Speeches by Tufnell.

“That is from one health board.”

“This is about transport and access.”

“So you are not factoring in the difficulties that patients will face if they are living in a more rural setting, for example.”

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

“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…”

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

“I want to build on this digital point, and I am also going to do a shout-out for west Wales for my colleagues over there, because you missed out west Wales.”

“I am more concerned about this number of patients; I do not understand where they are going, how it works for them and why they are not linked with you. I would rather explore that first—I think we are going to come to IPFRs later.”

“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 …”

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

“I still do not quite understand. You are the body responsible for commissioning services that you cannot provide in Wales—”

“Yes, the west is best. You mentioned digital and that, if a service is cross-border, you might want to move to virtual consultations with a particular consultant in that area—for instance, in our constituencies out west there is big rurality and very long distances. It was also raised yesterday that you might want to l…”

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

“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…”

“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.”

“One of the health boards said yesterday that it is currently “pathway by pathway, service by service and clinician by clinician”, and that it happens in particular instances but not routinely everywhere.”

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

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

“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…”

“Could you clarify some of the numbers that you put forward? You said you have 631 for outside the JCC and your relationships with Agnes Hunt and Bristol, but then you had 37 through the IPFR. The evidence from the previous session differentiated two lines, one through the established relationships—through Agnes Hunt an…”