Clinical decision on patient escorts

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The cost of travelling to the mainland to access health care and treatment is a concern for every islander.

Travel costs are covered by NHS Western Isles, but outwith the expenses allowed by the health authority, patients soon find that being away from home plunders the pocket.

Knowing that a family member might not be able to accompany you to appointments or treatment due to costs is also another issue for many who are forced to travel for healthcare.

And it is this issue of funding patient escorts which is concerning health groups in the Islands this week.

NHS Western Isles sparked the disquiet when it announced that a new system for approving requests for patient escorts is being introduced.

NEW SYSTEM

In a statement the health authority highlighted that: “The NHS Western Isles Patient Travel Policy sets out the criteria by which funding of escorts is approved.

“There is no change to the criteria for approving a funded escort or to the Patient Travel Policy. In regards to whether or not an NHS funded escort is required and approved, this will be made by the NHS Western Isles Medical Director, Angus McKellar, with advice from GPs, rather than by individual GP Practices.”

Dr McKellar explained: “Historically, it has been the responsibility of GP Practices to make the decisions regarding approval for patient escorts, and there has been a significant variation between the GP Practices in patients receiving approval for funded escorts.

“It is important that there is fairness across the Western Isles, and so a new process has been developed, and tested, where GPs will provide clinical information to me regarding escort requests, and the decision to fund an escort is approved via my office.”

The health authority revealed that the new system has been piloted in two GP practices – Langabhat (from March 2017) and Broadbay (from May 2017), and they say that the initial feedback has been positive.

It is intended that the new process will be rolled out to the three remaining GP Practices in Lewis and Harris later this month and introduced in the Uists and Barra in July.

OPEN LETTER

However this system change by the NHS has not found favour with the Hebridean Men’s Cancer Support Group, who have submitted an Open Letter to the Gazette this week highlighting their concerns.

In the letter addressed to Dr McKellar they detail: “The committee is disappointed to learn that Western Isles Health Board is seeking to move from a position where paid escorts will be agreed for all cancer patients travelling to hospital on the mainland for cancer diagnosis to be confirmed.

“The committee does not consider the pilot with Langabhat and Broadbay practices to have been a ‘success’ as you averred.

“Removing decision making in this matter from the practice to the Medical Director can not be described as success as it merely displaces the pressure felt by the practices on to the patient. That is not what the NHS is about.

“The NHS should deliver a comprehensive service ‘free at the point of delivery’. That begins in the doctor’s surgery when a decision is taken to refer a patient to a mainland hospital.

“From that time forward all care must be free and, if you live on an island, that includes travel. There must be no question of introducing a means test. Nor should patients be placed in a position of even more stress. Every effort should be made to de-stress travel.

“The committee commend the position of Shetland Health Board to you in this matter. SHB advocates that paid escorts be provided: ‘where they require help in understanding/remembering information and making informed decisions regarding their care’.

“That definition is inclusive of all patients in our experience. In the Men’s Cancer Group we are all living with cancer – we have all experienced the trauma of being told we have cancer.

“All of us have experienced treatment. All of us suffer some debilitation in our general health. We cope by supporting one another.

“At a time when a cancer diagnosis is being delivered, support is required.”

In regards to the system change Dr McKellar stressed that where escorts are clinically required the health authority will continue to fund them.

However, he added: “We must ensure that the criteria are applied in an equitable way. This will ensure that those patients who require an escort will continue to receive financial assistance, but it will also mean that those who do not meet the criteria will not receive NHS funding for an escort.”

MEANS TESTING FEARS

With anecdotal evidence suggesting that already there is a rise in the number of patients who are being refused escorts, and a recent case where an elderly person was refused an escort for a mainland appointment, some would say it is the financial bottom line which is being prioritised.

NHS Western Isles stress that patients will have the opportunity to provide supplementary information in support of their application for a funded escort if their initial request is declined.

But for patients who are dealing with the spectre of illness, or receiving treatment, why should they be put in the position of arguing for the support they feel is vital?

For many the new system smacks of means testing by the back door, yet, the balance between support of patients and using available funding wisely is a delicate one.

In 2017, around 44 per cent of patients from the Islands who were required to travel were accompanied by a funded escort, with some GP Practices authorising escorts for 50 per cent.

This is considerably higher than other Island health authorities, with other Boards funding escorts for around 30 per cent of patients. With patient travel locally costing £31 million over the last 10 years it has been indicated that savings in this area could result in significant amounts of money being reinvested back into patient care locally.

IN ANSWER TO POINTS RAISED

In answer to the points raised in the Open Letter by the Hebridean Men’s Cancer Support Group, an NHS spokesperson stated: “NHS Western Isles would stress that there has been no change to policy or criteria used for the approval of escorts.

“What is being highlighted to patients by the Health Board is a change to the escort approval process, with decision-making being taken centrally (similar to the system used by NHS Shetland).

“The NHS Western Isles policy never specifically focused on the funding of escorts for all cancer patients travelling to the mainland for a diagnosis, and there was no consistency around this. The aim of the new approval system is to ensure that the consideration of funded escorts is taken consistently.

“With regard to the Hebridean Men’s Cancer Support Group’s statement that the NHS ‘should deliver a comprehensive service free at the point of delivery... all care must be free and if you live on an island, that includes travel’.

“NHS Western Isles would point out that, unlike the majority of Health Boards who means test any financial assistance with regard to patient travel, NHS Western Isles provides financial assistance to all patients with their travel costs if they live more than 30 miles from the hospital they are attending.

“Patients not on a qualifying benefit are only required to pay the first £10 of any claim. NHS Western Isles also provides financial assistance for escorts where patients meet the criteria. NHS Western Isles at no point has considered introducing a means tested system.

“In terms of any savings associated with repatriation, it would not be the intention of NHS Western Isles to use any potential savings to fund all escorts.

“Any savings would be redirected into providing the highest possible quality patient care (including, for example, funding high cost cancer drugs for local patients).”