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London Boroughs’Joint Overview and Scrutiny Committee

14 March 2008

Transport for London and Healthcare for London

Presentation by Michele DixManaging Director

TfL Planning

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Presentation outline1.Healthcare and transport in London •Introduction•Some facts and figures

2. The relationship between TfL and healthcare in London• NHS as a generator of travel• TfL as an enabler of access to healthcare•TfL promoting active travel and public health

3. Healthcare for London key principles and how they relate to TfL

4. TfL’s response to the NHS’ ‘Healthcare for London’

5. New work by TfL and NHS London Developing a Health Service Travel Model

6. Conclusions and next steps

Healthcare and Transport for London

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Introduction

• TfL is a key provider of transport to healthcare in London. Much of the activity to date has been on ensuring appropriate public transport services are in place, and on managing the impacts of health-related travel through travel plans.

• More recently TfL is developing a strategic overview of health-related transport issues - engaging with the GLA in developing its Health Inequalities Strategy: Living Well in London, and responding to the Healthcare for London consultation – the subject of today’s discussion.

• London boroughs have an established role in liaising with the NHS and taking action to promote health – reflected in new LAAs on health outcomes, such as ‘healthy life expectancy at age 65’.

• TfL is keen to learn from this experience and to work with boroughs on this issue in future.

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Healthcare and transport in London: some facts & figures

Total number of trips per day in London Source LATS 2001 household survey

18.2 million

Trips per day to/from health services < 1 million

Health trips as percentage of all trips made in London < 5%

Education trips as percentage of all trips made in London 13%

Shopping trips as percentage of all trips made in London 19.5%

Proportion of health trips made by car (driver/passenger)

51%

Proportion of health trips made by walking 19%

Proportion of health trips made by bus 14%

Proportion of health trips made by tube/rail 10%

Number of GP practices in London ~ 1600

Average travel time to nearest GP 8 minutes

Percentage of Londoners for whom walking is the quickest way to access GP surgeries Source : TfL work on accessibility

> 80%

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The relationship between travel and healthcare in London

1. The NHS is a generator of travel - where/how health services are provided has an impact on travel patterns in London, and is an important issue for London boroughs.

2. TfL is an enabler of access to health care – responsible for ensuring safe, accessible public transport, and working with the boroughs to deliver door to door transport, walking and cycling facilities and highway access.

3. Promoting active travel and public health –TfL is actively engaged with the NHS and London boroughs to encourage walking, cycling and the use of public transport as part of a wider programme of public health promotion.

Health-related travel impacts on TfL and the boroughs in a number of ways:

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NHS as generator of travel: eg. Chase Farm Hospital, Barnet

Due to financial pressures Barnet & Chase Farm Hospital Trust is proposing closure of A&E facilities at Chase Farm Hospital, with patients transferred to nearest alternatives (Barnet & North Middlesex)

Transport implications:

• c.75,000 A&E patients attend Chase Farm p.a.• Nearest alternatives are both 5 miles away

(North Middlesex and Barnet) • The ‘transport’ assessment undertaken by the

Trust looked at ambulance response times only• Impacts on highway network, bus services,

patient access and active travel are not considered

• TfL and the boroughs have no planning or other powers to require a Transport Assessment as part of closure.

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TfL as enabler of access to health care: public transportand other services

• TfL works with boroughs and health providers to ensure that good public transport to hospitals and other facilities is available.

• Door to door services (Dial a Ride, Taxicard & Capital Call) provide for social trips for disabled/ older people who cannot access mainstream public transport. Some trips are used to access health care

• TfL and the boroughs fund Taxicard to around £17m per annum

• TfL supports enhancing patient choice in terms of:

- means of access to healthcare; and

- opportunities for possible shared funding of Taxicard with the NHS and London Councils in future.

TfL rerouted bus route 493 to St Georges’ Hospital

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TfL promoting active travel and public health Physical Activity Forum

Physical Activity Forum

TfL is a founder member of London Physical Activity Forum, which was established in 2005 and is chaired by Sport England with the involvement of some London boroughs.

Its objective is to increase physical activity through active travel - walking and cycling for short trips and in combination with public transport for longer trips.

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TfL is also involved in specific interventions on transport/health promotion. Three priority areas have been agreed with the NHS

1. General public:• Everyday Sport campaign • NHS pathways project• Sutton Primary Care Trust referral scheme

2. Schools and young people:• Healthy schools programme • School travel planning initiatives

3. Employees and workplaces:• NHS Trust travel plans • Research into benefits of active travel in reducing

absenteeism & improving productivity – ‘Wealth for Health’• ‘Activate your Workplace’• Workplace travel plan initiatives

TfL promoting active travel and public health

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NHS London consultation: Healthcare for London’s 5 key principles

5 principles guiding the NHS proposals and implications for transport

1. Services should be focussed on individual needs and choices

• TfL supports the move to enhance the choices available to NHS patients.

• If translated into more people being treated at home – as the Healthcare for London consultation suggests - this could reduce the demands placed on London’s transport network, although new NHS staff trips may be generated.

• But specialisation could lead to more patients travelling longer distances to London hospitals – often by car.

• In seeking to promote individual choice, the question of how people are able to access healthcare must form an integral part of the planning and delivery process.

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Key principles and how they relate to TfL

2. Services should be localised wherever possible, or regionalised where that improves the quality of care

• Reducing the need to travel, and prioritising walking, cycling and trips by public transport should be a key element in decisions on reconfiguration, as should the impact on door-to-door services.

3. There should be joined-up care and partnership working, maximising the contribution of the entire workforce

• TfL has had experience of successful working partnerships with the NHS, Primary Care Trusts (PCTs) and hospitals in London, and welcomes the commitment to this expressed in this document.

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Key principles and how they relate to TfL

4. Prevention is better than cure

• TfL’s work on active travel is a key agent supporting this principle. Policies such as the Central London Congestion Charging scheme and LEZ also support improved health, through better air quality, reduced accidents and improved access to services.

5. There must be a focus on reducing differences in health and healthcare across London

• We reserve judgement on how the proposals affect health inequalities in London until the full travel implications of the proposals are understood.

• But the ability of Londoners to access healthcare should not depend on whether they can drive or travel by car.

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Healthcare for London proposals and their potential impacts on transport

33 London Hospitals40% of Outpatient Activity devolved to polyclinics

150 POLYCLINICS

70% of GP services moved up to polyclinics1,600 GP Surgeries across London – the number will be

significantly reduced

Plus more careprovided at home

What are the transport implications of all this?

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Healthcare for London: Transport for London’s response

TfL welcomes the consultation. Our view is that any reconfiguration of healthcare services should:

Help to reduce the need to travel, especially by car

Help influence a shift towards more sustainable modes of transport

Encourage access on foot or by bicycle wherever possible – including through the design of healthcare sites

Reduce inequalities in access to healthcare.

To achieve this, TfL, NHS London, and other partners including boroughs and PCTs should together develop a set of criteria for optimising access to polyclinics, hospitals and other large-scale facilities.

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In collaboration with the NHS London and key partners including London boroughs, TfL would aim to:

Develop criteria for selecting suitable sites for polyclinics and larger facilities to ensure they are located where

accessibility is good

Carry out a comprehensive analysis of the potential impacts of reconfiguration – making use of the Health Services Travel Model underdevelopment and TfL’s Transport Assessment Guidelines

Develop appropriate measures to deal with impacts on transport – including Travel Plans for all polyclinics and larger sites

Influence the design of healthcare sites – to prioritise those arriving on foot or by bike, and to actively manage parking in the context of Travel Plans. London boroughs will play an important role in facilitating this through the development control process.

Healthcare for London: Transport for London’s response

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New work by TfL and NHS London: Developing a Health Service Travel Model

• TfL and NHS London are developing a modelling tool that can be used to assess the accessibility and demographic impacts of proposals for changes to NHS services.

• The Health Service Travel Model will measure journey times to health facilities across London and assess alternative configurations - e.g. polyclinics - by walking, public transport, cycling and potentially by car.

• It will allow different health service configurations to be tested for their transport impacts.

Map showing journey times to GPs in Ealing

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New work by TfL and NHS London Developing a Health Service Travel Model

The Model will be able to answer questions such as:

‘How many patients are disadvantaged by these proposals?’ ‘How many will benefit?’ ‘What is the average travel time increase/decrease?’ ‘What percentage of people do/will live within x minutes by public

transport of this service?’ ‘Is there a disproportionate effect on disadvantaged groups?’

• This will enable NHS London to better take account of the accessibility implications of changing health services and their locations – alongside other influencing factors (site availability, cost, clinical considerations etc).

• It will also provide TfL, in particular Bus Network Planning, with useful information on expected additional trips and population groups affected.

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Conclusions and Next Steps for NHS and TfL

• TfL is responding to the Healthcare for London consultation

• Completion of the Health Service Travel Model

• Ongoing liaison between TfL, boroughs and NHS/PCTs/Hospitals – Congestion Charging reimbursement scheme– ‘Smarter Travel’ and Travel plans– Promoting active health

• Draft Mayor’s Health Inequalities Strategy: Living Well in London (public consultation draft due later in 2008)

• Continuing TfL-NHS partnership working on ‘Healthcare for London’