NHS cross-border care between Wales and England: 2026

This statistical release presents data on NHS cross-border care activity between Wales and England, using data supplied by NHS Wales, Digital Health and Care Wales (DHCW) and NHS England. It covers GP registrations, Referral To Treatment (RTT) waiting lists and hospital admissions.

This report is published on the same day as NHS England's Referral to Treatment (RTT) Waiting Times statistical release, which includes data used in this publication.

Information on the commissioning and funding of cross-border healthcare is provided in the arrangements for cross-border care section below and in the background information.

• Joint arrangements are in place to fund and manage healthcare for patients who live in Wales or England but are registered with a GP or receive NHS treatment in the other country.
• In July 2026, 13,100 Welsh residents were registered with GP practices in England, and 20,900 English residents were registered with GP practices in Wales. 
• In March 2026, there were just over 28,700 open RTT pathways for patients resident in Wales on waiting lists in England. This is 20,000 more than in 2011. Comparable data are not available for English residents waiting for treatment in Wales because these data are not reported to NHS England.
• In 2025 to 2026, there were 66,100 finished consultant episodes (FCEs) involving Welsh residents admitted to NHS hospitals in England. 
• In 2025 to 2026, there were 10,200 finished consultant episodes (FCEs) involving English residents admitted to NHS hospitals in Wales.

Joint 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.

Figure 1: English residents registered at Welsh GP practices and Welsh residents registered at English GP practices, January 2020 to July 2026 [Note 1]

Image

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 practices. Both series have remained stable over time.

Source: NHS Wales Shared Services Partnership

Patients registered to general practices in Wales and England, by lower super output area of residence (StatsWales)

Patients Registered at a GP Practice (NHS England Digital)

[Note 1] Data are not available for April 2022.

Latest data for July 2026, show there were 13,100 Welsh residents registered with GPs in England and 20,900 English residents registered with GPs in Wales. There has been very little change in this series since January 2020, the earliest available data point.

A Referral to Treatment (RTT) pathway measures the time from referral to the point at which the pathway is closed, either because treatment has started or because treatment is no longer required. This includes time spent waiting for hospital appointments, diagnostic tests, scans and other procedures before treatment begins.

Welsh residents may receive some or all of their treatment in England. Data in this section relate to open RTT pathways for Welsh residents waiting for treatment in England. Comparable data are not available for English residents waiting for treatment in Wales because these data are not reported to NHS England.

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 UK (ONS).

Figure 2: Welsh residents on Referral To Treatment (RTT) waiting lists with NHS providers in England, September 2011 to March 2026 [Note 1]

Image

Description of figure 2: A line chart showing a long-term increase in the number of Welsh residents on RTT waiting lists in England. 

Source: Referral to treatment times, Digital Health and Care Wales

[Note 1] Data are provided voluntarily by NHS England trusts to DHCW. As there is no formal basis for this data supply, it is not possible to assess its coverage and quality to the same extent as the other official RTT statistics. While some quality issues may exist, the data are regarded as broadly reliable.

In March 2026 there were just over 28,700 open RTT pathways for patients resident in Wales on waiting lists in England, almost three times more than the lowest point in March 2012. 
This is similar to the long-term trend in the overall RTT waiting list in Wales, which is explored in our trends in NHS planned care report. 

Numbers waiting increased steadily up to 2020 and then sharply into 2021. The figure peaked at over 30,000 pathways before falling slightly in the most recent months. 

The inpatient activity data used in this section are 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 DHCW’s secondary care page and NHS Digital's Hospital Episode Statistics (HES) page. Data have been sourced from Wales’ Admitted Patient Care (APC) data (DHCW) and England’s Hospital Episode Statistics (HES) (NHS Digital).

Some Welsh local health boards (LHBs) and English Integrated Care Boards (ICBs) routinely commission services across the Wales-England border. This may occur where specialist or regional centres serve populations in both countries, or where services in general are more accessible in the other nation. The higher number of Welsh residents receiving treatment in England than English residents receiving treatment in Wales at least partly reflects the fact that certain planned care services are more readily available in England than in some parts of Wales. 

Figure 3: finished consultant episodes (FCEs) with admissions of cross-border patients, between 2014 to 2015 and 2025 to 2026

Image

Description of figure 3: a line chart showing there are significantly more FCEs with admissions for Welsh residents in English hospitals than for English residents in Welsh hospitals.

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 2025 to 2026 there were 66,100 FCE admissions for Welsh residents at English NHS hospitals and 10,200 admissions for English residents at Welsh NHS hospitals. The difference between these figures has been relatively stable over time, with both series increasing at similar rates since the coronavirus (COVID-19) pandemic. 

In 2025 to 2026, the number of finished consultant episodes (FCEs) involving admissions of cross-border patients was the highest on record.

Figure 4: proportion of finished consultant episodes (FCEs) with admissions of cross-border patients by type of admission, 2025 to 2026

Image

Description of figure 4: a bar chart showing that elective daycases are the most common type of FCE with admission for Welsh residents in English hospitals, and emergency admissions are the most common reason for English residents receiving treatment at Welsh hospitals.

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 2025 to 2026, over two-thirds of admissions of English residents in Welsh hospitals were emergency admissions. For Welsh residents admitted in English hospitals, half were for elective treatment and just under a third were emergency admissions.

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 2026, there were 13,100 Welsh residents registered with GPs in England and 20,900 English residents registered with GPs in Wales. 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 annual settlement figure is 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 (NHS England). 

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 

• England / Wales Cross Border Healthcare Services: Statement of values and principles (NHS England)
• Information on Cross-Border Healthcare for the NHS in England and Wales (NHS England)
• England and Wales NHS cross border healthcare (Welsh Health Circular)

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 where 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). Data for Welsh residents on NHS England waiting lists are provided voluntarily by NHS England trusts to DHCW. As there is no formal basis for this data supply, it is not possible to assess its coverage and quality to the same extent as the other official RTT statistics. While some quality issues may exist, the data are regarded as broadly reliable.

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 previous 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.

Hospital Statistics
Email: stats.healthinfo@gov.wales

Media: 0300 025 8099