of Corporate Affairs Meeting: 24 July, 2003 NORTH LINCOLNSHIRE COUNCIL CABINET

Transcription

1 Report of the Director Agenda Item No: of Corporate Affairs Meeting: 24 July, 2003 NORTH LINCOLNSHIRE COUNCIL CABINET REVIEW OF THE EFFECT OF HUMBER BRIDGE TOLL CHARGES ON PATIENTS AND THEIR VISITORS ATTENDING HOSPITALS ON THE NORTH BANK OF THE RIVER HUMBER 1. OBJECT AND BRIEF SUMMARY OF SUBJECT 1.1 Cabinet is asked to consider the recommendations of the review undertaken by the former Health and Social Affairs Scrutiny Panel into the effect of Humber Bridge toll charges on patients and their visitors attending hospitals on the North Bank of the River Humber. 2. ISSUES FOR CONSIDERATION 2.1 The former Health and Social Affairs Scrutiny Panel in October, 2002 began a review into the Humber Bridge Board s policy of charging patients and their visitors attending hospitals on the North Bank of the River Humber. The panel had a brief to - Examine the charging policy of the Humber Bridge Board for people using the bridge to attend health care appointments and their visitors. Review, along with partner organisations, the feasibility of establishing subsidised or concessionary transport scheme for people attending for health care to the North Bank of the Humber, or their visitors. Obtain views, where practicable, of those affected by the charging policy and seek to establish if improvements or other initiatives could be considered. Evaluate the impact of bridge tolls on the health and welfare of North Lincolnshire as a whole. 2.2 Details of the scope of the review, how it was carried out, the panel s findings and considerations, its conclusions and a number of detailed recommendations were contained in the report.

2 2.3 Full Council considered the report on 23 April, 2003 and referred it to Cabinet for consideration. The conclusions and recommendations of the panel are attached. The full report of the panel was circulated to all members prior to Council on 23 April, Cabinet is now asked to consider the conclusions and recommendations of the report. The appropriate cabinet member(s) and officers should then prepare an action plan for implementation of the recommendations to be submitted to a future Cabinet meeting. 3. RESOURCE AND OTHER IMPLICATIONS 3.1 There are no resource or other implications associated with the report. When the recommendations are developed into an action plan there will be some implications in implementing the recommendations. 4. OUTCOMES OF CONSULTATION 4.1 Extensive consultations were carried out by the panel before the report was published. These are set out in the report and appendices. 5. ISSUES FOR ACTION 5.1 To consider the detailed recommendations of the former Health and Social Affairs Scrutiny Panel with a view to preparing an action plan to be submitted to a future Cabinet meeting. Pittwood House Ashby Road SCUNTHORPE North Lincolnshire DN16 1AB MDH/JT 7 July 2003 DIRECTOR OF CORPORATE AFFAIRS Background Papers used in the preparation of this report : Report of the former Health and Social Affairs Scrutiny Panel detailed above. 2

3 page THE PANEL S CONCLUSIONS (i) The main difficulty that councillors had during this review was the lack of an identifiable local body willing to take responsibility for the funding of this issue. Whilst all those taking part in this review recognised that there should be more help for those visiting hospitals; budgetary and legal pressures prevented this. Whilst this problem may prove common during thematic or cross-cutting scrutiny studies, this was further complicated by the number of central government departments, agencies and other bodies with an interest. The panel therefore felt that the government should take responsibility for this issue. Section 3 describes some of these areas of responsibilities. However, there was no identifiable agency with specific responsibility for helping to arrange travel for all patients who need to travel to hospital. A possible solution to this lack of support is included within the panel s recommendations. (ii) Members of the panel believed that the best way to address the issue of patients and visitors having to pay bridge tolls in addition to other travel costs would be for the government to remove the toll for all drivers. Councillors believed that not only would the removal of tolls help those travelling to hospitals; it would also greatly benefit the entire region s economy, environment, level of inward investment and generally greatly assist the local population. (iii) Realistically, and because of the current debt level, members of the panel recognise that the only way that this debt could be removed would be to persuade the government that the detrimental costs to the region outweigh the benefits of continuing to collect the outstanding money. To persuade the government of the merit of removing the debt (and therefore the toll) the panel recognises that reliable, valid and thorough evidence is required. Councillors therefore welcome the forthcoming study by the Humber Forum investigating the economic, cultural, social, health and environmental impact of Humber Bridge tolls on the area. The panel believes that, without prejudging the results of this study, this will provide a useful mechanism to persuade the government of the benefits of debt removal. (iv) Members of the panel see the completion of the Humber Forum study as enabling and informing a wide-ranging lobbying of central government. This lobbying already has the support of local authorities in the area, local Members of Parliament, health partners and many others. The panel sees the role of North Lincolnshire Council s cabinet as helping to co-ordinate these individuals and bodies into a united lobbying movement. (v) There are a number of ongoing pieces of work relevant to this review that the panel would wish to monitor. In addition to this, we would hope that all parties contained within the recommendations (section five) would seek to keep up to date with any developments. These are:

4 page The forthcoming five-year review between central government and the Humber Bridge Board. The five-yearly negotiation is scheduled to occur in the coming months and may have an impact upon several aspects of the debt owed by the Bridge Board; 2. Shona McIsaac MP has arranged a local meeting to discuss how key partners in the area can take forward these issues with government departments. The initial meeting is scheduled later in April and the panel would be happy to contribute and pass on the findings within this report. 3. As stated above, the Humber Forum is about to undertake a wide-ranging research project on the impact of bridge tolls on the region. This research seeks to ascertain what effect the tolls have on the economy of the area and should be completed by the end of As part of this review, members of the panel intend to keep up to date with progress made, before formally revisiting the scrutiny topic in 12 months from the publication of this report. (vi) In addition to the above lobbying arrangements, the panel has identified several other areas where assistance to those travelling for treatment, and their visitors, could be improved. These are included within the panel s recommendations (section 5). (vii) One of the other main areas of concern to members of the panel is the current limited knowledge of the help already available to those travelling for hospital treatment. The panel cannot conclusively say that some people, eligible for the help discussed in section 3, do not receive it because of a lack of knowledge. However, the scrutiny panel believes that it is very likely to be the case, given the lack of public awareness of the existing schemes. The public consultation exercise showed that only around 50 per cent of people travelling over the bridge to hospital were aware that some people could receive help. Whilst many of these people may not be eligible for help, or may not wish to receive it, inevitably some people who could receive assistance either pay their own way to hospital or choose to stay at home. Clearly, the various health partners have a role in further promotion of the help available. The panel also believes that this promotion of existing arrangements should be handled proactively, asking if help in travelling is required rather than reactively, waiting for the patient to ask. (viii) One possible solution to increasing the awareness of the available help, and also to reduce the number of Did Not Attends (DNAs) for appointments, is for the NHS Acute Trusts to employ a dedicated travel co-ordinator. When a patient confirms their attendance at an appointment after referral, they could be asked if they require help with transport to hospital. If so, the travel coordinator could provide information on public transportation, Patient

5 page 23 Transport Services, the Voluntary Car Scheme, etc. and book these services as appropriate. Information could be sent out to the patient (see example from Royal Devon and Exeter NHS Trust in appendix 5), and arrangements could be verified the day before the appointment. The travel coordinator could also pass on details of the HTCS, Low Income Scheme and Community Care Grant for visitors. The panel believes that this approach would greatly assist those most in need and that the extra money required for the successful operation of this scheme would be offset by the reduction in DNAs. (ix) The panel welcomes the training of staff in the Local Links offices by the Primary Care Trust. Councillors feel that the provision of informed Patient Advice and Liaison Services (PALS) staff, through the Local Link offices, can help those in contact with the council to receive useful information about the available options when people have to travel for treatment. If this service operates with the above arrangements, the panel feels that knowledge of schemes such as PTS, the HTCS and low income schemes will improve. Despite this, councillors are concerned that the high turnover level of staff in the Local Links service inevitably means that some staff may not be trained to a high enough level to provide comprehensive information on the health service. Another scrutiny review currently being undertaken by the Education and Corporate Issues Scrutiny Panel has heard that from March 2002 to November 2002, 60 per cent of Local Links staff left their posts. The panel would wish to see ongoing and frequent PALS training to ensure all Local Links staff receive a comprehensive knowledge of the operation of the local healthcare system and the available help for patients and their visitors. We have passed on our concerns regarding this issue onto the members of the Education and Corporate Issues Scrutiny Panel. (x) The panel is aware that many aspects of centralisation of specialism are to be welcomed. As stated previously, this helps to enable increased provision of specialist equipment, develops greater knowledge and experience of staff and also provides centres of excellence, aiding teaching and clinical innovation. Despite this, the Department of Health document "Keeping the NHS Local A New Direction of Travel" states that "there is evidence that centralising services into larger hospitals does not necessarily deliver the expected benefits. The link between volume and outcome for surgical procedures is often overestimated; the financial benefits often expected from such mergers do not always materialise; and access to services may be reduced, particularly for older and poorer people". The same document asserts that there is likely to be an increasing ability in hospitals to use Information and Communications Technology (ICT) to avoid unnecessary travelling. "In the short to medium term, the relevance for configurations is that

6 page 24 doctors based in a large unit could assess patients remotely in a smaller hospital, using the Electronic Health Record and assisted by nurses and other nonmedical staff based in the local hospital." (xi) The panel recognises that North Lincolnshire PCTs role as a commissioner of healthcare is to seek the best services for the people of the county. Councillors realise that there is an inherent problem in balancing the provision of the best treatments with ensuring that these services are accessible to all. They therefore believe that the PCTs primary concern should remain the commissioning of the best health treatments available for North Lincolnshire residents.

7 page THE PANEL S RECOMMENDATIONS 1. Recommendations to North Lincolnshire Council s cabinet (a) That North Lincolnshire Council cooperate and take part in the forthcoming study by the Humber Forum into the economic, cultural, social, health and environmental impact of Humber Bridge tolls and pass on the concerns of the panel and the council as a whole. (b) Without prejudging the results of the Humber Forum study, use the report to lobby central government to remove the bridge toll. We would encourage North Lincolnshire Council as a whole to take a lead on this issue and act proactively to gain maximum support to increase the potential for successful lobbying. We would envisage that the lobbying group would include all local authorities and healthcare providers in the region, Yorkshire Forward, The Humber Forum, the Local Strategic Partnership, the Humber Bridge Board, the private and voluntary sectors, Scunthorpe Telegraph and other local media, the Health Partnership Board, local MPs and Euro-MPs and others. (c) Throughout the council, but particularly in Local Link Services, to actively promote the Hospital Travel Cost Scheme, the NHS Low- Income scheme and the Community Care Grant for those visiting hospitals. Also to provide information about the Patients Travel Service for those with a medical need requiring transport to hospital. Other areas for promoting the existing schemes could be features in Direct, help on the council website, promotion of discounted books of bridge tickets, posters in libraries etc. (d) That the cabinet recognises that high staff turnover levels and unfilled positions in the Local Links offices have a detrimental effect on the training of staff, including training related to the PALS service and the schemes discussed above. The cabinet should take appropriate action in line with any forthcoming recommendations from the Education and Corporate Issues Scrutiny Panel s review into the effectiveness of customer care within the Local Links service. (e) That the Highways and Transportation Division put together bids in the next funding round through the Rural Bus Challenge Scheme, Countryside Agency schemes and others, to help provide concessionary transport for patients and their visitors to hospitals. (f) That the Highways and Transportation Division continue to look at ways to promote the existing concessionary public transport scheme. This includes extensive publicity in the local and regional media surrounding the equalisation of eligibility for men and women at age 60 in April Recommendations to North Lincolnshire Primary Care Trust (g) To take part in the co-ordinated lobbying of central government to remove the tolls on the Humber Bridge as detailed in recommendation (b).

8 page 26 (h) To encourage GPs, nurses and other primary care health practitioners in regular contact with the public to pass on information about the Hospital Travel Costs Scheme, Patient Transport Services, NHS Low-Income scheme and Community Care Grants. (i) To ensure that the PALS training provided to staff in North Lincolnshire Council s Local Links offices is regular and frequent to combat the high turnover levels in these posts. Also, to ensure that this training covers the existing help available to patients and their visitors when travelling to hospital. Topics for inclusion should therefore include the Hospital Travel Costs Scheme, the Low Income Relief scheme, Community Care Grants, Patient Transport Service and the Voluntary Car Scheme. Any training should also include future changes to the existing schemes as described in recommendations (n) and (w), below. 3. Recommendations to Hull and East Yorkshire and Northern Lincolnshire and Goole Hospitals NHS Trusts (j) To take part in the co-ordinated lobbying of central government to remove the tolls on the Humber Bridge as detailed in recommendation (b). (k) To encourage those healthcare professionals in regular contact with the public to actively promote the existing travelling cost schemes previously mentioned. (l) To look at the possibility of automatically sending out NHS leaflet HC11 outlining entitlement to help with travel costs with all hospital referral letters. Letters also to include brief details of existing schemes. Ideally those who may be able to claim low income entitlement should receive the information early enough to be able to apply to the Health Benefits Department for an assessment in advance. Patients should be advised to use claim form HC1, or a copy of this could be included with the letter. (m) To consider implementing a post of travel co-ordinator. Such a leading position would address many of the issues contained within this report and could be operated in a similar manner to that described in (viii) in section four of this document (page 22-23) (n) To monitor the proposed extensions to the Hospital Travel Cost Scheme contained within the Social Exclusion Unit document "Making the Connections: Final Report on Transport and Social Exclusion" (pages ) and when further guidance is published undertake a wide-ranging publicity programme to promote these changes. (o) To continue to examine methods of utilising Information and Communications Technology and telemedicine techniques to minimise the need for patient travel, especially for assessment. 4. Recommendations to the Humber Bridge Board (p) To take part in the co-ordinated lobbying of central government to remove the tolls on the Humber Bridge as detailed in recommendation (b).

9 page 27 (q) To ensure that within lobbying arrangements the final objective remains the integration of the bridge into the road network, operating with a ringfenced government fund to enable dedicated staff for maintenance and other work. (r) To change the existing concessionary scheme to allow all those with a Blue Badge to cross the bridge for free upon production of the Badge. (s) To actively promote the Hospital Travel Costs Scheme. Possible examples could be posters, printing information on bridge ticket books, information on the Humber Bridge website, posters in buses using the bridge, etc. (t) To allow free crossing to vehicles operated by the Voluntary Car Scheme. 5. Recommendations to the Strategic Health Authority (NEYNLSHA) Social Services and Healthcare" (Audit Commission, 2001) and "Improving Non-Emergency Patient Transport Services" (Audit Commission, 2001). This should also involve consultation with all health agencies in the area, the voluntary and community sector, and local, regional and central government. 6. Recommendations to Lincolnshire Ambulance Service NHS Trust (w) To monitor the proposed extensions to the Patient Transport Service contained within the Social Exclusion Unit document "Making the Connections: Final Report on Transport and Social Exclusion" (pages ) and when further guidance is published take the appropriate steps in co-operation with the commissioning body. This should also include a wide-ranging publicity programme promoting any future improvements. (u) To take part in the co-ordinated lobbying of central government to remove the tolls on the Humber Bridge as detailed in recommendation (b). (v) As services are increasingly concentrated in regional centres of specialism, conduct a wide-ranging review of funding levels and mechanisms for travelling costs and also accessibility to health services throughout the region. This review should include the documents discussed within this report and also "Keeping the NHS Local: A New Direction of Travel" (DoH, 2003), "Going Places: Taking People to and from Education,