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.


The Adam Smith Institute thinks size doesn’t matter when housing young professionals. It’s wrong

A microhome, of sorts. Image: Wikimedia Commons.

The Adam Smith Institute has just published ‘Size Doesn’t Matter’, a report by Vera Kichanova, which argues that eliminating minimum space requirements for flats would help to solve the London housing crisis. The creation of so-called ‘micro-housing’ would allow those young professionals who value location over size to live inside the most economically-active areas of London, the report argues argues.

But the report’s premises are often mistaken – and its solutions sketchy and questionable.

To its credit, it does currently diagnose the roots of the housing crisis: London’s growing population isn’t matched by a growing housing stock. Kichanova is self-evidently right in stating that “those who manage to find accomodation [sic] in the UK capital have to compromise significantly on their living standards”, and that planning restrictions and the misnamed Green Belt are contributing to this growing crisis.

But the problems start on page 6, when Kichanova states that “the land in central, more densely populated areas, is also used in a highly inefficient way”, justifying this reasoning through an assertion that half of Londoners live in buildings up to two floors high. In doing so, she incorrectly equates high-rise with density: Kichanova, formerly a Libertarian Party councillor in Moscow, an extraordinarily spread-out city with more than its fair share of tall buildings, should know better.

Worse, the original source for this assertion refers to London as a whole: that means it includes the low-rise areas of outer London, rather than just the very centrally located Central Activities Zone (CAZ) – the City, West End, South Bank and so forth – with which the ASI report is concerned. A leisurely bike ride from Knightsbridge to Aldgate would reveal that single or two-storey buildings are almost completely absent from those parts of London that make up the CAZ.

Kichanova also argues that a young professional would find it difficult to rent a flat in the CAZ. This is correct, as the CAZ covers extremely upmarket areas like Mayfair, Westminster, and Kensington Gardens (!), as well as slightly more affordable parts of north London, such as King’s Cross.

Yet the report leaps from that quite uncontroversial assertion to stating that living outside the CAZ means a commute of an hour or more per day. This is a strawman: it’s perfectly possible to keep your commuting time down, even living far outside of the CAZ. I live in Archway and cycle to Bloomsbury in about twenty minutes; if you lived within walking distance of Seven Sisters and worked in Victoria, you would spend much less than an hour a day on the Tube.

Kichanova supports her case by apparently misstating research by some Swiss economists, according to whom a person with an hour commute to work has to earn 40 per cent more money to be as satisfied as someone who walks. An hour commute to work means two hours travelling per day – by any measure a different ballpark, which as a London commuter would mean living virtually out in the Home Counties.

Having misidentified the issue, the ASI’s solution is to allow the construction of so-called micro-homes, which in the UK refers to homes with less than the nationally-mandated minimum 37m2 of floor space. Anticipating criticism, the report disparages “emotionally charged epithets like ‘rabbit holes’ and ‘shoeboxes,” in the very same paragraph which describes commuting as “spending two hours a day in a packed train with barely enough air to breath”.

The report suggests browsing Dezeen’s examples of designer micro-flats in order to rid oneself of the preconception that tiny flats need mean horrible rabbit hutches. It uses weasel words – “it largely depends on design whether a flat looks like a decent place to live in” – to escape the obvious criticism that, nice-looking or not, tiny flats are few people’s ideal of decent living. An essay in the New York Times by a dweller of a micro-flat describes the tyranny of the humble laundry basket, which looms much larger than life because of its relative enormity in the author’s tiny flat; the smell of onion which lingers for weeks after cooking a single dish.

Labour London Assembly member Tom Copley has described being “appalled” after viewing a much-publicised scheme by development company U+I. In Hong Kong, already accustomed to some of the smallest micro-flats in the world, living spaces are shrinking further, leading Alice Wu to plead in an opinion column last year for the Hong Kong government to “regulate flat sizes for the sake of our mental health”.

Amusingly, the Dezeen page the ASI report urges a look at includes several examples directly contradicting its own argument. One micro-flat is 35 m2, barely under minimum space standards as they stand; another is named the Shoe Box, a title described by Dezeen as “apt”. So much for eliminating emotionally-charged epithets.

The ASI report readily admits that micro-housing is suitable only for a narrow segment of Londoners; it states that micro-housing will not become a mass phenomenon. But quite how the knock-on effects of a change in planning rules allowing for smaller flats will be managed, the report never makes clear. It is perfectly foreseeable that, rather than a niche phenomenon confined to Zone 1, these glorified student halls would become common for early-career professionals, as they have in Hong Kong, even well outside the CAZ.

There will always be a market for cheap flats, and many underpaid professionals would leap at the chance to save money on their rent, even if that doesn’t actually mean living more centrally. The reasoning implicit to the report is that young professionals would be willing to pay similar rents to normal-sized flats in Zones 2-4 in order to live in a smaller flat in Zone 1.

But the danger is that developers’ response is simply to build smaller flats outside Zone 1, with rent levels which are lower per flat but higher per square metre than under existing rules. As any private renter in London knows, it’s hardly uncommon for landlords to bend the rules in order to squeeze as much profit as possible out of their renters.

The ASI should be commended for correctly diagnosing the issues facing young professionals in London, even if the solution of living in a room not much bigger than a bed is no solution. A race to the bottom is not a desirable outcome. But to its credit, I did learn something from the report: I never knew the S in ASI stood for “Slum”.