Committee publication · Correspondence · 4 June 2026

Correspondence to and from Community Transport Association, following the 22 April evidence session on Cross-border healthcare arrangements between England and Wales

Inquiry: Cross-border healthcare arrangements between England and Wales

Summary

Following the Welsh Affairs Committee's 22 April evidence session on cross-border healthcare, the Community Transport Association (CTA) submitted written evidence and a detailed briefing on fuel price impacts. CTA's survey of 57 operators shows rising demand for cross-border health transport (particularly Wales to England), escalating fuel costs threatening volunteer driver retention, and financial pressures forcing operators to absorb losses or consider service cuts within 3–6 months unless intervention occurs.

Key findings

57% of CTA member operators actively deliver cross-border health transport; demand is growing significantly, especially for specialist appointments (oncology, renal, orthopaedics) from Welsh communities to English hospitals in Liverpool, Birmingham, Bristol, and Worcester.
78% of surveyed organisations report increased fuel costs; only 4% can sustain services beyond six months without raising fares; 26% report financial uncertainty about service viability.
HMRC Approved Mileage Allowance Payment (AMAP) rate unchanged at 45p per mile since 2011; RAC Foundation analysis indicates it should be 66p; volunteer drivers are withdrawing due to out-of-pocket costs, creating structural risk to service capacity.
Wales Ambulance Service Trust (WAST) cancels 600+ NEPT trips monthly with 24 hours' notice; NEPT eligibility in Wales has tightened, increasing demand on community transport; English NEPT coverage for Welsh patients is not guaranteed.
Hospital parking in England incurs charges (reimbursed to drivers) versus free parking in Wales; lack of accessible bays and waiting areas creates operational friction, particularly for volunteer drivers.

Recommendations

Welsh Government should urgently advocate to HM Treasury for HMRC AMAP rate review to include volunteers, recognising the 2011 rate no longer reflects real operating costs and is driving volunteer withdrawal.
Introduce a time-limited Community Transport Stabilisation Fund (additional to Bus Services Support Grant) to support operators facing immediate fuel-related financial pressure and service reduction risk.
Formally include community transport in UK fuel resilience and civil contingency planning frameworks, with priority fuel access arrangements during supply disruption.

Tone

Critical

Topics

cross-border-healthcarepublic-transportvolunteer-workforcerural-accessfuel-costs

Key actors

Ruth Jones MP, Gemma Lelliott, Community Transport Association (CTA), Welsh Affairs Committee, Wales Ambulance Service Trust (WAST), HM Treasury, Rachel Reeves MP, Aneurin Bevan University Health Board

Notable line

“Community transport organisations across Wales are facing a fuel cost crisis that is eroding financial reserves, threatening volunteer retention, and driving service reductions that disproportionately affect some of the most vulnerable members of society.”

Key Quotes

“I would like to take this opportunity to say how useful the evidence you gave us was for our inquiry, and how interesting the Committee found the session.”
— Ruth Jones MP · Thank you letter following 22 April evidence session

“Cross-border health transport is a significant and growing area of need for patients, leading to increased demand on the Community Transport sector.”
— Gemma Lelliott · Executive summary of CTA's written evidence

“Most of this demand is currently being met by volunteers, an almost invisible workforce that is directly enabling health and wellbeing for patients in Wales and England, that is under increasing pressure.”
— Community Transport Association · On volunteer reliance in cross-border health transport

“This is simply unaffordable for most people, and due to the very low numbers of accessible taxis, also very difficult to secure, especially at a time that meets patients' needs.”
— Community Transport Association · On taxi costs for cross-border journeys; average one-way journey of 18.3 miles costs £67 in Monmouthshire

“The Welsh Affairs Committee should push the UK Government to ensure the AMAP review includes volunteers as well as paid staff, both because there are some 1.7 million volunteers in transport across the UK who deserve a fair deal …”
— Community Transport Association · On AMAP rate review and volunteer fairness

“"Our drivers use their own vehicles and claim the normal 45p per mile to transport clients to hospital appointments, unfortunately a few drivers have not been willing to volunteer their time this month due Impact of Fuel Price Rises on Community Transport | May 2026 Page | 6 to increased fuel prices …”
— Community Transport operator (survey respondent) · Impact of AMAP rate inadequacy on volunteer retention

“The current fuel price crisis, if not addressed, risks eliminating a significant portion of this provision with consequences that will extend far beyond the transport sector itself, into health, social care, and the wellbeing of some of the most isolated communities in the country.”
— Community Transport Association · Conclusion on consequences of inaction

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Source · parliament.uk record ↗