NHS travel troubles: Five barriers patients face getting to appointments
Across England, patients need to attend millions of GP, hospital, and other appointments every year. However pressures on many health services and the rising cost of living can make it hard to get there.
When we looked at how patients travelled to NHS services in 2019, people told us that cost, public transport problems, and the distance to their appointments made travelling hard. Five years later, many people tell us they still struggle to get to healthcare appointments.
Five issues facing patients
1. Trouble accessing help to travel to healthcare
The NHS Low Income Scheme and non-emergency patient transport services for disabled people exist to help people with healthcare travel costs.
At a time when living costs are high and many people are struggling to make ends meet, schemes to help with healthcare travel costs are vital for improving access to care. But awareness of these schemes remains low, and we’ve heard from people who could benefit from the schemes being turned down.
“An asylum seeker had to travel over 50 miles to a hospital in Surrey. She had been told they aren't eligible for patient transport even though she has arthritis and feels she will struggle to get to the hospital on public transport. She also can't afford the cost to travel up front and needs to claim the money in advance of the trip. She is very worried that if she can't attend this appointment, she may have to wait many months for it to be rebooked.”
- Story shared with Healthwatch East Sussex
A report by Healthwatch Birmingham highlighted the difference support with transport can make. When parents of patients at Birmingham Children's Hospital were given help with the cost of transport, the number of children not attending appointments fell, leading to reduced waiting times for care.
Non-emergency patient transport is only for hospital appointments and isn’t available for GP or dentist appointments. For disabled people, this often means making long, difficult, and expensive journeys by public transport, relying on others for help, or going without care.
"I was taken off the dentist list without being notified about ten years ago. I'm disabled, and during the time I didn't visit, I was very unwell. When I went to go again, they told me I had been removed from their list. I have not seen a dentist since. I can't physically travel the 30 miles to an emergency dentist, so I have no dental support."
- Story shared with Healthwatch England
2. Inconvenient times and locations
We know that giving patients a choice in time, day, and location for appointments can reduce long waits and improve access to care.
Unsuitable times, days, or locations for care force people to make long and inconvenient journeys to more distant hospitals when more convenient locations are available.
When the NHS takes steps to centralise specialist services or close or reorganise more local services, this can have an impact.
"My 86-year-old father-in-law fell over and sustained significant facial injuries. NHS 111 recommended going to A&E. This is over an hour's drive away. This is an unacceptable distance to have to travel, especially with an elderly man with dementia. A full A&E service used to be available 15 miles away, but it was closed – very poor service for rural dwellers.”
- Story shared with Healthwatch England
While our 2019 report focused solely on travel to hospital appointments, we've heard about people having to make longer, inconvenient trips to see their GP or get NHS dental treatment. Closure of closer surgeries in more rural areas and many dentists stopping NHS treatments altogether are among the causes.
"The branch surgery two miles away is rarely manned by GPs now, so we have to travel a 14-mile round trip for face-to-face appointments."
- Story shared with Healthwatch England
The importance of listening to the patient's voice
In 2022, Healthwatch Isles of Scilly published a report assessing people's experience of all health and care services provided to people living on the islands. One of the issues raised by people who needed to travel to the mainland for hospital care was that the process of booking medical transport was difficult and stressful:
- Waiting for flight confirmation meant that people couldn't book the rest of their travel, including boats from the smaller islands, accommodation, and travel to the hospital from the airport or boat quay.
- If the booking was delayed, people would have to cancel medical appointments because no flights were available.
- The delay in booking could also cause difficulties in booking a funded medical escort for people who need one.
Healthwatch Isles of Scilly shared this insight with the Patient Transport service and the Royal Cornwall Hospital Trust. As a result, they simplified their process to include a dedicated booking line for Isles of Scilly patients so they can book their transport while on the phone.
Now, people living on the islands don't have to cancel so many medical appointments because of a lack of transport. They can book someone else to travel with them and feel more confident they can arrange the whole journey quickly.
3. Unreliable or limited transport
At a time when public transport has been substantially reduced, as recent research from Friends of the Earth has shown, the time, day and location of appointments matters. We heard about people being booked appointments at times before public transport could get them there or at weekends when there are limited or no services available.
Research by Healthwatch Rotherham found that without reliable or frequent public transport, people who depend on it spend a significant amount of time getting to and from their appointments.
"The client has a hospital appointment for a scan, but her appointment is on a Sunday, and she was told that there was no transport available. She suffers from severe anxiety and would have to get two buses to get there. If she cancelled her appointment, she would have to wait up to two months for another appointment."
- Story shared with Healthwatch County Durham
Booking patient transport is another issue. One person told us they waited over 13 hours for transport to an eye hospital. Others told us about long waits to speak to staff, a lack of availability for early morning or weekend appointments, unreliable services, and insufficient alternative booking options for people with hearing impairments.
"My dad had a couple of orthotic appointments for 10.30 AM. Patient transport could arrive anything up to two hours beforehand. He hated to get up early, plus it took two carers to provide his care first thing i.e. washed, dressed and into his wheelchair. Poor dad was awake at 07.30 AM for a 10.30 AM appointment at a hospital 10 minutes away."
- Story shared with Healthwatch England
4. Availability and cost of parking
A concern for patients who travel by car to their appointments is the lack of parking spaces and the cost of parking at healthcare facilities. People have told us they must leave home hours before their appointments to allow time to find a parking space.
"Arrived two hours early for his appointment to secure parking. On his last visit, he had to park on the road in an emergency and got a ticket; now he's not taking any chances, even though he knows the parking charge will be high after his appointment today."
- Story shared with Healthwatch Bracknell Forest
People had concerns about the cost of parking and found signs detailing parking charges confusing. For people whose appointments had been delayed or who had to wait a long time to be seen in A&E, this was particularly concerning:
"£18 to park for 9 hours! Had to wait ages to get a space while my dad was in A&E. After 9 hours, I could see it would be a long wait so moved my car to the disabled spaces in front of the hospital. Parking charges clearly state £12 for up to 12 hours, so why was I charged £18?”
- Story shared with Healthwatch Redbridge
5. Accessibility
We've heard from people with disabilities and Blue Badge holders that there aren’t always enough disabled parking spaces available.
People with limited mobility described having to use standard parking spaces instead. In one instance, all the disabled parking spaces were unavailable due to building work.
“Patients accessing the GP practices and the hospital have been complaining they are unable to use disability parking places due to building work taking over the space at the hospital car park. They asked if this could be communicated to the hospital and give some feedback.”
- Story shared with Healthwatch South Tees
Even if disabled parking spaces were available, people with limited mobility told us the spaces weren’t always appropriate.
We heard about disabled parking spaces being on an incline, making it difficult to get out of the car safely, and the spaces being situated some distance from the hospital entrance.
“For some reason since the car park was changed, they have put the disabled parking against the wall at the far end of the car park which is now on a steep incline. I have an adapted vehicle for my son who is wheelchair bound and can neither push him up into the vehicle nor safely get him out on such a steep incline. Very inconsiderate. I have had to ask passersby to help me.”
- Story shared with Healthwatch Doncaster
People need a choice of ways to pay for parking at healthcare settings. We heard that at some healthcare settings, the only payment method was online.
“If you don't have a smartphone you are discriminated against, especially for things like not being able to pay for parking in some places when going for appointments.”
- Story shared with Healthwatch County Durham
The steps that would help
Increasing access to financial support
NHS England’s Healthcare Travel Costs Scheme helps many low-income patients by covering the cost of travel to hospital appointments. Improvements to the scheme and greater awareness among the public would mean it could help even more.
Our recommendations for the Government:
- The Healthcare Travel Cost Scheme should be extended to cover all NHS appointments.
- Patients should have their travel and hotel costs covered when they choose to receive quicker NHS care away from their local hospital.
- The Government should review the NHS Low Income Scheme, which has not been reviewed for over twenty years.
NHS England can also improve the situation by:
- Introducing a new minimum standard for transport waiting times following discharge from hospital.
- Raising awareness of and promoting the NHS Low Income Scheme, including the Healthcare Travel Costs Scheme.
- Making these schemes available via the NHS App would also help more patients access support.
- Speeding up reimbursement through the Health Travel Cost Scheme and making sure people can have journeys pre-paid.
Thinking more about patients' transport needs
Listening to people’s needs and concerns around transport and travel for care can drive positive change in services.
Integrated Care Systems can play their part by:
- Actioning recommendations from the non-emergency patient transport service (NEPTS) review, including delivering universal access to NEPTS for people attending haemodialysis appointments.
- Implementing hospital discharge guidance, including asking patients about travel arrangements to get home and ensuring nobody is discharged at night unless transport can be arranged.
- Supporting NHS trusts in following car parking and Blue Badge guidance.
- Reducing the cost of parking charges, with more concessions available to visitors and carers of people requiring extended hospital stays.
What else can help patients:
- Healthcare professionals should discuss travel with patients when booking appointments, and explore the possibility of several appointments on the same day for people on multiple pathways.