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Time for the NHS to get on board Total Transport

Source: PSE Jun/Jul 17

At a time of stretched funds, it’s time the NHS stops dragging its feet on council-backed Total Transport pilots, argues Jonathan Bray, director of Urban Transport Group.

Stand on any street corner and it won’t be too long before some form of public sector-funded collective transport vehicle passes by. Be it regular public transport or be it connected to healthcare, social services or education. 

Yet these different services are orchestrated by different bureaucracies, different funding streams, different vehicle fleets and sometimes generate different profit streams. At a time when public funding is stretched, an observer from another planet would say: why on Earth would you waste public money in this way? Hence the recent enthusiasm for Total Transport pilots, designed to realise savings and synergies by combining vehicle fleets, budgets, bureaucracies – or some combination of all three. 

However, some of these pilots are being held back, or are even grinding to a halt, because of the lack of interest and real commitment from the NHS in putting non-emergency patient transport services into the Total Transport pot. It’s not as if the NHS in general is particularly good at non-emergency patient transport. All too often it’s a high-cost service, with inappropriate vehicles providing an inflexible, unreliable and inconsistent service to those who rely on it. For example, a survey in London found that 37% of those surveyed had missed an appointment because of patient transport services. 

As well as the stress and angst that must have caused the patients concerned, here is a service that has one job to do (get patients to appointments on time) and manages to fail to do so on a regular basis. And with the cost to the NHS of missed appointments estimated to be £750m a year, the failure of the NHS’s own bespoke transport operation costs the health service money it could be using to get on with the job it really likes doing, which is fixing people. 

We ran some maths on this, as part of a recent report we produced with the Community Transport Association (supported by the Association of Transport Coordinating Officers), which found that if by providing patient transport in a more efficient way we could prevent just 10% of the 5.6 million missed hospital appointments every year, then that would pay for 83 new MRI scanners (£895,000 each), or 8,793 heart bypass treatments (£8,470 each), or 13,252 hip replacement treatments (£5,620 per treatment). 

There are some working examples that show what’s possible. For example, West Berkshire Council is now providing accessible minibuses from its in-house fleet and trained driver resource to and from hospitals and other healthcare facilities in Berkshire, Oxfordshire and Swindon as a sub-contractor to the South Central Ambulance Service NHS Foundation Trust. This initiative has ensured that those using the service are able to attend appointments at diverse healthcare facilities in West Berkshire and its environs. In doing so, it has also led to much better utilisation of the council’s own vehicle fleet in the lull between its peak-time use for social care and schools transport. 

Or take Devon County Council, which has expanded the remit of its in-house transport co-ordination service (which manages public transport support, education and social services transport as well as its in-house fleet) to include non-emergency patient transport. The service now also assesses eligibility for patient transport and signposts non-eligible patients to other ways of getting to appointments. 

And that’s why all the excuses for foot-dragging we have seen so far from the NHS more widely on the pilots aren’t enough to excuse the inactivity. Health people like fixing people (for example, there is no culture in the NHS of organising anybody’s appointments with an eye to how people might get to the appointment) and transport people like fixing transport problems. So why not let transport people see if they can do a better job? The NHS can get on with doing what it’s good at, patients won’t have to worry so much about how they get to those vital medical appointments, and ambulances can make the best use of all that expensive equipment and on-board expertise to deal with real emergencies – rather than acting as massively over-specified taxis. 

Hopefully the report we have produced, with our friends at the Community Transport Association, provides the ammo that the Treasury and Department for Transport need to chivvy the Department of Health into putting some flashing blue lights on an idea that could bring benefits and savings across sectors and to real people in need.


To read the ‘Total Transport’ report, visit:



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