ABSTRACT
For some patients, clustering can yield accessibility benefits since in any one visit, they may make use of a range of specialist facilities. The analysis suggested that access costs fell into three categories: costs to the NHS of providing ambulance and car services, travel costs incurred by patients/relatives and visitors and clinical costs, incurred by the time and discomfort of travel to hospital or by any reduction in utilisation which access costs in the wide sense may impose. This chapter attempts to identify the significance of each of these for the structure of hospital provision. It is becoming standard practice in the UK for ambulance crews to be trained in a number of procedures designed to improve the injured person's survival chances. In general the clinical effects of long-distance transfer or of the costs – including, in the case of inter-hospital transfer, an accompanying doctor – of doing so are poorly evidenced.
