How well are patient transport services performing?
People face many challenges to getting the care they need, including long waiting lists for specialist care and difficulty booking GP appointments. For some people though, especially those with mobility issues and other health needs, getting to healthcare appointments can be challenging. People in these situations often require extra support in the form of patient transportation services.
Last November we looked at the five key travel issues facing patients. This November we’re taking a deeper look at people’s experiences of using patient transport services, including what’s working well and what needs to improve.
Eligibility for patient transport services
The general eligibility criteria for patient transport services are:
- being referred for hospital care or being discharged
- having a medical need for transport, a cognitive or sensory impairment requiring oversight, going to or returning from dialysis, safeguarding, wider mobility or medical needs, and;
- and there is no other suitable transport.
Local Integrated Care Boards (ICBs) have some discretion to add other criteria, such as long distances to travel or high transportation costs, and limited or complex public transport options. For example, people living on the Isles of Scilly only need to pay £5 towards the cost of plane, helicopter or boat travel to the mainland for hospital appointments.
Being able to get help with transport to hospital is important for some people who can’t get there by themselves.
“Enquirer has regular hospital appointments for eye injections. She also has to attend two days before each of her injections for an X-ray. The hospital is three buses and 15 miles away from her home. She worries that getting a taxi would cost too much. She has Chronic Obstructive Pulmonary Disease (COPD) so struggles to walk long distances. The patient transport team drop her right at the door of the eye clinic and come in with her to the appointment. If she got a taxi or bus, she wouldn't be able to easily get to the department as the eye clinic is not in the main building next to the hospital entrance.”
Story shared with Healthwatch Kirklees
People have told us that they felt the way in which eligibility rules were applied could be unfair, including being told they weren’t eligible if they could walk a few yards or get in and out of a car. People were expected to get public transport, which was often non-existent particularly at weekends or early in the morning.
“I contacted a number for transport. I am 85, have no car, cannot manage buses alone and can hardly walk. I was sent from one organisation to another. Eventually I got the right one but was told, very shortly, by an officious female that, as I could walk the few yards from my gate to a car, I didn't need and wasn't eligible for transport.”
Story shared with Healthwatch England
If a patient needs the skills and support of an escort, they cannot be left alone or their condition means they need someone with them, they can have a carer travel with them. We also heard about people who needed a carer to come with them not being able to be accommodated on patient transport.
“When my husband had to visit outpatients over last year, I was not allowed to travel with him. As he didn’t have full-blown dementia, I had to get myself to the various hospitals. No certain time was given and as I need to stay with him till transport arrived I then had to pray that traffic would be OK for me to get there before or at least at same time.”
Story shared with Healthwatch England
Difficulties booking patient transport
We also heard about the difficulties that people experienced phoning or using online systems to book transport, and having to book several weeks in advance. This meant it was impossible to get patient transport to urgent appointments.
“Caller telephoned the patient transport service only to be told there is a 14 day notice needed for patient transport. No good if you get a short notice cancellation like caller has. Caller now needs to use taxi.”
Story shared with Healthwatch West Sussex
We also heard that transport wasn’t available to take people to hospital for 7am for a procedure, at weekends or in the evenings. This made it difficult for them to get there by other means:
“I am a wheelchair user. Patient transport refused to take me into Leeds for an operation for 7am in the morning. When I raised a complaint the said they are not contracted to get anyone in before 8:30am. It cost me £98 for a wheelchair taxi that was contracted to the NHS who said I should not have had to pay.”
Story shared with Healthwatch England
A key issue is that people are often not told at all or told at the last minute that their transport has been cancelled, resulting in them having to book a taxi at great expense or even miss their appointment. Someone who had experienced this several times told us:
“Most of the time it has been excellent. But they have cancelled on the day just before the appointment and don’t acknowledge my written complaint. Sometimes you only find out about cancellation when the transport does not arrive.”
Story shared with Healthwatch England
What's Healthwatch done to improve patient transport?
In October 2019, we published ‘There and back -what people tell us about their experiences of travelling to and from NHS services’. The report looked at all aspects of travel to healthcare, including non-emergency patient transport.
At the time, the key issues people reported were how eligibility criteria were being interpreted locally, leading to some people with high needs being told they weren’t eligible, and poor experiences such as needing to be picked up a long time before their appointment and waiting for hours to be driven home.
At the 2019 Healthwatch National Conference, former NHS England Chief Executive Sir Simon Stevens announced a formal review of Non-Emergency Patient Transport Services (NEPTS). Our evidence fed into the review, resulting in a new national framework for patient transport, updated national eligibility criteria and improved use of technology to better coordinate appointments and communication to patients waiting for journeys.
After patchy implementation of the NEPTS review’s recommendations, NHS England wrote to ICBs in August 2024 urging them to deliver a universal transport offer to all dialysis patients. ICBs were asked to set-up working groups including local Healthwatch to improve implementation by March 2026.
Using patient transport
We are still hearing about people having to be ready early to be picked up, at least one but usually two hours, before their appointment time. They may also have to wait quite a while to be picked up after their appointment has finished.
“I live in Grimsby and received an appointment for a hospital appointment in Scunthorpe. I don't drive and don't have family. I got delivered to the hospital at 11am for my appointment at 2pm. On the way back I got picked up from Scunthorpe then went to Castlehill to collect others before heading back to Grimsby. It was such a very long day and I was in with the consultant for literally 4 minutes.”
Story shared with Healthwatch North East Lincolnshire
This story also shows that patient transport services may not be exclusive. They often pick up several people for efficiency reasons. However, people felt that patient transport bookers didn’t know the local area and routes, so they experienced unnecessarily long journeys:
“On pick up post dialysis crews would arrive early, cancel trips and leave people stranded. They sent crew travelling to a satellite unit in totally the opposite direction to my unit. Instead of filling vehicle with local people and then half hour trip up motorway, we'd go all round the houses (county) meaning an hour and a half trip to dialysis.”
Story shared with Healthwatch England
We also heard that people felt that vehicles used for patient transport could be very uncomfortable and they dreaded using it.
“The ambulances are very uncomfortable to travel in, because there seems to be no suspension in them. You get bumped about a lot. I have hydrocephalus and a damaged spine. I always have a headache by the time I get to the appointment.”
Story shared with Healthwatch England
Our recommendations
Despite national policy changes, people continue to share poor experiences of NHS transport support. This includes issues with complicated booking systems, a lack of communication, unclear and confusing eligibility, poor experiences of NEPTS journeys, and no options for carers to join them on journeys. These barriers lead to an over-reliance on public transport, which can be inaccessible and too costly for some patients.
People who need help to get to NHS appointments should be able to get the support they need. This includes older people, disabled people, and those who require regular NHS appointments for life-sustaining treatment.
We are calling for:
- A five year stocktake of the NEPTS review. Our evidence informing the NEPTS review unfortunately shares too many similarities with people’s current experiences, particularly around unclear eligibility and a lack of support for carers joining people on their journeys. Before August 2026, there should be an evaluation of how the 2021 review has helped, with identification of any further support ICBs need to ensure people are supported to get to and from vital NHS appointments.
- An overhaul of NEPTS booking systems. People must be given meaningful choice over how they book NEPTS travel. This includes in person, via telephone, or through digital channels including websites and the NHS App. All booking methods must ensure travel support is available for out-of-hours appointments.
- A formal review of the NHS Low Income Scheme. The Low-Income Scheme has not been reviewed for over twenty years. Support should be expanded to provide pre-paid transport support through the Health Travel Cost Scheme (HTCS). In line with the government’s shift to neighbourhood care, the HTCS should be extended to non-hospital appointments, such as GP, pharmacy, dental or community diagnostic visits, and should be better accessible via the NHS App.
- Reductions in the cost of NHS car parking. There should be a national reduction in NHS parking fees, with fees waived altogether for unpaid carers, those on low-incomes, and people visiting hospitals regularly for treatment of a long-term condition for themselves or someone close to them. The Government and ICBs should also ensure NHS trusts are following existing car parking and Blue Badge guidance.
- Better support for people who travel further for quicker NHS care. When people exercise their patient choice to travel out of area for quicker treatment, their travel and hotel costs should be covered through national funding to ICBs.
- More care coordinators to proactively discuss patient travel needs. The Government’s 10-Year Workforce Plan should invest in trained admin staff to help with patient transport and other non-clinical support.
- Better implementation of hospital discharge guidance. Everyone discharged from hospital should have a conversation with staff about their travel arrangements to get home and nobody should be discharged at night unless transport support can be arranged. To support implementation, a minimum standard for transport waiting times following discharge should also be introduced.
