Health board’s ‘moral decision’ to alter patient travel rules slammed

The daughter of an 89-year-old woman has criticised NHS Shetland and called for the health board to reverse a new travel policy that means patients are only able to book return flights a maximum of two days either side of an appointment.

Previously, the patient travel scheme allowed return travel at any point after a hospital appoinment. But health board chief executive Ralph Roberts said that approach had been inconsistent and there were issues about “fairness”.

Patients travelling to Aberdeen will now have to adhere to stricter travel guidelines.

The policy was brought in in September – amid concerns some were exploiting the system to take holidays – but for many it is only just coming to light. The first Joan Paterson knew about it was when she tried to book transport for her elderly mother, Mina Anderson, from Aith.

Mrs Paterson has called for the health board to reverse its “moral and judgmental” decision.

In a letter to NHS Shetland finance chief Colin Marsland, she blasted the health board for the move after trying to book flights for her mother.

Mrs Paterson said her mother needed to attend the eye clinic in Aberdeen on a Monday and she wished to book the return flight on Friday. However, this was outwith the two-day window.

Mrs Paterson, who lives in Aberdeen, wrote: “This was the first I had heard of this change. No consultation or notice appeared to have been allowed for patients. I have spoken to some other patients who travel to Aberdeen for hospital appointments and they did not know of this change either.

“My mother is 89 years old, lives on her own and has to attend the eye clinic every four to six weeks. She stays in Aberdeen with me for a few days each time as this allows me to look after her and give her company that she does not have at home on her own.

“I work and therefore cannot spend long periods of time in Shetland although I do try and travel with her as much as possible to assist her travelling and to assist her at home. You told me that the reason for the change was that some people had complained that a small number of patients attending hospital appointments were also going on holiday and therefore using the hospital appointment flight for the holiday also.

“My response was that this was an extreme change to deal with an issue which was a minor one and which did not cost NHS Shetland any more money.”

Mrs Paterson argued that there was no “abuse of a system” as long as the patient had a letter proving they needed treatment in Aberdeen.

“This is a perception of abuse by those who have not thought through all the issues.” she said. “This decision is a moral and judgmental one and not one based on health needs and this does not seem to have entered your consideration.”

Mr Roberts said he could not comment on individual cases. He said if “an individual felt they had a particular reason why they should be exempt [from the new policy] we would certainly look at that”.

NHS Shetland chief executive Ralph Roberts defended the move.

The chief executive said the shift had come on the back of work on patient and staff travel, which has included reviewing its patient escort policy to tighten its belt.

Mr Roberts said there had perhaps been a lack of clarity and inconsistency when it came to the health board’s view on timescales around journeys and appointments.

The move was about “fairness and perception of fairness”, the NHS chief said.

“It’s clear the Highlands and Islands Travel Scheme is for people travelling to an appointment,” Mr Roberts said. “If you said to somebody ‘would it be appropriate for somebody to go down to an appointment and then go away for two weeks holiday and the get us to pay for the flight after the holiday?’

“I think most people would say ‘no that’s not an appropriate use of public money’… It’s important we put a timescale on it so we treat everybody the same.”

Mr Roberts said the health board felt it was appropriate to provide the clarification, adding “in a sense it’s not a new rule”.

He said that was because staff would have a discussion with patients if they were wanting to be away for a longer period and if it looked “a bit odd”.

He said: “We think 48 hours is reasonable. If somebody has a reason to go down that does give them the opportunity to be down for four days either side of the appointment.”

Mr Roberts did admit, however, that he had not seen “strong evidence” that flouting the scheme to get a cheaper holiday was a big issue. There had been “anecdotal suggestions” about using flights for a longer trip, he said.

And if that led to people being keener for an escort, and people keener to go for an appointment south “you can see how it would be a point of concern”.

Mr Roberts added: “Arguably it doesn’t cost us any additional money.” That is because there is an agreement in place with Loganair and prices do not fluctuate depending on how close to an appointment the travel booking is.


Add Your Comment
  • john ridland

    • November 10th, 2017 18:54

    Same old story, One or two moaning minnies think somebody is getting something there not , And have now ruined it for everybody ,,, Well done…!

  • Malcolm Henry Johnson

    • November 10th, 2017 23:30

    Seriously? Restrictions had to be put in place because the previous system may have made patients “keener to go for an appointment south.” When patients travel to the mainland, they do so on the advice of their doctor because they need to access treatment that the local NHS does not provide. Are the representatives we elected to the local health board not aware of that?

    Health board members need to be educated about the very strong links between physical and emotional wellbeing. If having a few days “holiday” or spending time with family after an operation helps to make a patient feel better and is beneficial to their emotional health then this IS an “entirely appropriate use of public money.” Would members of the local “health” board not agree?

    In Mrs. Anderson’s case, her daughter is providing her with a few days of high quality personal care after each appointment. This is care that the local health and social care services are not having to pay for and as Mr. Roberts admits, is not costing the health board a single extra penny. Why should Mrs. Patterson have to prove that this situation is “exceptional” before being allowed to provide this free care?

    Last time I accompanied an elderly patient to the mainland, we spent some extra time in Aberdeen because the Met Office said we would have to do that to avoid travelling home in the middle of a storm. So we waited … entirely at our own expense … and travelled home on a calm day. How bizarre was that? If we have to do the same again this winter, we will now be in breach of the board’s 48-hour rule. Do none of the board members live in Shetland?

    Once again, members of the local health board are making complete fools of themselves. Patients travel to the mainland because your doctors tell them to. What patients choose to do after their appointment is none of your business.

    • Michael Garriock

      • November 12th, 2017 16:26

      Who are these “we” you speak of when you say, “representatives we elected to the local health board”?

      I have never had an opportunity to elect anyone in to any NHS poistion. As far as I’m aware health board members are cherry picked by Holyrood civil servants from volunteers. The main criteria for selection, or so it would seem, is to ‘get with the current Scots Govt. program’, or at least ‘not rock the boat’, along with token ‘representation’ from some sub-group of service users, which those civil servants perceive as be ‘trendy’ to get with for political/P.R. reasons.

      In other words, just another unaccountable, unrepresentative ‘club’ to enact, under a totally fake veneer of ‘public representation’, the Government’s bidding. and provide a punchbag for criticism when things go wrong or unpopular/unacceptable measures are introduced.

      Hence, we have what we have, a wasteful, disjointed, dysfunctional hotch potch, over which we have no effective influence or control, which can and does do what it likes without have to explain or account to us, the service funders and users.

  • David Thomson

    • November 11th, 2017 8:04

    It is time NHS Shetland published this policy, I have tried searching for it on their website to no avail. Or is it really made up on the hoof each time they want to change something?

  • Charles Tait

    • November 11th, 2017 16:12

    All NHS Shetland high heid yins should be banned from flying (except if they pay personally) and be forced to take the ferry without a cabin. Similarly bodies such as HIE and SIC should have their internet connections throttled to the slowest in Shetland until everyone gets a proper service.

  • Colin Hunter

    • November 11th, 2017 22:30

    Well! If it doen’t actually cost you any more, where’s the problem? Surely it is better for someone who has had a follow up appointment, (or whatever) to continue on another journey after that, rather than having to come home and go away again! Whatever happened to wanting to avert global warming?
    This just smacks of awkwardness and spite!

  • Deboshree Ghosh

    • November 11th, 2017 23:42

    Thanks to Joan Paterson for bringing out this issue. Travelling for health care and appointments is not equivalent to going for holidays. Patients and even normal people (who are not patients) need some days after the appointment to travel back because travelling is exhausting. I completely believe that government institutions have the best interest in taking actions but sometimes actions are not required. Policymaking on the basis of very low evidence is simply bad governance.

  • Thelma Pointer

    • November 12th, 2017 16:29

    Combining a hospital appointment in Aberdeen with a holiday or any other activity is a no-brainer as far as saving the planet is concerned and really should be encouraged.
    There is also the fact of Shetland people having twice the travel expense and time getting to the Mediterranean sun, for example, as those of us living on the UK mainland.

  • Johan Adamson

    • November 13th, 2017 9:17

    Are staff also banned from taking more than 2 days to come home after they have been away for training, conferences or meetings? If so, is that true for all NHS staff? Orkney patients and staff? What about the wider public sector?

  • Stella Winks

    • November 17th, 2017 7:21

    What a load of codswallop! Folk whom need escorts get escorts. It is of no relevance if a return flight is 2 days or 2 weeks after a patient has had their appointment, the journey, for medical reasons was made. It costs the Health Board no more if a return is immediate or otherwise.
    Isn’t it an infringement of liberties to dictate when a patient has to embark on their return journey? Reads as if ‘The State’ aka the ‘Health Board’ in this instance holds folk to ransom with respect to travel they are entitled to. That makes me spectacularly uncomfortable and alarmed as we live in a democracy and not under a dictatorship…..Given our civil liberties, I can’t see that this directive is legal……


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