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

Six tests for PM’s London-style vision

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Boris Johnson wants transport in the rest of the UK’s metro areas to be a lot more like London and a lot less so so. So here’s six early indicators to watch out for that show whether we are on course for this… or not.

1. All the political big names love buses these days – if they can’t claim blood relatives in the industry, they are making models of buses in the evenings. True love means long term commitment though and if bus decline is going to be turned upside down then we need to see the bus get a bigger slice of the transport funding pie. So all eyes will be on the Budget and Spending Review to see the extent of reform and any funding increase.

2. There’s been lots of talk both pre and post election on ramping up devolution and even significant local government reform. Early signals are that we could be looking at some rationalisation at least – with one model (city region mayors) for the big urban areas and another for the shires (less tiered than now). But will Whitehall now really take the plunge and give up its ability to pull the strings and take the credit for local government successes?

Getting some longer term stability on local transport funding will be particularly crucial if we are to see the ramping up of investment in transforming local transport in towns and cities. At present there’s excessive reliance on ad hoc competition funding which makes for great press releases and helps clever and important people in meeting rooms in central London feel suitably omnipotent. It’s true that separate new funds for potholes, electric bus towns, cycling, superbuses, future mobility and so on all make tremendous sense in their own terms. But it all adds up to a nonsense way of doing things if you are trying to plan local transport networks as a whole in an integrated long term way.

For example, what if it makes sense for your authority to focus on different things in different years due to the lumpiness of some projects (such as BRT systems, trams, major interchanges)? What about projects that cut across different competition headings? How do we fund the stuff that doesn’t have its own pot? What about the costs of all the bids that fail? How on earth does a local transport authority plan its workload and develop its staff when it doesn’t know what competitions are coming next and when they will win? How do you meet the long term challenges of urban transport when all of these funding pots are relatively short term? So what happens early on with local transport funding could set the tone for years ahead about whether we are looking at real devolution or a more vigorously spun version of the usual puppeteering from the centre.

3. Talking of devolution we can now expect to see rail reform following on from the Williams Review. The PM has been strong in speeches about handing over more control over local rail networks. However the Williams Review team could hardly have been more cautious – if not borderline negative. How this is resolved is key to whether or not our metro areas are going to get the fully integrated, London-style urban transport systems that the PM has said he wants to see. Because for many of our big urban areas the heavy rail network is the tram/light rail/S-Bahn system they haven’t got (or only partially got). So, no meaningful control over urban rail means no meaningful wider integrated public transport network.

4. Not so high profile, but rumbling along in the background is the government’s moves to establish a legal and regulatory framework that can cope with new mobility options, such as the transformation of the PHV sector, powered personal mobility devices (including e-scooters), connected and autonomous vehicles and so on. Urban transport authorities don’t want the overarching technical safety role. But they do need a legal and regulatory framework which gives them the ability to strike the right balance in their areas between consumer benefits and the wider public interest; between ‘sandboxing’ innovations and taking action if flooding of cities with new mobility options is causing wider problems, such as for public safety, congestion or street clutter. The danger is that if this doesn’t happen urban transport policy will end up being re-centralised by the back door – with Whitehall setting one-size fits all rules for new mobility over the top of the more locally specific arrangements for old mobility (buses and trains).

5. Post election everybody is talking post-industrial towns. A good job about that, last year while everyone else was writing repetitive reports about cities, we put together the one and only report on how transport can help post-industrial towns thrive. In short it found there are no magic bullets. Among its findings were that town centres should radiate easy cycling and walking routes and that town stations and interchanges can act as hubs, gateways and community and business premises. It also made the case for the transport sector to be an exemplary employer because it is a major employer in towns (from bus and taxi drivers to workers in big shed logistics centres). But it also showed the need for attention to local detail and the views of local communities. A prime example of the need for patient, long-term policies which again requires real devolution of powers and funding.

6. One more thing and it’s the biggest thing. The thing that is going to grow as we head towards the make or break international talks in Glasgow in November – the climate emergency. It’s likely in 2020 that at the very least this will lead to a ramping up of moves to electrify road transport. This means we will need to move from the current cottage industry of charging infrastructure to something much more comprehensive. And for that we need a bigger top table of those who are going to bring it about – with the city regions given a seat alongside government, catapults, the vehicle manufacturers, public transport providers and the energy sector.

More widely, if we really mean it about it being an emergency, then it should change the way we look at everything – in particular how much sense it makes that bits and pieces of staggeringly expensive road schemes (which in turn are a guarantee of more car dependent sprawl) are still so dominant in transport spending when they are utterly non-compliant with a climate emergency and counter-productive in nearly every other way too. It could also mean we are back in the business of modal shift and traffic reduction targets as well as big leaps forward in the scale of car-free ambitions (take a bow Birmingham).

So in closing we remain, as ever, so near but yet so far on urban transport. Take Liverpool city region as an example. Right now it is taking delivery of the first of what are the UK’s most sophisticated commuter trains which will transform what its extensive S-Bahn equivalent urban rail network provides. In parallel with bus reform it’s now within grasp to bring this all together within the next five years into a single, modern and fully integrated network which will look and feel akin to the ‘one network, one ticket, one system’ that London and European counterpart cities take for granted. Indeed it could be up there with the best of them. And the same is true of course not just in Liverpool city region but in other city regions too. What happens with the six pointers above will give an early indication of whether this will be finally achieved over the next five years, or remain a ‘so near but yet so far’.

Jonathan Bray is Director at Urban Transport Group

The blog first appeared in Passenger Transport Magazine.

Six to watch on urban transport from the new Government

Early days but here’s six to watch that could be early indicators of the long term direction of the new government on urban transport. 

 
1. All the political big names love buses these days – if they can’t claim blood relatives in the industry they are making models of them in the evening. True love means long term commmitment though and if bus decline is going to be turned upside down then we need to see the bus get a bigger slice of the transport funding pie. So all eyes on the spending review to see the extent of reform and of any funding increase. We show how every pound of bus subsidy brings multiple benefits for departments across Whitehall here

2. Lots of talk both pre and post election on ramping up on devolution (and even talk about significant local government reform). But will Whitehall now really take the plunge and give up on its ability to pull the strings and take the credit? Particularly crucial if we are to see the ramping up of investment in transforming local transport in towns and cities will be getting some longer term stability on local transport funding. At present there’s excessive reliance on ad hoc competition funding which overall is inefficient and wasteful. Separate new funds for potholes, electric bus towns, cycling, superbuses, future mobility etc all make sense in their own terms. But they don’t make much sense if you are trying to plan local transport networks as a whole in an integrated long term way over time. What happens early on with local transport funding could set the tone for years ahead. 

 3. Talking of devolution we can now expect to see rail reform following on from the Williams Review. The PM has been strong in speeches about handing over more control over local rail networks. However the Williams Review team (as part of what is probably the most DfT captured of all the recent rail reviews) could hardly be more cautious – if not borderline negative. How this is resolved is key to whether or not metro areas are going to get the fully integrated, London-style urban transport systems that the PM has said he wants to see (more on this at the end of this piece). There’s more on the case for rail devo here.

4. Not so high profile, but rumbling along in the background, are government moves to establish a legal and regulatory framework that can cope with new mobility options, such as the transformation of the PHV sector, powered personal mobility devices (including e-scooters), connected and autonomous vehicles and so on. Urban transport authorities don’t want the overarching technical safety role but they do need a legal and regulatory framework which gives them the ability to strike the right balance in their areas between consumer benefits and the wider public interest. Between ‘sandboxing’ innovations and taking action if flooding of cities with new mobility options is causing wider problems such as for public safety, congestion or street clutter.

5. Post election everybody is talking towns. Good job last year when everyone else was writing very similar repetitive reports  about cities we put together the one and only report on how transport can help post industrial towns thrive. In short there are no magic bullets – it requires attention to local detail and joined up policies across transport and other sectors too. The report, blogs, infographics – all here

 6. One more thing. The biggest thing. The thing that is going to grow as we head towards the make or break international talks in Glasgow in November – which is the climate emergency. It’s likely in 2020 that this will lead to a ramping up of moves to electrify road transport. Which means we will need to move from the current cottage industry of charging infrastructure to something much more comprehensive. And for that we need a bigger top table of those who are going to bring it about – with the city regions given a seat alongside government, catapults, the vehicle manufacturers and the the energy sector. More widely, if we mean it about this is being an emergency, then it should change the way we look at everything – in particular how much sense it makes that bits and pieces of staggeringly expensive road schemes (which in turn are a guarantee of more car dependent sprawl) are still so dominant in transport spending when they are 100% non-compliant with a climate emergency and counter-productive in nearly every other way too.

 And in closing. We remain, as ever, so near but yet so far on urban transport. Take Liverpool city region as an example. There is a smartcard, there is an extensive urban rail network (with the UK’s most sophisticated new commuter trains due to enter service shortly), there is a bus network. It’s within grasp to bring this all together within the next five years into a single, modern and fully integrated network which will look and feel akin to the ‘one network, one ticket, one system’ that London and European counterpart cities takes for granted. Indeed it could be up there with the best of them (I wrote about this here). And not just in Liverpool city region but in other city regions too. What’s more the new government has said it wants urban transport in the metro areas to be more London. What happens with the six pointers above will give an early indication of whether this will be finally achieved, or remain a ‘so near but yet so far’.