1. Patient transfer

A considerable number of people from the Isle of Man, who have complex medical conditions, require specialist treatment not available on the island. We understand that there will be an increase in the need for patient transfer in the future. Patients travelling for routine check-ups are relatively well and so the normal airport/ferry facilities are adequate. There are also patients who are not at all well, who have specific needs yet do not require the air ambulance and therefore need to travel through the airport/ferry terminal and onto scheduled flights/sailings alongside happy healthy holiday makers/business people.

A half hour flight to/from Liverpool may seem insignificant to some but when a person has no option but to travel when feeling so ill, it is believed that a much greater level of comfort and care should be provided, particularly through the airport/ferry terminal and on flights/sailings. It should also be acknowledged that patients undergoing prolonged treatments and/or facing frightening surgery deserve a much higher level of comfort and care than currently provided.

2. Medical passport

Following research and various meetings, it has been agreed that a medical passport is essential for the improvement of patient transfers. This would also be helpful when patients book normal flights/sailings. A simple document could be made available for selected passengers, to be signed by a registered medical practitioner authorising the request.

Information required:

Name: Select passenger and travel companion

NHS number

Passenger requirements (tick appropriate boxes)

  • Airport/ferry arrival drop off (extended drop off time) Wheelchair
  • Fast-track check-in
  • Specified in-flight/on-board seating
  • Fast-track through security
  • Airport/ferry terminal waiting area with comfortable seating
  • Access to a private room for peg feeding and other medical needs
  • Oxygen tanks
  • Buggy etc. not to be dismantled

For transfers (Bridgewater)

  • Direct airport/hospital transfer
  • For the return journey (accepting the above for all airports)
    In-flight/on board cabin support (passenger awareness)

Name of destination hospital

The above document would be submitted to patient transfer at the time of flight/ferry booking and a ‘select passenger’ identification reference would be included on the check-in documents. It has been suggested that a ‘scan-able’ wristband could be issued by patient transfer.

Advice for patients in case of delays/cancellations

At the time of booking, patients should be advised that medication and medical supplies such as peg feeds, colostomy bags etc. should be carried in hand luggage for use when there are flight delays or cancellations. Special sealed carriers could be provided for use through security/on-board for peg feeds, etc. Hospitals should be aware that flights can often be delayed and help patients to be prepared with emergency medical supplies for use in such instances.

3. Air Travel from the Isle of Man to UK airports

Flights are efficiently arranged through patient transfer but the patient experience could be greatly improved with the introduction of the medical passport.

It is clear that a simple improvement for patients at Ronaldsway airport would be a subtly screened- off area with a variety of comfortable seats to suit patients’ needs. A customer services telephone, good Wi-Fi connection, water cooler and phone charging plugs would also benefit patients. A direct telephone to a patient transfer representative is required within Ronaldsway for use in case of flight delays and cancellations. This would need to be available out of office hours when it is most likely to be needed.

The goal would be to provide patients and their travelling companion with an outstanding level of care and service from their arrival at Ronaldsway Airport, until safely back on the Isle of Man.

It has been suggested that workshops could be held for airport staff where patients could share experiences to explain how customer service at the airport could be improved.

4. Suggested procedure from Ronaldsway Airport

a) Arrival

On arrival at Ronaldsway Airport, the medical passport could be shown to the airport police if required, allowing more time for drop-off. Not every ‘select’ passenger will need a wheelchair but they could benefit from a little more time and a little less stress by not being moved along so quickly by the airport police.

b) Check-in

‘Select’ passengers should not be expected to join long queues at check-in; rather they could use the fast check-in lane. A code on the ticket would advise check-in staff that additional consideration should be given as to where the passenger would choose to sit. Often, certain seats on the plane can be ‘blocked’. Under special circumstances, these can be made available on request, however not everyone is aware of this. Having to travel with a complex medical condition creates additional stress so anything that can be done to alleviate this is a benefit. Having a patient transfer coordinator present, especially at times of busy flights, would be a support to anxious patients.

c) Fast-track security

The code on the ticket could be clearly marked on boarding cards, to notify the staff member at the entrance to security that the ‘select’ passenger and companion should go through the ‘fast-track’ lane. Currently patients must walk passed the fast track security door to join the often slow security queue unless they choose/need to be assisted. Not all patients require or want to be assisted however given the fairly unique position of patients on the Isle of Man, and their need to fly for treatment such as chemotherapy/during times of illness, surely fast-track for these patients is essential.

d) Departure lounge

Once in the departure lounge, a dedicated seating area should be provided. This area needs to include a variety of seating, particularly important at times of flight delays as some passengers will be in pain, feeling unwell or be exhausted. The seating area should provide a quiet, calm environment, which is comfortable and welcoming with plants or a partition to give a level of privacy without giving a claustrophobic, ‘boxed-off’ feeling. As previously suggested, a customer services telephone, good Wi-Fi connection, water cooler and phone charging plugs would also be beneficial within this area. A direct line to a patient transfer representative should also be provided.

e) Private room

A private room for the use of patients would be invaluable as they can be travelling to or returning from treatment and can still be extremely unwell. Through research, it has been highlighted that some patients need to use medical equipment or peg feed and the alternatives are to use a public seating area or the toilets. This is both embarrassing and undignified and can often be very challenging, especially in the case of flight delays.

f) Boarding

Once the flight is ready for boarding, ‘select’ passengers could be given the opportunity to board the plane before other passengers. However, this should be the choice of the individual as some patients may prefer less time spent on the actual flight and so should be allowed the option of waiting to board after other passengers. We do recognise that those requiring transfer to the plane while in their wheelchair need to be boarded first.

g) In-flight

If a passenger becomes ill and it is necessary to use a sick bag, airline staff must have a strict code of conduct and method of disposal. This is vitally important when cancer patients are returning from chemotherapy treatment. Not only is it common courtesy but also a matter of safety to all. Through research we are aware that at present patients or their companions are expected to take the bag with its contents off the plane to dispose of within the airport. This is completely unacceptable.

h) Arrivals at UK airports & transfers to UK hospitals

Upon arrival at the destination airport, in particular Liverpool and Manchester, there should be seating provided within the baggage hall for ‘select’ patients to await the arrival of baggage.

Once in the arrivals hall, patients should be met in an area with sufficient seating. Transfers to hospitals are very well managed but there should be a more discrete collection policy as patient confidentiality and data protection is overlooked at present.

Consideration should be given to avoid very poorly patients having to endure a trip to several hospitals en-route to their destination. This is particularly important on the return journey when patients may be feeling very unwell following surgery or chemotherapy. The roads around and within hospital grounds have many speed bumps, which can cause nausea even in healthy individuals.

5. Previous attempts to resolve issues at Ronaldsway Airport

In early 2014, prior to the formation of Bridge the Gap (BtG), a founder member of BtG made an approach to Ronaldsway Airport Management representatives, in an attempt to resolve some of the issues highlighted above. At first there appeared to be an acknowledgment that improvements were needed but in later emails, the Airport Management representative considered that adequate service is available for all patients travelling through Ronaldsway Airport.

a) Special assistance/fast-track/comfortable seating

In an email received on 16th May 2014, an Airport Management representative advised that ‘Ronaldsway has a formal (airport universal) process of assistance for passengers’ and that in their opinion ‘there is not the need, nor passenger numbers, to set up another process’.

BtG would suggest that, due to the numbers of patients travelling off island for surgery and other treatments, there is, without doubt, the need for another process. It is hoped that statistics can be obtained by Travel Watch to qualify the need.

The email continued, ‘We have a formal policy for looking after passengers at the Airport who need assistance (often known within the airlines as PRM service, i.e. passengers with reduced mobility). This is for all types of passenger who need some form of assistance, including for example, pregnant passengers, cancer patients, amputees, elderly passengers etc. i.e. not just wheelchair users etc.

The key area for us for the seating of these passengers who need assistance is landside – this is the place where there is the most amount of waiting’.

The seating area for passengers needing assistance (photographs at end of document) offers no privacy or comfortable seating. Not all patients who need a wheelchair for long distances are unable to transfer into comfortable seating while waiting for a flight, however the seats in this area do not have armrests and are quite low and so unsuitable for this.

The email continued, ‘the amount of time spent in Departures should be minimal. So, as passengers with assistance are normally boarded first, those passengers are taken from the specified landside seating area, assisted through Central Search into Departures and onto the aircraft, almost without stopping in the process of going landside to airside.’

Research by BtG has shown that this procedure is not in the best interest of all patients needing to travel. Many patients would prefer to transfer through security to departures in their own time, enabling them to purchase drinks to take onto the flight (as these cannot be taken through security) as well as giving them time to make use of the public conveniences immediately prior to boarding the flight. One patient said, ‘we just want to keep things as normal as possible’.

The email continued, ‘I am sorry that we are not able to offer a fast track through Security other than for the PRM assistance process currently in place. The PRM passengers are escorted from landside to the aircraft – and their escort provides not only the assistance to the passenger but also has a security pass with which they need to take the PRM passenger through to Central Search.

Other than a 40 minute peak in the evenings, our security lines are quite fast moving (as compared to other airports).

Unless the patients have an escort, which is provided under the formal PRM service, there is no means of a) getting the passenger through the relevant door to the Central Search, and b) no means of identifying that the patient is a patient and not an impatient passenger just looking for a short cut’.

BtG would propose that the suggested medical passport and ‘scan-able’ wristband would address these points.

The above email continued: ‘We did have one airline who asked us to put in a fast track line through central search, however it was felt that this would just upset other passenger in the line and also that there was not often in the day the need to have a fast track system’.

The fast-track system being suggested is not for the general public but for ill patients.

Perhaps to someone who has not experienced travelling while unwell, the queue through security may not necessitate a ‘fast-track’ but for patients identified by BtG, a ‘fast-track’ would greatly reduce the stress of travelling.

b) Comfortable seating in the departure lounge

It had been pointed out to the Airport Management representatives that there is no comfortable seating within the airport for very ill patients or those needing back support for example. The BtG representative was told that ‘a couple of chairs’ would be considered air side, however there would be no means other than signage to manage these chairs. In an email, the BtG representative was advised that there are, ‘no staff based within Departures, who could keep an eye on the seats’, which highlights the next issue which needs to be addressed.

c) Lack of staff in departures – a patient experience, which highlights the need for immediate improvements

Due to a strict cancer treatment regime, one patient had to leave the island to start treatment the following day. The flight to Liverpool had been delayed several times and was eventually cancelled, this at the same time as the Manchester flight was called for boarding. It was crucial that the patient be transferred to the Manchester flight and then travel to Liverpool by taxi. There were no staff available within departures that could help and this is where a customer services telephone for patients is crucial. In the absence of a telephone, the travelling companion was told at security that they would have to return to check-in (landside) to discuss this and would then have to come back through the security queue. All of this would take too much time and the Manchester flight would have departed. The patient would also have been left alone in departures at a very distressing time. By providing a designated seating area within departures, together with a phone for emergencies such as this, the distress caused could easily have been avoided.

Unfortunately, as of September 2016, there appear to be no improvements.

6. Air travel from UK Airports

On return journeys, patients may have experienced debilitating treatment, surgical procedures and be dependent on regular medication and medical care. The medical passport needs to be recognised by UK airports and all necessary information included on the ‘return document’.

a) Air travel from Liverpool Airport

Further issues have been identified by patients of all ages, disabilities and differing needs on their return from Liverpool.

Security

Wheelchair patients are fast-tracked however chair/body searches are very public and distressing. For able-bodied patients (some on crutches), long queues can be very exhausting and can increase pain and discomfort. All patients with a medical passport should be fast-tracked through security and always treated with the utmost respect.

Seating

The main waiting area is now limited to bench seating with no backrest. Chair type seating should be reinstated.

Departure gate procedure

Passengers are usually called to the departure gate even though the aircraft has not arrived at the stand. The departure area has very limited seating and on occasions waiting time has been in excess of one hour. This has resulted in weary patients having no alternative than to sit on the floor, experiencing discomfort, distress, and embarrassment. It must be recognised that this is absolutely unacceptable, particularly with regards to hygiene. These areas must have a high standard of hygiene, which is not always the case.

Flights have been called for boarding only to be delayed, with patients again waiting up to half an hour on the iron staircase. This is not ideal for any passenger but unacceptable for patients. Patients should be allowed to wait at the seating area until they are definitely able to board.

Check-in staff/flight delays/cancellations

BtG understands that each IOM flight has a check-in staff of two. On at least one occasion a flight was cancelled and an overnight stay at Liverpool airport required. Having boarded the aircraft it was necessary for all passengers, regardless of disability, to return to the airport services desk in departures to be allocated a flight for the following day and to arrange accommodation.

Those at the rear of the queue were unaware of what was happening. Patients, the elderly and children should have been given priority – this was not the case. There were not enough seats on the flight the following day and ten passengers had to be transferred at 6am the following morning to Manchester. This should not be seen as acceptable.

There are regular flight delays, often without explanation and with no means of contacting ground staff for information. BtG would recommend that a flight information/helpline telephone be available at the gate area.

When flights are cancelled, priority must be given to patients when new flights are being arranged. The list of passengers on the flight should highlight those who are patients (just as it currently does for those needing special assistance) and these patients should be called to the front of the queue.

b) Air travel from Manchester Airport

As with Liverpool airport, similar distressing scenarios have been reported to BtG and demonstrate that a standard procedure for all Isle of Man residents with medical conditions needing treatment in the UK, require a medical passport that guarantees a high level of patient care and service.

Disembarkation in Manchester

It is understood that at Manchester Airport, on several occasions, a wheelchair passenger has been carried from the plane in the emergency evacuation chair and then transferred back to a wheelchair once off the plane. This would appear to be completely unacceptable; surely the correct loading equipment as used when boarding in the Isle of Man should be used.

7. Sea Travel to and from Douglas with the Steam Packet

Information has been received via the Bridge the Gap website questionnaire regarding issues with patient transfer by boat.

a) Early boarding and reserved seating

From this research, it is clear that patients and families can become distressed when facing several hours of travel. An early boarding system would allow time for patients to settle in a seating area where there is privacy and near to the disabled toilet.

One young patient has a large, powered wheelchair from which he is unable to transfer. It is very difficult to find a seating area where he is not blocking an aisle, where he is not constantly bumped into or where he doesn’t have to move to allow people to pass. This makes for an unpleasant and uncomfortable journey. BtG have contacted the Steam Packet to arrange reserved seating in requested seats. This made for a much less stressful outward-bound sailing but unfortunately, due to a communication error, the seats were not reserved on the return trip. It seems that staff are more than willing to help and offer an excellent level of care but the needs of the patient must be successfully communicated or the disappointment can add further distress. Perhaps contact could be arranged directly between patients/patient transfer with the customer service team on the vessel rather than the central reservations.

b) Private area

A private, quiet area for patient transfers would be invaluable as often patients are travelling to or returning from treatment and can still be unwell. On the Mannanan, there is no quiet area that is accessible via powered wheelchair. On the Ben My Chree, cabins are only available through patient transfer under certain circumstances, subject to availability, and can only be reserved if the booking is made more than 24 hours in advance.

It has been highlighted that some patients need to use medical equipment or possibly peg feed etc. and the alternatives are to use a public seating area or the toilets. This is both embarrassing and undignified and can often be very challenging.

c) Cabins on the Ben My Chree

On the Ben My Chree, there are cabins available for patients recognised as requiring a cabin. The patient passport could highlight those patients who should automatically have access to a cabin.

It should be recognised that not all patients needing urgent hospital treatment are able to transfer to UK hospitals by plane and instead can face a gruelling sea and road journey for treatment. These sailings, as well as less urgent trips, can be last minute bookings. It is understood that a cabin has to be booked more than 12 hours in advance, in which case direct communication with the customer service team on the vessel is seen as essential, given that a last minute booking would indicate an even greater need for the patient to have the use of a cabin. The same would apply to a return trip, as most patients wish to return to the island as soon as permission for discharge is given.

d) Suggested survey

Perhaps the Steam Packet customer service desk could carry out a survey to determine whether the general public who have booked a cabin would be willing to give up their reserved cabin, should a patient be in need of the facility when travelling to or from hospital. This is something that should be considered.

e) Accessible cabins

It should be noted that even within the accessible cabin there is very little space for a patient who is unable to transfer from their wheelchair and perhaps this could be considered during future refurbishments.

f) Assistance

While staff on the ferries are helpful and try to ensure boarding and unloading are stress-free, patients have had to constantly make themselves known to staff that they require certain allowances when boarding with the car i.e. extra room at the rear of the vehicle for wheelchair access and with easy access to the lift. This could be avoided by the introduction of the medical passport and notes on the travel documents.

g) Sailings to Liverpool

The ferry service to Liverpool has been reduced over the last few years and as most patients access hospitals in Liverpool, this can cause problems. Travelling via ferry to Heysham for four hours and then having a two-hour drive from Heysham to Liverpool is not ideal. This has been highlighted by the family of a young person with a muscular problem, who must travel feeling very unwell and in a wheelchair from which he is unable to transfer.

h) Need for improvement when travelling as a foot passenger in a wheelchair – patient experience

‘On occasions we have had to travel as foot passengers and this has been particularly horrendous. Without a vehicle to get on board you have to access a mini bus. This is not adapted for wheelchairs. This meant that we were left standing on the dockside, in the cold with a young man who had just been discharged from hospital, for approximately 40 minutes while staff tried to figure something out. They called a taxi eventually which when it arrived was also not wheelchair accessible and this meant after almost one hour we had to walk with the young person in his wheelchair down very steep ramps and up the car ramp etc. to gain access to the boat.’

Summary

There have been many similar patient transfer scenarios to those included in this document and it is likely there will be more until matters are addressed.

Perhaps adult patients may cope with a long day of discomfort and are not so easily embarrassed when faced with indignities. However, for teenagers and young people, it should be enough that they undergo painful and debilitating medical treatment without feeling that they are on show and being stared at when travelling for medical treatment. There is no doubt this also adds additional upset and stress for parents who need all possible support.

The priorities for Bridge the Gap are:

  •   Improvements as suggested to the Isle of Man airport procedures and facilities
  •   A direct telephone to connect with a patient transfer representative, including out of hours
  •  Advance delay notification for both air and sea travel
  •  Implementation of a Medical Passport
  •  Improvements at the Steam Packet to include guaranteed reserved seating and reserved cabins, particularly when sailings are booked within 24 hours of travel, as well as additional awareness of patient needs on board the vessels if   requested
  •  Improvements to Liverpool and Manchester Airport procedures and facilities, in particular extra seating as suggestedThroughout this document, the emphasis is on quality of patient care, confidentiality and on ensuring a VIP service for those who must travel off island while extremely ill. The aim is to make this a much more bearable experience.Some of the suggested improvements involve various agencies and it is appreciated that these changes may take some time. However, other improvements, such as those suggested at Ronaldsway Airport, are long overdue and should be implemented as soon as possible. We have already been approached by local businesses, keen to be involved in sponsoring such improvements.Bridge the Gap seeks the support of Isle of Man Travel Watch in the quest to greatly improve the experiences of patients when transferring to UK hospitals, in the areas identified, particularly for teenagers and young people with complex medical needs.Compiled and evidence gathered by Trustees of Bridge the Gap. Updated following consultation with the Council of Voluntary Organisations (CVO) and representatives from Patient Transfer.
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