In a stunning display of bureaucratic logic, an 83-year-old cancer survivor who has already survived two heart attacks was forced to drive himself on a four-hour round trip for medical tests after being refused non-emergency transport because - wait for it - he owns a car.
Charles Swift, who lives in Borth, Ceredigion, was referred to Withybush Hospital in Haverfordwest, Pembrokeshire, for heart tests in August. The journey is 70 miles each way. When he inquired about non-emergency transport, a call handler from the Welsh Ambulance Services Trust (WAST) refused him upon learning he owned a vehicle. "I can't understand why pensioners have to run about in their own car," Swift said, presumably while recovering from the exhaustion of doing exactly that.
Swift, who has been treated for three types of cancer and has had two heart attacks, said when he rang hospital taxis, he was asked if he could walk, climb stairs, and owned a car. When he answered yes to all three, he was told: "You'll have to use that then." "I don't understand. What's the difference if you've got a car or not? I'm 83. It's not a good journey to do. It was tiring," he said, mastering the art of understatement.
On another occasion, Swift was told on a Friday afternoon that his hospital transport for an appointment in Haverfordwest the following Monday had been cancelled, leading him to cancel the appointment altogether. When he eventually got hospital transport for a subsequent appointment, he described it as "very pleasant, no problem at all" - a rare glimpse of the system working as intended.
Hywel Dda University Health Board's website states that patients travelling to and from hospital are normally expected to organise their own transport. When that's not possible, some patients may be eligible for non-emergency patient transport provided by the Welsh Ambulance Service, but only if they meet criteria such as receiving regular dialysis or cancer treatment, needing a stretcher or oxygen, or travelling in their own wheelchair. Public transport is not a realistic option: trains from Borth to Haverfordwest take a minimum of three-and-a-half hours in each direction.
Councillors in Ceredigion have called for a better hospital transport system in rural areas. Hugh Hughes, one such councillor, met Swift shortly after his first appointment when the health board wanted him to return for a second. "He was distraught. He didn't know how he was going to manage it. He was absolutely exhausted after the first experience," Hughes said.
After Swift's initial request for transport, the ambulance service reviewed his phone call. According to Mark Harris, WAST's assistant director of operations, the transport would not have been refused if the service had more information. "We've changed our processes now, and we've put some training out to our call taking team, so when Mr Swift rings again, he'll get a different answer," Harris said. He added that demand for transport and the distances travelled to appointments are increasing, placing a strain on resources, which can lead to cancellations. "We are seeing an increase in the volume of journeys we have to cancel where the demand exceeds our available resource," he said. "So we will get occasions where we have more work than we can fit on our vehicles within a day [and] we're in the middle of a significant improvement programme now to address that."
Councillors and voluntary organisations involved in patient transport say that even when a patient gets transport, bookings are frequently cancelled the day before the appointment. Hughes said: "We've got a very good hospital in Bronglais just on our doorstep yet many of the services seem to be migrating further south. We've got to accept there will be occasions where you have to travel. But this seems to be becoming far more prevalent."
Dolen Teifi, a community transport service based in Llandysul, has 42 vehicles and 160 volunteer drivers covering Ceredigion and Carmarthenshire. The charity's manager, Rod Bowen, said drivers make about 50 journeys to hospital appointments each week and have noticed that the ambulance service's capacity "has been stretched". While the non-emergency ambulance service is free, Dolen Teifi charges an average of 57p a mile to partly cover its costs. "The demand for hospital appointments has gone up," Bowen added.
Bowen said the charity had taken 145 calls in the past two months when hospital transport had been cancelled the day before an appointment, and it was able to help in about a third of cases. "We've been able to fill that gap, and it's quite an important gap to fill because basically that means the person can actually get to the hospital for their appointment," he said. "We've seen a huge increase of people having to travel past their main hospital door to a hospital that could be anything up to 40 to 50 miles away." Bowen also noted that longer journeys for appointments were more common and older patients were "not really comfortable" driving to hospitals in unfamiliar areas.
Hughes said the health board and the ambulance service needed to work together as people were "falling through the net and are not getting the transport they need". Andrew Carruthers, chief operating officer at Hywel Dda health board, said the board covered a large rural area and it was "aware of the challenges that some of our patients face especially when they have to travel longer distances to access specialist treatment." He added that it worked closely with WAST and would raise concerns to see how "transport options available for our patients" could be improved.