Bus Stop to Better Health

Waiting for the busIn this special guest post, Nick Bosanquet, Emeritus Professor of Health Policy at Imperial College sets out ways in which transport support could be used to connect people to work and therefore to better health.

The great health divide

There is a huge hidden problem of economic loss and wasted potential in the UK. At present 18 per cent of the adult working age population are out of the workforce permanently and another 7 per cent are unemployed. This is the great health divide.

There is a spiral of decline by which inactivity leads to worsening of health, poor diet and ever lower activity. Long term medical conditions affect those out of the workforce so that within a few years, levels of disability are 50 per cent in the inactive group. There is a great deal of misery and wasted human potential as well as higher mortality.

Economic inactivity creates a major burden in the form of increased welfare payments and loss of output. If the inactivity rate were the same across the UK as in the South East—around 9 per cent—the net gain to the public sector would be £100bn in reduced support payments and increased tax revenues.

If policy makers are serious about health inequality and poverty they have got to make a priority of providing assistance back into the workforce. Given that around half of households in the lowest income quintile have no access to a car or van, support to connect to employment opportunities using public transport, cycling and walking should form a key component of this assistance.

What might such a programme look like?

A new back-to-work rehabilitation programme

Working in partnership with other sectors  (including transport) the Department of Health, NHS England and the Department for Work and Pensions could develop special investment programmes for jobseekers including counselling and a special 12 week back-to-work rehabilitation programme.

The programme would need to reflect the complex range of barriers to employment faced by each individual – from childcare to housing issues. From a transport perspective, the programme could, for example, include personalised journey planning support to broaden travel horizons and help people understand the range of opportunities they can reach using public transport, walking and cycling. It could also include three month back-to-work travel passes to help meet the costs of travelling to interviews and travel costs during the first weeks of a new job.

The precise format of support should be informed by research into how people outside of the workforce view their main transport problems as well as by a consultation on the most cost effective means of providing transport support to jobseekers.

WorkWise signSuch a consultation could draw on the expertise of PTEs who have a long and successful track record of developing local initiatives that help unemployed people into work by removing transport barriers (WorkWise schemes, for example).

There is an opportunity for supporting these existing local schemes as well as further creative approaches which show how localism can produce results on an intractable problem that Whitehall policies have struggled with over the last 20 years. PTEs understand their local communities and the transport barriers they may face and are well placed to tailor interventions accordingly.

Greater integration between transport and health

These new back-to-work programmes could form part of a broader drive towards greater integration between the health and transport sectors.

GPs now have more power though the Clinical Commissioning Groups, whilst Directors of Public Health have a ring-fenced budget for spending on public health interventions. These powers could be used to commission provision that supports people back into employment or encourages them to become more active through everyday activities like walking and cycling.

There needs to be an organized drive across government on improving travel to work to assist more people back into the workforce. The next few years give an excellent opportunity to help those outside the workforce to share in the recovery.

Professor Nick Bosanquet

Ten years of the pteg Support Unit: Part three

In the last of a series of three blog posts, pteg Support Unit Director Jonathan Bray concludes his look back over ten years of the pteg Support Unit.

Ten years of pteg: the way we work and the way cities will work in the future

Evening city scene - Liverpool

Focus on what transport does for people, economies, cities, the environment and society.

The way we work

  • ‘Train hard, fight easy’. You need your stats, your evidence, your best arguments in place before you start to engage in a policy debate.
  • If you want to achieve policy change you need to be sharper, more relentless and be better at strategy than those who seek to defend the status quo because the incumbents always have the advantage and usually have greater resources.
  • Get the right staff. When your resources are limited and everything you do should be better than the incumbants (see above!) you need to make sure you have the right staff – so we put the time and effort into recruitment and got the right staff.
  • Press every button. It’s hard to know exactly why suddenly old policy consensus crumbles and new ones are established – so press every button available to you from reports, use of the media, stakeholder engagement – the lot.
  • Don’t commission research as a displacement activity or leave whoever is writing it to their own devices. Or let it sit on the shelf when done. Go through the pain barrier with whoever is working on it to ensure it fits the bill and then use it as the bedrock for the work you do in that area for the next couple of years at least. And find ways to get people to read it once it’s published.
  • Don’t go on about transport too much. Transport people love transport detail. The rest of the world doesn’t care. They are interested in what transport does for them, their economy, their cities, their environment, their society, the world they live in. Focus on that.

Building our reputation and effectiveness

pteg reports (Picture: Brainstorm Design)

Our reports have set a direction for emerging policy areas, like Total Transport (Picture: Brainstorm Design)

The Support Unit isn’t big, pteg may not always be liked – but we are good at what we do, we are a force to be reckoned with, we’ve saved our members millions and we have made the weather across a range of urban transport policy issues. Some of what’s been achieved is covered elsewhere in the previous parts of this blogpost, but it’s also been gratifying how we’ve been able to set a direction for emerging policy areas through focussed research and policy documents and through painstaking work to get internal and external stakeholders on board. Three examples:

  • In my view our work on social inclusion and transport over the decade (and in particular on young people in the last few years) has been the most lucid, consistent and focussed from any UK body in setting out the key challenges and how best they can be addressed
  • Our 2011 report on ‘Total Transport’ remains the primary document on pooling vehicle fleets and budgets
  • Our work on the opportunities for transport from the devolution of public health responsibilities is encapsulated in a hub on our website which provides the best introduction out there to local transport authority officers on what they can achieve in this area.

Smart cities / smart grid / smart transport

What seemed very far away now seems much closer. Cities with smart grids based on renewable energy powering largely electric transport systems. Mobile phones giving access to all forms of transport (from rental electric cars and bikes to public transport). Roads which are more social spaces than channels for cars. And this future is starting to form itself in big cities like Berlin. These kinds of developments transform the whole nature of the transport debate and open up some exciting opportunities for transport authorities to take the lead in guiding these changes in a way that maximises the benefits. There’s more on all of this in our recent blogpost on ‘Three global transport trends that should reshape our cities’.

Electric car, Berlin

Smart cities: there for the taking

So near…

Our city regions are not so far as it might sometimes seem from emulating what London takes for granted. Not in terms of underground rail networks and the scale of provision overall – but in getting the key building blocks in place. If the city regions can gain more say over rail and bus – then smart ticketing can fuse the two into the same single network that is the basis for London’s successful transport system. From there our cities can kick on to go smart and offer comprehensive total mobility packages, electrify transport systems in the most cost effective way and transform urban centres into more sociable, sustainable and prosperous places. It’s there for the taking.

Jonathan Bray

< Read Part two in the series ‘Ten years of the pteg Support Unit’, focusing on the unstoppable force of devolution.

< Read Part one in the series ‘Ten years of the pteg Support Unit’, featuring top ten highlights of the last ten years plus the influence of London.

pteg visits…Dales Integrated Transport Alliance (DITA)

The pteg team outside the Grassington Hub

The pteg team visit the Grassington Hub (L-R: Rebecca Fuller, Saila Acton and Jonathan Bray – all pteg; Ann Wild, Grassington Hub; Randall Ghent, DITA; Pedro Abrantes, pteg)

On the 7th August, the pteg team travelled from Leeds to the beautiful Yorkshire Dales to visit Dales Integrated Transport Alliance (DITA). DITA is a community-led group of individuals and organisations who want to get better transport in the rural area of the Yorkshire Dales National Park and Nidderdale Area of Outstanding Natural Beauty. DITA was formed to assist Metro (West Yorkshire PTE) to deliver the ‘Connecting the Dales’ project which secured £1.1 million from the Department for Transport’s Local Sustainable Transport Fund (LSTF).

An on-train briefing

Our day began with a train journey to Skipton station (‘Gateway to the Dales’) during which time Connecting the Dales Project Leader Randall Ghent was able to fill us in on some more of the background to DITA.

He told us about the four strands of DITA’s work:

1. Local transport needs assessment – including a baseline survey of 1,200 local people conducted by sustainable transport charity, Sustrans complemented by a Visitor Survey to capture the travel needs of the many tourists who flock to the Dales.

2. Integrated service development – including trialling of new transport services; subsidies for bus (and sometimes rail) services; a fares initiative for young people; and improved coordination of the existing transport network through a network of local ‘hubs’.

3. Active Travel support – including through the hubs; printed leaflets; education work; support for cycle paths; and electric bike hire. Future plans include a series of accessible circular walks as well as activities linked to next year’s Tour De France Grand Départ, which will take place in Yorkshire.

4. Customer-facing marketing and information – delivered through the local hubs, online and via printed materials.

Randall is keen to stress the ‘bottom-up’ nature of the project – this is very much a community-led scheme which accepts bids for funding from local operators and communities who have identified a transport need and a sustainable approach to solving it.

Your Dales Hub Grassington

Train journey and initial briefing complete, we hop on a Pride of the Dales bus service to Grassington, which calls right outside Skipton Station. Later, we would visit the Pride of the Dales base in the village, however, our first stop is Your Dales Hub Grassington, one of the eight hubs across the Dales started with funding from DITA and a key delivery mechanism for DITA’s work.

Bespoke hub leaflets

Bespoke hub leaflets

Each hub provides the local community and visitors to the area with advice on all forms of transport. They can make bookings, access real time information and pick up helpful leaflets. All hubs have their own bespoke leaflet outlining travel options in the area – these are distributed to every address locally, often together with the parish magazine. Indeed, the idea is for hubs to have a hyper-local marketing and outreach role, building community capacity and ownership.

In common with all the hubs, Grassington’s is located within an existing community facility – in this case, the village library. Other locations include Tourist Information Centres, Community Offices, a museum and even the front room of a Bed and Breakfast!

With funding tight, multi-functional spaces – and people – are essential. The LSTF funding allows each hub to pay for a manager for one day per week. This person usually performs a number of other roles, with funding from a range of sources. In Grassington, that person is Ann Wild who we meet in a small office at the back of the library, together with Helen Flynn, Chair of DITA.

Ann provides advice on transport via the hub and works closely with the community and local operators to gather information on local transport services and needs. In common with every hub manager, she maintains a page on the DITA website for the area she covers, providing up-to-date transport information for Grassington. Together with the pages for the other hubs, the website provides a comprehensive picture of transport services across the Dales. Ann also maintains the twitter feed for the hub @GrassingtonHub (you can also follow the Dales Connect project on twitter @DalesConnect).

As well as transport, Ann’s role covers community development, outreach and fundraising (including submitting bids to funding bodies, a regular village movie night and a photocopying and printing service for local businesses).

Helping Hands

When we meet, Ann is in the midst of applying to the Big Lottery Reaching Communities fund for funding for a coordinator for the hub’s Helping Hands scheme that provides transport to medical appointments via a network of 40 volunteer drivers who use their own cars. The nearest big hospital is a 44 mile round trip from Grassington.

Given the distances and costs involved, transport to health facilities is a big issue in rural areas, particularly for those who do not qualify for free patient transport. Even those who do qualify experience a service that is over-stretched and can involve long journey times and waiting times at either end.

Ann and Helen agree that local providers could deliver a better, more responsive service but that they struggle to bid for NHS contracts. Helen tells us that the Social Value Act should mean that bid evaluation takes into account other factors that add value (e.g. that the bidder is a social enterprise) – however, the legislation is still new and seems not to have filtered through to decision making. There is also as yet untapped potential to consolidate hospital appointments to make patient transport more viable in rural areas.

It has been a long held ambition of DITA to get local transport and NHS stakeholders together to discuss the issues of access to healthcare and of more sustainable funding options. The Helping Hands service, for example, is reliant entirely on the goodwill of volunteers and donations from those who use the service. It would be in the interests of the NHS to support such schemes which, among other things, help avoid missed appointments. This is something we too have noted in our ‘Total Transport’ report of 2011.

One Way £1 for under 19s

Next on our itinerary is a visit to the Pride of the Dales bus garage, base for a small fleet of vehicles providing bus services between Buckden in the North, and Skipton and Ilkley in the South. The services are provided on behalf of North Yorkshire County Council. Here we meet Richard Dean, who – following the multi-functional theme – is both mechanic and occasional bus driver for Pride of the Dales.

The 'One Way £1' logo

The ‘One Way £1’ logo is displayed on all participating bus services

Richard fills us in on another strand of DITA’s work – the trial of a ‘One Way £1’ scheme for under 19s. As the name suggests, this scheme allows young people to travel for £1 on their outward journey and £1 on their return journey when travelling within the Dales area. This represents a considerable saving on the usual fares and is designed to make bus travel easier and more affordable for young people. During term-time, the scheme applies on weekday evenings after 5pm and at any time over the weekends. In the school holidays, the scheme is available at all times.

The scheme fits the simple, flat and consistent model for child fares that we know works (see, for example our ‘Moving On’ report) and is very popular with young people themselves – indeed, the local Youth Council were actively involved in developing this initiative. Since launching in October 2012, patronage among young people has grown – one operator is already intending to take forward the scheme commercially after the DITA funding runs out in October this year.

Evaluating success

Next up, a further chance to discuss the work of DITA with Randall, Ann and Helen over a wholesome lunch at The Retreat, a vegetarian café in the village. Conversation turns to the importance of evaluation and DITA’s plans to collect evidence of effectiveness for each strand of the project – evidence that will be vital in securing future funding for the scheme whether as a whole or for individual elements. We noted that the best practice guidance on LSTF monitoring and evaluation, produced for pteg by AECOM, might prove a useful resource as this work progresses.

After lunch, there was time to stock up on souvenir fudge before heading to the National Park Centre just outside the village which also serves as a small bus station. From here it was back on-board a Pride of the Dales bus to Skipton followed by a comfortable ride on the electrified Airedale line back to Leeds.

All in all a fascinating visit to an organisation that is very much led by the communities it serves and as such, delivers initiatives that meet the needs of residents and visitors alike. We would like to thank Randall Ghent for organising the visit and Ann Wild, Helen Flynn and Richard Dean for spending time with us on the day.

Rebecca Fuller