Given the divergence in health policy between England and Wales, and the significant number of patients who cross the border for treatment, the Welsh Affairs Committee examined the interface between the two systems and the effectiveness of co-ordination between the Department for Health and the Welsh Assembly Government. It wanted to discover whether cross-border patients are treated fairly and whether the Welsh Assembly Government and the Department of Health consider the border in the development of the diverging policy environment. The Committee was aware of significant confusion amongst patients, for example in knowing what they are entitled to receive from their health service and that cross-border providers were being disadvantaged by the need to cope with two separate funding and commissioning schemes. The Committee's interim report on this topic (HC 870, session 2007-08, ISBN 9780215521682) concluded that four key criteria should be established in cross-border health policy: clinical excellence as close to home as possible; border-proofing of policy and practice; cross-border citizen engagement; and transparent and accountable co-operation between localities, regions and governments. This report returns to these key criteria. The Committee is very disappointed that a protocol on cross-border health services has not been agreed, further evidence of a clear lack of co-ordination between the UK and Welsh Assembly governments and which leaves clinicians and administrators in a strained position and risks adversely affecting patients as a result of cross-border commissioning and funding problems. Better information for patients must be provided. The Committee finds the Department of Health's delay in responding to its interim report until some 6 months after publication to be unacceptable.

Working practices between the UK and Welsh Assembly governments in relation to cross-border policies appear much improved since the Committee's earlier reports on this subject. But a number of outstanding issues remain in transport, health and further and higher education. On transport the Committee welcomes the planned electrification of the Great Western Main Line. However, the Department for Transport appears to have washed its hands of any strategic responsibility for cross-border roads. The A483 is the clearest example of a road vital for travel within Wales but which is not important to the English region in which it is located, and as a result loses out on funding. The Committee stresses the need for comparative data on which to build solid research comparing NHS performance in the devolved nations. More needs to be done to raise public awareness of the differences in services people can expect to receive on both sides of the border. Transparency of information is vital. Research proposals in the UK Government's Higher Ambitions strategy for higher education make no reference to nations other than England, despite the UK-wide research remit of the Department for Business, Innovation and Skills. The Committee calls for details about how research funding proposals apply to all four nations.

Work of the Committee 2008-09 : Third report of session 2009-10, report, together with formal Minutes

The effective operation of devolution stands the best chance of success if both the UK and Welsh governments share knowledge and understanding, concludes the Welsh Affairs Committee in this report. The Committee makes a number of recommendations to improve the relationship between Wales and Whitehall. A broad review of how intergovernmental relationships are coordinated is required. The Joint Ministerial Committee should meet on a regular basis and ministers at all levels should be alert to the consequences of policy and legislation on devolved areas. The Cabinet Office should take lead responsibility for devolution strategy in Whitehall. Whitehall has lost a focus on the devolution settlement and too often has displayed poor knowledge and understanding of the specificities of the Welsh settlement. The Civil Service needs more consistent training and clear department-by-department focus on retaining devolution knowledge and understanding. The Welsh Assembly Government should have the confidence to interact with Whitehall and to promote areas of good practice. The Cabinet Secretary and the Permanent Secretary to the Welsh Assembly Government should give evidence annually to the Welsh Affairs Committee. Finally, reform of the Barnett Formula is required. The current financial settlement does not appear sustainable and a new arrangement needs to be built on an agreed and enduring basis which is demonstrably fair and sensitive to the particular circumstances of Wales.

Incorporating HC 1110, session 2008-09

The proposed National Assembly for Wales (Legislative Competence) (Local Government) Order 2009 is the twelfth Legislative Competence Order on which the Welsh Affairs Committee has reported. The Order will give the Assembly powers in respect of the structures and work of local government in Wales at all levels. The Welsh Assembly Government has requested this power because it wishes to develop and strengthen the role of community councils and councillors in Wales. The proposed Order will allow the Welsh Assembly Government to fulfil its commitment to seek legislation to address issues identified in the 2003 'Aberystwyth Report'. The Committee agrees that a clear need for the proposed LCO has been identified and is consistent with the Government's commitment to build up the capacity of town and community councils. The proposed Order is drafted in broad and accessible terms with the minimum of exceptions and interpretation. The Committee is concerned, however, that there are now many terms used to describe the various tiers of local government in Wales and agree with the suggestions put forward that the Minister should speedily undertake a review of terminology relating to local government. Specifically the term 'community' is cited as having various meanings dependent on context. Furthermore, given that there have already been several LCO proposals identified in terms of local government, to call this the National Assembly for Wales (Legislative Competence) (Local Government) Order introduces the potential for confusion. A title such as 'National Assembly for Wale (Legislative Competence) (Community Councils) Order or similar is suggested

There is a pressing need for more prison places in Wales. There are only four prisons in Wales, all of which are in South Wales. The Committee urges the Government to be flexible in its approach, which would be consistent with the considered views expressed in recent reports by the Justice Select Committee.