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Multi-hospital NHS Trusts: Transportation

Volume 710: debated on Wednesday 9 March 2022

I beg to move,

That this House has considered transportation between sites in multi-hospital NHS trusts.

It is a pleasure to serve under your chairmanship, Ms Nokes. First, I put on record my huge gratitude for the work of my local trust, and for all who have worked so assiduously and faithfully during these long months and years of the pandemic, and before that. I also pay tribute to those at my hospital trust for their journey from special measures to “good” and “outstanding”. That reflects so well on their determination and commitment to raising standards and providing the best patient care.

Let me give something of the context for my hospital trust. The East Sussex Healthcare Trust consists of three linked hospitals, the Conquest in St Leonards- on-Sea, Eastbourne District General Hospital and, in between those, Bexhill Hospital, which offers additional ophthalmology, rehabilitation and intermediate care services. ESHT has nearly 7,100 dedicated staff, and 74% of them report having to travel between sites for work.

The region has a statistically higher proportion of residents who are more advanced in years, and the road between the main two hospitals is single carriageway and fraught with delay and disruption. It can prove to be quite a challenging journey. Over the past years, however, the hospital story is one of reconfiguration of services; reconfiguration of maternity, paediatrics and, most recently, cardiology and ophthalmology services are under consideration in the name of the pursuit of clinical excellence.

I recognise the value of clinical excellence and specialisms. My little boy has journeyed his way, through the years, from Great Ormond Street to King’s College and St Thomas’s just over the road. I recognise the value of ever-increasing specialist care, but access is at stake. The sorry truth is that for the one in four families in Eastbourne in my constituency who do not have a car, the journey is costly and difficult when services are reconfigured.

For example, none of our hospitals is located next to a train station. They are near bus stops, but there are no direct bus routes between the sites, so those travelling to and from them are heavily reliant on cars. Method No. 1 of travel might be: walk, then get the first bus, for which there is a 43-minute wait, then get the second bus, and then walk. That takes approximately two hours and 36 minutes, but there are commonly delays, and it costs £8 to £10. The second scenario is: walk for one mile, then get a train from Hampden Park to St Leonards Warrior Square, and then get a bus. That takes approximately one hour and 30 minutes, subject to delays, and costs £10 to £20. A taxi or private hire vehicle takes 26 minutes to one hour at peak times, and costs £35 to £50. For the fortunate three in four who drive their own vehicle, the journey takes 26 minutes to one hour at peak times, and costs £3 to £6 in petrol or diesel.

Given those travel options, it is unsurprising that almost everyone attempts to drive between hospital sites, rather than using public transport. Those who do not own a car are substantially disadvantaged, in terms of time, cost and practicality, in accessing healthcare or, importantly, visiting loved ones.

The hospitals recognise the challenge. Their focus is provision for their staff. I quote from their 2019 survey. I humbly recognise that it was published just before the pandemic, which will arguably prove to be the ultimate disruptor of normal work patterns. There will have been an increase in video conferencing and a change in virtual appointments, so all of this must be looked at through that prism. None the less, the trust recognises unique challenges in supporting its staff. A freedom of information request in April 2020 about travel spend in the year ending 2019-20 showed that 2,519,848 miles were claimed. In cost, there was £1,261,327 reimbursed.

Some of those claims, of course, will be community based, and cannot be easily designed out by any more direct bus routes or a shuttle service, but the hospital trust asked its staff whether they would use a shuttle bus service, should that be required. Of the 201 EDGH-based staff, 83% said that they would use a shuttle bus; 91% of Conquest-based staff said they would, too. They cite some positives; first, on productivity, if there was wi-fi and USB charging points on board, they would be able to work on the journey; secondly, there would be a reduction in stress. Unfortunately, although the survey was very comprehensive, and its results were compelling, after the review, the ESHT senior management team agreed not to take forward the project. The financial risk of investing the required funding outweighed the potential benefits. The biggest factor in that decision was that the team could not guarantee that passenger numbers would be sufficient to cover overall travel expenses.

The staff are one, clearly significant, group; but what of the patients, and their carers and visitors? The findings of my own survey work is reflected in these comments from a doctor, a nurse, a patient and a carer. The doctor said:

“Due to car parking problems, changing sites during the day is currently a huge waste of time…Car park ‘rage’ incidents are not unheard of and savvy staff allow as much as half an hour extra to be sure of a place to park.”

Another said:

“I found myself struggling to attend appointments at the eye hospital in Bexhill, unable to properly see, and unable to rely on public transport…I spent £200 per week on taxis instead.”

One patient’s mother—this was really difficult to read—said:

“It was enough to be dealing with a dying child; I didn’t need to be doing that journey by car every day. I didn’t feel like I was in the right frame of mind to be driving, but I had no choice.”

My office recently conducted a survey that had just 200 responses—a small-scale sample, but none the less representative. The number of missed appointments cited by respondents was 50. That is hugely expensive. Again, some of the commentary was really difficult to read and understand. One respondent said:

“Husband was having lymphoma treatment and consultations. Often very long journey with him in a very poorly state by the time we arrived.”

Even more difficult to read was one who said:

“I have been to Hastings hospital about 5 times in the last 12 months. I’ve gone as a patient as well as with my daughter. We have been lucky; a couple of times I’ve got lifts there but the rest we have had to get a taxi and when we do that we lose our food shopping money to do so.”

Very clearly, there is an impact on patients. There is also an impact on their clinical outcomes. In an October 2019 survey, nurses working in acute hospital settings identified that two fifths of patients without visitors would require additional support from the nursing team. The lack of visitors was felt by nurses to have a detrimental effect on patients’ health and the speed of their recovery. They were likely to be less mobile, less likely to be stimulated through conversation, and less likely to follow medical advice. A considerable number were more likely to have a longer stay in hospital.

There are a number of precedents across the land for hospital trusts providing this kind of shuttle-type service. They are successful, well established and comparable. Ashford and St Peter’s Hospitals NHS Foundation Trust in Surrey carries 110,000 passengers annually on its free inter-site hospital hopper shuttle service. The service was created 20 years ago as a result of a merger. Oxford University Hospitals NHS Foundation Trust and Newcastle upon Tyne Hospitals NHS Foundation Trust are just two more examples; there are many others. Manchester University NHS Foundation Trust and the Sheffield Teaching Hospitals NHS Foundation Trust use electric shuttle buses. That is notable at a time when we are considering the impact of transport on the environment and its carbon cost.

The potential benefits are readily understood. One benefit is around road congestion. Road congestion in our part of the world is forecast to increase by 36% to 60%, so there could be a significant benefit to the wider network. There have been 61 deaths in Eastbourne attributable to air quality; parking stress, productivity and greenhouse gas emissions are also issues. A hospital shuttle survey demonstrated that having a shuttle service, instead of a wave of individual cars going to and from hospitals, could bring about a carbon dioxide saving equivalent to 3,800 new trees being planted every year. Then there is the cost; at over £1 million for the trust, it is weighty, and there is the opportunity cost that sits behind that.

Others have mentioned recruitment and retention, which are important dynamics, but for me this is about providing a far better hospital service. Whether we have a fully fledged green hydrogen shuttle bus service, or make improvements to bus providers such as Stagecoach, improvements will end a penalty being paid by those who can least afford to make the journey. Ultimately, this is about access to hospital services and health equalities. When a hospital trust decides on good, clinical grounds that it will reconfigure services, what responsibility does it have towards those who are potentially left behind?

I have a number of asks of the Minister, as he will expect. One is around consultations. When my hospital consults on changes, it asks about ethnicity, race, gender—a host of important characteristics. It does not ask whether people have a car, yet that is the single determinant of whether someone will continue to be able to access services as they should. In consultations, what place does transport have? How important is it in the dynamic around clinical change?

I understand that there is a review of the criteria for patient transport support. I would be interested to know more about when that is coming down the line, and how it might benefit constituents in Eastbourne who are struggling with the costs of travel. Would the Minister join me in urging my hospital trust to revisit its 2019 survey and to, this time, include the patient voice? I know that it cares about its patients first and foremost, but the transport needs and access requirements need to be given far greater prominence when change is considered.

To what extent does the improvement strategy that is coming, and the funding that sits behind it, recognise the strategic significance of access to hospitals? My understanding from engagement with Eastbourne ECO Action Network is that, while there are improvements coming in our local plans, they do not feature inter-hospital transport, only transport from the town to each hospital in isolation.

I end by thanking my hospital teams, who work so hard. I want to thank my local paper and its reporter India Wentworth, whose reporting has reached right across the town. She has uncovered many of the stories that sit behind this issue. I thank the Minister, who, over a long period has been generous with his time and his interest.

It is a pleasure to serve under your chairmanship, Ms Nokes. I congratulate my hon. Friend the Member for Eastbourne (Caroline Ansell) on securing this important debate. As she alluded to, she has been a regular and persistent—albeit always courteous—campaigner for the NHS in her constituency, for her local hospital and, most importantly, for her constituents and their ability to access the services they need. I am aware of her long-standing interest in the issue. It is fair to say that her constituents are incredibly lucky to be represented by someone with such a passion for Eastbourne.

I join her in paying tribute to her hospital trust and everyone who works there, across the three sites, for what they have done, not just over the past two years in extraordinary circumstances, but what they do every day, year in, year out. I also join her in paying tribute to the Eastbourne Herald, of which I am maybe not as assiduous a reader as I should be. The latest story I read was about disco public lavatories. I have followed the important work undertaken by India Wentworth, since she joined the Herald in 2020, in campaigning on the issue and drawing to public attention the challenges faced by my hon. Friend’s constituents and others in Sussex.

It is rightly the responsibility of clinical commissioning groups—CCGs—or what will soon become integrated care boards and trusts, to plan for reconfigurations of NHS services. It is important that any such plan commands local legitimacy and confidence. I will respond to my hon. Friend’s questions. One was about consultation around reconfigurations, and how public transport and accessibility featured in that. All reconfigurations are subject to four Government tests. The first is strong public and patient engagement. To her point about the 2019 survey, I encourage her trust to continue engaging with that patient voice, including specifically around access. I will come on to access in a moment in the reconfiguration criteria.

Other tests are consistency with current and prospective need for patient choice: a clear clinical evidence base; and support for proposals from clinical commissioners. It is important to hear from as many local people as possible about the practical impacts and concerns. None of the decisions on reconfigurations is easy or straightforward. They are about balancing different needs and benefits. Rightly, in the different reconfigurations my hon. Friend alluded to—ophthalmology and cardiology —as we would expect in any reconfiguration, clinical needs and safety in achieving the best clinical outcome for patients are obviously paramount.

Achieving that sometimes comes with challenging changes to where people may access services, compared with where they previously did so. We would expect, among that consideration of benefits and challenges, patient transport, inequalities and equality of access to feature heavily. I expect my hon. Friend’s trust, in reaching decisions, will have given due weight to such considerations.

I am well aware of the geography of her constituency and that of her near neighbour, my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart), having grown up on Romney Marsh and having late grandparents who lived in the Icklesham/Winchelsea area of my hon. Friend’s constituency. I know the area well, going across to Hastings and further to Bexhill and Eastbourne. I also know the horror which is the A259, on most days. I was going to say at rush hour, but it is not just at rush hour these days. My hon. Friend’s comments about congestion going up from 36% to 60%, certainly on that road, chime with me; and that is going back 20 to 25 years to when I was last regularly in that part of the world.

The challenges of getting between the three sites are considerable. My hon. Friend alluded to the bus routes. There are bus routes but she is right that, certainly in one case, a change must be made to make the connecting journey. A patient going into hospital wants to minimise the stresses and challenges faced in getting there and back.

My hon. Friend alluded to two specific reconfigurations. With regard to the ophthalmology reconfiguration, the travel analysis summary, included as part of the consultation documents, set out that proposals would affect outpatients and people who come to the Conquest Hospital, in the constituency of my hon. Friend the Member for Hastings and Rye, for procedures but do not stay overnight. That is around 27% of all ophthalmology patients who attend East Sussex Healthcare NHS Trust hospitals for treatment and care. The analysis indicates there will be an increase in travel time for around 21% of patients who would use public transport and for 8% of patients who might travel by car—their own car, taxi or similar.

Were the proposals to go ahead, some people would have a shorter journey and others a longer journey to their appointment. The longer journeys would cost more, but, as the trust pointed out to me, people would, hopefully, have fewer appointments overall, would therefore not have to go to the hospital as often, and would not incur cumulatively the cost for the extra appointments that were no longer required, so they should not pay too much more.

My hon. Friend set out the impact on people on low incomes—the 25% who have no car and for whom a taxi or private hire vehicle might be prohibitively expensive—and she gave a moving example in her remarks about the choices that some people might have to face. I expect the trust to consider that extremely carefully.

My hon. Friend touched on the shuttle bus service and gave an example of where it has worked well in providing a service that works for patients, and it has environmental benefits as well. I encourage her trust to continue looking at such options. If it is helpful to my hon. Friend, I will speak to NHS England’s south-east region to see whether it can convene a meeting to discuss that further with her and her trust to see what options might help fill the gap, even if what was initially put forward might be deemed impractical by the trust.

My hon. Friend focused on patients and the impact on them, but she talked about staff as well, and it is important that in considering services and transport services for people to get to, from and between hospital buildings in the same trust, we do not forget the impact on staff. Although I know that sunny Eastbourne, Hastings and Bexhill are wonderful places to live, work in and visit, I will not tempt my hon. Friend to talk about the challenges of the rail links between her constituency and London. Because of the location of the hospitals and trusts, there is still a degree of temptation or ability for highly qualified professionals to perhaps say, “I will have a longer commute and work in London”, or, “I will go and work in a big London teaching hospital”, so we need to do everything we can to make it attractive and easy for people to make the conscious choice to work in the local hospitals to make sure we have the workforce that we need.

My hon. Friend raised other issues. As well as thanking the team and her local paper, she has talked in the past about getting me down to Eastbourne to visit her local hospital—something I have agreed to—and I will see whether that might be possible during the Easter recess. I hope sunny Eastbourne will be sunny by the time we get to April.

I am sure the Minister will join me in congratulating my hon. Friend the Member for Eastbourne (Caroline Ansell) on her well-presented and organised argument. Will the Minister also consider the community volunteering work that went on during the pandemic at HEART, for example, in Hastings? Perhaps a helping hand could be given there. It took patients to hospital and helped in that way, but sometimes these organisations need a bit more resourcing. Will he look at how we could maximise the potential of the community volunteer groups that have really grown throughout the pandemic to see how best we can utilise them in taking people to hospital for appointments?

Before my hon. Friend’s intervention and although my private secretaries will wince at the logistics, I was about to offer to try to come down to Eastbourne, via Bexhill, and then go to see my hon. Friend in Hastings and visit the Conquest. I may then re-live the experiences of travelling along the A259 and possibly regret doing so. None the less, I will be happy to visit her at the same time. She mentioned, rightly, the hugely important role played throughout the pandemic—and in more normal times—by organisations of volunteers, charities and third-sector organisations to help with patient transport.

My hon. Friend mentioned HEART—I entirely endorse what she says about the value of such organisations. I encourage local authorities and NHS trusts to recognise that value and seek to work collaboratively with such organisations to enable them to continue doing that vital work. In same spirit, I am also an occasional reader of the Hastings and St Leonards Observer. I enjoy my local papers. I tend to find the news I get in local newspapers rather more interesting and accurate than some of what I read in national newspapers. Perhaps when we go down to visit her, we might talk to both local papers if that would be helpful.

My hon. Friend the Member for Eastbourne raised a number of points about the bus improvement strategy and the broader approach to improving public transport links in this country. My right hon. Friend the Member for North East Somerset (Mr Rees-Mogg) set out recently in the House that the Government are investing more than £5 billion in buses and cycling during the course of this Parliament. Local authorities have published bus improvement plans, which provide an assessment of existing services in the area, including details of current provision for rural and coastal communities. It is right that those plans are driven by local authorities, who know their areas best and have that local engagement. I encourage them to think broadly, about not just links between a town centre and other areas but the broader transport links that might exist in an area and how public transport can help enhance them, reflecting the patterns of travel that individuals have for particular purposes, be it work, going to a hospital appointment or otherwise.

We recognise that for those unable to travel independently, NHS-funded patient transport services are essential. Those services are commissioned locally for eligible patients with a specific need for transport assistance to and from their care provider for planned appointments and treatment. Although most people can travel to treatment independently or with support from family and friends, as my hon. Friend set out, those services play a hugely important role for those whose medical condition, severe mobility constraint or financial circumstances make that challenging. They deliver around 11 million to 12 million patient journeys each year, covering around half a million miles each weekday.

In August 2021, NHS England and NHS Improvement published the outcome of a review into patient transport services. The review’s final report sets out a new national framework for the services, with the aim of ensuring that they are consistently responsive, fair and sustainable. The first component of the new national framework is a commitment to update the national guidance on eligibility. That commitment responds to the concerns raised by patient groups and others during the review process that access to patient transport services is inconsistent between areas.

One of the issues we have seen is reimbursement. It is a hugely bureaucratic process that also involves up-front costs for those who need to access that support. My concern remains that eligibility is still very narrow, yet there is significant movement across the piece, not least from maternity and paediatrics, where transport often involves taking little people. I hope that features in the review.

My hon. Friend is right to highlight the breadth of people and groups who need to be included and reflected in that. We have consulted on the new national eligibility criteria. They have been developed through engagement with a wide range of stakeholders, including patient groups and charities, transport providers, healthcare providers and commissioners. On her question of when, we look forward to publishing them very shortly. If she wishes to make any last-minute representations to the team, she is welcome to write to me.

In the final few seconds I have left, I pay tribute once again to my hon. Friend the Member for Eastbourne for securing this debate and to my hon. Friend the Member for Hastings and Rye for speaking in it, and for their work in this place as such vocal champions of their local communities.

Question put and agreed to.

Sitting suspended.