That this Bill be read a second time.

During the passage of the recent Health Bill through your Lordships’ House, I tabled an amendment to the effect that it should become a duty on primary care and hospital trusts to co-operate with relevant local transport authorities to co-ordinate the provision of patient transport services. By the way, the phrase “co-operate with” was appropriately non-specific and flexible to allow for the differing needs of each local area. I tabled my non-clinical and practical amendment because of concerns about which I had been made aware: that an existing failure to co-ordinate transport for patients is wasting public funds and making travel to and from hospital unnecessarily difficult for many people. I was certain that Her Majesty’s Government would share my view that that needs to be tackled.

For example, I have been told that 25 per cent of the “did not attends” at Newham Hospital can be attributed to transport problems. That is distressing for the patients who may not get another appointment for some time, and it is an incredible cost to the NHS which has a statutory duty to provide patient transport. I was in a major London teaching hospital a week ago and saw people who had been sitting for hours in an outpatients' waiting room just waiting for transport to get home. That is an unpleasant and bad situation. While it is right for patients to have transport provided, I argued that it was not sensible for the NHS to be providing that service without any consideration of whether passenger transport authorities, unitary authorities and county councils might assist in meeting that need possibly at a much lower cost than that faced by the NHS.

I am not talking about severely ill or disabled people with needs for specialist transport but outpatients and those who sometimes after ridiculously long waits are despatched home in a taxi. That is a different group of people from those needing ambulance and specialist care while being transported.

The noble Baroness, Lady Thornton, who I am delighted is responding today, agreed with me when she replied to my amendment that it is vital for the NHS to engage with its local passenger transport authorities and key partners in providing a health service that is of high quality, that is responsive to the needs of the patient and that people can access. Indeed, that lies at the heart of the vision of a modern NHS. The Minister went on to inform the House that guidance to primary care trusts published in August 2007 clearly states that they are responsible for commissioning ambulance services and patient transport services to such extent as the PCT considers necessary. In cases of hardship, patients with a social need for transport may seek reimbursement through the benefits system. In her response, the Minister cited local examples of health organisations and local authorities working well together across a range of health, transport, education and social care services to ensure that patients are offered the most appropriate transport services that best meet their individual needs and that the expectation is that such good practice will be spread more widely.

In the process of withdrawing my amendment and pointing out that a willingness to pilot such co-operation and co-ordination in some areas is not quite the same as imposing a duty to do so, I begged leave to think about whether I could take the issue forward in some way, and hence the Bill. I tabled it because the evidence of my own eyes tells me that the good practice evidenced by the Minister has not spread to the extent that was hoped. In an attempt to reduce the level of anecdote around the issue in advance of today’s Second Reading, I sought evidence of current levels of NHS local authority spending on patient transport. Officials at the Department of Health have informed the Lords Library that this information is not collected centrally. Spending on this form of transport takes place at the local primary care trust level. The large number of trusts and local authorities would make further research a Herculean exercise that I am not in a position to undertake, but plainly there is very little interest at a central level in the economics, let alone the waiting times for individuals as this is not collected. In the present financial climate, I suspect that local authorities' trusts will see the implementation of such measures as costly and a burden. Some might well claim that that is the case. In many cases, they would feel that public transport is already available. I think that they are wrong and are missing a trick.

As for value for money, as part of the duty on primary care trusts, hospital trusts and local transport authorities, my Bill specifically requires them to have due regard to the efficiency and economy of providing patient transport services from the point of view of both the users of such services and service providers. It could be said that a greater use of public transport would ease the problem, but this is unrealistic, particularly in rural areas, as we know. I am not talking about large public service vehicles operated by one of the major transport companies, but smaller, minibus-type transport run by a trust or local authority—the sort of bus that takes 10 or 20 people, which can access virtually any road or street and collect people from their doorsteps and take and return them to the doctor, the hospital, the clinic or the day centre, with the reason for the journey being health, social care or education. Moreover, even in our towns and cities, the transport needs of some of the patients in terms of special needs impairment, disability and access will be such that the use of a public bus would be unsuitable and, in rural areas, virtually non-existent.

While I am on the subject of the vehicles, I would anticipate that school buses for children with special needs might be included here. I should like to be certain that during the day and through the school holidays these vehicles are utilised for the benefit of the whole community. Currently, a plethora of small vehicles are ferrying people around our towns and villages, but their arrivals and departures are not well co-ordinated. While you wait for the health bus, the social bus passes your door without stopping—and, in the way back, the passengers on the social bus wait and watch you depart on your health bus, which may pass their door. The waits that we all grin and bear in clinics and outpatients departments are the same as often endured by those folk, who have to wait before and after their appointments for travel to and from the venue, often turning a 10-minute consultation into a day-long endurance course, which for many frail people is not a pleasant experience.

My Bill would reduce the current waste of resources and improve the user experience by taking the guidelines and turning them into reality by enclosing a duty on local authorities and the NHS primary care trusts and hospitals to co-operate and collaborate in the provision of patient transport. It would also ensure that such collaboration is evidenced and the outcomes audited. I beg to move.

My Lords, it is very difficult to disagree with the aim behind this Bill—that you should have better co-ordination of services which relate to each other and have an effect on each other, to try to get the best out of them. Do we need a Bill to achieve that? That is the question, and one which the crystal ball of experience suggests might be referred to in the Minister’s speech. Best practice is often very difficult to achieve; we all know that it is there, but we all know that people like to defend and control budgets and do not like their pet schemes interfered with. Thus a degree of sympathy comes from these Benches on this matter. However, how do you enforce it? What sort of contracts should we take on and how do we go?

We have a degree of sympathy but also a great deal of regret that it is even considered necessary to bring forward a Bill. What is the Government’s thinking about this? As the noble Baroness, Lady Greengross, pointed out, missing appointments for medical treatment will probably account for a considerable degree of wasted organisation and money from the public purse—probably more than the more moderate proposals in this Bill would cost. There may be no absolute parity between them, but it is certainly a compensatory factor here, and a saving may be made by greater reliability of service. However, you cannot guarantee that people will turn up on the day, even if the transport comes to their door.

What are the Government doing to address the problem the health service finds itself in of not getting people to appointments for treatment? It invariably leads to more costly emergency procedures later on. We need an answer to that. Indeed, the noble Baroness may well think that there is progress somewhere else. But she has identified a real problem. The Government may be able to tell us that progress is happening, what is being done to monitor that progress and change things where they are not working. If so, answers to some of the points raised in this Bill will be delivered. However, the noble Baroness has a point. If you do not get people to health service appointments on time, you invariably end up paying for that later, one way or another. The noble Baroness has pointed out a real problem.

My Lords, I thank the noble Baroness, Lady Greengross, for introducing this important Bill, which is so important for patients, the elderly and disabled people.

The Bill reminds me of a national inquiry which I chaired some years ago into the services for disabled people known as the artificial limb and wheelchair services. The service was highly unsatisfactory: the money was plentiful but the management incompetent. In particular, the transport arrangements were expensive and inefficient. Often an ambulance would collect a number of patients from quite a large area but this would take so long that they would be late for their appointments. Some would have missed the appointment altogether by the time they arrived and then would have to go straight back home. Someone worked out that the cost per patient per mile was greater than that for Concorde.

The situation improved over time with better management, but as the noble Baroness, Lady Greengross, emphasised, there are still problems with the patient transport services today. Patients are still arriving late for appointments. Some vehicles simply do not turn up. That causes all sorts of knock-on effects on patient treatment and welfare.

According to the National Kidney Care Audit patient transport survey carried out by the NHS Information Centre, kidney patients travelling to hospital for life-saving treatment received a more punctual service from private and public transport than from hospital-provided transport. The survey asked all 19,000 patients who had treatment in dialysis units their views on patient transport, which can have a major effect on the quality of life. Nearly two-thirds of all haemodialysis patients, who typically have three or four hours of dialysis treatment three times a week, completed the survey. It concluded that just over 60 per cent of patients said that the service met their needs, which is good news. Unfortunately, the rest reported long delays and journey times when using hospital-provided transport.

The views of managers from all 247 dialysis units were invited and responses received from 212 units surveyed—a response rate of 85 per cent. The survey was also extended to commissioners who were asked to report for each renal centre for which they commissioned. There was a 90 per cent response rate from the commissioners. The responses from dialysis unit managers and renal care commissioners suggested several possible causes of transport problems.

First, only one-third of units have clear eligibility criteria for hospital transport. I always remember going to one centre for disabled people, and staff there pointed out to me a patient who came every few months for adjustment to his artificial leg. They told me that he insisted on hospital transport whereas he actually visited the centre once a month using his own transport because he enjoyed the trip and the social occasion. When it was pointed out to him that he might use his own transport rather than the hospital one he looked slightly embarrassed.

Secondly, the survey showed that only half the managers in the survey reported having a system in place to monitor the quality of transport for which they were responsible. Thirdly, the staff felt powerless to influence the provision of transport for their patients.

Among its recommendations, the audit said that there should be clear and transparent commissioning arrangements for kidney patient transport and that patients should be involved in the commissioning and monitoring process. It recommends that no patient should have to pay for transport to and from treatment and that transport should be an important factor in deciding the location of new dialysis units. Of course that brings up the interesting issue that, in the past, far too many hospitals and treatment centres have been located in areas more for the convenience of the local MP than of the actual patients.

It would be helpful if the Minister could outline what procedures are now in place to co-ordinate patient transport services in the NHS, and how the Bill might change the existing set-up. Can the Minister assure the House that transport services for disabled and elderly people are also taken into account? With regard to the report into patient transport services for those with kidney problems, can the Minister say what action has been taken to improve the situation?

My Lords, the Patient Transport Bill tabled by the noble Baroness, Lady Greengross, seeks to place a duty on primary care and hospital trusts to work with local transport authorities to co-ordinate the provision of patient transport services with the provision of other passenger transport services, such as local bus services, within the areas over which the trusts have responsibility. I am pleased to have the opportunity to discuss this important issue today.

Patient transport services—which, if the House permits, I will now refer to as PTS—are services for people with a medical need for transport to and from a health facility. Department of Health guidance sets out the broad criteria by which patients are eligible for PTS. Who is eligible? Primary care trusts are responsible for providing PTS where a patient’s medical condition is such that they require the skills or support of PTS staff on or for the journey, where the patient’s medical condition impacts on their mobility to such an extent that they would be unable to get healthcare by any other means, or where it would be detrimental to the patient’s condition or recovery if they were to travel by other means.

So patients are eligible for free non-emergency patient transport services if they have a medical need for such transport. A clinical need for treatment does not imply a medical need for transport. Medical need for non-emergency patient transport is determined by a healthcare professional. The principle that should apply is that each patient should be able to reach a healthcare facility in a reasonable time, in reasonable comfort, without detriment to their medical condition. That would apply across the piece, including to kidney patients. I am not going to into social need, which is a different issue about providing additional money for people who cannot afford to get to facilities under a separate programme that is not addressed by this Bill.

The guidance sets out and includes, among other things, the criterion for the patient’s medical condition, which, it says,

“is such that they require the skills or support of PTS staff on/after the journey and/or where it would be detrimental to the patient’s condition or recovery if they were to travel by other means”.

I am describing the criteria for PTS to make it clear that patients who require PTS have different needs from other kinds of passengers. They have different needs from patients who have a social need, to whom I have just referred, for whom provision is made separately under the healthcare travel costs scheme.

The department explicitly supports co-operative working, which is the principle behind the Bill. I congratulate the noble Lord, Lord Addington, on his work today as a multi-disciplinary Liberal Democrat spokesperson; I wonder what he did to deserve such punishment. He absolutely put his finger on the point: this requires local leadership and management to get it right at the right level. That is the eternal dilemma that we often face in these issues.

In the same guidance document which I just quoted, the Department of Health’s 2007 Eligibility Criteria for Patient Transport Services, the explicit point is made that the NHS should engage with the local passenger transport authorities and other key partners, such as local authorities and county councils, when co-ordinating access for the public to health services. It also states that:

“A range of different providers may provide PTS”,

and that primary care trusts,

“may lawfully ask other bodies to assist in the exercise of their commissioning functions”.

The measures described in the Bill allow for and encourage co-operation between local services. These are already clearly and explicitly laid out in our guidance.

It is worth saying that I am talking about the particular needs of patients because there is a real issue about, for example, whether you can use a vehicle to take children to school or on a school trip when you possibly need wheelchair access, oxygen or particular facilities. There is an issue about what kind of vehicles you would need and how to co-ordinate that, which presents the kind of challenges that the noble Lord, Lord Addington, recognised need local management and local leadership. It is not that they cannot be overcome, but they need that sort of co-ordination. It is an issue of safety and—I will go on to talk about this—such vehicles would need to be registered with the CQC. I will talk about the new regulatory framework that is being brought to bear on this region.

As the noble Baroness, Lady Greengross, has said, we do not collect centrally information that would measure how many co-operative arrangements are in place and how they are working. This is an issue for local areas, and not for the Government to micromanage. However, I can absolutely see where the noble Baroness is coming from in her determination to make the most effective and cost-effective use of public resources in this area. I completely accept that point.

I am sure the noble Baroness will be pleased to learn that we know that a recent change in the financial arrangements for PTS has led to a change in approach to this issue locally. PTS was recently removed from the acute tariff funding arrangements, which has led to a shift from most PCTs delegating commissioning responsibility to acute trusts, towards primary care trusts taking day-to-day responsibility for their PTS commissioning. This means that many primary care trusts are now in a good position to begin exploring new partnership working opportunities with local councils and others. We certainly want them to do so. These new arrangements can be informed by good practice which has already been developed and shared locally. The department recognises the guide Providing Transport in Partnership, which was published by the North West Centre of Excellence in 2009, as an example of where joint approaches can help to ensure better use of health, community and public transport networks. We must ask, given the principle that NHS services should be organised and managed locally, whether placing a requirement for co-operation in national law would be a disproportionate use of legislation in these circumstances.

One further element of the Bill may seem a trifle unclear. I ask the noble Baroness to look at this when she gets to the later stages of the Bill. The existing guidance says that it is,

“the responsibility of the PCT to ensure that appropriate services are being provided at an appropriate cost and standard”.

Therefore, the NHS needs to retain the responsibility for patients with medical needs. PCTs, when working in partnership with local authorities and other stakeholders, need to retain responsibility for those people. Does Clause 1(2) raise a question over that paramount responsibility and where it rests? Is that what the noble Baroness intended? She may need to explore that.

The different level of responsibility for PTS patients is illustrated by the fact that all services commissioned to provide PTS will now be expected to register with the Care Quality Commission from April 2010. This is a new requirement, as PTS was not previously regulated, but the CQC has identified PTS as an activity that requires registration because of the inherent risks in transporting unwell and often vulnerable patients.

I am aware that the noble Baroness raised this issue during the passage of the last health Bill; indeed, we discussed it then. While I regret to say that we do not agree at the moment that this is necessarily the way forward, I hope that she will acknowledge that we are making progress in this area. Her determination to keep raising the issue has undoubtedly contributed towards that and I expect that we shall continue to have this discussion.

My Lords, I start by thanking the noble Lords, Lord Addington and Lord McColl, for their support and for raising incredibly important issues. I also thank the Minister for her empathetic and understanding attitude towards what I am trying to do by raising the issues in the Bill. I appreciate that this is a complex area but I feel that, when I have had a chance to consider the points that she raised, there will be ways in which we can take this forward.

I agree that local leadership is important and necessary. I am delighted that CQC registration has been introduced, as that is of benefit to everyone. The recent changes that the Minister outlined are also good if we are trying to get this right. I appreciate that primary care trusts retain overall responsibility for each patient, but I think that, when they are co-operating, they already manage to do these things. They also manage to put people in taxis sometimes and somehow that is thought to be all right, so there must be ways round this. I am hopeful that, by taking the Bill forward, we can both reduce the obvious waste of resources that occurs through non-attendance, as the noble Lord, Lord Addington, pointed out, and deal with some of the acute difficulties that the noble Lord, Lord McColl, outlined in his helpful remarks. All this would be of benefit not just to patients but to taxpayers and the wider community, so I urge noble Lords to support the Bill and I ask the House to give it a Second Reading.