How the NHS can save UK Transport

I recently had the pleasure of speaking at a conference on Decarbonising the NHS. Having heard about optimisiation of surgical gloves and sharing of power generation, I took a different approach, highlighting the challenges we face in transport, and how the NHS could be a catalyst for change.

Welcome to Transport Planning 111 - How the NHS can save UK Transport

Everyone is a transport planner, in everything we do, we make decisions about how we will travel. ?Transport planning is often simplified down to how do we get people to use cars less and use active, sustainable and efficient modes more. But that is an over-simplification of the career I’ve chosen and the challenges which we share.

One such challenge we share with the NHS is planning, delivering and sustaining the transport options that can support businesses, communities and those with mobility constraints to complete their day-to-day activities. This includes moving goods, staff and customers.

Our daily travel experience impacts our physical and mental health, as well as how we experience the rest of our day. For essential travelers (customers, patients, visitors) and essential workers of the NHS, the impact of their travel can have an even greater toll. So let’s try to solve this challenge for the millions of staff, patients and freight involved in the NHS.

PROBLEM SOLVED RIGHT?

In the same way that there are three R’s of recycling there are three R’s of transport planning REDUCE??????????? ??????????????? REMODE?????????????????????????? REFUEL

REFUEL: Can all vehicles that interact with an NHS Trust be shifted to net zero fuels?

The low hanging fruit of the industry is seen to be to electrify the fleet and for all car journeys to be made by net zero (at the tailpipe) vehicles. Unlike many other sectors where there is a single fleet to address, each NHS Trust will seek to solve emissions for pool fleet, delivery vehicles, ambulances and private vehicles, let alone helicopters. Decarbonising some of these vehicles is within a trusts gift, but it does require shifting a diverse and potentially stubborn fleet. This also leads to more questions around parking supply, highway capacity, parking pricing and electric vehicle charging. For example, if you have electric ambulances, what happens when the power goes out, and is the power supply in the right place to spot charge them?

REMODE: Can trips just be shifted to active, efficient and sustainable modes?

Hospital workers don’t tend to work your standard nine to five, with shifts often starting and ending at less social hours. This is similar for patient appointments and their visitors, that aren’t all going to occur during the morning or evening peak travel periods. This means that public transport needs to provide a broader service, needing to be available early in the morning and late into the evening. ?Reliability of service is vital for NHS travelers to even consider public transport as a mode.

Walking and cycling are great options for staff, assuming they live close enough, have safe routes to the trust sites and have secure parking in place. Micro-mobility including electric bikes has also extended the potential journey lengths of cycling. But active travel to NHS sites is still complex as their locations are often spread out and located in lower density areas.

Additionally, due to the scale of the NHS properties and lack of permeability, often their footprint alone acts as a barrier to both active travel and public transport. As a result, upon reaching a site, you may have to walk quite far from a bus stop, or cycle quite far to access cycle parking.

REDUCE: Can non-essential patient appointments be shifted to virtual?

NHS journeys are truly the definition of essential trips, and just like a plumber, services can’t all be delivered virtually. Well not yet! Since the Covid-19 pandemic there has been an increase in non-essential patient visits moving virtual, which significantly reduces the carbon impacts of those journeys. However, a virtual appointment for a cough for example, won’t identify tuberculosis. Additionally, many tests require attendance at a hospital, sometimes multiple times at multiple venues.

SO PROBLEM SOLVED RIGHT!

At City Science, we look for hard to unlock, often seen as hard to solve, problems and provide data insights to decision makers. So let’s move 5 years ahead and assume all the above is solved. Fleets are net zero, active travel networks are delivered and non-essential trips are virtual, maybe visits for tests are even optimised to a single visit.

DATA LED DECARBONISATION

Throughout my time transport planning in the UK, the NHS has forever been the holy grail of unlocking transports many challenges, and too often remains just out of reach of integration.

The challenges for transport planning are generally having enough demand to make a public transport route viable, competitive to other alternatives and reliable, particularly for those without other options of travel. This means that my career has gone from focusing on the peak hour commute, to supporting rural connectivity, community transport and truly essential travel.

Similar to the transport sector, the NHS is data-rich but insight-poor. The data for the NHS has extensive information on how people travel, when they travel, demographics, purpose, disability etc. But it is sensitive information, similar to bus operators and mobile phone companies having commercially sensitive data. So, the chances of this data being made available to a transport planner (like myself) is uncertain, even if aggregated. The locations of the NHS trust sites are often in the exact low-density areas we are trying to support with better transport offerings.

NHS facilities are what we refer to in bus planning as anchors. They are places where enough travel is generated to facilitate the need for a bus service that serves the wider community. Due to the scale of the NHS, each travel plan has the potential to reduce the overall mode share of the local system. And most importantly, many of these travelers are either essential workers, or essential journeys (e.g. mobility impaired). It is also essential that patients and staff arrive on time and know there will be an option to get home.

BUT WHAT DOES THIS LOOK LIKE IN REALITY?

So, in addressing NHS transport, we could deliver viable transport systems that support their broader local community through an ABC approach: Anchoring bus routes, removing Barriers to active travel and acting as a Catalyst for integrated community transport.

Active Travel: Helping communities develop active travel networks that link to hospitals and other NHS facilities, by addressing network barriers and using NHS sites as hubs for spokes of active travel.

Local Buses: Collaborating with local bus operators and councils as part of the Department for Transport’s Bus Service Improvement Plan programmes to use hospitals as anchors for services.

Community Transport: The NHS has an important role in unlocking the potential of community transport in the UK. They already provide their own transport and have many services provided by community groups. Most of these operations are data-poor, family operated or community groups, lacking integration and missing the technological revolution. This results in an unclear network of services in a sector prime for technological advancement. Unlocking this potential requires some form of centralisation by a trusted party that can, whilst adopting technological change, look after and support those potential passengers who need additional assistance in booking or travelling. Councils could take up this mantel, but even then, they are restricted by geography, and what if your closest hospital is not in your council region. As a trusted provider, seeking the best for the community, the NHS could play a kingmaker role in community transport, by providing the central booking point for UK community transport.

Summing up

Without collaboration with local councils and bus operators, local buses could continue to decline in frequency and general provision, forcing staff and patients to use private car travel.

Without an overarching service provision for these operators, they will struggle to adapt to new booking technology, fleet fueling alternatives and data integration. This risks many of the most vulnerable travelers losing their options for travel to health provision and other community led activities.

Without active travel integration accessing health services will be restricted by active modes (even with e-bikes unlocking the potential of travel), and NHS sites could remain physical barriers to physical activity. And with successful travel plans, parking interventions and support, it is possible to deliver decarbonisation of travel to and from NHS facilities for staff and patients.

The NHS can do so much to deliver decarbonisation of transport.

About

Simon Lusby is Managing Director and Transport Lead at City Science, a UK SME dedicated to supporting decarbonisation through data-led evidence, advisory and digital solutions. He’s a Chartered Transport Planner, specialising in sustainable solutions. He oversaw and contributed to London’s Accessible Bus Stop Design Guidance, Healthy Streets for London and TfL’s Assisted Mobility Policy. He also wrote the never released (due to Covid-19) Mayoral Transport Manifesto for Rory Stewart.

As a business, City Science has supported the Devon and Royal Exeter NHS Trust with travel planning, we have also done a lot of work on travel planning, parking strategies (Exeter, Southend, London Councils), EV action plans (Southwark, Blackpool, Walsall), rural bus reviews and community transport studies (Cambridgeshire and Peterborough). We also provide carbon action planning, energy planning and retrofit support, including net zero pathways for Oxfordshire, Royal Town Planning Institute and many London boroughs.

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