Healthwatch Isles of Scilly/Commons Select Committee, Transport 14-03-14 1 To Commons Select Committee, Transport
14th March 2014
Written evidence to the inquiry on passenger transport in isolated communities- Isles of Scilly Submitted by Healthwatch Isles of Scilly
With reference to the extent that the needs of different groups of passengers (e.g. people with disabilities, older people, young people) are taken into account in determining the provision of public transport to isolated communities. This includes people undertaking necessary medical travel.
1) Introduction
i. Healthwatch Isles of Scilly is part of the local Healthwatch network created by the Health and Social Care Act 2012. Local Healthwatch is tasked with obtaining the views and experiences of local people regarding health and care services and with working with services towards improvement where necessary. Difficulties regarding necessary medical travel feature significantly in community feedback.
ii. On island health services for residents comprise the GP Practice, Community Hospital and NHS Dentist. The Community Hospital provides a minor injuries unit, community nursing, and inpatient beds for assessment and recuperation. Some therapies and specialist services are provided by visiting practitioners. Most secondary, acute and urgent health care is provided in Cornwall and islanders must travel for treatment.
iii. There is now a single transport provider, Isles of Scilly Steamship Group. They provide a year round sea freight service, a year round air passenger service and a summer only sea passenger service.
iv. This submission is concerned with travel for urgent or routine treatment. On average, 35 people a week undertake medical trips1. Emergency medical evacuations are provided by Cornwall Air Ambulance and the Coastguard Search and Rescue Service. In 2013 there were 172 emergency evacuations2.
1
Figure derived from number of travel warrants issued. 2
Figure received from South West Ambulance Service. 2) Summary
o Transport schedules - the time window available to complete an appointment o Seat availability - difficulty in arranging travel to the first offered appointment o Transport resilience - weather disruption and cancellation of treatment
o Difficulties of the journey - the impact on health outcomes o Cost to patient - time and monetary expense
o Accessibility of the planes/boat for people with limited or impaired mobility o Related medical transport issues
o Conclusion 3) Transport schedules
i. The majority of passengers to and from the Isles of Scilly are holiday visitors and transport schedules reflect this. There are more flights in the summer season and the boat operates a day return from Penzance (it is not possible to complete a day return from Scilly to Penzance by sea). The winter flight schedule is limited and there is no winter sea service.
ii. The journey is governed by first and last flight times (and check-in times) and connections with onward public transport. We provide a graphic map of the journey to NHS booking clerks which illustrates the time window available to complete an appointment in a day trip, and which we update every time the schedule changes. Examples are included in an appendix at the end of this document.
Healthwatch Isles of Scilly/Commons Select Committee, Transport 14-03-14 2 In winter, a reasonable time window to complete an appointment in Truro is 1145 to 1330. In summer 2012, this time window was 0945 to 1445.
In summer 2014 it will be 1145 to 1445.
The reduction in the time window since 2012 is due to a shorter flying day in the current schedule.
iii. The short time window available is often incompatible with the arrangements of NHS clinics. 4) Seat availability
We receive a very high number of comments about the difficulty in arranging travel for an appointment or admission because of flight schedules. In the last 18 months people have also reported that seats are not available on a required flight, even when booking some weeks ahead. The need to rearrange an appointment or admission around availability of transport causes delays to treatment.
5) Weather disruption
i. In winter 2012/13 we received a lot of feedback about the difficulty of medical travel due to weather disruption to air transport. We tested this with a patient questionnaire in the first three months of 2013.
The full report is available here: Medical Travel from the Isles of Scilly Winter 2012-13
ii. We found that:
25% of respondents were unable to arrange travel for their first offered appointment; 20% of respondents could not travel on the day of their appointment/admission because
of flight delay or cancellation;
52% of respondents experienced delays on the outward journey; 40% of respondents experienced delays on the return journey.
iii. People reported that actual disruption or the likelihood of disruption caused them to either: include this in their travel plans and arrange to stay on the mainland for extra nights at additional expense, or: cancel or delay their treatment.
iv. The closure of Lands End airport due to waterlogged runways was a significant factor in the disruption to travel. Flights which are re-routed to Newquay airport are at changed times, the surface leg of the journey is longer and surface transport links from Newquay airport are poor. v. Transport disruption also affected clinics held on Scilly by visiting consultants and therapists.
Consecutive cancellations of the weekly local X-ray clinic meant that patients had to travel to Penzance when flying resumed and/or wait longer for diagnosis.
vi. It is of great concern that the severe weather disruption of winter 2012 has been repeated in winter 2013, and that nothing has been achieved in the interim to improve the resilience of transport links.
6) Difficulties of the journey
i. Attending for treatment in Penzance is fairly straightforward. The journey to Truro is more time consuming and time sensitive regarding connections, and anywhere else is difficult to achieve on public transport. One may instead choose to book hospital car transport at additional expense. In this regard, islanders have the same experience and choices as people in Cornwall without access to private transport.
ii. What people tell us about is the added stress of the journey because they are in effect under a curfew. There is – all too often – uncertainty about whether the outward flight will be delayed, affecting onward connections, or cancelled. Once at the clinic, there is anxiety about whether their appointment will run on time, and anxiety about making all the return connections to be at the airport in time for check-in for the return flight. Patients report that this can have a negative impact on their consultation or treatment.
Healthwatch Isles of Scilly/Commons Select Committee, Transport 14-03-14 3 iii. We also hear from people about their experience of undertaking a time consuming and
complicated journey while feeling very poorly, for instance on discharge from hospital. iv. We ran a community survey in October 2013. General comments about travel were
overwhelmingly negative (95%). People used words like ‘stressful’, ‘difficult’ and ‘nightmare’ to describe the experience of medical travel.
iv. All this has led some patients to decline or delay treatment. We do not provide case studies for publication, because in a small community people can often be identified by their stories. The following is a post on ‘Scilly Today’ online, and sadly is representative of comments we have received:
“It is so stressful now getting to critical appointments. Even thinking of leaving a few days before, despite incurring extra expense means you can’t even guarantee you will get there. I have had recent cancer follow up appointments which are really stressful in themselves and the extra worry of whether I will even get there results in panic attacks at the airport waiting to see if I will fly or not or the plane will turn around when I’m nearly there.
I’m not passing blame to anyone but just want people to realise how hard it can be for patients and their families. I have even put off querying a lump because I could not face getting to Treliske.*” *Truro Hospital
7) Cost to patient
i. The NHS subsidises travel to Penzance under a travel warrant scheme, the cost to the patient being £5. As noted, from Penzance the options are the same as for anyone without access to private transport.
ii. However, because of transport schedules, it is not always possible to complete one’s appointment or treatment in a day trip, or be able to travel on the day of admission or discharge. Islanders therefore incur additional costs for overnight accommodation and subsistence.
iii. Weather disruption and limited seat availability also necessitate travelling a day or two either side of one’s appointment. People tell us that this causes them to cancel or delay treatment for reasons of expense, time off work, and time away from family responsibilities and childcare.
8) Accessibility of planes/boat
i. Skybus operates Twin Otter and Islander aircraft. Passengers must be able to board and disembark aircraft without assistance. The Twin Otter has steps which are an integral part of the lowered door, with cables which are not as solid or substantial as a handrail. Once aboard, there is limited headroom or room to manoeuvre. The Islander is boarded by climbing into one’s seat, rather like getting into the back seat of a two-door car. Both types of aircraft are challenging to impossible for passengers with limited mobility, for instance people with a disability, the elderly, or orthopaedic patients.
ii. Skybus can convert an Islander for stretcher transport, for patients who require it in order to go to the mainland for treatment or who cannot return home from hospital any other way. It can also be arranged for non-medical passengers who have limited or impaired mobility. The cost to the NHS or individuals is approximately £700 each way. This is not a commissioned service and availability is dependent on other operational demands.
iii. The Scillonian III ship has been fitted with a lift which is operated by a crew member on request, and also with clamps for a non-motorised wheelchair. The passenger and wheelchair must be carried aboard. The sea journey is not suitable for everyone. Seasickness aboard is not uncommon and this can be very debilitating.
iv. We recognise and appreciate that the Isles of Scilly Steamship Group has made every effort to meet the needs of disabled passengers within regulations governing their air and sea
Healthwatch Isles of Scilly/Commons Select Committee, Transport 14-03-14 4 in this area. Passengers on the helicopter were given assistance on the steps, which also had a solid handrail.
9) Related medical transport issues
When the cessation of the helicopter service was announced in August 2012 it was clear that there would be an immediate and significant impact on the transport of patients and medical goods. Local Authority, transport, and NHS partners have undertaken a great deal of work to enable the continued transfer of patients with impaired mobility, patients with mental health needs, and expectant mothers up to 39 weeks of their pregnancy. There has also been the need to make alternative arrangements for the transport of medical goods, eg. drugs, blood for transfusion and bio-hazard goods (specimens for testing). These arrangements have all been tested by two consecutive winters of severe weather disruption, and this has resulted in crisis management. We do not consider this to be sustainable.
10)Conclusion
i. Link4Scilly/Healthwatch Isles of Scilly has been collecting feedback and information, and undertaking work regarding medical travel for four years. The NHS has been responsive regarding appointment times and in arrangements for admission and discharge; also with regard to ongoing improvements to on-island provision which reduce the need to travel. ii. Nonetheless, there has been a marked deterioration in the situation since the end of 2012.
This is due in part to weather disruption but also because transport schedules have become more limited, regarding the time of the first and last flights of the day, onward connections, and reported limitations on seat availability.
ii. We have mentioned the loss of the helicopter service because it must be acknowledged that this is a factor in the reduction in service regarding schedules, seat availability, and transport of certain categories of patient and medical goods. However, the loss of the service may be seen as a casualty of a deteriorating situation regarding transport provision, rather than a cause.
iii. Transport provision is dependent on tourism. The lifeline service for medical and other essential travel is therefore linked to market forces and is adversely affected by an economic downturn.
v. Transport provision is weather dependent. Lands End airport is vulnerable to water logging and travel via Newquay is not viable for completing an appointment in a day trip. Flights are affected by high winds or low visibility. There is no adequate alternative sea passenger service, particularly in winter.
vi. We consider that current provision for essential travel is not adequate, on these grounds: o Islanders often cannot undertake necessary medical travel without additional cost, both in
time and monetary expense;
o These factors, together with the difficulties and stress of the journey, have led to some patients cancelling or delaying their treatment;
o Travel related disruption to accessing mainland health provision has led to delays in diagnosis and treatment;
o Travel related disruption to on-island health provision has led to delays in diagnosis and treatment.
vii. We present this evidence for consideration in the examination of wider transport issues, and are not qualified to offer a solution. However, we recommend that:
o Mechanisms are put in place to ensure that the transport service is economically resilient and weather resilient;
o Mechanisms are put in place to ensure that an adequate service for essential travel is protected from the adverse effects of wider market forces.
Healthwatch Isles of Scilly/Commons Select Committee, Transport 14-03-14 5 APPENDIX: Comparison of patient journey map 2012 and 2014
Healthwatch Isles of Scilly/Commons Select Committee, Transport 14-03-14 6 Submitted by:
Jane Hurd, Director Healthwatch Isles of Scilly Thorofare St Marys Isles of Scilly TR21 0LN 01720 423037 [email protected]
