Non-Emergency Health Transport

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1 Ovr 14 i n v r y p o p l in N SW l iv NCOSS Background Papr Non-Emrgncy Halth Transport b l o w t h p o v r ty li n... Council of Social Srvic of NSW Fbruary 2014

2 What is transport disadvantag? Transport disadvantag is xprincd by popl affctd by spcific circumstancs that lav thm with limitd or no accss to privat transport, and mak it difficult or impossibl to accss convntional public transport. Popl most likly to xprinc transport disadvantag includ popl with mobility limitations, popl on low incoms, popl in rural and rgional aras, and Aboriginal popl. Non-mrgncy halth transport plays a critical rol in hlping disadvantagd popl accss halth srvics. Whil not as visibl or wll-known as th Ambulanc Srvic, for many disadvantagd popl in NSW it is thir liflin to halthcar. It hlps popl gt th right car, at th right plac, at th right tim - kping thm halthy and out of hospital. Th Council of Social Srvic of NSW (NCOSS) has prpard this background papr to provid an ovrviw of th non-mrgncy halth transport systm in NSW. It dscribs th diffrnt srvics and why thy ar important. It thn outlins why th currnt systm is not working, and suggsts how it can b improvd. This papr supports th NCOSS position statmnt on non-mrgncy halth transport, and is part of th NCOSS FAIRbruary halth transport campaign for a bttr fundd, mor coordinatd halth transport systm in NSW. About non-mrgncy halth transport Non-mrgncy halth transport hlps popl with non-acut conditions who hav difficulty travlling to or from halth facilitis. Th Ambulanc Srvic transports popl in mrgncis, but for most popl thir visits to halth srvics ar lss urgnt. In providing accss to this lss urgnt but no lss important car, non-mrgncy halth transport plays a crucial rol, hlping popl xprincing transport disadvantag. Th NSW non-mrgncy halth transport systm is complx: Diffrnt govrnmnt and non-govrnmnt providrs dlivr a rang of programs, fundd by a numbr of govrnmnt agncis. Th main typs of non-mrgncy halth transport ar: w Community transport: Not-for-profit community transport organisations oprat passngr transport srvics, including cars, vans, and mini-buss. Thy provid srvics to frail oldr popl, popl with a disability and thir carrs, and popl xprincing transport disadvantag to assist thm participat in th community. 1 Th NSW Ministry of Halth provids a small proportion of thir funding for Non- Emrgncy Halth Rlatd Transport. 2 w NSW Local Halth Districts (LHD) and Spcialty Halth Ntworks (SHN) transport: At th local lvl, NSW Halth funds and dirctly provids non-urgnt transport to varying dgrs. Srvics vary across districts, and may includ Halth Transport Units, own-flt vhicls, funding to non-govrnmnt providrs, and/or taxi vouchrs for patints.

3 w NSW Ambulanc Srvic Non-Emrgncy Patint Transport Srvic (Grn Flt): In addition to th mrgncy rd flt, NSW Ambulanc Srvic oprats a non-mrgncy grn flt srvic providing intrhospital, appointmnt and discharg transport to popl who would not othrwis b abl to accss halthcar. In , NSW Ambulanc providd 227,000 non-mrgncy patint road trips. 3 w Privat and othr not for profit providrs: A numbr of othr providrs, including taxi srvics, hlicoptr and fixd wing mdical rtrival srvics, such as CarFlight, and othr non-govrnmnt organisations, such as th Cancr Council NSW and Aboriginal community-controlld organisations, also provid transport to popl rquiring accss to halth srvics. w Travl subsidis: In addition to passngr transport srvics, NSW Halth funds support programs for popl who can organis thir own transport but who hav to travl long distancs or undrtak rpat journys to accss halth srvics. Ths includ th Isolatd Patints Travl and Accommodation Assistanc Schm (IPTAAS) and Statwid Infant Scrning-Haring (SWISH) Travl Assistanc Program. Main providrs of non-mrgncy halth transport Th importanc of halth transport Trips pr yar Community transport 680,000 Ambulanc Srvic 227,000 Local Halth Districts 190,000 Halth transport hlps popl gt th right car, at th right tim, at th right plac: Th bst halth srvics and most advancd clinical car cannot b ffctiv if popl ar unabl to gt to thm. By improving accss to halth srvics, halth transport hlps kp popl halthy and out of hospital - a ky goal of th NSW Govrnmnt. 4 Transport can b a major barrir to accssing halth srvics. Factors such as cost, distanc, lack of public transport, or mobility issus caus many mmbrs of our community to miss out on appropriat halthcar. Thos popl most likly to hav difficulty travlling to halth srvics ar thos alrady xprincing disadvantag, such as popl on low incoms, popl in rural aras, and Aboriginal popl. Halth transport is ssntial in nsuring vryon has fair accss to halth srvics. Halth transport is a critical nablr of an fficint and ffctiv halth systm. According to th World Halth Organisation, transport costs can prsuad popl to dlay tratmnt and b a significant impdimnt to housholds rciving timly car. 5 Whn popl can t attnd doctor s appointmnts, diagnostic srvics, or mdical tratmnt thr is a gratr risk of halth conditions going undtctd or dtriorating. This can lad to incrasd hospitalisations, poorr halth outcoms, and gratr costs to th halth systm. Did you know Around on-third (680,000) of th two million community transport trips providd ach yar ar for halthrlatd purposs. Community transport only rcivs approximatly on-tnth of its funding from th NSW Ministry of Halth, yt on-third of its trips ar halth rlatd. Around 90,000 rqusts for halth-rlatd community transport ar unabl to b mt ach yar. Sourc: Cancr Council NSW, Council of Social Srvic of NSW (NCOSS), Community Transport Organisation (CTO) (2007) No Transport No Tratmnt, Sydny Sourc: NSW Govrnmnt, NSW Budgt Paprs, Budgt Papr 3 - Budgt Estimats, Sydny

4 Problms with th currnt systm Dspit th importanc of non-mrgncy halth transport, th currnt systm is undr-fundd and poorly coordinatd. Numrous rports ovr th last dcad hav consistntly idntifid issus that nd to b urgntly addrssd, including growing unmt dmand, srvic gaps, and a lack of coordination. Growing unmt dmand Dmand for transport to halth srvics is alrady high and will continu to grow du to dmographic prssurs and halth srvic changs. Th aging population and an incras in chronic halth conditions ar major drivrs of currnt and futur dmand. Changs in th way halth srvics ar providd, such as gratr cntralisation of spcialist srvics, us of day surgry, and arly discharg practics hav also ld to gratr nd for halth transport. NSW Mdicar Locals population nds assssmnts on halth transport Accss to halth-rlatd transport is hugly problmatic Far Wst NSW Mdicar Local, Nds Assssmnt Rport Tmplat 2013, p13 Transport is a major barrir to accssing halth srvics, particularly for vulnrabl, frail agd, disabld popl and thir carrs and socially disadvantagd popl Many popl ar missing out on ssntial halth car du largly in part to insufficint or inappropriat transport options. North Coast NSW Mdicar Local, Whol of Rgion Nds Assssmnt Vrsion 1.0 for consultation, 2013, p5 Th xcllnt local community transport srvic is unabl to cop with th dmand and th long trips rquird. Intrim Joint Halth Consumr Committ of th Npan-Blu Mountains Mdicar Local and th Npan Blu Mountains Local Halth District, Community Rport on th Blu Mountains Community Forums on Halth, 2012, p19 Transport rmains on of th NEML community s most constant worris and is oftn and frquntly raisd in any consultation with th community. Affordabl transport options ar limitd and not only impact on thos attnding halth appointmnts but impact on social bnfits associatd with indpndnc and rcration for th young, ldrly, disadvantagd and disabld. Employmnt and ducation opportunitis ar also affctd. Nw England Mdicar Local 2013 Nds Assssmnt Rport, p25

5 Currnt dmand for halth transport wll xcds supply. Workshops with community transport providrs in 2012 found halth transport srvics ar svrly undr-rsourcd. 6 Th 2007 No Transport, No Tratmnt rport stimatd community transport providrs rfusd 90,000 rqusts for halth-rlatd transport du to inability to mt dmand, in addition to th 680,000 halth trips thy provid ach yar. 7 Dmand is likly to hav incrasd sinc Howvr mor rcnt figurs ar not publicly availabl du to a lack of systmic data collction and rporting. NSW Mdicar Locals rcnt community halth nds assssmnts confirm th high unmt dmand for halth transport (s boxd txt). Th assssmnts, compild from community consultations, halth srvic profils, and quantitativ data, show transport to halth srvics is a major issu in almost all rgions across NSW. Common issus raisd includ a lack of community transport, poor transport srvic coordination, high travl costs, and low community awarnss of availabl srvics. Lack of a systmic, coordinatd approach Thr is no ovrarching, consistnt systm for non-mrgncy halth transport that brings togthr th diffrnt providrs, programs and srvics in a coordinatd, stat-wid approach. As a rsult, srvics ar duplicatd and rsourcs ar not usd fficintly. Th NSW Halth 2006 Transport for Halth Policy attmptd to stablish a framwork for an intgratd non-mrgncy halth transport systm, but this Policy was nvr fully implmntd. Th proposd stablishmnt of Halth Transport Units and Halth Transport Ntworks in ach Ara Halth Srvic was intrruptd by th dvolution to Local Halth Districts. Many Districts do not hav Halth Transport Units, and whr thy do xist, thir ffctivnss varis. Th 2012 Rform Plan for NSW Ambulanc highlights th problms causd by th lack of coordination, noting Local Halth District halth transport units hav diffrnt procdurs, practics and rporting rquirmnts and a lack of coordination across district boundaris rsulting in inquality of accss, patints having to wait too long for drop off or pick up from appointmnts and th infficint us of rsourcs. Th 2012 NSW Ambulanc Rform Plan also highlights othr infficincis with NSW Halth-providd non-mrgncy patint transport srvics, including: Non-mrgncy vhicls bing dispatchd by Local Halth Districts with singl passngrs whn othrs ar waiting for transportation to th sam dstination; Vhicls rturning mpty whn thr ar popl waiting for transport that could hav bn pickd up on th way; and Continuing instancs of mrgncy ambulancs bing usd to transport non-mrgncy patints. Whil som individual Local Halth Districts, Mdicar Locals and community transport organisations hav initiatd projcts to improv srvic coordination locally, th stat-wid natur of th problm rquirs a mor comprhnsiv, systmic rspons. Cost-bnfit of non-mrgncy halth transport UK Charity, Transport for sick Childrn stimats savings of 4.3 on vry pound spnt by providing transport to disadvantagd familis who would othrwis b unabl to attnd appointmnts. Transport for Sick Childrn (2009) Th Cost of Did Not Attnd to th Gratr Manchstr NHS. Rtrivd Sptmbr 5, 2013 bit.ly/1dzjup7 Florida Transport Disadvantagd Srvics found $11.08 was savd for vry $1 invstd in mdical trips du to avoidd hospital stays. Th Markting Institut, Florida Stat Univrsity Collg of Businss (2008) Florida Transportation Disadvantagd Srvics: Rturn on Invstmnt Study. Rtrivd Sptmbr 5, 2014 fla.st/1faa816

6 Ptr s * Story Ptr is an ldrly man who livs in Blacktown and who uss a whlchair. Until rcntly, Ptr travlld to Blacktown Mount Druitt Hospital thr tims vry wk for dialysis. Although Blacktown Hospital has a fr bus for dialysis patints as wll as patint transport, its transport srvics ar not accssibl to popl with mobility problms. Ptr thrfor travlld with th local community transport srvic, who ar abl to accommodat popl in whlchairs. Following a cancr diagnosis, Ptr s dialysis was transfrrd to Wstmad Hospital, maning h must now travl much furthr ach wk in ordr to continu tratmnt. Th local community transport srvic is no longr abl to mt Ptr s transport nds, as thy do not hav th rsourcs rquird to provid an ongoing transport srvic from Blacktown to Wstmad thr days a wk. Aftr making numrous phon calls in his sarch for an altrnativ transport solution, Ptr found his only option was Wstmad Hospital s patint transport srvic. To us this srvic Ptr must lav hom at 7AM in th morning, and h is oftn not rturnd hom until 10PM. Th srvic cannot accommodat Ptr s whlchair, and h is thrfor transportd on a strtchr and transfrrd to a hospital whlchair on arrival. Community transport could hav assistd with som of th rturn trips, but bcaus Ptr was unabl to tak his own whlchair h ndd strtchr transport to gt back hom again. At what is alrady a challnging and strssful tim in his lif, th lack of appropriat halth transport has addd to Ptr s difficultis. * Not his ral nam Furthr rform is ndd Th NSW Govrnmnt has improvd som parts of th halth transport halth systm, but it has still to addrss th largst providr of nonmrgncy halth transport trips: community transport. Rcnt halth transport improvmnts includ: Incrasd patint travl subsidis and improvd ligibility and administration of IPTAAS in NSW Ambulanc Srvic Rform Plan that stablishd non-mrgncy patint transport as a sparat srvic from urgnt ambulanc srvics in Cntral booking systm for govrnmnt-providd Non-Emrgncy Patint Transport commncd in Whil improvmnts to ths srvics and programs ar wlcom, thy ar only part of th pictur. Community transport s rol in supporting vulnrabl and disadvantagd popl must b rcognisd within th non-mrgncy

7 halth transport systm. A comprhnsiv and systmic approach is ndd to improv th funding and coordination of non-mrgncy halth transport srvics across NSW. How non-mrgncy halth transport can b improvd It s tim for th NSW Govrnmnt to complt th halth transport pictur: transport must not b a barrir prvnting popl xprincing disadvantag from accssing halth srvics. Community transport providrs hav dmonstratd that thy ar wll placd to rspond to nd and improv accss to halth car through local, flxibl transport srvics. But for th systm to b truly ffctiv, furthr rforms ar rquird. NCOSS calls on th NSW Govrnmnt to: 1) Provid an immdiat incras in funding to community transport providrs to mt th growing nd for non-mrgncy halth transport srvics. 2) Rquir th NSW Ministry of Halth to rviw th dlivry of nonmrgncy halth transport in NSW, including community transport providrs. 3) Implmnt a rform plan for non-mrgncy halth transport that dlivrs a coordinatd systm at th Local Halth District lvl and a consistnt approach for rsponding to popl in nd of transport assistanc. Making sur popl can gt to and from halth srvics is ssntial to a fairr, mor fficint and ffctiv halth systm. Now is th tim for th NSW Govrnmnt to work in partnrship with th community sctor and othr stakholdrs to dlivr a mor coordinatd and bttr rsourcd non-mrgncy halth transport systm for NSW. Furthr rading and rfrncs Cancr Council NSW, Council of Social Srvic of NSW (NCOSS), Community Transport Organisation (CTO) (2007) No Transport No Tratmnt, Sydny. ncoss.org.au/rsourcs/ no-transport-no-tratmnt.pdf Council of Social Srvic of NSW (NCOSS) (2014), Position statmnt on non-mrgncy halth transport, Sydny. fairbruary.nt/rsourcs/ halth-transportposition-statmnt.pdf Council of Social Srvic of NSW (2012), Providd thr s transport: Transport as a barrir to accssing halth car in NSW, Sydny. ncoss.org.au/rsourcs/121206halth-transport-rport.pdf NSW Halth (2012), Rform Plan for NSW Ambulanc, Sydny. NSW Halth (2006) Transport for Halth Policy Dirctiv [PD2006_068], Sydny. Mor information Extra copis of this background paprand additional information on th Non-Emrgncy Halth Transport Campaign can b accssd at: fairbruary.nt/ complt-th-pictur

8 Endnots 1 Community transport organisations ar primarily fundd to support this targt group undr th, th Community Car Program fundd by NSW Aging, Disability and Hom Car, th Commonwalth Hom and Community Car (HACC) Program and th Community Transport Program fundd by Transport for NSW. NSW Halth funding only covrs around 10% of th halth rlatd transport task undrtakn by community transport providrs. 2 Cancr Council NSW, Council of Social Srvic of NSW (NCOSS), Community Transport Organisation (CTO) (2007) No Transport No Tratmnt, Sydny. 3 NSW Halth (2012) Rform Plan for NSW Ambulanc, p15. FAIRbruary Goal 11, NSW 2021: A Plan to Mak NSW Numbr On, NSW Govrnmnt, (2011), Sydny. 5 World Halth Organisation (2010) Halth systms financing: th path to univrsal covrag, Gnva, p Council of Social Srvic of NSW (2012), Providd thr s transport: Transport as a barrir to accssing halth car in NSW, Sydny 7 Cancr Council NSW, Council of Social Srvic of NSW (NCOSS), Community Transport Organisation (CTO) (2007) No Transport No Tratmnt, Sydny Th Non-Emrgncy Halth Transport Campaign is part of FAIRbruary a month of advocacy for sharing th bnfits and building a fairr NSW: fairbruary.nt #fairbruary2014 Th Council of Social Srvic of NSW (NCOSS) is th pak body for th social and community srvics sctor in NSW. NCOSS works with its mmbrship on bhalf of disadvantagd popl and communitis towards achiving social justic in NSW. 66 Abion St, Surry Hills NSW 2010 phon wb ncoss.org.au mail facbook on.fb.m/ncoss

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