If you had to make a list of health services, would you include transport? While it might sound like an odd question, public health advocates familiar with the social determinants know the importance of transport for people to access services, employment opportunities, and social activities to live active, connected and healthy lives. Solange Frost, Senior Policy Officer, NCOSS, outlines the importance of transport services for people using health services and some of the challenges for the health and welfare sectors when pushing for changes in this area. She writes:
A lack of affordable or accessible transport is one of the biggest barriers for people accessing health services. NSW Medicare Local population health needs assessments shows transport to health services is a major community concern in almost every region across the state. When people miss out on timely care it can lead to poorer health and greater cost to the health system.
But should health departments fund transport services? Obviously health departments cannot reasonably be expected to provide mainstream transport just because it supports health – otherwise they would have to fund everything from public housing to education. Yet they do have a role in facilitating people’s access to health services.
The ambulance service is the most visible representation of the health system’s role in transport. Australians accept – and expect – quick transport to hospital in an emergency. What is less well known is the role of non-emergency health transport in facilitating people’s access to health care, particular for disadvantaged Australians.
In NSW, the non-emergency health transport system is struggling to meet demand and significantly under-resourced. Community-based health transport providers are unable to meet around 90,000 requests for health transport each year – a figure that’s likely to keep growing due to demographic and health service provision changes. While around one-third of community transport trips are for health purpose, providers only receive around one-tenth of their funding from the NSW Ministry of Health.
But the problem is also one of coordination. There is a complex mix of funders, providers and programs that lacks a consistent overarching framework or state-wide approach. The 2012 Reform Plan for NSW Ambulance found services are duplicated and resources are not used efficiently.
Last year NSW Health started streamlining the system for government-provided patient transport services in response to the review findings. Yet community transport, which provides almost three times as many non-emergency health trips as the NSW Ambulance service, was left out of the equation.
The Health Minister, Jillian Skinner, recently indicated the government will consider how community transport could be linked in to a centralised patient transport booking system. However, she did not commit to additional funding that is desperately needed to meet unmet and growing demand.
The NSW Government needs to improve funding and coordination of the whole non-emergency health transport system, not just a one part of it. Because irrespective of whether transport is considered a health service or not, making sure people can get to and from health services is essential to a fairer, more efficient and effective health system.
The Council of Social Service of NSW (NCOSS) ran a campaign with the community sector for a more coordinated and better resourced non-emergency health transport system in NSW early this year. See http://www.fairbruary.net/