More focus needed on how people travel to and from NHS services

Why patient transport is important

Between March and May this year, the Healthwatch network carried out a nationwide conversation asking communities how they want the NHS to improve locally, engaging with over 30,000 people across the country.

We found that travel was a key issue, with nine out of 10 people telling us that convenient ways of getting to and from health services is important to them. Indeed, people put transport above other things, such as choice over where to be treated and improving digital access to services.

In two-thirds of the country, communities told us they wanted more focus in local plans on improving transport links between health and care services.

This builds on work carried out last year by Age UK that estimated 1.45 million older people find it difficult or very difficult to get to their healthcare appointments.

Kidney Research UK has also previously reported on the problem of poor transport services and the impact they have on people who receive dialysis (who currently account for 50% of those who use NHS patient transport services). For many of these people they have made up to six journeys a week to receive treatment, so their journey to and from care has a significant impact on their overall experience.

We have partnered with Age UK and Kidney Care UK to share our evidence on people's experiences travelling to NHS services in our new publication.

Gaps in the data

One of the biggest challenges with transport to NHS appointments is that services don’t currently capture enough information to help them make good decisions about the commissioning or delivery of transport.

With services that are outside of its direct control, like bus routes and timetables, the NHS is not routinely looking at publicly available data to understand how the options available affect how people can access healthcare. When it comes to services within their control, the NHS is often not even collecting the data in the first place.

We wrote to all 191 Clinical Commissioning Groups (CCGs) under the Freedom of Information Act (FOI) and asked them for data on how many people were using Non-Emergency Transport Services and how many people had been refused help between 2015/16 and 2018/19.

What we found

In total, 107 of the 191 CCGs in England responded (56%). Roughly half of these were unable to provide any of the information we asked for, mostly stating that they do not collect it. However, 61 did provide either all or some of the information we requested.

Even though only a limited number of CCGs were able to respond, the data they provided did suggest some concerning trends, which we believe require the NHS to investigate further.

• Between 2015-16 and 2018-19, the number of journeys completed by Non-Emergency Patient Transport Services across the 61 CCG areas fell by 42%.
• For the 18 CCGs that recorded the number of times people were denied access to the Non-Emergency Patient Transport Services, we found that refusal rates rose by 182%.
• In real terms, that means the number of times people were turned away increased from 13,025 in 2015-16 to 36,719 times in 2018-19.
• None of the CCGs who responded recorded any data relating to appeals or the outcome.

Our call for change

In partnership with Age UK and Kidney Care UK, Healthwatch England has been working with the NHS to take action. NHS England has announced they will carry out a national review. We look forward to working with them on this to ensure that people’s views and experiences inform their plans, from better commissioning of NHS patient transport services to working more closely with transport authorities and providers to ensure the NHS is connected in practical and affordable ways with the wider world.

Simon Stevens, Chief Executive of NHS England said:

“Attending hospital can be a worrying time for many patients which is why we want to make sure that their journey to and from appointments is as smooth as possible.”

“Building on the NHS Long Term Plan's commitment to creating a person-centred healthcare service this national review of non-emergency patient transport will listen and act on concerns raised by patients.”

Imelda Redmond CBE, National Director, Healthwatch England said:

“Patient's attending health and care services are not ‘packages to be delivered’, they are people with individual needs that must be considered as health services implement plans for care.

 

"If people are to truly be at the centre of how services are designed, then transport is a key element of how services and peoples care needs can be aligned and integrated at a local level."

Caroline Abrahams, Charity Director, Age UK said:

“A Government review of hospital transport is a welcome and much needed step forward. Too many older patients struggle to get to and from their appointments at the moment and suffer unnecessary stress, exhaustion and sometimes pain, because good, reliable transport services are not there to support them.
 
“Through our Painful Journeys campaign, we have called for the Department for Health and Social Care to review patient transport services for older people and take the necessary action. Our research shows that almost a fifth of over-65s feel worse after their hospital appointment because of the stress involved in their journey and it is clear that the way patient transport is organised needs a total overhaul to make it fit for purpose.  
 
“Older people who need support to get to an appointment must receive it, irrespective of where they live. There are also some simple things which can be done to reduce the stress of these journeys, such as calling patients in advance, so they don’t have to get ready hours before their transport arrives and making provision for older people with dementia to have a friend or relative travel with them to help them feel safe and secure.  
 
“The Government and the NHS are both committed to making our health services fit for an ageing population and this will only be achieved once older people can be confident that the process of getting to and from hospital is user-friendly and reliable. This should be the goal of the review announced today.”

Fiona Loud, Policy Director, Kidney Care UK said:

“There are differences between (dialysis) units in how transport is organised; there are different policies for the reimbursement of patients for the few who make their own way to hospital.

"Patients, healthcare staff, and healthcare providers are concerned that there is evidence accumulating that these differences may become worse due to increasing financial pressures on commissioners."