Speeches by Tufnell.

“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?”

“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…”

“Are you able to put a figure on it?”

“Does that concern you?”

“It sounds like a very minimum interaction.”

“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…”

“I want to quickly follow up on Gerald’s question with you, Phil. Ben and Ann have left, but you presumably face additional challenges in your area given the level of distance—you have to cover Carmarthen all the way up to Borth. The geographical area is greater than what some of your colleagues on the call cover. Do yo…”

“How does that work? You have these established relationships with Agnes Hunt and Bristol. If you want to move to a virtual consultation with a particular consultant in those areas, or if you want to change the appointment to facilitate that transport, what does that look like with those contractual agreements that are …”

“So you would dispute the fact that you did not assess those two situations in terms of cutting and non-management?”

“Are you suggesting that those established relationships are around 90% or 95% of the cases that you handle, and that, outside the things you referenced—I think we had reference to cancer pathways and pre-term birth in the Wirral, for example—IPFRs are a very small percentage of the total caseload that you deal with?”

“Building on what Henrietta just set out, evidence has been submitted that the licence process is overly complex, slow and impractical, and that it had to go to Ministers for personal approval in order to get that through. That does not necessarily sit well with what Henrietta just set out. Can you comment on that, Sall…”

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

“You started by referring to the statement of values and principles that you said had been helpful in improving the patient experience. I am going to read out two of those principles now. The first is, “Both countries will act in the best interest of patients at all times, and there will be no delay in accessing healthc…”

“On the relationship with the JCC, how do you find that? From what you are saying, it sounds like you try your level best to avoid them. You create those established pathways, and that works better than going through—”