We need transport that allows people with lung conditions to easily access treatment

Oooh, a bus. Image: Getty.

In debates about transport, it can be easy to forget that those most in need of infrastructure to support them are often those who are most vulnerable in our society. Discussions about cycle lanes and trams abound, and every year we see wonderful new advances in our connected cities and networks. But time and time again, these discussions and developments fall short of addressing how transport and healthcare, for many people, are inextricably linked. For the one in five people living with lung conditions in the UK, it has long been clear that the communities we live in need to be developed to become more accessible to, and interlinked with, our healthcare services. 

Lung disease and respiratory illnesses have failed to capture much public attention over the last few decades. In a 2018 survey commissioned by the Taskforce for Lung Health, 92 per cent of respondents didn’t know much or anything about lung disease when questioned.

This lack of awareness has had a knock-on effect for people with lung disease. It has been proven that many people with lung disease can benefit from pulmonary rehabilitation, a lifechanging, drug-free treatment. An exercise and educational treatment programme tailored for people with lung conditions, pulmonary rehabilitation improves the quality of people’s lives through a combination of exercise, psychological support, and guidance. In real terms, this treatment can mean the difference between being able to go out to the supermarket to buy your weekly shopping, and not being able to walk to your front door without struggling to breathe. Yet only 15 per cent of people eligible for this treatment get referred to the service. 

One of the reasons pulmonary rehabilitation is not as widespread a treatment as it could be is that it can be difficult for people to access easily. Transport is a key factor for this. In 2015, The Royal College of Physicians found that just 12 per cent of programmes in England and Wales provided funded transport to people who required the service. 

Part of the issue is that, while many people will make it a matter of priority to travel to specialist treatments like surgery, no matter the cost, regular treatment can seem like a costly investment if affordable transport isn’t available. Pulmonary rehabilitation sessions may be as frequent as twice a week for six to eight weeks, and centres can be far away and difficult to access, which is challenging for people with lung conditions who are breathless.

The reality is that lung disease is strongly linked to health inequalities. For instance, for chronic obstructive pulmonary disease (COPD), the second most common lung condition after asthma, prevalence is 2.5 times greater in the most deprived 20 per cent of the population. The associated costs of frequent travel can limit a person’s ability to attend and complete treatment. Those who have COPD are more likely to be over 65 and reliant on a pension, so any additional costs can add up. 

This treatment programme is one of the most cost effective and beneficial treatments available to people with lung disease. In one study, 90 per cent of people with COPD reported feeling an improvement to their well-being after undergoing a course. Pulmonary rehabilitation has the potential to reduce hospital visits by 26,600 a year, so ensuring it is more easily accessible makes sound social and economic sense.

The NHS Long Term Plan aims to increase access to pulmonary rehabilitation. If we are to create communities which support people living with lung disease in the future, it is imperative that access to ongoing treatments becomes a priority. Venues for treatment need to either be within the community, or have good transport links that don’t present too much of an additional cost to patients. In turn, small steps to make such services more accessible can help the NHS deliver its other needs, such as its net zero carbon ambitions and reductions in air pollution.

Developing a transport infrastructure which can support people to access medical treatment, regardless of financial income or distance from the provider, is something that must become a part of future planning. 

Jessica Eagelton is co- chair of the Pulmonary Rehabilitation group at the Taskforce for Lung Health.


What's actually in the UK government’s bailout package for Transport for London?

Wood Green Underground station, north London. Image: Getty.

On 14 May, hours before London’s transport authority ran out of money, the British government agreed to a financial rescue package. Many details of that bailout – its size, the fact it was roughly two-thirds cash and one-third loan, many conditions attached – have been known about for weeks. 

But the information was filtered through spokespeople, because the exact terms of the deal had not been published. This was clearly a source of frustration for London’s mayor Sadiq Khan, who stood to take the political heat for some of the ensuing cuts (to free travel for the old or young, say), but had no way of backing up his contention that the British government made him do it.

That changed Tuesday when Transport for London published this month's board papers, which include a copy of the letter in which transport secretary Grant Shapps sets out the exact terms of the bailout deal. You can read the whole thing here, if you’re so minded, but here are the three big things revealed in the new disclosure.

Firstly, there’s some flexibility in the size of the deal. The bailout was reported to be worth £1.6 billion, significantly less than the £1.9 billion that TfL wanted. In his letter, Shapps spells it out: “To the extent that the actual funding shortfall is greater or lesser than £1.6bn then the amount of Extraordinary Grant and TfL borrowing will increase pro rata, up to a maximum of £1.9bn in aggregate or reduce pro rata accordingly”. 

To put that in English, London’s transport network will not be grinding to a halt because the government didn’t believe TfL about how much money it would need. Up to a point, the money will be available without further negotiations.

The second big takeaway from these board papers is that negotiations will be going on anyway. This bail out is meant to keep TfL rolling until 17 October; but because the agency gets around three-quarters of its revenues from fares, and because the pandemic means fares are likely to be depressed for the foreseeable future, it’s not clear what is meant to happen after that. Social distancing, the board papers note, means that the network will only be able to handle 13 to 20% of normal passenger numbers, even when every service is running.

Shapps’ letter doesn’t answer this question, but it does at least give a sense of when an answer may be forthcoming. It promises “an immediate and broad ranging government-led review of TfL’s future financial position and future financial structure”, which will publish detailed recommendations by the end of August. That will take in fares, operating efficiencies, capital expenditure, “the current fiscal devolution arrangements” – basically, everything. 

The third thing we leaned from that letter is that, to the first approximation, every change to London’s transport policy that is now being rushed through was an explicit condition of this deal. Segregated cycle lanes, pavement extensions and road closures? All in there. So are the suspension of free travel for people under 18, or free peak-hours travel for those over 60. So are increases in the level of the congestion charge.

Many of these changes may be unpopular, but we now know they are not being embraced by London’s mayor entirely on their own merit: They’re being pushed by the Department of Transport as a condition of receiving the bailout. No wonder Khan was miffed that the latter hadn’t been published.

Jonn Elledge was founding editor of CityMetric. He is on Twitter as @jonnelledge and on Facebook as JonnElledgeWrites.