Multi-hospital NHS Trusts: Transportation

(Limited Text - Ministerial Extracts only)

Wednesday 9th March 2022 Westminster Hall

[The Minister for Health (Edward Argar)]

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.

[Sally-Ann Hart (Hastings and Rye) (Con)]

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?

[Edward Argar]

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.

[Caroline Ansell]

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.

[Edward Argar]

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.