Total Transport: totally worth it?

NWAS151

As the nation awaited the announcement of the next Prime Minister this week, the Department for Transport (DfT) – quietly and without fanfare – released its review of the 37 Total Transport pilot projects which begun in 2015. The information on which the review is based was collected back in April 2017 and – reportedly by popular demand – the findings have now been made public.

The reasons for sitting on the report for so long are unclear. Whilst results have been modest, Total Transport, as DfT recognise, is and always will be a ‘slow burn’ with ways of working taking time to bed-in and produce tangible results in terms of savings and improvements in passenger experience.

That the process takes time is something we have made clear since we first coined the phrase ‘Total Transport’ in our 2011 report of the same name to describe a task that many local authorities have attempted over the years with varying success. The task being to work across public policy divides to deliver better outcomes for communities and taxpayers through the sharing of transport resources (e.g. vehicles, scheduling/booking systems, budgets) and expertise. In doing so, the idea is to remove unnecessary duplication; design complementary networks; utilise what would otherwise be vehicle downtime; reduce administration costs; and ultimately deliver savings and a better passenger experience.

We followed our Total Transport report with an event the following year for local authorities and their partners to share their experiences of working on these kinds of approaches with one another. The key learning points that arose from that event seven years ago echo many of those included in the DfT’s review this week.

Back in 2012, our delegates told us that Total Transport projects may have a long-term strategic vision in mind, but usually start small to build trust and buy-in from would-be partners. DfT’s review also found no easy ‘one size fits all’ solution and that constructive local engagement took time, as did realisation of bigger savings.

At our event, delegates pointed out the central importance of knowing your stakeholders and putting in at least six months of preparatory work in order to build trust and relationships. Even then, as the DfT pilots found, people come and go and too often this means that engagement is severed and relationship building must start again from scratch.

Our delegates expressed particular frustration with getting the health sector on board. Similarly, DfT note in their review that many participants saw integration with NHS non-emergency patient transport (NEPT) fleets as representing ‘the biggest prize for better integration’ but also ‘the most difficult to unlock’. Indeed, difficulties in engaging with the health sector, not least finding and keeping hold of the right person to speak to, is described by DfT as ‘perhaps the single most significant barrier to the adoption of Total Transport’.

This certainly chimes with what we have heard over the years in respect of Total Transport and more widely for other areas of potential collaboration with the health sector. Whilst the situation has improved considerably for collaboration with public health (having moved under the umbrella of local authorities), the NHS more widely frequently feels like an unknowable and impenetrable entity.

This is something we have sought to address in numerous ways from roundtables bringing stakeholders from health and transport together to companion guides for the two sectors to help them understand one another. In 2017, we worked with the Community Transport Association to specifically explore the potential of Total Transport for NEPT, estimating that the NHS could save some £74.5 million per year if more efficient patient transport could prevent just 10% of missed appointments.

More recently, we have written to the Chief Executive of the NHS suggesting the need for an independent government review to examine the efficiency and effectiveness of NEPT and potential reforms. Our letter also calls for a health and transport champion in each region charged with making the connections between health and transport and bringing leadership on the issue.

A key recommendation from DfT’s review is that ‘more work is needed to involve the NHS in Total Transport and unlock the substantial opportunities for joint working which remain untapped.’ It goes so far as to say that local engagement alone may not be enough and that ‘some degree of coercion might be appropriate to encourage organisations to participate that have so far declined to do so.’ We certainly agree that some form of push at the highest level is required, hence our decision to write directly to the NHS Chief Executive highlighting what we believe to be huge potential for more joined up thinking and working between our two sectors. We will also be making the case to the new Government in the coming months.

It is telling that despite the difficulties encountered, the majority of Total Transport pilots are continuing in some form, using their own resources. Local authorities and their partners would not do this if they could not see the potential of Total Transport and what is, necessarily, a ‘softly, softly’ approach. Like the release of the DfT’s review, the results will come slowly and without fanfare but that does not mean they will not be worth celebrating.

Rebecca Fuller is Associate Director at the Urban Transport Group

(Image: North West Ambulance Service)

Five takeaways from Health in All Policies 2019

Prevention is better than cure’ is a truth universally acknowledged and one that has recently taken centre stage in UK health policymaking. The extent to which we can prevent poor health depends on influencing the wider determinants of health and wellbeing, neatly summarised here…

Social determinants of health

Many of these determinants are within the control of local authorities, underlining the case for a ‘Health in All Policies’ (HiAP) approach which:

‘systematically and explicitly takes into account the health implications of the decisions we make; targets the key social determinants of health; looks for synergies between health and other core objectives and work we do with partners; and tries to avoid causing harm with the aim of improving the health of the population and reducing inequity.’

The recent HiAP 2019 conference at the Royal Society of Medicine sought to identify those synergies. I spoke at HiAP 2019 about the connections between transport and health and the opportunities for collaboration between the two sectors. You can read my presentation here.

Here are five things I took away from the day:

1. Give up power

Throughout the conference was a recognition that, to achieve HiAP, health – and other professionals – need to be willing to give up some power and, where possible, some funding. That might include, for example, the health sector giving up some power to enable other sectors – such as transport, housing, playwork – to tackle the wider determinants of health. It might also include professionals recognising that the amenities, services and places we design must work for the people and communities that we want to see using them. That means co-design, listening and acting on what communities say they need rather than what we think they should have.

2. Social participation is vital for good health

Dr Piroska Ostlin of the World Health Organisation talked about social participation as a key means for, and goal of, health equity. If we ask and act on what communities say they need (which itself is social participation) they are more likely to get out of the house and use it once it is delivered– whether that’s an attractive, well-cared for green space in the neighbourhood or a new bus service. Good public transport, walking and cycling have a vital role in linking people to each other and to opportunities to participate.

3. Place-based, not service-based

In line with HiAP, health policy is increasingly looking to intervene at the level of place rather than individual health services. How can we design our places and provide the amenities required to promote health and wellbeing? This plays directly into our Year of Action on Healthy Streets – an approach that seeks to put people and their health at the heart of the way we design individual streets. At HiAP 2019 I learnt about other models and frameworks that can help us think about how whole places can be designed with health in mind including the TCPA’s 6 elements of healthy places and Scotland’s Place Standard, pictured below. How people travel and move around a place is a central consideration in both frameworks.

Scotland's Place Standard

4. These places are already putting HiAP…

Wales: The Well-being of Future Generations (Wales) Act requires public bodies to think about the long-term impact of their decisions, to work better with people, communities and each other, and to prevent persistent problems such as poverty, health inequalities and climate change.

Norway: Government departments and politicians have a mandatory obligation to take account of health in all policy decisions.

New Zealand: The forthcoming 2019 Budget will place wellbeing, kindness and compassion at its heart. For the first time, alongside GDP, it will measure performance against five key priorities aimed at improving New Zealanders’ quality of life including: supporting mental health; improving child wellbeing; and creating opportunities. Any Minister wanting to spend money must prove it will improve inter-generational wellbeing.

5. Watch out for these…

A raft of new publications and resources are due in summer:

  • The Department for Health and Social Care’s Green Paper on prevention.
  • Public Health England’s Joint Strategic Framework for Health Inequalities (working title). A live, modular resource, the Framework is intended to provide a structure and vision for people working at local level on place-based action to tackle health inequalities.
  • The Health Foundation’s HiAP case studies collection.

For more on the connections between transport and health as well as tools to foster collaboration take a look at our Health and Wellbeing Hub.

Rebecca Fuller

Oh, Vienna! Lessons from the world’s most liveable city

jacek-dylag-579742-unsplash

As part of our ‘Healthy Streets for All’ year of action, we were delighted to sponsor this year’s Healthy Streets conference which took place at the Guildhall in London. The day amply illustrated the ever growing ranks of cities seeking to put people, their health and wellbeing at the centre of their urban planning. In a day packed with inspiring city case studies, the one that particularly stood out for me was Vienna – named the world’s most liveable city nine years in a row. Maria Vassilakou, Vienna’s Vice Mayor and Deputy Governor painted a compelling picture of how this came about. Here’s what we can learn from Vienna’s approach – note also how it meets all ten Healthy Streets Indicators, flagged up in bold.

Children are the key to a healthy city

Vienna’s urban planning takes the needs of children as its starting point. The city’s leaders believe that if a city is good for children, it is good for everyone (Everyone feels welcome). A city that welcomes children means that families, and young professionals thinking about starting a family, are not driven out to the suburbs but are encouraged instead to stay and build their lives in the heart of Vienna. Doing so not only creates a vibrant, multi-generational environment, it also cuts the congestion and pollution associated with commuting (Easy to cross, Clean air, Not too noisy).

Places that are designed around children are pleasant places to be. Designing for the needs of a child means plenty of safe space for walking and cycling, restricting car traffic and providing opportunities for play and exploration (People choose to walk and cycle, People feel safe, Things to see and do).

Some 50% of Vienna is green space and they intend to retain this (Shade and shelter). City streets are dotted with trees and interspersed with splashy water features which are great fun for kids and offer interest, animation and a calming environment for everyone else. The idea is for people to feel relaxed, slow down and take time to enjoy city spaces which offer them something to experience (Things to see and do, People feel relaxed).

Affordability and fairness

Vienna, home of grand palaces, high culture and an impressive musical, artistic and intellectual legacy (Mozart, Beethoven, Klimt and Freud all called it home) is not necessarily the place you would expect to prize affordability and access for all. But you don’t get to become the world’s most liveable city by excluding people. Vienna’s vision is for a city where everyone can afford to have a good life (Everyone feels welcome).

An annual public transport ticket is 365 Euros, just 1 Euro a day to travel throughout the city! Imagine that. This, together with a welcoming urban realm, helps to explain why 73% of trips in the city are by public transport, cycling and walking. They aim to increase that to 80% by 2025 (People choose to walk and cycle).

The city also offers annual grants to communities to transform under-used spaces into temporary ‘neighbourhood oases’. Crucially, these must be available to everyone ‘without consumption’ – places that can be enjoyed without buying anything (Places to stop and rest).

The party where everyone’s invited

As Maria put it in her presentation, ‘People will go where the party is…let your city be the party’. Vienna is all about creating excitement and interest (Things to see and do). Giving children space to play. Creating public spaces that allow for temporary uses. Building an environment where everyone feels welcome. As UTG lead Board member for health, Jon Lamonte put it in his presentation about Greater Manchester’s emerging ‘Streets for All’ programme, we need to ‘make streets an invitation’. An invitation to play, to enjoy, to stay.

Rebecca Fuller