Consultation on the Hospital 
Travel Costs Scheme 


Consultation on the Hospital 
Travel Costs Scheme 


DH INFORMATION READER BOX 
Policy 
HR/Workforce 
Management 
Planning 
Clinical 
Estates 
Performance 
IM & T 
Finance 
Partnership Working 
Document Purpose Consultation/discussion 
ROCR Ref: Gateway Ref: 7026 
Title Hospital Travel Costs Scheme 
Author DH/Experience and Involvement/Information 
for Choice 
Publication Date 19 Jan 2007 
Target Audience Directors of PH, Directors of Finance, 
Communications Leads, Patient and Public 
Involvement leads, Equality and Diversity 
leads and SHA and PCT leads in Health 
Inequalities 
Circulation List Voluntary Organisations/NDPBs 
Description This is a consultation looking at how patients 
can be reimbursed for their travel expenses as 
more care is delivered closer to home. It will 
also look at raising awareness of the scheme 
in staff and patients. 
Cross Ref N/A 
Superseded Docs N/A 
Action Required N/A 
Timing Responses by 13 April 2007 
Contact Details Julie Chapman 
Department of Health, Information for Choice 
Room 5E62 Quarry House 
Leeds 
LS2 7UE 
For Recipient’s Use 


Contents


Foreword 2 
1 Introduction 3 
2 Why are changes to the Scheme necessary? 5 
3 The current Scheme 6 
4 Why are we seeking your views? 8 
5 Payments to patients 11 
6 Awareness of the Scheme 14 
7 Issues that we will not look at 17 
8 Making your contribution 19 
A Annex A: Glossary 20 
B Annex B: Background to the consultation 22 
C Annex C: Consultation process and Scheme amendments 25 
D Annex D: Some options for payments to patients 26 
E Annex E: Consultation criteria 28 


Foreword by the Minister of
State for Delivery and Reform


The government’s recent White Paper, ‘Our health, our care, our say’, set a new strategic 
direction to move NHS care closer to home. Because of this shift, more services will be 
available locally and provided by a wider range of health care professionals. However, even 
with services closer to home, people will still have to travel to receive some of their NHS 
care. 

NHS care will always be provided free at the point of delivery. Many of us take for granted 
our ability to travel. Improving access to health care is a key priority, and there are a 
number of ways by which this is being achieved. The White Paper is one example, with 
proposals to increase the range and scope of community services, so care is delivered closer 
to home. 

For some people, the cost of travelling to NHS care could be a significant proportion of 
their income if help wasn’t available. Without that support, people may forego care because 
of financial concerns. This should never be the case. People’s health should not suffer 
because of their financial circumstances. It is right that those who have low incomes should 
be able to receive the same NHS care as other better off patients living in the same area. 
Taking further action to improve health outcomes for those most in need is one of the ways 
the Department of Health and NHS are tackling health inequalities. 

This consultation is about looking at ways the Hospital Travel Costs Scheme should remain 
accessible as more services are delivered closer to home. It will find out how much those 
patients who are eligible to use the Hospital Travel Costs Scheme know about it and what 
can be done to keep it simple for them to use. We are keen to hear your ideas on how to 
make the system work for both patients and the NHS, so we can ensure people get the care 
that they need. We would be grateful for your views to help us achieve this. 


Andy Burnham 

Minister of State for Delivery and Reform 


1. Introduction
1.1 
This document, aimed at public and staff, sets out how and why the Department of 
Health will consult on operational issues relating to the reform of the Hospital Travel 
Costs Scheme (the Scheme). Changes are needed in order to support the wider health 
reforms outlined in the Government’s White Paper ‘Our health, our care, our say’, 
which will lead to more services being delivered in local communities rather than in 
general hospitals. Delivery of services nearer to communities also helps to address the 
problem of health inequalities in disadvantaged groups and areas by improving service 
use and providing better access. 
1.2 
The Scheme operates within a national framework, and it is important to identify 
common operational issues and solutions as changes to delivery of care develop. In 
line with the direction set by the White Paper, we need to ensure that the Scheme 
better fits in with the way people lead their lives, taking into account the views of 
those that use services, as well as organisations that operate the Scheme. 
1.3 
This consultation will look at operational issues only, specifically how the Scheme 
could operate and ways to reimburse people for their travel expenses. It will not 
address issues of eligibility based upon financial need – this will stay the same (see 
The Current Scheme) and the fundamental purpose of the Scheme remains – to 
target financial help to those who need it most. 
• 
We begin with an overview of the consultation’s principles and the Hospital 
Travel Costs Scheme. 
• 
Next, we provide information on the current Scheme, and specific issues that the 
consultation would like you to focus on 
• 
Finally, we provide details about how you can send us your views. 
1.4 
At the end of the document are a number of Annexes. These provide additional 
information that may help you understand more about the Scheme. 
1.5 
Your views about the proposals in this consultation document are important and so it 
would be helpful if you would complete the patient survey as well as sending us your 
comments. You may wish to complete it online, send it to us by post, or pass to a 
local NHS organisation who will send it on to us. We also have a survey for NHS 
staff, which can be accessed via the NHS network. (We will use the responses to both 
surveys to help us understand the communication needs of specific groups and which 

Consultation on the Hospital Travel Costs Scheme 

approaches to raising awareness work well). The NHS can then use this feedback 
to target information about the Scheme to those groups. Both will be available in 
February online at the Department’s website (www.dh.gov.uk) under Policy and 
Guidance > Policy A-Z > H > Hospital Travel Costs Scheme 
(http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/ 
HospitalTravelCostsScheme/fs/en) 

1.6 Annex E provides detail about the government criteria for consultations. 

2 Why are changes to the 
Scheme necessary? 

2.1 
The NHS now delivers more care in community settings than ever before, 
including services traditionally provided in hospital. This includes services such 
as physiotherapy and talking therapies. The recent White Paper, ‘Our health, 
our care, our say’, signalled the intention to accelerate the trend of providing 
NHS care closer to home. 
2.2 
Accessing care is not always easy, especially when patients have to travel. Access 
to, and use of, the NHS can also affect health inequalities. There is evidence that 
those in greatest need of services often have the lowest levels of use – and the 
poorest access to them. This is greatly compounded both by poor access to public 
transport, and lack of alternative transport options. 
2.3 
The Department of Health is committed to ensuring that those patients with a 
financial need for assistance to travel to their treatment get the help and support 
to which they are entitled. This will become even more important with the 
introduction of patient choice through Choose and Book, which may mean 
patients choosing to travel longer distances to the hospital of their choice. 
2.4 
Financial support for patients on low incomes is only delivered through the 
Hospital Travel Costs Scheme. 
2.5 
Patients need to know what financial support is available to them and how they 
can access it. Care providers need to ensure that this information is available to 
everyone who may need it. 
2.6 
Patients also need to have a clear and easy-to-use process through which they can 
access any payment of travel costs to which they are entitled in a way that suits 
their needs. This process also needs to reflect the fact that illness and subsequent 
treatment can leave some people feeling vulnerable and unable to find their way 
around the system; and 
2.7 
Whilst we will look at views outside of this scope, the Scheme will remain 
targeted to patients with a specific financial need, as set out in the regulations 
that govern the Scheme. This consultation will not therefore consider the 
financial eligibility criterion for assistance with hospital travel costs; we are 
looking at operational issues related to the Scheme only. 

3 The current Scheme


3.1 
The Hospital Travel Costs Scheme was established in 1988 as part of the NHS Low 
Income Scheme. The Scheme provides financial assistance to those patients who do 
not have a medical need for patient transport services, but who require assistance in 
meeting the cost of travel to and from their care. 
3.2 
It currently operates on a number of criteria: 
• 
The care is arranged with or by a consultant (such as a surgeon or rheumatologist, 
but not a GP). 
• 
The care is not part of the essential care that GPs or Dentists provide as part of 
their normal contract (i.e. all other NHS services). 
• 
The care is paid for by the NHS, regardless of whether it is carried out by an 
NHS professional or an independent one; and 
• 
The patient has a low income, but does not have a medical need for transport as 
determined by doctor, midwife or dentist. 
3.3 
Patients must satisfy all of the above criteria to be entitled to claim. 
3.4 
Ultimately, the NHS primary care trust is responsible for the payment. However, for 
the patient’s convenience, providers (mainly hospitals currently) generally make the 
payment to the patient and claim this money back from the primary care trust 
responsible for the patient. 
3.5 
Eligible patients can claim back their travel costs in two ways: 
• 
At the finance / cashier’s office of the NHS hospital where they are treated 
presenting their travel receipts and proof of eligibility, or 
• 
At a later date by sending completed claims (no more than three months after the 
date of travel) on a claim form together with their travel receipts. Forms are 
available from local Jobcentre Plus offices or NHS bodies, and completed forms 
should be sent to the address of the organisation listed on the claim form. The 
patient should receive payment, or told that they are not entitled to payment, in 
due course. 
3.6 
In addition, patients may receive payments in advance where necessary. 

Consultation on the Hospital Travel Costs Scheme 

3.7 
Hospitals help to raise patients’ awareness of the Scheme by providing information 
with appointment or admission letters, and through posters and leaflets being 
available in patient areas. 

4 Why are we seeking 
your views? 

4.1 
The changing delivery of care in the NHS means that the Scheme needs to reflect 
this. ‘Our health, our care, our say’ (DH, 2006), the Department’s White Paper on 
community services, made a commitment to widening the Hospital Travel Costs 
Scheme (HTCS) so that it also covers NHS care referred by a health care professional, 
and not just care under a consultant. Patients must still satisfy the other eligibility 
criteria to claim under the Scheme. 
4.2 
As the NHS changes, more services will be provided locally and fewer people will 
have to attend appointments in hospitals. We therefore need to ensure that the 
Scheme still applies to people who are receiving care that they would previously have 
received in hospitals, but now have in other settings, even if they are provided by GPs 
or other primary or community health professionals. Routine services provided by 
your local GP or dentists will remain excluded from the Scheme as are urgent primary 
care services during the out of hours period (i.e. between 1830 and 0800 weekdays and 
at weekends or on bank holidays). 
4.3 
We will ensure that extended services provided in general practices or other 
community settings are within the Scheme – i.e. those services where the patient’s 
registered GP has referred the patient to another provider. 

Consultation on the Hospital Travel Costs Scheme 

Case Study – Anomalies with the current scheme 

Jane is in receipt of Income Support and her doctor made an appointment for her to see 
a rheumatologist at her local hospital. At the appointment, the rheumatologist referred 
Jane for treatment with a physiotherapist at a nearby health centre. Under the current 
system, Jane is eligible for reimbursement of her travel expenses to the physiotherapist. 

John is also in receipt of Income Support and was referred to the same physiotherapist 
directly by his family GP for treatment of the same condition as Jane. However, under 
the current system John is not entitled to have his travel expenses to the physiotherapist 
reimbursed because he hasn’t been referred to the physiotherapist by a consultant. 

The change to the scheme that we are proposing will resolve this issue so that Jane and 
John will be eligible under both circumstances. 

4.4 
>From October 2007, the regulations that govern the Scheme will be amended so that 
they cover the care that patients would previously have received whilst under the care 
of a consultant. Delivering more care in the community and out of acute hospitals 
poses a challenge to the operation of the Scheme, in particular how patients are paid 
for their travel costs in community settings, such as local health centres and clinics. 
The patient choice reforms around Choose and Book will also increase the need for 
robust systems for payment in advance. 
4.5 
Additionally, a number of patient organisations tell us that take up of the Scheme 
could be improved. This was corroborated by the Health Select Committee report on 
NHS Charges that was published in July 2006.There are a number of reasons for this 
low awareness, including; 
• 
the bureaucracy around the Scheme 
• 
lack of clarity about who pays the reimbursement 
• 
poor awareness of the Scheme amongst health professionals and those who are 
entitled. 
4.6 
We intend to improve guidance to make clear where responsibilities lie for both 
patients and NHS staff to help resolve this. 
4.7 
In meeting the new Disability Equality Duty, which came into force in December 
2006, NHS trusts will have to involve disabled people in the design, delivery and 
evaluation of services to ensure they meet the needs of disabled persons to whom they 
provide services. NHS trusts may well have to make reasonable adjustments that treat 

Consultation on the Hospital Travel Costs Scheme 

disabled people more favourably so that they have access to services. Trusts will have 
to consider carefully the implications of the Duty based upon their local 
circumstances. 

4.8 
This consultation should help us to make sure we balance the Scheme so that it is 
accessible to patients whilst not being too bureaucratic to administer. Using ideas and 
suggestions from people who use the Scheme and from those who run the Scheme we 
hope to improve it to find the best solution for everyone. 

5 Payment to patients


5.1 
This consultation will look at the practicalities of paying patients through the 
Hospital Travel Costs Scheme. One of the main issues is that health centres, and GP 
and dental surgeries that provide specialist (outreach) services may not have the 
facilities to pay patients directly. 
5.2 
What we need to decide are the principles on which reimbursement systems should 
work. The following are some suggested options: 
1 
Accessibility 

• 
A range of reimbursement options for patients should include face-to-face and 
postal, as one size does not fit all 
• 
Cash and cheque based systems 
• 
Payment in advance where necessary 
• 
Account taken of the needs of different groups, particularly disadvantaged and 
“hard to reach” groups, within communities so that the patient can choose the 
option that is right for them at the time 
• 
Face-to-face reimbursement as close to home as possible, or as close to the service 
the patient attends as possible 
• 
Commissioners and service providers consult patients that use particular services 
to see which reimbursement methods are most suitable. This should be seen as 
part of meeting equality duties and the duty on NHS organisations to consult 
service users 
2 
Communications 

• 
Responsibilities of providers and commissioners should be clear to both staff and 
patients, regardless of where they receive information about the Scheme 
• 
Clear communication strategies by health service commissioners, including 
openness about conditions under which patients can claim pre-payment for their 
travel expenses 
• 
A central point of contact for information about how the Scheme operates locally 

Consultation on the Hospital Travel Costs Scheme 

• 
Communication aids and materials are available in different formats and 
languages 
3 
Cost 

• 
Factor in the cost of administering the Scheme into local planning and contract 
arrangements 
• 
Reimbursing patients should not result in any unnecessary costs to patients. For 
example, a patient may choose to apply for reimbursement through the post, but 
if they wanted to be reimbursed face-to-face, the cost of travel to be reimbursed 
should not be at the patient’s expense. 
• 
Methods of delivering the Scheme should be in favour of patients rather than at 
their expense, even if more costly 
5.4 
Do you agree that these are the right principles? Is anything missing or are there too 
many? How could specific ones be strengthened? 
Some Possible Payment Options 

• 
By post – by making the claim to their local primary care trust which would pay 
once travel had been completed. This would take time but would mean there is a 
local contact point for the area. It would also place additional pressure on the 
primary care trust, although they are ultimately responsible for the Scheme. 
• 
By post – by making the claim to the Prescription Processing Division (PPD) at 
the NHS Business Services Authority, who will then contact the patient’s local 
primary care trust and ask them to pay the patient retrospectively. This would 
take more time than applying by post direct to the local primary care trust, but 
would mean there is one contact point for all patients to claim. This would place 
a pressure on the NHS Business Services Authority. 
• 
In person – making the claim at the organisation that provides treatment, 
including private hospitals, which will then claim the reimbursement back from 
the patient’s local primary care trust. This would be fast for the patient and 
enable a cash repayment option, but may involve a lot of administration. 
• 
In person, making the claim at a different organisation to the treatment provider, 
but one that the NHS works with, who will then reclaim the money from the 
patient’s local primary care trust. This could be fast for the patient and enable a 
cash repayment option, but may involve a lot of administration, may cost the 
primary care trust money to buy in the service, and would also place additional 
pressures on the organisation involved in repayment. 

Consultation on the Hospital Travel Costs Scheme 

5.5 
In all cases, patients would need to produce proof that they were eligible. A healthcare 
professional would confirm an escort was needed where applicable. A local 
organisation involved in the patient’s care would need to decide if the costs claimed 
were reasonable. 
5.6 
The advantages and disadvantages of these options are explored in more detail at 
Annex D towards the end of this document. 
5.7 
The option of being paid in advance will also remain as a decision to be made locally 
and on a case-by-case basis. Commissioners of health services will need to make it 
clear to patients and staff the conditions under which pre-payments can occur, 
ensuring pre-payments are secure and available to genuine claimants. This is 
particularly important as patients may travel further distances under the Choice 
reforms and therefore may not be able to afford the travel payment up front. Where 
trusts are making payments in advance, we would particularly like to hear about this 
experience and the circumstances under which these payments are made. 
5.8 
We would also welcome views on other ways that patients could be reimbursed, as 
well as examples of practice happening locally that are already working to address the 
issues raised. 
Questions to test your ideas 

When suggesting your own ideas for payment and providing feedback on the ideas 
above, you should consider: 

1. 
Would this make it quick and easy for patients to claim? 
2. 
Would this make it easy for providers to verify or pay out the claim (including if 
an escort was needed and the amount was reasonable even if receipts had been 
produced)? 
3. 
How much extra work could be involved for staff? 
4. 
Would this provide a secure method for patients to be paid? 
5. 
Would the idea work for someone who attends many appointments at different 
places? 
6. 
Have you considered how this may impact on disabled people? 
7. 
What combination of payment options would provide the best combination of 
ease of access for patients, and efficient administration? 

6 Awareness of the Scheme


6.1 
The Department’s good practice guidance on the Department’s website 
(http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/FinanceAndPlanning/ 
HospitalTravelCostsScheme/fs/en) suggests ways to communicate the Scheme to 
patients. Feedback from patients is clear that these approaches aren’t always used or 
that they are told too late in their care to take advantage of their full entitlement. 
Additionally, it’s not clear who patients should ask for further help. We need to find 
new ways for patients to receive the right information. We also need to support health 
care providers in delivering that information at the right time in a way that is best for 
patients. 
6.2 
We would like you to consider the following ways to promote the Scheme, as well as 
others that you can think of, explaining why you think any particular idea is better 
than another both in terms of cost to do and how well it will work. Ways in which 
people could receive information could include: 
• 
Leaflets or posters in Jobcentre Plus offices and Post Offices 
• 
Information with every appointment letter 
• 
Displays in hospital car parks detailing help available 
• 
Leaflets, posters and message boards in the waiting area or consultation room, 
especially in GP surgeries, specialist dental practices or NHS Walk-In Centres 
• 
Doctor, nurse, health visitor or other staff that give out health information 
• 
Information in local NHS publications such as ‘Your Guide to Local Health 
Services’ or practice leaflets 
• 
Information as part of the information strategy of NHS trusts 
• 
Information provided by social services, NHS, and voluntary organisations 
• 
Staff newsletters and internal communications 
• 
Magazines, journals and media targeted at those working in care settings and at 
patient groups 
6.3 
A systematic approach to informing patients about entitlements is likely to be most 
effective in improving the Hospital Travel Costs Scheme awareness and take-up. We 
are investigating whether new government plans to improve patient care, such as the 

Consultation on the Hospital Travel Costs Scheme 

‘Choose and Book’ system, information prescriptions, and Personal Health and Social 
Care Plans could also be routinely used to inform patients about the Scheme. We 
would welcome any comments you might have about raising awareness, or how you 
are working together locally with other stakeholders and the community to ensure 
patients have access to the information that they need to use the Scheme. 

6.4 
As with our suggestions around payments to patients, these are just some of the 
options and we would like your comments on these ideas, as well as ideas of 
your own. 
Case Study – Joining up information about transport 

Peterborough City Council has been working closely with local NHS trusts to inform
patients how they can make better choices about how they can travel to health care in
Peterborough. The leaflet, ‘Transport to healthcare’, brings together information on
walking and cycling, buses, trains and community car schemes, as well as information
about the Hospital Travel Costs Scheme and Patient Transport Services.


Working in partnership with local providers is one approach that the local NHS can use 
to ensure that patients who may have difficulty accessing services know about what 
options are available to them. 

Testing your ideas 

When suggesting ideas and proposals for communications and providing feedback on 
the suggestions above you might find it useful to consider some of the following 
questions: 

1. 
What would be your first choice for how you would like to be told about the 
Scheme? 
2. 
When is the most useful and relevant time to tell patients about the Scheme? 
3. 
Will all patients be able to access the information, including groups that face 
particular cultural or language barriers? 
4. 
Is it in a format they can easily understand and which is sensitive to their needs? 
5. 
Where should information be displayed so that patients notice it? 
6. 
Is it clear where patients can find out more information? 
7. 
Would it be costly to do? 
8. 
How often would it be updated? 

Consultation on the Hospital Travel Costs Scheme 

9. Would patients want to keep the information? 
10. How may care providers assess whether patients are aware of the Scheme? 
11. How would people in disadvantaged groups and areas, with low levels of use and 
access to services, be targeted? 
12. How would people with low literacy be targeted? 
13. How should potentially frequent users of the Scheme, such as those requiring 
specialist, ongoing treatment, be targeted? 
14. How would this impact on disabled people? 
15. Should one senior member of staff have responsibility for administering the 
scheme? If so, who would be the most appropriate person? 
16. Should awareness and take-up levels be monitored to ensure equity across 
patients? 

7 Issues that we will not 
look at 

7.1 
Eligibility will continue to be based on a patient’s ability to pay and will not look at 
the eligibility criteria based on need. We are not looking to extend eligibility to cover 
specific conditions, without accounting for a patient’s income. This may have the 
adverse effect of widening health inequalities, as better off patients would find it easier 
to receive healthcare, leading to better health for them. 
Case Study – The argument for not widening the Scheme to specific conditions 

It is difficult to estimate how much extending the scheme to cover all cancer patients
would cost the NHS. The calculation below gives us a rough estimate.


The Office of National Statistics’ figures show that on average in recent years there are 
around 227,500 cancer diagnoses per year. Macmillan Cancer Support’s research found 
that cancer patients who incur travel costs pay £325 on average during the course of 
their treatment to reach their cancer treatment. If we extend the current scheme so that 
all cancer patients are eligible and assuming that they all incur costs, this would mean 
that the NHS could spend up to £74m on transport for cancer patients and this is 
money that would be diverted away from patient care. 

This is the estimated cost for just cancer alone. Estimates for other conditions where 
regular attendance occurs, such as physiotherapy, renal services and talking therapies, 
could result in similar costs. It is for this reason that the Scheme will remain targeted at 
those patients with a specific financial need. 

7.2 
This consultation will not look at non-emergency Patient Transport Services as this 
operates under different rules to the Hospital Travel Costs Scheme. Patient transport 
services are free at the point of use, and are provided for patients who have a medical 
need for transport to hospital (although this is being expanded to treatment provided 
in the community, like the Hospital Travel Costs Scheme). Information on Patient 
Transport Services is set out in Annex B. We are consulting separately on the guidance 
governing Patient Transport Services. Copies of this consultation can be accessed at 
www.dh.gov.uk (go to the live consultations part of the consultations section). That 
consultation closes on 16 February 2007. 
7.3 
We are also aware that patients have experienced problems seeking reimbursement 
where there have been referrals between hospitals and uncertainty exists about who is 

Consultation on the Hospital Travel Costs Scheme 

responsible for payment. We will clarify this relationship by improving the guidance 
on the Scheme, outlining responsibilities for a patient-centred NHS, through 
communications in during 2007. 

7.4 
Whilst we welcome additional views that you have, we ask that you focus on the 
operational issues that the consultation identifies and is aimed at. 

8 Making your contribution 

When should you submit your contributions by? 

Ideas and proposals should reach the Information for Choice programme at the latest 
by 13 April 2007. We will be looking at responses as they come in throughout the 
process, and will weigh up any options or proposals in time to inform the final 
Consultation Working Group in May 2007. 

Where should you submit your contribution? 

By email to: 
htcs@dh.gsi.gov.uk marking your contribution clearly for the 
Hospital Travel Costs Scheme consultation 

By post to: 
‘Hospital Travel Costs Scheme consultation’
Information for Choice Programme
Department of Health
Room 5E62, Quarry House
Quarry Hill, LEEDS LS2 7UE


Online: 
>From February we have a survey with questions that you can 
complete online. The website address is 
http://www.dh.gov.uk/PolicyAndGuidance/OrganisationPolicy/ 
FinanceAndPlanning/HospitalTravelCostsScheme/fs/en or you can 
reach it from www.dh.gov.uk and clicking Policy and Guidance > 
Policy A-Z > H > Hospital Travel Costs Scheme 

What should you submit? 

• 
Please send us views and ideas on any of the issues mentioned, but most 
importantly workable solutions to those issues; 
• 
Let us know of any additional ideas that may support patients and providers 
administer the Scheme as well as any good practice that happens locally; 
• 
Please send all contributions to the Information for Choice programme at any 
time during the consultation through the above routes; 
• 
Please note your responses may be published or attributed in the document that 
will report the findings of the consultation. 
Final date for contributions: 13 April 2007 


Annex A: Glossary


Acute hospital An NHS hospital that provides treatment such as surgery and 
diagnostics. Your GP will send you to one if you need treatment 
that they normally wouldn’t be able to prescribe. 
Choose and Book A computer system that patients use to book follow-on hospital 
appointments once they have seen their GP 
Commissioners NHS staff or organisations that arrange and pay for health services 
on patients’ behalf. This is usually a primary care trust 
Disability A new legal duty placed on public bodies to promote equality of 
Equality Duty access to services to disabled persons, 
Hospital Travel Costs Scheme to reimburse some patients with a certified low income for 
Scheme (HTCS) their travel expenses 
Income Support A benefit for people who can’t work full time and who don’t have 
enough money to live on depending on their circumstances 
Income-based A benefit for people who are unemployed and available for work 
Jobseeker’s depending on their circumstances 
Allowance 
Information A new initiative being tested where doctors and nurses direct 
Prescriptions patients to additional information about their condition and 
support available 
Macmillan A charitable organisation that supports people affected by cancer, 
Cancer Support and campaigns on their behalf 
National Health The health service established in 1948 by the government to 
Service (NHS) provide free health care to everyone 
NHS Low A scheme for patients on low incomes that don’t automatically 
Income Scheme qualify for other financial support 


Consultation on the Hospital Travel Costs Scheme 

NHS trusts A variety of NHS organisations, responsible for ambulances, 
hospitals and other services. 
Patient Transport 
Services (PTS) 
Non-emergency transport commissioned by PCTs for patients that 
have a medical need for transport to access care provided in hospital 
settings or those which are now available in a community setting 
Personal Health and 
Social Care Plans 
A joined up plan for people with a long-term condition that have 
social care and health care needs. 
Prescription and 
Pricing Division 
(PPD) 
This is part of the NHS Business Services Authority and they are 
responsible for administering the NHS Low Income Scheme. They 
were previously the NHS Prescription and Pricing Authority. 
Primary care trusts 
(PCTs) 
NHS organisations that arrange and pay for services covering 
patients in a certain area. They can buy services from other NHS 
trusts, and private hospitals. They are responsible for managing 
most NHS money. 
Providers Organisations where patients are treated, such as hospitals and 
health centres. They include private and NHS organisations 
Regulations These are rules set out in law, controlling how a particular system 
operates. 
Service Providers See providers 
Social Services This is care designed to look after the welfare of the population, in 
particular vulnerable groups like children and older people. Some 
local councils arrange these services 
Specialist Outreach 
Services 
Services where a health professional delivers care in a community 
setting rather than in a hospital. This helps people in that 
community receive that care as they don’t have to travel far to reach it. 
White Paper A policy document published by the government to explain or 
discuss matters. 
Your Guide to Local 
Health Services 
A booklet produced annually by PCTs to inform people about what 
services are available in their area and how the organisation is 
responding to feedback from the public. 


Annex B: Background to the 
consultation 

Additional background to the Hospital Travel Costs Scheme 

• 
Patients on low incomes are entitled to full or partial reimbursement for their 
actual travel expenses, provided that they travel by the cheapest means of 
transport available to them. If patients choose a more expensive mode of 
transport when a cheaper means is available, they will be refunded the smaller 
amount. 
• 
Benefits and allowances that entitle patients (and their dependents) to full or 
partial reimbursement of travel expenses under Hospital Travel Costs Scheme 
include: 
– 
Income Support 
– 
Income-based Jobseeker’s Allowance, 
– 
Pension Credit Guarantee Credit, 
– 
Child Tax Credit*, 
– 
Working Tax Credit* with Child Tax Credit*, 
– 
Working Tax Credit* with a disability element, or 
– 
Certificate from the NHS Low Income Scheme 
* 
Tax Credit entitlement subject to an income ceiling 
Patient Transport Service (PTS) 

Non-emergency patient transport services, known as PTS, are typified by the non-
urgent, planned, transportation of patients with a medical need for transport to and 
from a premises providing NHS healthcare and between NHS healthcare providers. 
This can and should encompass a wide range of vehicle types and levels of care 
consistent with the patients’ medical needs. 

Eligible patients are not charged for Patient Transport Service provided by the NHS, 
although if they are eligible for Patient Transport Service then they are not eligible for 
Hospital Travel Costs Scheme. 


Consultation on the Hospital Travel Costs Scheme 

A non-emergency patient is one who, whilst requiring treatment, which may or may 
not be of a specialist nature, does not require an immediate or urgent response. 

Eligible patients should reach healthcare (treatment, outpatient appointment or 
diagnostic services i.e. procedures that were traditionally provided in hospital, but are 
now available in a hospital or community setting) in secondary and primary care 
settings in a reasonable time and in reasonable comfort, without detriment to their 
medical condition. Similarly, patients should be able to travel home in reasonable 
comfort without detriment to their medical condition. The distance to be travelled 
and frequency of travel should also be taken into account, as the medical need for 
PTS may be affected by these factors. Similarly, what is a “reasonable” journey time 
will need to be defined locally, as circumstances will vary. 

The White Paper (‘Our health, our care, our say: A new direction for community 
services’) extended PTS eligibility to cover patients with a medical need for transport 
referred by a health care professional for treatment in a community setting. The 
extension to PTS is expected to come into force from 1 April 2007. Consultation on 
updated guidance to reflect these changes is currently underway and is due to finish 
on 16 February 2007. Consultation documents are available in the consultations 
section of www.dh.gov.uk. 

‘Our health, our care, our say’ White Paper 

• 
The White Paper, published by the Department of Health in January 2006, set 
out a new vision for community services. It followed on from a major national 
consultation looking at how people wanted community services delivered. 
• 
One of the themes was rapid and convenient access to high-quality, cost-effective 
care, so that when people access community services, they should do so in places 
and at times that fit in with the way they lead their lives. Furthermore, services 
that would serve people better if they were placed in local communities should be 
located there and not in general hospitals. 
• 
The longer-term aim of the White Paper is to bring about a sustained realignment 
of the whole health and social care system. Far more services will be delivered in 
settings closer to home; people will have real choices in both primary care and social 
care; and services will be built around the needs of individuals and providers. 
• 
Consequently, with more traditional hospital treatments being carried out in 
community settings, with referrals coming directly from family doctors rather 
than hospital consultants, some care would therefore fall outside of the eligibility 
criteria for reimbursement of travel expenses under the current Hospital Travel 
Costs Scheme. 

Consultation on the Hospital Travel Costs Scheme 

The future of Hospital Travel Costs Scheme 

• 
Extending eligibility for the Hospital Travel Costs Scheme to include patients 
referred by a health care professional for treatment in a primary care setting, and 
who meet the other existing criteria, means that patients will still be able to claim 
travel expenses without having to see a hospital consultant first. 
• 
With more treatments carried out closer to home, there may not be the facilities 
to reimburse patients. We need to ensure that there is means for patients with a 
financial need to claim their entitlement securely, conveniently and efficiently, 
which is the focus of the consultation. 
• 
Additionally, Macmillan Cancer Support’s research, ‘Cancer Costs’ (2006), and 
the Health Select Committee’s report on NHS Charges found that uptake of the 
Scheme is low due to poor awareness. Informing patients of their entitlements 
beforehand will ensure that most patients with a financial need can attend 
appointments without having to worry how they will finance their travel. 

Annex C: Consultation process 
and Scheme amendments 

As part of the consultation, there will be ongoing stakeholder engagement, as well as 
some focused stakeholder workshops where we can discuss during and after the 
consultation which ideas people think will work best. We will invite a broad mix of 
organisations to the stakeholder workshops, including patient, NHS, local and other 
government departments and organisations. We will also ensure that there is good 
representation from disadvantaged groups who potentially have the most to benefit 
from the Scheme. 

At Annex E, we have included details of the patient survey that we are asking people 
to complete. You may wish to consider these to help develop your ideas. 

Following consultation, we will revise the guidance and communicate the changes to 
the NHS, voluntary organisations, independent providers and patients / the public. 
We will also need to amend the regulations that govern the Scheme to meet the 
White Paper commitment. 

The timetable for this consultation and to make subsequent changes is: 

Oct 2006 Consultation Working Group to look at ideas for the consultation 
Jan 2007 Start of consultation 
Mar 2007 Consultation Working Group to consider ideas so far 
Apr 2007 End of consultation 
May 2007 Consultation Working Group to consider all proposals 
May 2007 Ministers agree proposals 
Jun 2007 Communications to providers about the new arrangements 
Jun 2007 Communications to patients about the new arrangements 
Jul 2007 Amendment regulations laid before Parliament 
Oct 2007 Revised Hospital Travel Costs Scheme begins operation 


Annex D: Some options for 
payments to patients 

Option Advantages Disadvantages 

Patients Administrators Patients Administrators 
By post, making 
the claim to their 
local primary care 
• 
• 
One regional 
contact point 
Can claim at 
• Regional 
accountability 
for Scheme 
• Payments could 
take up to four 
weeks 
• Increased 
workload for 
PCTs 
trust (PCT), which 
would pay once 
any time when 
it’s convenient 
• Reduced 
workload for 
• Payment may 
be cheque or 
• Increased 
difficulty to 
travel had been health care bank transfer check eligibility 
completed. providers only • Patients may 
• Claims may get not complete 
lost in post whole of claim 
• Pay for postage form 
• No on-the-spot 
help to fill in the 
claim form 

By post, making 
the claim to the 
Prescription 
Processing Division 
(PPD) at the NHS 
Business Services 
Authority with 
payment made by 
PCT. 

• One contact • National • Payments could • Increased 
• 
point for 
everyone 
Can claim at • 
accountability 
for Scheme 
Reduced • 
take up to eight 
weeks 
Payment may • 
workload for 
PCTs and PPD 
Increased 
any time when 
it’s convenient 
workload for 
health care 
providers 
be cheque or 
bank transfer 
only • 
difficulty to 
check eligibility 
Patients may 
• 
• 
Claims may get 
lost in post 
Pay for postage 
not complete 
whole of claim 
form 
• No on-the-spot 
help to fill in the 
claim form 

In person, making 
the claim at the 
place that provides 
treatment, 
including private 
hospitals. 

• 
• 
Patients may 
claim straight 
away 
Patients can get 
on-the-spot 
advice on how 
to complete 
claim form 
• 
• 
Local 
accountability 
for Scheme 
Eligibility can be 
checked with 
patient at time 
of claim 
• 
• 
Can only claim 
at certain times 
of day 
Must have 
evidence of 
entitlement with 
them 
• 
• 
Increased 
workload for 
health care 
providers (e.g. 
NHS hospitals) 
Private hospitals 
may not be 
contracted to 
do this 
• May not have 
facilities to pay 


Consultation on the Hospital Travel Costs Scheme 

Option 

In person, making 
the claim at a 
different 
organisation to the 
treatment provider 
that the NHS 
works with, who 
will then reclaim 
the money from 
the patient’s local 
primary care trust. 

Advantages Disadvantages 
Patients Administrators Patients Administrators 
• 
• 
Patients may 
claim straight 
away 
Patients can get 
on-the-spot 
advice on how 
• 
• 
Local 
accountability 
for Scheme 
Makes use of 
existing systems 
in accessible 
• 
• 
Can only claim 
at certain times 
of day 
Must have 
evidence of 
entitlement with 
• 
• 
Increased 
workload for 
the local 
organisations 
PCT will have to 
contract a 
to complete 
claim form • 
places 
Eligibility can be 
checked with 
them service which 
will cost money 
patient at time 
of claim 


Annex E: Consultation criteria


This consultation follows the revised Cabinet Office code of practice which is available from 
the Cabinet Office website. This requires government departments to: 

Consult widely throughout the process, allowing a minimum of 12 weeks for written 
consultation at least once during the development of policy 

Be clear about what proposals are, who may be affected, what questions are being asked and 
the timescale for responses. 

Ensure that consultations are clear, concise and widely accessible. 

Give feedback regarding the responses received and how the consultation process influenced 
the policy. 

Monitor their effectiveness at consultation, including through the use of a designated 
consultation co-ordinator. 

Ensure consultations follow better regulation best practice, including carrying out a 
regulatory Impact Assessment if appropriate. 

The Code also invites respondents to “comment on the extent to which the criteria have 
been adhered to and to suggest ways of further improving the consultation process”. For 
DH consultation, comments or complaints (but not your response to this consultation) 
should be sent to: 

Consultations Coordinator 
Department of Health 
Skipton House 
80 London Road 
London SE1 6LD 

Email: (mb-dh-consultations-coordinator@dh.gsi.gov.uk) 

Please do not send consultation responses to this address 


Consultation on the Hospital Travel Costs Scheme 

Information provided in response to this consultation, including personal information, may 
be published or disclosed in accordance with the access to information regimes (these are 
primarily the Freedom of Information Act 2000 (FOIA), the Data Protection Act 1998 
(DPA) and the Environmental Information Regulations 2004). 

If you want the information that you provide to be treated as confidential, please be aware 
that, under the FOIA, there is a statutory Code of Practice with which public authorities 
must comply and which deals, amongst other things, with obligations of confidence. In 
view of this it would be helpful if you could explain to us why you regard the information 
you have provided as confidential. If we receive a request for disclosure of the information 
we will take full account of your explanation, but we cannot give an assurance that 
confidentiality can be maintained in all circumstances. An automatic confidentiality 
disclaimer generated by your IT system will not, of itself, be regarded as binding on the 
Department. 

The Department will process your personal data in accordance with the DPA and in the 
majority of circumstances; this will mean that your personal data will not be disclosed to 
third parties. 


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