical skillset.
These statistics are pre-announced on the Statistics and Research area of the Welsh Government website. Access to the data during processing is restricted to those involved in the production of the statistics, quality assurance and for operational purposes. Pre-release access is restricted to eligible recipients in line with the Code of Practice (UK Statistics Authority).
Quality
Statistics published by Welsh Government adhere to the Statistical Quality Management Strategy which supplements the Quality pillar of the Code of Practice for Statistics and the European Statistical System principles of quality for statistical outputs.
Data standards and definitions are established by the WISB. Guidance is issued to the data providing organisations and training provided to staff responsible for collecting the data at source. DHCW collates and validates data and queries anomalous and missing data directly with suppliers. Before validated datasets are provided by DHCW to Welsh Government, all data are signed off by suppliers. DHCW provides validated datasets to Welsh Government, where analysts process the data to produce the aggregate statistics in the format required for publication. Welsh Government undertakes final validation checks which can be queried with DHCW and suppliers before publication. The statistical release is signed off by senior statisticians before publication.
Value
The purposes of this statistical article are: to provide evidence for policy development; to inform the media and wider public.
Reliable statistics on the volume of activity undertaken in the NHS and the size of waiting lists and activity conducted are vital to inform users about the state of NHS services and the performance of the Welsh government and the LHBs. These services have a significant impact on citizens’ lives and these topics feature prominently in media coverage and political discourse.
The information published here also supports the Welsh Government’s long term plan for health and social care: A Healthier Wales.
The timeliness of the data provides the most recent update using reliable data.
You are welcome to contact us directly with any comments about how we meet these standards. Alternatively, you can contact OSR by emailing regulation@statistics.gov.uk or via the OSR website.
Well-being of Future Generations Act (WFG)
The Well-being of Future Generations Act 2015 is about improving the social, economic, environmental and cultural wellbeing of Wales. The Act puts in place seven wellbeing goals for Wales. These are for a more equal, prosperous, resilient, healthier and globally responsible Wales, with cohesive communities and a vibrant culture and thriving Welsh language. Under section (10)(1) of the Act, the Welsh Ministers must (a) publish indicators (“national indicators”) that must be applied for the purpose of measuring progress towards the achievement of the wellbeing goals, and (b) lay a copy of the national indicators before Senedd Cymru. Under section 10(8) of the Well-being of Future Generations Act, where the Welsh Ministers revise the national indicators, they must as soon as reasonably practicable (a) publish the indicators as revised and (b) lay a copy of them before the Senedd. These national indicators were laid before the Senedd in 2021. The indicators laid on 14 December 2021 replace the set laid on 16 March 2016.
Information on the indicators, along with narratives for each of the well-being goals and associated technical information is available in the Wellbeing of Wales report.
Further information on the Well-being of Future Generations (Wales) Act 2015.
The statistics included in this release could also provide supporting narrative to the national indicators and be used by public services boards in relation to their local well-being assessments and local well-being plans.
We want your feedback
We welcome any feedback on any aspect of these statistics which can be provided by email to stats.healthinfo@gov.wales.