When Should Transport for NHS Patients be Free at the Point of Delivery?
The world bank estimates that healthcare in the UK accounts for 9.1% of GDP but healthcare is highly travel intensive accounting for nearer 20% of domestic UK journeys. Despite this high demand, the special needs of health travel are often missed. Each election generates political promises to fix the problems, but why is transport for healthcare not a higher priority anyway?
Parking problems at hospitals often attract the greatest criticism. Cancer charities have highlighted how some patients requiring treatments like radiotherapy have run up huge parking bills. Low wage shift workers in the NHS still pay high parking charges, despite their travel often being at times of day when no public transport is available. The case has been well made that something needs to be done to redesign transport to better serve the travel needs of health staff, patients and visitors.
In Scotland and Wales, the Government has made parking at most hospitals free, and some progress has been made designing parking discount schemes elsewhere. However more needs to be done. For the 2017 general election, the most specific promise was in the Labour manifesto budgeting £162 million to make hospital parking free. However, parking costs are only one small element of the current transport challenges. In Scotland, where there is far less congestion than in England, the parking ‘free for all’ at many hospitals means that driving to hospital is no longer an option due to parking congestion.
There are two essential things that any incoming government must do. The first is to set a clear national policy for travel times and transport fares and charges to healthcare. The second is to implement measures to ensure that practical door to door transport solutions enable equitable access to healthcare for everyone. Health service delivery has changed radically since the rules about NHS payment of travel costs were designed, and transport service delivery needs to catch up.
There is nothing particularly radical or undeliverable about making these changes, but concerted action is overdue linking national and local action for transport and healthcare. 20 years ago, the incoming labour government made planned accessibility for all people a flagship policy in its manifesto, and successive governments since then have confirmed their goal to better reflect social and economic goals like healthcare needs in the travel times and costs available to people. Policies for planned access, total transport, business travel plans, door to door service design, mobility as a service and other policies have dominated policy agendas and delivered successful local projects. However, the gap between transport policy and practice has grown for all the reasons forecast in the 1990s. The destabilising effect of siloed government funding has probably done more to undermine the development of markets for integrated health transport than any other factor.
More generally for public health, it remains unclear to what extent the promotion of active travel is a transport budget responsibility or part of primary healthcare. Those guided by transport economic appraisal rules in WebTAG (STAG in Scotland and WelTAG in Wales) treat a mode shift from car to walking as a negative transport economic change, but with positive health and other wider benefits. Many transport authorities using these rules to prioritise funding do not invest as they could in transport for healthcare. A simple change to clarify accountability for funding could go a long way to enabling desirable healthcare transport outcomes.
The lack of effective transport to support primary, secondary and tertiary healthcare is one of the more important gaps in effective transport delivery, so it is not surprising that each election brings a new round of promises that reflect voter perception of the problems. Well-funded and well connected private mobility providers have seen the potential, such as rideshare app Uber’s partnerships with social care service delivery to provide transport services for care staff and NHS patients. However better transport for healthcare deserves a more clearly defined agenda within which to balance best value viable transport provision with wider social aims.
Defining the terms of the national health transport tariff could support more efficient procurement and service delivery compared with the current ad hoc arrangements, not just parking charges at hospitals but commitments to provide a level of access to healthcare to meet all needs. Transport for healthcare can never be free at the point of delivery, but it can be designed to ensure that the NHS remains true to its values. The public do not expect health service providers to be transport experts, so the buck will always stop with the transport sector, not least for road and parking congestion around hospitals. If transport providers can focus more clearly on people’s needs for what remains one of the fastest growing trip purposes, there should be substantial benefits for everyone, not just manifesto commitments for politicians at election time.