Patient Transport Disability Equality Scotland Briefing Paper

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Patient TransportDisability Equality Scotlandbriefing paperOverviewDisability Equality Scotland is a national charity working to achieve fullaccess and inclusion for disabled people in Scotland.We promote access in its widest sense. This includes access to the builtand natural environment and access to the same opportunities as areenjoyed by others in our communities thus promoting a life of dignity,respect and independence. This extends beyond physical access toinclude access to information, access to inclusive communication andinclusion in decision-making, whether with planners over inclusivedesign or transport providers about accessible travel.Our aim is for every disabled person to have the opportunity toparticipate in a fulfilling life and for their voice(s) to be heard.We represent the views of individuals with any type of impairment, aswell as disability organisations and groups who share our values.We are a membership organisation and as such listen to the views ofdisabled people and champion on their behalf. We work to influencethe policies of the Scottish Government, which affect how disabledpeople live, and work to encourage others to be inclusive and informedin their attitudes towards disabled people.We are also the umbrella organisation for all disability Access Panels inScotland and the principal provider of support and guidance to theAccess Panels presently representing disabled persons at a local levelthroughout Scotland. Access Panels are committed to improving accessand equality in its widest form, which means access to the physical1

environment, Education, Housing, Health, Transport, Leisure &Recreation and Social Justice amongst other areas.Patient TransportIn November 2018, Disability Equality Scotland ran a weekly poll of itsmembers on the topic of patient transport and access to transport forhealthcare and medical appointments.The results of this survey from November 2018, indicated that 66% ofrespondents (25 people) had experienced problems when bookingtransport for medical or health care appointments. The results of thissurvey were shared with the Mobility and Access Committee forScotland.In August 2019, Disability Equality Scotland received a request fromMACS to follow up on this topic with its members. This was to assistthem in gathering evidence on transport to health. It is the intention ofMACS to host a multi-organisational roundtable discussion on this topiclater in 2019. The discussion will include representatives from theScottish Ambulance Service, NHS Boards, local authorities, RegionalTransport Partnerships, and other statutory bodies and DPOs.For the week commencing Monday 5 August 2019, Disability EqualityScotland posed the question:“Have you had problems booking or getting transport to medical/healthcare appointments?”We received an overwhelming response, with our highest ever numberof respondents to a poll (848 respondents) demonstrating how much ofan emotive subject this is for our membership. The results were asfollows: YES – 98% (829 respondents) NO – 2% (19 respondents)2

In summaryOverwhelmingly, our members had experienced problems with thepatient transport service and with transport to medical appointments ingeneral. Some of the key points raised through the poll included: Examples where disabled people were told their carer could notaccompany them in the patient transport and would have to maketheir way separately to the hospital or appointment. Examples where wheelchair and powerchair users were told theycould not be transported in their chair. That bookings for patient transport could only be made up to threeweeks in advance, and several people were told the services werefull. There are also ‘eligibility criteria’ that are employed by someservices. A consensus that patient transport services are over-subscribedand current resources cannot meet demand. Examples of people being refused patient transport andsubsequently being unable to afford the taxi journey required to getto their appointment. A general experience that hospital car parks were difficult tonavigate, and spaces were rarely available. In this instance, somerespondents chose to travel by patient transport to avoid the needto park. Respondents in rural or island communities commented on howdifficult it can be to coordinate transport, particularly when travelingfrom island communities and where coaches have replaced publicbuses in some rural areas. Incidents of patient transport bookings being cancelled at shortnotice, meaning missed appointments and re-joining the waitinglist. Disabled people have to commonly rely on friends and family totransport them to and from hospital in the absence of patienttransport.3

Key ThemesEligibility for Patient Transport/Booking Patient TransportBelow are comments from our members about their experiences oftrying to book patient transport, and the criteria employed to determinetheir eligibility.“I am grateful for the opportunity to comment on this as there are somany failures from booking transport, knowing if you remain eligible withthe criteria and what to do when your transport is running late, and theclinic won’t see you. I talk to other patients when I am waiting for mytransport home and we all have the same problems.”“I try to book transport for my dad as I work and can’t take him all thetime. The ambulance service is very unhelpful and change the eligibilitydepending on who is at the other end of the phone. It should be thesame all the time. I don’t answer any of their questions different andsometimes get told yes and sometimes no.”“Only need transport back from hospital as my treatment makes me feelquite unwell but the ambulance service has refused this because I mademy own way in.”“Always problems trying to book and normally have to get my doctor tostep in.”“I have a spinal cord injury and use a wheelchair. I don’t do muchindependently but according to the ambulance service I don’t qualify fortheir transport.”“The ambulance booking system is all wrong and too time consuming.needs simplified and also need to be consistent re criteria andapplication.”“I work in a health centre and spend most of my time trying to booktransport for patients to get to hospital appointments for referrals. It isvery inefficient and poor use of my time as I am on the phone while Ishould be welcoming and helping patients.”4

“Because I can walk a short distance on a good day, I am not allowed anambulance even though I have no other way of getting to the hospital onmy own.”“Too many horror stories. My family take time off work now to take me tosave me all the stress.”“I am disabled and need transport to hospital but don’t think I shouldhave to show the receptionists my PIP letter as proof every time. Wouldbe nice if they just took my word and treated me with some dignity. Lifeis hard enough.”“I note that an ambulance if available “ if you have a medical conditionthat would put you at risk if you travel independently” but went you tellthem you can’t travel on your own because of a lack of confidence oranxiety then this isn’t assessed as a medical condition. It is a hiddendisability but they don’t recognise this because you can walk andbecause of this condition I don’t have confidence to use the bus.”Delays and CancellationsThere were examples of patients relying on patient transport, which isoften delayed or cancelled, which can exacerbate illness.“Lengthy delays to return home by ambulance often means I am reallyunwell by the time I get home.”“There is not enough ambulances to cope with the pressures. That’s whythey are always late or cancelled and you wait hours to get home.”Rural AreasPatients in rural areas face difficulties accessing medical appointmentsdue to distance and geography.“I need to attend the SMART centre at the Ashley Ainsle as it is the onlycentre for driving assessments for disabled people in Scotland. I live inInverness and it is a lengthy round trip of over 350 miles. Theambulance service won’t help with transport to get me there”“I live north of Inverness and have regular appointments at Raigmore.Around a year ago our bus was replaced by a coach (Stagecoach) andthe steps on the coach are too high for people with mobility impairments5

such as myself. We now can’t use the bus service to get to Raigmoreand this is the only bus on the route. Being rural we have no trainservice. Community transport has also been depleted. The ambulanceservice does not have enough crews and vehicles to meet this extrademand now that people can’t get a bus to Raigmore so many medicalappointments are going unattended and cancelled which I am sure iswasteful to the NHS.”CarersThere were examples of patients being told their carers could notaccompany them in the ambulance and had to travel separately. Thiscaused stress and extra expense for many.“I really need my carer to attend the hospital with me but the ambulanceservice no longer allows this so I can’t use ambulance transport andhave to pay for taxis that I can’t afford. I wouldn’t manage by bus.”“It’s helpful and less stressful if your carer or companion can travel withyou. There never used to be an issue with this, but the ambulanceservice doesn’t allow a carer now and this policy needs reviewed.”“I want to be able to travel in the ambulance with the carer as I needtheir help at hospital, but this isn’t allowed anymore, and I often don’t gobecause of this. I can afford to pay for my carer to travel separately tomeet me at the hospital as they suggest. This is ludicrous as there arenormally empty seats in the ambulance.”Public Transport - AccessibilityPublic transport often was not a viable alternative to those trying toaccess medical appointments as their transport was not accessible fortheir needs.“Public transport needs sorted and needs to be more accessible.Currently hit and miss.”“My bus service changes and doesn’t go near the hospital or a stopwhere I can change over. I can’t get an ambulance as I don’t need careduring the journeys.”“Bus stops are too far away from main outpatients to walk from the stop.The accessible travel framework talks about door to door journeys and6

this can’t be achieved as long as busy stops as outside the hospitals andtoo far away from the clinics.”“The buses to the Royal Infirmary Edinburgh stop further away from thehospital than they used to, and it is no longer within walking distance forlots of people.”“I have problems in the summer months for short notice appointments asI live on Arran and the ferries are normally full of tourists and hauliers.There should be a system that prioritises crossings for islanders medicaland urgent appointments.”Public Transport - CostThe cost of travelling by public transport was also a factor in making itdifficult to travel independently to medical appointments, with manypatients having to use taxis or else the frequency of journeys made thecost untenable. In one example, a patient was forced to skip meals toafford the travel to hospital.“I normally end up taking a taxi as I can’t manage on the bus, but taxisare expensive, and I can’t always afford it.”“Public transport is not adequate or affordable and the ambulanceservice don’t have enough resources. These things need to be lookedat.”“People don’t consider the cost of getting to your appointments.Accessing healthcare should not be unaffordable at it currently is.”“Cumbernauld to GRI is hard and expensive by bus but I am expected todo this as apparently I don’t qualify for ambulance transport and GRI iseasier to get to than Monklands for treatment.”“The cost of getting to medical appointments for people on low incomesneeds to also be considered.”“I have a very low income and it would help if they sent a free travel passwith the appointment. I don’t mind being means tested to qualify for thisand it would help a lot.”7

“On the days I have to travel to hospital I have to skip a meal to affordthe travel. I don’t mind doing this because I need to see the nurses anddoctors, but should this really be the choice?”“It’s a shame on our nation that in this day and age I can’t afford thefares to get to a medical appointment be it the hospital or my GP at themedical centre. There needs to be an acknowledgement that it costsmore to travel in rural Scotland as we have to go further to accessservices.”Hospital ParkingTaking private cars to hospital appointments was also not viablebecause of the difficulty in parking at hospitals.“Parking is terrible at hospitals or not affordable. Everybody uses theblue badge spaces without a badge, and nobody enforces this. I know Ishouldn’t, but I just book an ambulance now to save me the stress andcost of getting parked. I’m sure others do this too and it is probably whythe ambulance service can’t cope and are always cancelling or runninglate.”“They need to have adequate blue badge parking at hospitals and healthcentres that you don’t need to pay for to keep it affordable”How improvements can be made to Patient TransportThere were several suggestions as to how improvements could be madeto transport for medical appointments.“There needs to be sustainable investment in local community transportschemes as they can help especially in rural areas.”“You need to involve the patients in designing the services like they aredoing with social security”“The powers that be need to get more people involved in planningtransport to medical appointments to better understand what they needand plan to meet this.”“There have been long standing issues with transport to healthcare. Canthe governments experience panels or citizens panel help with this andmake sure the services are designed by the people who will use them?”8

“There needs to be a national database with numbers for organisationsthat can help you get to hospital”“If the ambulance service can’t cope invest in community transport orvolunteer drivers. They provide the best service.”“There needs to be overall accountability from one organisation tomanage transport to medical Appointments whether it’s the health boardor ambulance service. The current system is not joined up makes it hardfor people as no one is willing to accept responsibility of help”.“Sharing resources between the ambulance service, hospitals and localcouncils is the way forward. Make them share budgets too and that willget them working and planning together. This has worked for transportpilots.”In conclusionOverall our members felt that more had to be done to shake up theplanning and organisation of patient transport as it plays such animportant part in ensuring patients receive the treatment andconsultations they need. Some patients chose not to travel toappointments at all, citing that the process was too stressful while othersprepare for appointments, to have to cancel them when their transportdoes not appear. This in turn has an impact on NHS resources andwaiting times.Disability Equality Scotland would like to see better processes andsystems in place to ensure those who require transport to appointmentsare catered for in a timely and appropriate manner.9

Appendix 1: Full comments from weekly poll questionThe following shows the verbatim comments from 300 of therespondents who chose to qualify their response with a comment.‘Have you had problems booking or getting transport tomedical/healthcare appointments?’YES – 98% (829 respondents)I gave up trying with ambulance transport. Too time consuming andinconsistent.Ambulance booking needs major improvements in time it takes to book.I normally end up taking a taxi as I can’t manage on the bus but taxis areexpensive and I can’t always afford it.I try to book transport for my dad as I work and can’t take him all thetime. The ambulance service is very unhelpful and change the eligibilitydepending on who is at the other end of the phone. It should be thesame all the time. I don’t answer any of their question different andsometimes get told yes and sometimes no.I try to make my own arrangements for transport to healthcareappointments as I cannot rely on patient transport to get me there ontime. I understand that transport patients jump the queue but one cannotfail to realise the impact this has on clinic staff and other patients thathave to wait because I have arrived late. I am also quite deaf and find ithard to hear what is being said on the phone.I only need transport back from hospital as my treatment makes me feelquite unwell but the ambulance service has refused this because I mademy own way in.There needs to be sustainable investment in local community transportschemes as they can help especially in rural areas.Public transport is not adequate or affordable and the ambulance servicedon’t have enough resources. These things need to be looked at.Booking is the problem.10

Public transport needs sorted and needs to be more accessible.Currently hit and miss.My bus service changes and doesn’t go near the hospital or a stopwhere I can change over. I can’t get an ambulance as I don’t need careduring the journeys.Booking transport is the stressful part and the criteria for acceptance isinconsistently applied.I am a member of DES and I would like them to make this their maincampaign to address the barriers for disabled people accessinghealthcare. It is a basic human right to be able to access healthcare andtransport is a barrier that needs to be removed to achieve full accessand inclusion for all.People don’t consider the cost of getting to your appointments.Accessing healthcare should not be unaffordable at it currently is.If the Mobility and Access Committee have asked for this poll are theygoing to do something about the problems?Mainly problems ambulance transport but the public transport wouldn’tget me to the hospital so I need to use ambulance.Yes there are problems with public transport and ambulance transport.Always problems trying to book and normally have to get my doctor tostep in.The ambulance booking system is all wrong and too time consuming.Needs simplified and also need to be consistent re criteria andapplication.Cumbernauld to GRI is hard and expensive by bus but I am expected todo this as apparently I don’t qualify for ambulance transport and GRI iseasier to get to than Monklands for treatment.The system is too heavily reliant on individuals having to work transportout.11

The Poverty and Inequality Commission in Scotland have just donesome work of transport poverty. The cost of getting to medicalappointments for people on low incomes needs to also be considered.I need to attend the SMART centre at the Ashley Ainsle as it is the onlycentre for driving assessments for disabled people in Scotland. I live inInverness and it is a lengthy round trip of over 350 miles. Theambulance service won’t help with transport to get me there.I work in a health centre and spend most of my time trying to booktransport for patients to get to hospital appointments for referrals. It isvery inefficient and poor use of my time as I am on the phone while Ishould be welcoming and helping patients.Needs vast improvement to be fit for purpose.You need to involve the patients in designing the services like they aredoing with social security.I have shared this poll as I know many people have an interest and wantto see improvements. They feel helpless and as if nobody is listening totheir problems.Transport doesn’t respond to patients’ needs.Always have problems booking transport and getting through to the callcentre and long waits for transport home after clinic.I think the receptionists at hospital are the gatekeepers to the ambulanceservice and they do a good job as they are always obstructive and tellyou that you can’t get transport even when you have before. Veryinconsistent.A friend has just shared this poll with me as I am not a members ofdisability equality Scotland. I am glad someone is looking at this and willsign as a member to get my say.My GP normally has to intervene to get me transport as the a

environment, Education, Housing, Health, Transport, Leisure & Recreation and Social Justice amongst other areas. Patient Transport In November 2018, Disability Equality Scotland ran a weekly poll of its members on the topic of patient transport and access to transport for healthcare and medical appointments.