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

When it comes to mobility, sharing is caring

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Could shared mobility be one of the missing pieces in the puzzle that is the future of transport? That was certainly the impression I got at the recent CoMo Collaborative Mobility conference in Birmingham, which brought together practitioners and policy makers working on shared cars, bikes and rides from the UK and abroad. I came away feeling inspired about the potential role for shared mobility in a sustainable transport future and here are some of my highlights and key takeaways.

Shared mobility inquiry

Professor Greg Marsden, of the University of Leeds, presented the findings of the Commission on Travel Demand’s Shared Mobility Inquiry. Car is still the dominant mode choice for travel in England, used for 61% of trips in 2017, and occupancy rates remain low, at an average of just 1.2 people per vehicle for commute trips. The average car is only in use for around 3-4% of the time and one third of cars do not move on a given day, suggesting private vehicle ownership is incredibly inefficient. Clearly there could be a role for shared mobility to make the way we use vehicles more efficient and allow us to meet policy goals around congestion, air quality and addressing the climate crisis, and the inquiry recommended further research and analysis of the potential for more shared mobility.

Shared asset model

Enterprise Car Club and Liftshare are coming together to create a shared asset model, looking at how car club vehicles could be used by Liftshare customers. One car club vehicle, which might be a pool car for an organisation, will have multiple uses at different times of day and for different audiences under a shared asset model. So it might be used for business travel during the working day, for commuting for multiple staff lift-sharing outside of working hours during the week or for leisure travel at the weekend. By joining these models up, vehicle occupancy can be increased using shared vehicles, creating multiple benefits.

Wandsworth way ahead

Nationally, around 1% of the population access vehicles through a car club, but in Wandsworth, London, one in seven drivers are car club members! There are four car club operators in Wandsworth and the high usage rates show that given the right circumstances and density of vehicles, then usage can increase.

Mobility hubs

Mobility hubs – physical places which bring together a whole range of transport and non-transport services – could enhance seamless journeys. Belgium is already implementing mobility hubs. Essential features include information screens, shared cars, cycling facilities and public transport, but additional features could include EV charging, package pick up and drop off, toilets, seating, water refilling, WiFi and phone charging. The provision of transport information in a physical location can have benefits for those who might otherwise struggle to access information, such as those without a smartphone. And it’s interesting to note that BP is looking to invest in mobility hubs, because assets such as petrol stations could potentially become less attractive in the future as fossil fuel vehicles are phased out.

Sharing for social inclusion

Shared mobility also has potential benefits for social inclusion. A recent study in Glasgow looked at how improving access to shared bikes could reduced barriers to cycling amongst a range of demographic groups, including those who are homeless, seeking asylum and unemployed as well as targeting women, those from an ethnic minority background and those living in the most deprived areas. Participants were given annual access to the city’s bike hire scheme for £3 and offered additional support including cycle training, group rides, route finding support and advice. An impressive 95% of participants felt they had experienced an improvement in physical and mental wellbeing as a result of the project and other benefits included increased confidence to cycle, improvements in social life, reduced spending on transport and ease of access to employment.

With 36 million empty seats commuting to work in cars in the UK everyday, we need to think seriously about how we change travel behaviour in order to address congestion and the contribution of transport to the climate crisis.

Dr Clare Linton is Policy and Research Advisor at the Urban Transport Group and a trustee of CoMoUK 

A city that works for children, works for everyone

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‘A city that works for children, works for everyone’ – this was a phrase repeated time and again at this year’s International Healthy Streets Summit, an event that the Urban Transport Group is proud to have sponsored for the second year running.

The host for this year’s event was Glasgow, a city with big plans for its wide, traditionally car-friendly streets, many of which are being transformed by the £150m ‘Avenues’ programme. Glasgow City Council has taken the bold step of saying that it is ‘prepared to put the private car last’ – something it sees as absolutely the right thing to do, particularly as less than half of Glasgow households own a car.

The Avenues scheme will be transformative, placing people and their health at the heart of streets. Streets will be designed for vehicle speeds of up to 15 mph, they will be tree-lined, pleasant and safe, with more space for pedestrians and cyclists and less for motor vehicles.

But the real test will be their suitability for the city’s smallest citizens.

95cm tall and full of beans

Helen Forman, West Yorkshire Combined Authority’s Urban Design Manager, presented a thought-provoking challenge for delegates at the Summit. What do streets look and feel like from the height of a 95cm child, a child who is full of energy, curious about the world and looking for fun? What are the opportunities in the environment for that child? What are the restraints?

Can they run, jump, climb and explore? Are there trees, plants and wildlife to discover, water to splash in, interesting things to see, hear and smell?

Or is the environment designed in such a way that they must proceed directly from A to B with no diversions, hand held tight to an adult for safety? Are their tiny lungs and airways assaulted with fumes from passing cars as they walk in the wake of exhaust pipes that are low to the ground, just like them? Are they confronted with a sea of grey, dotted with high windows and closed doors?

Glasgow’s Avenues will certainly provide the former, rather than the latter experience, a goal that is increasingly being pursued by cities across the world. Whilst play equipment is undoubtedly valued, designing for children in a way that benefits everyone is about more than that. Children are skilled at finding opportunities to play anywhere.

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Playful anywhere

Travelling back from Glasgow on the train, I tried to think of the carriage from a child’s perspective. I saw large, low windows presenting an ever-changing view – animals, fields, the sea, houses, castle walls. I saw tray tables to flip up and down. Seats to hide under, aisles to run up and down. Buttons to push. People to meet. There was no play equipment but there were certainly opportunities to play.

When we think about streets in the same way it makes sense to restrict motor traffic to enable wide, safe spaces to walk and run, cycle and scoot. It makes sense to provide walls to balance on; stones to hop between; benches to rest on; sculptures that can be climbed on; water to splash in; trees to hide behind; flowers to smell; bees to spot; fruit and veg to pick; windows to look into. The list is endless. And the best thing is – these are features that everyone likes – whatever their age.

So let’s play and find joy together. And let’s not confine these opportunities to ‘destination’ places. Let’s spread them to the back streets and neighbourhoods – communities beyond the city centre – just as Glasgow is doing with its next phase of work – ‘Avenues Plus’. And to bring hearts and minds with us, let’s design with, rather than for, communities. Let’s not talk about ‘transport projects’ or ‘streetscape improvements’ but focus on what benefits these will bring to how people live their daily lives. How we will create what one speaker called ‘loveable’ neighbourhoods that people young and old can be proud of and, crucially, part of.

Becky Fuller is Assistant Director at the Urban Transport Group