New concerns raised over patient travel provision

Fiona MacVicar

In its June issue, Am Pàipear shared concerns expressed by patient bodies and third sector organisations that the gap between travel costs incurred and reimbursement payments made by NHSWI was leaving many patients out of pocket and having a detrimental effect on their health and wellbeing.
The article prompted a number of readers to get in touch with Am Pàipear to raise awareness of another issue negatively affected patients travelling to off-island medical appointments: the funding of escorted travel.

The NHSWI Travel Policy details the criteria for allowing funded, patient escorts: “In general, a travel escort will only be provided by NHS Western Isles if the patient has a significant clinical condition that makes independent travel impossible.”

Prior to 2018, requests for funded escorts were approved by the patient’s GP; the new Travel Policy places that responsibility with the Stornoway-based NHS Western Isles Medical Director.

Patients say that the change has resulted in fewer escort approvals, leaving many vulnerable patients with a difficult choice; to face the stress of travelling alone or to pay the additional travel costs of an escort themselves. Those without adequate funds face a starker choice still: either travel alone or don’t travel at all.

As one patient told us: “It’s expensive to be poorly in Uist and Barra and illness doesn’t single out the wealthy.”

Steven MacDonald, originally from North Uist and now living in Wester Ross, spoke to Am Pàipear of the trauma his family faced when his heavily pregnant wife Sophie became ill while on a visit home last year:
“At 5pm we phoned NHS 24 as Sophie wasn’t feeling great and were asked to head to the hospital. Her blood pressure was quite high, so the doctor was concerned.

“Arrangements were made to fly us to Raigmore and at this point, I was told I would not be allowed to be her escort. They were willing to fly my heavily pregnant wife on her own to Inverness. Eventually, at 10pm, we were told we were being flown out to Aberdeen of all places. We didn’t arrive until 1am and the paramedic on board told us he tried to have us routed to Glasgow, but this was against the doctor’s wishes.”

After intense discussion, Steven was finally granted permission to travel with Sophie, but the family have still to receive any reimbursement for the cost of Stephen’s travel:

“We submitted claim after claim with all appropriate receipts and to this day have never got our money back.”

Many of the other people Am Pàipear spoke to wanted to share their experiences with readers, but asked to remain anonymous. They spoke of the financial and emotional impacts of being refused funded escort support.

An older woman told of her lost independence following a serious fall: “I used to do everything myself but since the fall, I can’t get about on my own and I’ve lost my confidence.” Despite mobility issues and crippling anxiety, she has been refused an escort, and told Am Pàipear that she is now considering cancelling her appointment: “I just don’t think I can face going alone.”

Another woman who regularly travels to the mainland for cancer treatment described the situation as ‘an inequity of the service’:

“If you live in Glasgow and are going to the sort of appointment where you could potentially get bad news, you would have someone with you. That’s not an option here in the islands and you would be required to travel home alone. I have seen people on the plane visibly upset after receiving bad news at an appointment.”One cancer patient with addiction issues was refused an escort, despite letters of support from the GP, his support worker and the MacMillan nurse: “Had it not been for a Cancer Care Forum paying for an escort to travel with him, he would not have attended hisscan.”

Another woman, who regularly travels to the mainland for specialist breast screening appointments, highlighted the prohibitive cost of patient travel: “A standard room with no breakfast cost me £192.00 and I waited approximately four weeks for reimbursement. If I couldn’t afford that, I would have cancelled my appointment, which some have unfortunately had to do.”

The sentiments shared with Am Pàipear echo the responses to a survey developed by retired nurse and North Uist Community Council member Effie Rodgers, and the late Flora MacDonald, Ahmore. The survey detailed the views of 11 local cancer patients highlighting the financial hardship and emotional strain of travel to and from off island appointments. The survey is expected to be rolled out to the wider patient community in due course.

Responding to the concerns raised, an NHS Western Isles spokesperson said:

“It is important to stress that, where escorts are clinically required, they are approved in line with our policy. However, we must ensure that the criteria are applied in a fair way. This will ensure that those patients who require an escort will continue to receive financial assistance, but it will also mean that those who do not meet the criteria will not receive NHS funding for an escort. We understand and acknowledge that in some cases, this will be disappointing. However, there is a limited budget for patient travel, which is under significant pressure, and we must ensure that the money available is spent appropriately.”

The NHS Travel Policy is due for review this month.