How improving transport support could help us address health inequalities

The 10 Year Plan is expected next week. Both National Voices and Healthwatch England have been closely involved in its development, setting out our respective priorities on the National Voices website here and Healthwatch England website here.   

The need to address health inequalities has been central to both organisations’ efforts and we are reassured this is something that the Secretary of State for Health & Care Wes Streeting understands. Speaking at the NHS Confed Expo conference earlier this month, he said that a “postcode lottery in quality of care” was an “affront to the values the NHS was built on, the values of my party, and my personal values.” 

However, quality of care must be seen, not just as outcomes from care received, but missed outcomes from people not being able to access care in the first place. We have therefore been clear that, alongside long-term reform to improve health inequalities, a focus on practical, more immediate support for people facing inequalities will also be required.  

What does this mean in practice? Transport would be one place to start. 

A small step that could make a big difference to people facing inequalities would be understanding why people find it so hard to access the NHS travel schemes that are specifically designed to break down access barriers. 

The main scheme to support those on state benefits and/or low incomes with the costs of travel is the Healthcare Travel Costs Scheme (HTCS). However, the low uptake of the scheme compared to the number of those eligible suggest it is unknown to most people – most concerningly among those on low incomes who would benefit from the scheme.  

The NHS must do much more to promote the scheme to patients, but even if people are aware of it, the scheme remains unaffordable for many on benefits and low incomes. This is because individuals still have to pay the upfront costs for travel, even if they get reimbursed later. For people with multiple health conditions this can be a particularly expensive problem, with individuals unable to afford travel to new appointments as they are still waiting for reimbursements from earlier ones. 

It is positive that there are schemes in place to support patients with transport, but we must do better if we are to take tackling health inequalities seriously. The NHS could deliver the best care in the world, but if the poorest patients cannot afford to get to and from the required services then we can hardly call it a universal service.   

There are some clear changes we would like to see in the 10 Year Plan, or the implementation strategies that follow. These are: 

• A national awareness raising campaign on Healthcare Travel Cost Scheme (HTCS), to include marketing and advertising, better information available in NHS facilities and promoted on the NHS App.

• Implementation of the recommendations from the Non-Emergency Patient Transport Scheme (NEPTS) review. Specifically, rapidly amend HTCS regulations to streamline assessment by NHS Business Services Authority of eligibility of claims (the aim was to do this by the end of 2023).

• Go further to reduce reimbursement time from months, down ideally to a pre-payment system. The NEPTS review called for maximum limit of 30 days, with aim for ‘far shorter’. This was based on data of claims taking 90 days. 

• Widen the HTCS eligibility criteria to include people facing significant medication shortages so that they can claim back the costs of travelling further or for longer to access medication stock that they cannot secure from their local area. 

We hope this would just be the start. If the government was serious about supporting those on low incomes, it would review the entire NHS Low Income Scheme that provides help with things like prescription costs, dental charges and eye care costs. This scheme hasn’t been reviewed since the early 2000s. 

Mr Streeting is right that “whatever your background and wherever you live, you should receive first class healthcare, based on need not ability to pay.” But this ability to pay must include how people access care in the first place.