Healthcare and accessibility

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Setting the policy context

Providing health services that are of consistently high quality and responsive to the needs of the patient lies at the heart of the Government's vision of a modern and dependable health service. Ensuring that people can access those services when they need them is crucial to good health and transport is a key factor in accessibility.

The majority of NHS service users, their families and carers travel to services either by private or public transport.

The NHS has responsibility for providing transport services to get a patient to hospital where the individual's medical condition makes this necessary. Providing a clinician decides there is a medical need, transport is provided free of charge, as part of NHS treatment. In each case medical need is decided by a doctor or other health professional. In making that decision, the availability of private or public transport and the distance to be travelled is taken into account. The principle that should apply is that a patient should be able to reach hospital in reasonable time, reasonable comfort and without detriment to their medical condition.

Transport to treatment is important in maintaining access to a wide range of health services, especially with the increasing development of specialist treatment centres. Door to door transport is particularly important to those with disabilities that would prevent them using public transport and critical to the success of day care programmes.

The NHS also provides financial support for people on low incomes to get to hospital for treatment through the Hospital Travel Costs Scheme. (The Community Care Grant element of the Social Fund can provide financial support for those visiting a relative in hospital.)

Accessibility

The NHS Plan sets out the ten-year programme to transform the health service so it is redesigned around the needs of patients. A wide range of reforms supported by sustained investment in increased staffing and new facilities are giving patients greater choice over where and when they receive their treatment. While recognising the need to maintain specialist treatment centres, the drive is to improve accessibility through the development of primary care services, particularly in disadvantaged areas, the provision of more local treatment and the use of information technology such as NHS Direct.

Keeping the NHS Local-A New Direction of Travel (http://www.dh.gov.uk ) sets a clear direction of travel for the NHS, especially when considering service expansion and redesign. It helps the local NHS to find high quality, sustainable solutions for local services, including solutions for smaller hospitals to secure their valued role at the heart of local communities.

SEU report: Making the Connections

It is recognised that for some the lack of available and affordable public transport services presents a barrier to accessing health services and contributes to the health inequalities that persist across England.

Transport and improved access to services can, therefore, make a valuable contribution to reducing health inequalities and working towards the Department of Health's PSA target for 2010 to reduce the gap in infant mortality across social groups and raise life expectancy in the most disadvantaged areas faster than elsewhere.

Therefore, the Department of Health (DH) has made a number of commitments to support the report from the SEU.

These commitments are also set out in the Government's strategy to tackle the persistent and stubborn health inequalities that exist across England Tackling Health Inequalities: A Programme for Action (www.dh.gov.uk ). This sets out plans to tackle health inequalities over the next three years to establish the foundations required to achieve the national PSA target for 2010 to reduce the gap in infant mortality across social groups, and raise life expectancy in the most disadvantaged areas faster than elsewhere.

The local NHS, with Primary Care Trusts in the lead, will support the new process of accessibility planning. The role of the NHS will be developed from the accessibility pilots and from other work.

DH is currently taking forward policy commitments from the SEU report to:

  • amend the criteria for eligibility for Patient Transport Services to include medical, mobility, public transport and financial grounds;
  • develop options to provide information and advice on getting to healthcare facilities and book transport where appropriate; And;
  • ensure accessibility will be factored to a greater extent into decisions on the location and delivery of healthcare, and into the performance framework for the NHS.

Text Provided by Department of Health, October 2003