Is transport the cure-all that the NHS needs?

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Greater Manchester’s Cycling and Walking Commissioner Chris Boardman was recently quoted as saying “Pick a crisis: congestion, obesity, inequality, air pollution, global warming, safety…Investing in cycling and walking is as close to a silver bullet as you’ll get.”

The NHS is certainly in the market for a cure-all, unveiling last month the ‘For a greener NHS’ campaign. The campaign aims to ensure that the NHS and its staff step up efforts to tackle what it calls the climate ‘health emergency’. It recognises that what is bad for the planet – global warming, flooding, air pollution – is also bad for people’s health, with evidence linking these conditions to heart disease, strokes, lung cancer, asthma and the spread of infections and diseases.

The campaign involves the establishment of an expert panel to chart a practical course to get the NHS to net zero emissions; a new NHS Standard Contract calling on hospitals to reduce carbon from buildings and estates; and a grassroots movement to encourage staff and hospitals to reduce their impact on the environment, and in doing so, improve people’s health.

Transport is recognised in the campaign as having a key role to play in placing the NHS on the path to net zero. It is estimated that patients and visitors to NHS facilities alone generate 6.7 billion road miles every year. The NHS Long Term Plan has previously committed to making better use of technology to reduce the number of face-to-face appointments patients need to attend. Staff travel is also a problem and the grassroots campaign will encourage more employees to travel on foot or by bike. In addition, NHS fleets are acknowledged as needing a clean-up, with NHS Chief Sir Simon Stevens pledging last year to help ‘blue lights go green’ to reduce their impact on climate and air pollution.

Transport, health and climate are inextricably linked to, and dependent on, one another. The transport choices we make as individuals, organisations and policy makers influence the speed of climate change and the quality of our air. They also help determine the amount of physical activity a person undertakes, their mental wellbeing and their access to opportunities.

For many years we have been calling for greater recognition of the connections between transport and health and for more collaboration between the two sectors. The tools and evidence base we have built and collected over this time can be found on our Health and Wellbeing hub. The ‘For a greener NHS’ campaign presents a big opportunity to strengthen and maximise those connections and relationships.

To this end, we have written to the newly appointed Chair of the NHS Net Zero Expert Panel, Dr Nick Watts, welcoming him to the role and expressing our wish to work with the NHS in a strategic way to address our shared challenges. Our letter includes four propositions that we believe could help:

  1. A health and transport champion in each region charged with making the connections between the sectors and bringing leadership on the issue.Evidence suggests that progress on making the connections between transport and health is frequently driven by passionate individuals keen to make a difference above and beyond their day jobs. When these individuals move on, or when their organisations are restructured, the momentum can be quickly lost.Creating a specific, permanent role within each NHS England regional team to champion and drive forward joined-up thinking between health and transport could provide a stable footing for strategic, long-term collaboration.
  2. A health and transport convention in each region of England co-owned by the Department of Health and Social Care (DHSC) and the Department for Transport (DfT) to seek to broker ways forward.Our research shows that despite growing collaboration between our two sectors, significant barriers remain, from differing standards of evidence to the use of codified languages. From a transport perspective, even identifying whom to engage in the NHS – and maintaining that engagement – can prove very challenging.There would be value in enabling key health and transport stakeholders in each region to meet, build relationships and broker ways forward.
  3. Require the NHS to consult with transport authorities when making decisions on healthcare locations. The DfT and DHSC should co-commission good practice guidance on ensuring sustainable transport access to healthcare to support this.Evidence gathered from our members suggests that consultation by the health sector with transport bodies about decisions to open, close, merge or re-locate healthcare settings is patchy. When transport bodies are consulted, too often location decisions have already been made. Sites that are poorly integrated with public transport, walking and cycling networks generate more car journeys, contributing to congestion, poor air quality, climate change and physical inactivity.These issues can be avoided if transport authorities are consulted at the earliest possible stage. They can provide expert advice about which sites would be most accessible, minimise traffic and support non-car access (and therefore positive climate and health outcomes), enabling these factors to be designed into the scheme from the outset.
  4. An independently chaired government review to examine the efficiency and effectiveness of non-emergency patient transport services (NEPTS) and potential reforms.We believe that there is considerable scope to improve the efficiency and effectiveness of NEPTS to reduce the number of journeys and vehicles on the road.In 2017, we worked with the Community Transport Association and the Association of Transport Coordinating Officers to explore alternative approaches to commissioning non-emergency patient transport and found that taking a ‘Total Transport’ approach to NEPTS has the potential to generate significant savings for the NHS as well as deliver better outcomes for patients.

    Total Transport would see multiple public and community sector fleets (e.g. NHS, social care, education) bought together into a shared pool under a single point of access catering for a wide range of passengers (from patients to school children). Often there is considerable overlap in the vehicle standards and care components required across sectors. The pool of vehicles would be coordinated and scheduled centrally, taking into account options on the mainstream network. It would ensure that the entire public sector vehicle fleet is put to maximum use throughout the day and that the right vehicle is deployed for the right job (avoiding over-specification).

    In doing so, NHS and other public sector partners could achieve more using fewer vehicles and reduce the number of trips made overall. The benefits would be further extended if the pooled fleet was made up of zero or low emission vehicles.

As well as the Chair of the NHS Net Zero Expert Panel, we have also shared these ideas with HM Treasury, Sir Simon Stevens (CEO of the NHS) and the Director of the Sustainable Development Unit (the body which supports the sustainable environmental, social and financial development of the NHS, public health and social care).

We hope that colleagues in the health sector find the ideas useful and take up our invitation to work more closely together at strategic level to fully realise the potential of clean, active transport as a prescription to cure the ills of people and planet alike.

Rebecca Fuller is Assistant Director at the Urban Transport Group

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