Memorandum submitted by Macmillan Cancer
Relief (CP 23)
1. SUMMARY OF
RECOMMENDATIONS
Patients who undertake regular visits to hospital
for cancer treatment should be exempt from hospital parking charges.
Department of Health guidance on parking should
be more prescriptive and should instruct hospitals to offer exemptions
to specified groups of patients, including cancer patients who
travel regularly to hospital.
All patients travelling to hospital for regular
cancer treatment should have their travel costs reimbursed through
the Hospital Travel Costs Scheme (HTCS) on a non-means tested
basis.
Compliance with Departmental guidance on HTCS
should be seen as a "must-do" requirement and not an
optional extra. All hospital trusts should be routinely informing
patients about HTCS and local parking concessions through posters
and appointment letters. We urge the Committee to ask the Department
of Health to outline the action it intends to take to ensure that
trusts comply with this guidance.
Patients undergoing treatment for cancer should
be exempt from prescription charges for life-saving cancer drugs
or for drugs and treatments to control the debilitating side effects
of treatment. Terminally ill patients receiving palliative care
at home should be exempt from prescription charges.
The Disability Living Allowance (DLA) and Attendance
Allowance (AA) hospital downrating rules should be relaxed in
recognition of the additional costs, including phone and TV charges,
incurred by hospital in-patients.
Before treatment commences patients should be
routinely advised about the range of charges and expenses they
are likely to incur during the course of their treatment.
All cancer patients should be offered specialist
benefit advice at diagnosis and at key points in the patient journey.
Referral mechanisms should be built into care pathways so that
patients are given advice about the right benefits and concessions
at the right time.
2. INTRODUCTION
2.1 Macmillan Cancer Relief helps people
who are living with cancer. Each and every day over 600 people
in England are told they have cancer. More than one million people
in the UK today have had a cancer diagnosis, and more than one
in three will be diagnosed at some time in their life. As well
as taking action today to support people from the moment they
suspect they have cancer, Macmillan is shaping the future of cancer
care. Our increasing range of services, including our Macmillan
nurses, doctors and other health and social care professionals,
cancer care centres, cancer information, practical help at home
and help with money, is funded entirely through the generosity
of our supporters.
2.2 Macmillan welcomes the opportunity to
contribute to the Health Committee's Inquiry into Co-payments
and NHS Charges. In November 2004 Macmillan launched the Better
Deal campaign to highlight the financial costs of cancer. The
evidence about hospital travel and parking policies in this submission
is taken from studies commissioned as part of the campaign and
from the personal stories of cancer patients who have contacted
us after hearing about the campaign.
2.3 Financial worries are a major source
of stress for patients. Over three quarters (77%) of respondents
to a survey of the CancerVOICES network said they had incurred
extra costs as a result of cancer.[29]
Patients typically incur a wide range of additional expenses including
hospital travel and parking, domestic duties, prescription charges,
childcare costs, clothing (due to weight loss/gain), wigs, complementary
therapies, and diet supplements. In 2004 our Macmillan Grants
service provided financial assistance to 17,102 people affected
by cancer and this year we expect to support over 20,000 people.
To date this year we have assisted 2,411 people with hospital
travel costs (including parking costs), 753 people with hospital
visiting costs, and 174 people with prescription charges.
3. ARE NHS CHARGES
EQUITABLE AND
APPROPRIATE?
3.1 Hospital parking charges
3.1.1 Parking charges at NHS hospitals have
become an increasingly important source of revenue since hospital
car parks ceased to be Crown properties in the 1980s. One hospital
trust source told the Health Service Journal that their trust
raises more than £250,000 a year from parking charges: "Charging
is a big money-maker for trusts. In the last five or six years,
trusts have cottoned on to the revenue potential of charging for
car parks and turned it into a tax on health".[30]
Hospital parking charges in England are not regulated by the Department
of Health (DH). In 2003 then health minister John Hutton said:
"It is a matter for individual hospitals to decide whether
or not to charge for car parking and the cost of such charges
in the light of local circumstances".[31]
3.1.2 Macmillan's 2005 report Free at the
point of delivery? is the most comprehensive survey to date of
hospital parking charges in the UK.4 Between June 2004 and January
2005 Macmillan conducted a telephone audit of 285 of the 292 UK
hospitals that have cancer centres or cancer units. In England,
information was collected from 227 of the 229 hospitals providing
cancer services. The data from the audit was analysed by Dr Foster
Ltd and the key findings about parking charges were: [32]
— 92% of hospitals in England charged
patients for parking;
— Parking charges are more prevalent
in English hospitals than in the rest of the UK—53% of hospitals
in Wales, 20% of hospitals in Northern Ireland and 6% of hospitals
in Scotland charged patients for parking;
— Hourly rates in English hospitals
ranged from 30p to £4.00 an hour, with an average hourly
rate of £1.22;
— Charges for 24-hour stays in English
hospitals ranged from 50p to £30 a day, with an average charge
of £5.67 a day;
— Six out of 10 hospitals (59%) that
charged patients for parking did not provide concessions for cancer
patients.
3.1.3 Macmillan believes that charging patients
for parking when they are attending hospital for potentially life-saving
cancer treatment is inappropriate and morally unjustifiable. Firstly,
cancer patients in particular are penalised by parking charges
because they need to make multiple trips to hospital for chemotherapy
and radiotherapy. Secondly, the changing nature of cancer treatment
means that patients are increasingly receiving these treatments
not as in-patients but as outpatients. Four out of five patients
receive radiotherapy treatment as outpatients. Finally, the unsuitability
and unreliability of public transport and hospital transport means
that cancer patients have no alternative but to travel to hospital
by car.
3.1.4 In order to explore the travel problems
faced by cancer patients, Macmillan commissioned Opinion Leader
Research to conduct patient focus groups.[33]
The findings from the focus groups highlighted the number of hospital
visits that cancer patients are having to make:
— Outpatient radiotherapy involves
daily round trips to hospital, five days a week, for up to six
weeks;
— Outpatient chemotherapy commonly
involves two-three journeys to hospital a week but the length
of time spent in hospital is longer than for radiotherapy sessions,
with chemotherapy patients often having to park for a whole day;
— Patients who took part in the focus
groups undertook on average 20-30 round trips to hospital for
radiotherapy treatment alone, with some patients making up to
50 visits;
— Adding in repeat visits for diagnostic
tests, consultant appointments, and follow-up appointments, patients
made an average of 60 hospital visits throughout the duration
their treatment with the number of visits ranging from 30 to 120;
The following cases illustrate the cumulative
cost of parking charges for cancer patients.
Carol, Breast Cancer Patient, Bristol
After having surgery to remove the tumour, Carol
had to travel to Bristol Royal Infirmary to receive radiotherapy
and chemotherapy treatment, every day (Monday to Friday) for five
weeks. Car parking costs £1.50 for a two hour stay. A course
of treatment lasting five weeks has cost her an estimated £162.50
in parking charges.
Sally, Leukemia Patient in her early Thirties, West
Midlands
Sally was diagnosed with acute lymphoblastic
leukaemia just before Christmas 2004, and has been undergoing
high-dose treatment—about 10 types of chemo and radiotherapy—at
Birmingham Heartlands Hospital. She had an autograft (stem cell/bone
marrow support) in July. She and her husband spent £8 a day
(£2 an hour) parking there every day for five weeks—a
total of £280 over a five week period.
AC, Breast Cancer Patient in her Forties
"Since my diagnosis in May 2001 I have
spent over £500 on hospital car parking at various hospitals."
3.1.5 Most of the patients who participated
in the focus groups had opted to travel to hospital by car because
of the unsuitability and unreliability of public transport and
hospital transport. Patients undergoing courses of chemotherapy
and radiotherapy commonly experience side effects such as extreme
fatigue, nausea, diarrhoea and neutropenia (a condition which
makes patients prone to infection). Consequently these patients
are unable to use either public transport or non-emergency ambulances.
Patients regularly complain that the non-emergency Patient Transport
Service (PTS) is unreliable and involves long waits and lengthy
ambulance journeys as other patients are picked up or dropped
off along the way. The availability of volunteer driver services,
which are better suited to the needs of cancer patients, is patchy
and the capacity of such schemes can be limited due to the shortage
of volunteers. The following quotes from focus group participants
illustrate these problems:
"Sometimes you don't make it to the bottom
of the driveway before you throw up. I was ill. I was terrible,
I was sick the whole way home, every single time. There's no way
I could have got on a train."
"We were able to get an ambulance . . .
but it takes it about 5 hours to get there and 5 hours to get
back. It would have been alright to get there but no way could
I have sat in it coming back because you feel so nauseous."
"I just stood and waited on the bus. I
must have stayed an hour and a half waiting on a bus and I'd just
had radiotherapy."
The Department for Transport estimates that
1.4 million people miss, turn down or simply choose not to seek
medical help because of transport problems.[34]
However, missing an appointment is not an option for cancer patients
for whom treatment may literally be a matter of life and death.
Charging cancer patients for parking when they have no alternative
but to travel to hospital by car is effectively a tax on illness.
If the NHS wants to avoid the charge that it is profiting from
sick and vulnerable patients it should ensure that specific groups
of patients are exempted from charges.
Recommendation: Macmillan Recommends that Patients
who Undertake Regular Visits to Hospital for Cancer Treatment
should be Exempt from Parking Charges.
3.2 Prescription charges
3.2.1 Cancer patients who are not receiving
in-patient treatment may be liable to pay for prescriptions for
a wide range of drugs and treatments. The prescriptions required
by cancer patients are mainly for drugs to counteract the side
effects of treatment (nausea, fatigue, etc.). However, some patients
who are prescribed cancer drugs such as tamoxifen or oral chemotherapy
agents may also be liable for prescription charges. A list of
the range of drugs and treatments for which cancer patients might
incur prescription charges can be found at Appendix 1.
3.2.2 As radiotherapy and chemotherapy treatment
is increasingly being delivered on an outpatient or day surgery
basis, it is becoming more and more common for cancer patients
to incur charges for prescriptions. Nearly one in five respondents
(17%) to Macmillan's survey of the CancerVOICES network said that
prescription charges were one of the extra expenses they had incurred
since being diagnosed with cancer.[35]
One in six respondents to a recent Macmillan survey of 50 breast
cancer patients said that prescription charges were their single
biggest expense.[36]
Most of the patients who took part in the focus groups conducted
by Opinion Leader Research for Macmillan said that the cost of
multiple prescriptions was a major concern.[37]
The following examples illustrate the costs incurred by patients:
LC, Breast Cancer Patient in her Fifties
She took Tamoxifen and other drugs for three
years. Her bi-monthly prescription would, at the current rate
(£6.50 per item for 18 prescriptions), cost £117 in
total. In addition she also had to pay a monthly prescription
charge for anti-depressants and for sleeping tablets.
DB, Breast Cancer Patient in her Fifties
During treatment DB was prescribed a number
of items including steroids, relaxants, anti-sickness medication,
and constipation medication. Each fortnight she was spending £24
on prescribed items an, over a period of six months she spent
approximately £288 in total. When she finished treatment
she was prescribed tamoxifen.
AC, Breast Cancer Patient in her Forties
Although AC didn't have to take Tamoxifen she
took a whole host of other drugs as a result of her cancer ie
painkillers, anti-depressants, anti-nausea medication, medication
for constipation. She had five items each month, which at current
rates would cost £32.50 each month.
PJ, Ovarian Cancer Patient in her Sixties
She was given prescriptions to combat the side-effects
of her treatment. "It's unfair that you have to pay for medication
to counteract the side-effects of your treatment, it doesn't even
dawn on you that you may need to do that", she said.
Recommendation: Patients undergoing treatment
for cancer should be exempt from prescription charges for life-saving
cancer drugs or for drugs to control the debilitating side effects
of treatment. Terminally ill patients receiving palliative care
at home should also be exempt from prescription charges.
3.3 Television and telephone charges
3.3.1 Cancer patients who took part in the
focus groups conducted by Opinion Leader Research reported a range
of costs incurred by hospital in-patients, notably food and drink,
magazines, TV rental and telephone calls. Several participants
were "highly critical of the premium rate charged for calls
into the hospital to the bedside phone".[38]
Television rental and phone charges were among the most commonly
cited costs incurred by cancer patients according to benefit advisers
in our recent Access Denied report.[39]
The study explored benefit advisers" perceptions of the problems
faced by cancer patients in accessing disability benefits. In-depth
interviews were conducted with 17 cancer-specialist advisers who
work in Macmillan-funded advice services which provide advice
and support to over 10,000 cancer patients a year.
3.3.2 The following case studies illustrate
the impact of charges for phones, televisions and the Patientline
communications system (which combines telephone, television, email
and internet access).
PJ, Whose Sister had Bowel Cancer
PJ's sister was treated at St Thomas' in London.
PJ spent £53 in total calling her sister on Patientline and,
consequently, her monthly telephone bill more than doubled. It
cost 39p a minute off peak and 49p a minute at peak rate but as
she says "when someone is ill there is no peak or off peak".
For patients to call out the charge was 10p a minute while TV
rental cost her sister £3.50 for 24 hrs—but she would
only want to watch a couple of programmes so this worked out to
be very expensive. She says that her sister was in hospital for
three weeks and had no choice but to use Patientline. "It's
like grave robbing, they're making a profit out of other people's
misery", said PJ.
PW, Breast Cancer Patient in her Thirties
"[Patientline] cost me a fortune, but I
had to use it as I have a young daughter who I needed to keep
in contact with and make arrangements for". In relation to
TV charges she said "I had no choice but to pay to use the
TV. I was stuck in bed, it was difficult to move, and the TV was
the only entertainment. I never expected I'd have to pay for the
privilege"
AC, Breast Cancer Patient in her Forties
She had to pay a deposit for the TV and £5
a day hire. AC said that it "added up to quite a bit but
you don't really have much choice, you have to pass the time somehow".
3.3.3 Disability Living Allowance (DLA)
and Attendance Allowance (AA) are the main benefits for meeting
the extra costs of disability. However these benefits are withdrawn
for adults after 28 days spent in hospital—either in one
continuous spell or separate spells linked together by periods
of less than 28 days (the so-called "linking rule").
Currently, other social security benefits are downrated after
52 weeks though, as the Chancellor announced in the March 2005
Budget, the hospital downrating rules will be scrapped altogether
from April 2006 for all benefits except DLA and AA. In a 2003
parliamentary debate Maria Eagle MP, then Parliamentary Under-Secretary
of State for Work and Pensions, explained the rationale behind
the DLA/AA in-patient rules: "All in-patients' disability-related
needs are met by the national health service. That is where the
rule against overlapping provision comes in, and that is why DLA
and AA are withdrawn".[40]
However, as our evidence shows, in-patients incur a range of extra
costs including charges levied by NHS hospitals for phone and
television use. These are not frivolous types of expenditure but
essential to ensure the emotional well-being of patients undergoing
treatment for cancer.
Recommendation: The DLA and AA downrating rules
should be relaxed in recognition of the additional costs, including
phone and TV charges, incurred by hospital in-patients.
3.4 The hidden costs of travel
3.4.1 Although hospital travel costs may
not appear to be NHS charges, Macmillan believes that these hidden
treatment costs should also be regarded as co-payments. As we
have explained in para 3.1.5 above, cancer patients have no alternative
but to travel to hospital on a regular basis for treatment. The
delivery of chemotherapy and radiotherapy on an outpatient basis
means that cancer patients incur quite substantial travel costs
during their course of their treatment. Patients who took part
in the Opinion Leader Research focus groups spent £380 on
average on travel and parking charges with costs ranging from
£25 to £848.[41]
3.4.2 The NHS is making considerable savings
by delivering treatment on an outpatient or day surgery basis.
An influential NHS Modernisation Agency document which urged hospitals
to make day surgery rather than in-patient treatment the norm,
estimated that trusts could save £200 a day as a result.[42]
A hospital can therefore save £6,000 by delivering a six
week course of radiotherapy on an outpatient basis. Whilst we
are in favour of hospitals delivering treatment in more cost-effective
ways, this should not be achieved by shifting the financial burden
onto patients in the form of travel and parking charges. The NHS
is supposed to be free at the point of delivery and therefore
we strongly believe that these hidden costs of treatment should
not be borne by patients undergoing treatment for serious and
life-threatening diseases like cancer. We would like to see the
NHS take a more holistic approach to the issue of financial efficiency.
If hospitals are introducing new ways of delivering treatment
which free up in-patient beds, the financial implications for
patients should always be considered. In the case of outpatient
cancer treatment we would like to see some of the considerable
savings that trusts are making reinvested into helping patients
with travel costs.
Recommendation: All patients travelling to hospital
for regular cancer treatment should have their travel costs reimbursed
through the Hospital Travel Costs Scheme on a non-means tested
basis.
4. WHAT IS
THE OPTIMAL
LEVEL OF
CHARGES?
4.1 As we have said earlier, Macmillan believes
that parking charges and prescription charges for patients undergoing
cancer treatment are morally unjustifiable.
5. IS THE
SYSTEM OF
CHARGES SUFFICIENTLY
TRANSPARENT?
5.1 Hospital car parking charges appear
to be reasonably well advertised on hospital websites. However,
as our Free at the Point of Delivery? report shows, patients are
not being routinely informed about parking discounts or about
the Hospital Travel Costs Scheme (HTCS) under which parking charges
can be reimbursed for patients on benefits/low income (see para
7.1 below).
5.2 While prescription charges might be
reasonably transparent, patients are not always warned at the
start of their treatment that they might incur such expenses nor
are they routinely advised about pre-payment certificates, which
reduce the cost of repeat prescriptions as the following examples
illustrate:
PW, Breast Cancer Patient in her Thirties
She hasn't ever been told about pre-payment
certificates. She saw a sign in the chemist about it but doesn't
think it would be cost effective for her. She never expected that
she would have to pay for drugs after her treatment, she says
it's "extra money from my pocket, another extra expense when
cancer had already meant my income was reduced."
AC, Breast Cancer Patient in her Forties
Despite having to spend over £30 a month
on prescriptions she was never told about pre-payment certificates—she
found out about these herself. "It was really daunting to
fork out all this money when I was so ill", she said. She
was never told that she would have to pay for all of this medication
after she finished treatment.
5.3 Although Patientline leaflets detailing
the charges are available on hospital wards, relatives and carers
are not always warned about the cost to the caller of phoning
the patient in hospital. PW, a breast cancer patient in her thirties,
told us that relatives and friends "weren't aware that the
charges would be so high". PJ, whose sister had breast cancer,
said that each time she called the Patientline telephone system
there was an introduction of at least a minute before she could
dial the patient's extension which she could not skip. Often her
sister would turn her phone off as she felt too ill to speak and
did not want to be disturbed but there was no way for PJ to find
this out until she had got past the recorded message and dialled
the number, by which time the call may have cost £1 or more.
Recommendation: Before Treatment Commences Patients
should be Routinely Advised about the Range of Charges and Expenses
they are likely to Incur during the Course of their Treatment.
6. WHAT CRITERIA
SHOULD DETERMINE
WHO SHOULD
PAY AND
WHO SHOULD
BE EXEMPT?
6.1 Department of Health (DH) guidance on
car parking charges advises hospitals to "consider"
concessions for certain patient groups but does not specify which
patients should be granted concessions. [43]By
contrast, the equivalent Scottish Executive Health Department
guidance specifically suggests that "consideration should
be given to providing concessions to certain categories of patient
(for example "patients attending regularly for dialysis or
radiotherapy)".[44]
The consequence of the Department of Health's laissez faire approach
to parking charges in England is a postcode lottery of charges
and local concessions. A reanalysis of our hospital audit data
found that only four in 10 hospitals (42%) with cancer centres
provide free parking for certain cancer patients.[45]
Appendix 2 illustrates the variations in practice.
Recommendation: Macmillan recommends that Department
of Health guidance on parking should be more prescriptive and
should instruct hospitals to offer exemptions to specified groups
of patients, including cancer patients who regularly travel to
hospital.
6.2 The current system of medical exemptions
from prescription charges, which was drawn up in 1968, is outdated
and riddled with anomalies. 30 years ago cancer patients were
much more likely to be treated in hospital and die from the disease.
Consequently, prescription charges were not such a big issue for
cancer patients. Today, as a result of more effective treatments,
improved survival rates and the shift from in-patient to outpatient
treatment, cancer patients increasingly find themselves liable
for prescription charges often for long periods of time. This
trend is set to continue as oral chemotherapy becomes more widely
employed. Patients can purchase pre-payment certificates and may
be eligible for free prescriptions if they are in receipt of certain
means-tested benefits or if they satisfy the NHS Low Income Scheme
means test. However, Macmillan wants cancer patients to be eligible
for free prescriptions without having to undergo a means test.
As we have argued earlier, cancer patients should not have to
pay for cancer drugs or drugs and treatments to control symptoms.
7. HOW SHOULD
RELEVANT PATIENTS
BE MADE
MORE AWARE
OF THEIR
ELIGIBILITY FOR
EXEMPTION?
7.1 Department of Health guidance to hospital
trusts specifically states that "notices about the HTCS should
be displayed in all patient areas" and that "provider
units should ensure that they provide details of the HTCS and
of local transport and concessionary fare arrangements with appointment
or admission letters".[46]
However our hospital audit shows that this guidance is not being
implemented. We asked cancer nurses and information postholders
in cancer centres/units how the HTCS and local parking concessions
were promoted in their hospitals and found that:
Promotion of HTCS
— 48% of health professionals in England
either did not know how the scheme was promoted or else said it
was not promoted;
— Only one in five respondents in England
(19%) said that their hospital was promoting the scheme through
posters, website, appointment letters or at first appointment;
— 34% of respondents in England said
that patients were informed by word of mouth alone;
— Only 7% of respondents who knew if
the HTCS was being promoted (UK-wide) said it was advertised in
appointment letters, while 21% said it was promoted through posters.
Promotion of Parking Discounts
— Parking concessions varied from hospital
to hospital—some hospitals provided free parking for cancer
patients while others offered discounted rates;
— Only 9% of hospitals promote parking
discounts by leaflets and less than one in five (18%) promoted
through posters. The most common method of promoting parking discounts
for cancer patients was word of mouth;
— Hospitals do not always promote parking
discounts. As one respondent told us "In theory there's a
service people can apply for to get parking for £3 a day,
but in reality it's not openly offered, advertised or discussed".
7.2 A 2001 Audit Commission report found
that the Hospital Travel Costs Scheme (HTCS) was not well publicised.[47]
Four years since that report was published it is clear that little
progress has been made and that some hospitals are deliberately
not advertising the scheme. One respondent told us that "Transport
and parking issues are not highlighted to patients because the
area is too problematic". Another said that her hospital
did not promote the HTCS because too many patients would claim
travel costs and the hospital did not have sufficient funds to
cover this (even though Primary Care Trusts reimburse hospitals
for HTCS expenditure). It is unacceptable that some hospitals,
either deliberately or through omission, are not advising patients
of their statutory entitlement to financial help under the HTCS.
Recommendation: Macmillan Believes that Compliance
with Departmental Guidance on HTCS should be seen as a "Must-Do"
Requirement and not an Optional Extra. All Hospital Trusts should
be routinely Informing Patients about HTCS and Local Parking Concessions
through Posters and Appointment Letters. We urge the Committee
to ask the Department of Health to outline the Action it intends
to take to ensure that Trusts Comply with this Guidance.
7.2 We would also like to know what progress
the Department of Health is making in implementing the recommendations
in the 2003 Social Exclusion Unit report Making the Connections.[48]
The SEU recommended that the Department of Health should develop
options to provide information and advice on getting to healthcare
facilities and book transport where appropriate. One idea floated
by the SEU was the development of a "one-stop shop"
service which would provide advice to patients on transport options
and arrange patient transport. However, to date, we have seen
no evidence that the Department has acted on this recommendation.
7.3 Macmillan wants a much more systematic
approach to advising patients about the full range of concessions
and benefits to which they might be entitled. The NHS is very
poor at informing patients about financial concessions and benefits.
A recent National Audit Office report found that 77% of cancer
patients were not given information about financial benefits.[49]
However, simply giving patients written information is not sufficient.
Patients also need help to interpret complex information about
benefits and concessions and support to negotiate the benefits
maze.
Recommendation: Macmillan wants to see all Cancer
Patients offered Specialist Benefit Advice at Diagnosis and at
Key Points in the Patient Journey. Referral Mechanisms should
be built into Care Pathways so that Patients are given Advice
about the Right Benefits and Concessions at the Right Time.
8. SHOULD CHARGES
BE ABOLISHED?
8.1 Macmillan's primary concern is to ensure
that cancer patients do not have to pay for the "privilege"
of undergoing cancer treatment. Therefore we support any reform
which means that cancer patients do not have to pay for travel,
parking charges or prescriptions.
8.2 It could be argued that foregoing revenue
from car park charges means redirecting money away from other
front line hospital services. We think this argument is disingenuous.
Firstly, we believe that the failure to consider the impact of
charges on repeat visitors amounts to poor planning. Secondly,
as we have said earlier 42% of hospitals with cancer centres provide
free car parking for certain cancer patients. If these hospitals
can provide front line services without having to levy parking
charges on cancer patients then we can see no good reason why
all other hospitals cannot do the same.
9. CONCLUSION
9.1. Macmillan believes that an investigation
of the punitive impact of NHS charges and co-payments is long
overdue. We would like to give oral evidence to the Committee.
Considered in isolation each charge or co-payment may not appear
particularly onerous, but when these costs are added up the financial
impact of cancer on patients' lives can be very substantial. Moreover,
many patients find themselves having to meet these additional
costs at precisely the same time that household income may be
depleted through loss of earnings. In a recent Macmillan survey
one in four breast cancer patients said they had to cut back on
food shopping or bought cheaper food (28%).[50]
A recent survey by CancerBACUP found that 39% of working age cancer
patients had experienced "significant financial difficulties'
as a result of cancer.[51]
NHS charges and co-payments represent a significant component
of these additional costs and it is vital that action is taken
to relieve the financial burden on cancer patients.
Duleep Allirajah
Senior Policy Analyst
Macmillan Cancer Relief
December 2005
29 Macmillan survey of CancerVOICES network (2003-unpublished).
CancerVOICES is a network of people affected by cancer that is
supported by Macmillan. Back
30
Health Service Journal Special Report, No walk in the park:
how trusts manage their car parking, 16 September 2004. Back
31
House of Commons Written Answers, 28 April 2003, Col 278W. Back
32
Allirajah D, Herbst K, Morgan L, Free at the Point of Delivery?
Exposing the hidden cost of hospital travel and parking for cancer
patients, Macmillan Cancer Relief in association with Dr Foster
Ltd (2005). Back
33
Opinion Leader Research (June 2005), Macmillan Cancer Relief
Better Deal Costs. The findings from this study were published
in Allirajah et al Free at the Point of Delivery? (2005). Back
34
Department for Transport (DfT), Accessibility of local services
and facilities (2002). Back
35
Macmillan survey of CancerVOICES network (2003-unpublished). Back
36
Can you afford to have breast cancer? Macmillan Cancer
Relief press release, 26 October 2005. Back
37
Opinion Leader Research (June 2005), Macmillan Cancer Relief
Better Deal Costs. The findings from this study were published
in Allirajah et al Free at the Point of Delivery? (2005). Back
38
Opinion Leader Research (June 2005), Macmillan Cancer Relief
Better Deal Costs. The findings from this study were published
in Allirajah et al Free at the Point of Delivery? (2005). Back
39
Miller S, Access Denied: Benefits advisers' perceptions of
the problems cancer patients face when claiming Disability Living
Allowance and Attendance Allowance, Macmillan Cancer Relief
(2005). Back
40
House of Commons Hansard, 25 March 2003, Col 27WH. Back
41
Opinion Leader Research (June 2005), Macmillan Cancer Relief
Better Deal Costs. The findings from this study were published
in Allirajah et al Free at the Point of Delivery? (2005). Back
42
NHS Modernisation Agency, 10 High Impact Changes for service
improvement and delivery: a guide for NHS leaders (September
2004). Back
43
Department of Health, Income Generation-Car parking charges:
A guide to implementation (1996). Back
44
Scottish Executive Health Department, Guidance on hospital
car park charging, NHS HDL(2004) (April 2004). Back
45
In November 2005 Macmillan re-analysed the hospital audit data
and found that 18 out of 42 hospitals with cancer centres (42%)
provide free parking for radiotherapy or chemotherapy patients
or both. Back
46
18 Department of Health, The hospital travel costs scheme
(published on the DH website). Back
47
See Audit Commission, Going Places: Taking people to and from
education, social services and healthcare (2001) and NACAB,
Unhealthy Charges: CAB evidence on the impact of health charges
(2001). Back
48
Social Exclusion Unit, Making the Connections: Final Report
on Transport and Social Exclusion 2003. Back
49
National Audit Office, Tackling Cancer: Improving the Patient
Journey February 2005. Back
50
Can you afford to have breast cancer? Macmillan Cancer Relief
press release, 26 October 2005. Back
51
CancerBACUP, Work and Cancer: How cancer affects working lives
(2005). Back
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