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A new system for approving requests for NHS-funded escorts is being introduced, to ensure that an equitable system is delivered across the Western Isles.

In certain cases, patients travelling off island require an escort to accompany them. The majority of Health Boards across Scotland only fund patient travel on a means tested basis, with only Boards covered by the Highlands and Islands Travel Scheme (Western Isles, Highland, Orkney and Shetland) providing financial assistance to patients and eligible escorts regardless of income.

The NHS Western Isles Patient Travel Policy sets out the criteria by which funding of escorts is approved – which is strictly based on clinical need.

There is no change to the criteria for approving a funded escort or to the Patient Travel Policy. However the decision with regard to whether or not an NHS funded escort is required, and therefore approved, will be made by the NHS Western Isles Medical Director, Angus McKellar, with advice from GPs, rather than by individual GP Practices.

Dr McKellar explained: “Historically, it has been the responsibility of GP Practices to make the decisions regarding approval of funding for patient escorts, and there has been a significant variation between the GP Practices in the percentage of patients receiving approval for funded escorts. Certain practices also indicated that they no longer wished to provide this service, and would rather that it was carried out centrally.

“It is important that there is fairness across the Western Isles, and so a new process has been developed, and tested, where GPs will provide clinical information to me regarding escort requests, and the decision as to whether or not a funded escort is approved is made via my office.”

The new system has already been piloted in two GP practices – Langabhat (from March 2017) and Broadbay (from May 2017), and initial feedback from both the GP Practices and from the patient travel office has been positive.

During the course of the pilot, the process has been refined and improved. Patients now have the opportunity to provide supplementary information in support of their application for a funded escort, should the funding have been initially declined. If a request is declined, patients clearly still have the option of arranging to take an escort independently. The patient travel office will be able to advise of any local schemes to help reduce costs in these circumstances.

The new process will be rolled out to the three remaining GP Practices in Lewis and Harris  in April. It is intended to implement the new process in the Uists and Barra in July 2018. Patient information materials will be available shortly.

“It is important to stress that, where escorts are clinically required, we will continue to fund them in line with our policy,” said Dr McKellar. “However, we must ensure that the criteria are applied in an equitable way. This will ensure that those patients who require an escort will continue to receive financial assistance, but it will also mean that those who do not meet the criteria will not receive NHS funding for an escort. We understand and acknowledge that in some cases, this will be disappointing. However, there is a limited budget for patient travel, which is under significant pressure, and we must ensure that the money available is spent appropriately.”

NHS Western Isles patient travel has cost in the region of £31million over the last 10 years (2008/9 – 2017/18). Therefore small percentage savings in cases where escorts are not required could result in significant amounts of money being reinvested back into patient care in the Western Isles.

NHS Western Isles is considerably higher in percentage terms than the other Health Boards covered by the Highlands and Islands Travel Scheme in terms of the number of escorts that receive financial assistance, with other Boards funding escorts for around 30 per cent of patients who are required to travel. In 2017, around 44 per cent of patients from the Western Isles who required to travel were accompanied by a funded escort, with some Western Isles GP Practices authorising escorts for 50 per cent of patients who had to travel for care/treatment.

It is also the aspiration of NHS Western Isles to provide as much care and treatment as is safely possible here in the Western Isles. This will ensure that, where possible, funding is spent on patient care, rather than on avoidable travel costs.

Dr McKellar explained: “Travel can be stressful for patients and so, where possible, NHS Western Isles wishes to provide care on island. The quality of healthcare services we provide here is second to none, and we are introducing new innovative ways to prevent unnecessary travel. This includes increasing the visiting services to the islands by mainland specialists, and using remote consulting, such as our new popular ‘Attend Anywhere’ tele-respiratory service, which means that patients can access appointments with a Respiratory Consultant via a webcam on a laptop, tablet or mobile phone. This not only eliminates travel, but reduces waiting times and means that associated costs can be reinvested back into patient care.”