The geography of Wales means that there are areas where cross-border arrangements are necessary. The population of north Wales is too small to support specialist units, so patients travel to Liverpool and Manchester. There are no large hospitals in Mid Wales at all. More than 31,000 Welsh patients were treated in English hospitals in 2013/4. In October 2014 Jeremy Hunt claimed that English hospitals close to the Welsh border were under "absolutely intolerable pressure" and that people were fleeing the "second class health service" in Wales.