Agenda item

This report is for the attention and action of Board members, sharing two reports from Healthwatch York.

 

These respectively share feedback received about how changes to non-emergency patient transport, following the tightening of eligibility criteria in April 2025, have affected people across York and North Yorkshire and an exploration into whether reports of poor experiences in accessing local healthcare services from some trans, non-binary and intersex (TNBI) people in York, shared with Healthwatch, were common for this community.

 

Report 1:

 

The first Healthwatch report was presented by the manager of Healthwatch York, who noted that the work had been completed in partnership with Healthwatch North Yorkshire to better explore the impact of national changes to eligibility for non-emergency patient transport after these changes were implemented locally.

 

She explained that in addition to members of the public, Healthwatch had heard from local voluntary and community sector partner organisations who had not found out about these changes until implementation, and there was concern why some people previously eligible for transport no longer were.

 

Healthwatch had shared a survey with residents and with partners, and while they had heard from some people who reported that they consistently would not have been eligible for transport both before and after the changes, and also from people trying to access services for which transport had never been provided, they still believed this information to be useful, since it illustrated both that transport services and criteria were not well understood, and that transport needed to be a key consideration in any future health and care estate planning.

 

Key themes emerging from the work were:

 

·       Cost - a significant financial burden in paying for transport meant some people were choosing not to attend appointments were not taking the opportunity to receive health care

·       Time – including the time spent arranging transport, which could be difficult, particularly where specific mobility issues existed. There was also increased time spent traveling when direct transport wasn’t available, and time waiting when appointment times did not align with the timing of available transport.

·       A lack of alternatives – with too few community transport options within the city.

·       An impact on mental and physical well-being – whether through stress, anxiety or the physical demands of managing transport and transport options independently.

·       Inconsistencies in non-emergency patient transport provision – with variations in service availability and understanding of the eligibility from within services and outside.

·       Specific accessibility issues – barriers experienced by people that made travel particularly difficult or unsafe.

·       Eligibility – where in the early days of the scheme, some people were incorrectly advised that they were no longer eligible.

 

She highlighted several specific case studies from the report to illustrate the challenges, stressing that these issues required joined-up thinking to ensure full access to healthcare for all.

 

Members highlighted the point regarding people stopping treatment because they can’t get to appointments; suggesting that it was important to focus on the point about transport alternatives when older people were expected to cover a great distance for appointments shortly after their bus passes became valid in the morning, since they would otherwise be obliged to pay a fare in these circumstances.

 

The Manager, Healthwatch York responded that residents could use their hospital letter concerning an appointment to get on the bus before 9:30am without paying a fare, though she had recently received feedback that a driver had refused to acknowledge a Patient Knows Best letter on their phone for this purpose, so there was still work required here on promotion and consistency.

 

Members noted that from a prevention perspective – and on the cost point – stopping treatment could lead to even more costly interventions down the line if people did not pursue their treatment to its conclusion.

 

Members asserted that accessibility and transport must be considered a fundamental aspect when planning developments such as neighbourhood health centres, or revising city infrastructure in the future, in the interest of all residents accessing healthcare, prevention and support as soon as possible.

 

The Executive Director of Communications, Marketing and Media Relations, NHS Humber and North Yorkshire Health and Care Partnership confirmed that ensuring neighbourhood hubs and health centres were accessible tied into the wider agenda, and that an estate mapping tool was being used, which actively considered this as a key driver. She also emphasised that there was a focus on putting as much care as close to home as possible, with a home-first approach and a reduction in unnecessary appointments and procedures. Some appointments could potentially be undertaken a different way, such as moving to a digital format where appropriate (acknowledging that some residents face challenges accessing digital services of any kind).

 

Members agreed that these findings highlighted unintended consequences of the changes to patient transport, and that thoughts should now turn to how to capture and surface this following on from the report.

 

 

Report 2:

 

The second Healthwatch report was presented by the Manager of Healthwatch York, the Student Volunteer from Healthwatch York and the Chair of GeneraTe. This report summarised the lived experience of Trans, Non-binary and Intersex people in York and their interactions with healthcare service providers.

 

The Manager of Healthwatch York explained that in late 2024, a York Voices meeting convened to explore gender health. This meeting had identified some serious challenges, where access to basic health care was being sought in the city. Around the same time, York Health and Care Partnership had also been exploring data around health inequalities, which highlighted significant concerns about higher levels of poor mental health amongst the trans community as well as significant discrepancies across healthcare settings about how gender identity was being recorded and asked for.

 

Consequently, a partnership had been developed to further explore these issues; this partnership encompassed GeneraTe, York LGBT Forum, York Disability Rights Forum, York Hospital, York Health and Care Partnership, York Medical Group, Priory Medical Group as well as volunteers and people with lived experience.

 

She explained that users of health services not so much facing ignorance about TNBI people from professionals, but a lack of understanding, and sometimes significant challenges around dignity and respect within healthcare settings, including refusal to use preferred pronouns and publicly dead-naming trans individuals in healthcare settings.

 

The report noted that few health care professionals had effective training in TNBI healthcare, and many contributors reported feeling responsible for educating professionals in their appointments with them. There was little to no support locally while on the long waiting list for gender identity clinics across England, and there was no consistent approach to shared care within York or the wider Humber and North Yorkshire ICB.

 

They had also noted incredibly long waiting lists for support from Gender Identity Clinics (GICs), with reports of waits from two years to two decades depending on which clinic. They highlighted instances where a GIC had needed to intervene when GPs had not wished to treat certain patients, which they noted was concerning from both a health safety and also from a logistical perspective. The current model for NHS primary care was seen as problematic, with primary care being asked to take on shared care agreements without an appropriate funding source, especially concerning gender care given the lengthy first appointment waiting lists for NHS GICs.

 

No GPs in York offered shared care with private providers and this pushed people out of the care system in the direction of unmonitored do-it-yourself hormone replacement therapy with no specialist input. The Chair of GeneraTe advised that the service received, and the experiences in care were hugely variable by area and by healthcare provider, and depended greatly on the “pushiness” of the person seeking care.

 

Gender affirming care was happening locally but was not widely supported; it was led by committed and concerned health professionals. The report acknowledged many health care professionals were keen and willing to undergo training and proceed with carrying out gender-affirming health care and some healthcare professionals had been extremely understanding and made people feel comfortable talking about their health care needs.

 

Based on the points raised in the report, the presenters recommended that:

 

·       All agencies should reinforce the need to treat all people with dignity and respect.

·       There was a need for improved training and take up of training around gender identity and gender affirming care

·       Improved support must be developed for those waiting to be seen at gender identity clinics so that that waiting time was not just a holding space while people put their life on hold for potentially years.

·       Organisations should promote their support and inclusion of TNBI identities and where possible offer holistic care (for example where there is an overlap of people who are both TNBI and Neurodivergent).

·       Social prescribers should work with TNBI people to further support non-healthcare issues and lead the way across Humber and North Yorkshire and beyond. People should be encouraged to tell the NHS that they are TNBI so that they can be signposted to charities and organisations who can support them, and to get onto GIC waiting lists.

 

Members noted the emphasis on the need for training in the report, asking the Chair of GeneraTe if she was the only one presently undertaking this training. The Chair of GeneraTe advised that for 41 years it had been only her training people, but that she was developing a training package that she hoped to have adopted by the NHS and Local Authority, which could be used for others to undertake wider training in the future.

 

The Director of Public Health asked how they felt the shared care issue could best be addressed, and what feedback could be addressed for services commissioned under Public Health.

 

The Chair GeneraTe responded that a common concern when speaking with service providers or going through gatekeepers was repeated misgendering was a microaggression and by the time you reach the person you want you are in no state to speak to them. The Manager Healthwatch York added that there had been particularly positive feedback around the Sexual Health services in York, where screenings could be undertaken and no undue questions were asked of patients. There had been no specific feedback around Drug and Alcohol Services but they would monitor this.

 

The Director, Care Group Director of Operations and Transformation at TEWV asked for advice about more effective training methods.

 

The Chair, GeneraTe responded that the most-effective training on TNBI was from a person who had both lived experience and who was resilient. Currently there were not enough such people to do this in the area due to the negative way society treats trans people and she would very much welcome allies to assist with this training.

 

Members expressed concern and empathy about the link between gender identity and mental health. As with other negative influences, this could start with repressive comments as early as school, which could impact people for life. They fully supported cascading training to social prescribers or Local Area Coordinators.

 

Members highlighted the need to collectively share positive stories where training is having a positive effect, and celebrating instances of success and positive impact.

 

The Manager, Healthwatch York noted that several people had suggested looking at this from a social prescribing angle, and that Healthwatch felt this was a topic that the board, and the ICB, should return to in the future.

 

The Chair, GeneraTe advised that as chair of an LGBT group in the city, she would be very keen to maintain a relationship with the board, especially since this helped TNBI issues be better represented in the city.

 

The Chair of HWBB asked the authors of the report to remain in contact with the board in order to provide future updates.

 

The board then

 

Resolved:   To receive Healthwatch York’s reports, “Getting to Healthcare – The impact of non-emergency patient transport eligibility changes on people in York and North Yorkshire” and “What Trans, Non-binary and Intersex People Told Us About Health Services in York”.

 

Reason:      To keep up to date with the work of Healthwatch York and be aware of what members of the public are telling us.