The NHS patient transport system isn’t working. So what can we do about it?

Some ambulances at St Thomas’ Hospital, London. Image: Getty.

The hallmark of an effective transport service is one which gets people to where they need to be at the time they expect. The more timely the service, the more people like it.

To make this possible transport operators need accurate information. They need to know how many people they will transport and when. In this ideal ecosystem, this would mean that transport can be matched to need, and passengers would have a reliable service.

In hospital transport, where people are often being taken to appointments, timeliness is particularly important. Clinical Commissioning Groups (CCGs) commission non-emergency patient transport for patients who have a medical need for transport between NHS healthcare providers. This is provided by a mix of in house services, private providers, and community transport operators.

You might only be familiar with patient transport from the news stories which focus on where it doesn’t work, where patients are waiting for transport, or they have to use transport which is unsuitable for their needs. Across the country, patients who rely on these services are greeted with changing eligibility criteria, variable services, and long waiting times. If they can’t use this transport at all getting to hospital can be expensive, stressful, and inconvenient.

Everyone should be able to get in and out of medical appointments in a way which supports good health. But at the moment, this experience is by no means universal.

Planning effective patient transport within the NHS is incredibly difficult. There is poor data collection and use of travel data, commissioning does not support continuous improvement, and demand is often unpredictable. It’s impossible to improve services where operators do not know what they are tendering for, where the commissioning body does not enable improvements, and where patients have no effective mechanisms to hold anyone to account.

For patients who need recurrent treatments such as dialysis or chemotherapy, transport is a significant part of their lives. Staff across the NHS work every day to ensure these patients receive the greatest level of care, but the patient transport environment does not currently reflect their commitment.

In community transport we hear about this a lot. Our members provide hospital transport, often without pay, to ensure people in their communities can get to where they need to be. There are lessons we can learn from their approach to personalisation and accessibility that can transform health transport.

We need to create a culture of innovation which encompasses innovative commissioning practices. It’s necessary to look at how community transport, and communities more widely, can play a greater role in the commissioning, provision, and evaluation, of hospital transport. CCGs also need to share and collect more meaningful data.

These aren’t abstract travel problems which are impossible to resolve. It’s time to learn the lessons from our local communities on how we can make our hospital transport better.

You Can Read CTA’s New Report: Innovations in Health Transport here.

The CTA is the national body for the providers of community transport. You can follow its work at @CTAUK1 and on its blog.


How US planners experimented with “the iron hand of power” over colonial Manila

Manila in ruins, 1945. Image: Wikimedia Commons.

In 1904, Manila must have appeared to its new overlords a despairing prospect. Racked with poverty and disease, it was still recovering from years of war, epidemic and a fire that had left 8,000 homeless.

For architect Daniel Burnham, it was an opportunity to put to work the radical ideas he had dreamed of in America.

He was among those asking how America’s unprecedented wealth at the turn of the century could be reconciled with the lives of the country’s poorest. Like many, he admired the ideas of harmonised city-planning articulated in Edward Bellamy’s bestselling science-fiction Looking Backward (1888).

At the 1893 World’s Columbian Exposition in Chicago, Burnham constructed the “White City”. Built across 686 acres of parkland, boulevards, gardens and neoclassical structures rendered a spray-painted plaster vision of the future – all laid out to one comprehensive plan.

It was impressive – but implementing grand designs where people actually lived meant laborious negotiations with citizens, businessmen and politicians.

Instead, opportunity lay in America’s new overseas territories. As Daniel Immerwahr describes in How to Hide an Empire: A Short History of the Greater United States, “They functioned as laboratories, spaces for bold experimentation where ideas could be tried with practically no resistance, oversight, or consequences.”

An architect’s dream

The US had gone to war with Spain in 1898, taking advantage of an empire-wide insurrection. It ended up controlling the entire Philippines, along with Guam and Puerto Rico.

As a “territory”, the Philippines existed outside the protections of the constitution. Congress could impose any law, proclaimed the attorney general in 1901, “without asking the consent of the inhabitants, even against their consent and against their protest, as it has frequently done.”

Which is how Burnham, upon invitation by the Philippine’s new rulers, came to wield what the Architectural Record called “the iron hand of power” over Manila.

 Burnham’s plan for Manila. Click to expand.

Where Burnham’s Chicago plan was complex, took years and entailed collaboration with hundreds of citizens, Burnham spent six months on the Manila plan, and just six weeks in the Philippines. And with no voters to persuade, there seemed little reason to register Filipino input in his designs.

In 1905 Burnham submitted his Report on Improvement of Manila. It described filling the toxic moat of the Spanish fortress Intramuros and developing a rectangular street system modelled on Washington D.C., with diagonal arteries which even Chicago lacked.

Central to his plan was the city’s beautification through monumental buildings, waterfront improvements, and parks – “wholesome resorts” to “give proper means of recreation to every quarter of the city”

Burnham charged William E. Parsons as the omnipotent “Consultant Architect” to interpret his plan, who relished its authority over all public building as an “architect’s dream”. When concerned with the extent of his purview, he also chose to standardise a number of public buildings.

“I doubt if this method would bear fruit in our own city improvement plans, in which everything depends on slow moving legislative bodies,” reported the Architectural Record’s correspondent.

Despite Burnham’s colonial sentiments his biographer concluded his plan was “remarkable in its simplicity and its cognizance of Philippine conditions and traditions.”

His plans did not shy from asserting the colonial government’s authority, however. The Luneta, a favourite park, was to become the nuclei of government. The city’s avenues would converge there, for “every section of the Capitol City should look with deference toward the symbol of the Nation’s power.”

Unusual monumental possibilities

Burnham also worked on a summer palace for US administrators at Baguio, 150 miles north in the mountains. On land inhabited by Igorot people, Burnham saw an opening “to formulate my plans untrammelled by any but natural conditions”.

Baguio’s “unusual monumental possibilities” were facilitated by a road whose construction employed thousands, risking death from disease and falling off cliffs. Civic buildings would “dominate everything in sight” and a golf course would rival those of Scotland.

“Stingy towards the people and lavish towards itself,” griped La Vanguardia, the government “has no scruples nor remorse about wasting money which is not its own.”

As enthusiasm for US empire soured in the States, local power was relinquished to Filipinos. Parsons resigned in protest in 1914. He was replaced by Manila-born Juan Arellano, whose rebuke to imperialists was the mighty, neoclassical Legislative Building which hosted the elected Philippine Legislature. Arellano upheld Burnham’s plan, producing a beautified city bearing resemblance to Burnham’s White City.

But the Legislative Building, along with Burnham’s great edifices and almost everything else in Manila, was levelled as US troops recaptured it in 1945, this time ousting the Japanese in a brutal battle. “Block after bloody block was slowly mashed into an unrecognizable pulp”, recorded the 37th Infantry Division as they exercised their own “iron hand” over Manila.

American artillery had transformed Manila into ruins. “It was by far the most destructive event ever to take place on US soil,” writes Immerwahr, even if few soldiers realised they were liberating US nationals at the time. Burnham’s expansive vision was lost in the debris, and though some buildings were rebuilt a majority were replaced. Today, Manila’s pre-war architecture is remembered with fondness and nostalgia.