Health and Sport Committee

Meeting date: Tuesday, May 28, 2013

Official Report 541KB pdf

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Community Transport Inquiry

Item 3 is an evidence-taking session on community transport to feed into the Infrastructure and Capital Investment Committee’s inquiry on the subject. The committee has a particular interest in access to health and social care and, indeed, many members regularly come across such issues in their constituencies.

At this round-table session, we will supposedly do more listening than talking; we will see whether we, as politicians, can meet that challenge. I am conscious that we have run on quite a bit so, to save a wee bit of time, I suggest that we introduce ourselves when we ask questions or make comments.

To kick off the session, I note that we received a briefing this morning from Audit Scotland, which, as you will be aware, produced a report some time ago on transport for health and social care, in which it made a number of recommendations and highlighted certain issues. Its main findings included the need to work together and the need to introduce integrated transport strategies that focus on people. Does anyone want to talk about Audit Scotland’s work and its findings?

Would you like me to start, convener?

That would be helpful.

It might be helpful if I point out first of all that I was a member of the advisory group on the Audit Scotland report. I will not recapitulate it in any great detail—I am sure that all committee members have read it—but I will say that, since its publication, partnership work has been going on across Scotland to look at how we might take the recommendations forward. The Scottish Ambulance Service is keen to see how we can work towards implementing Audit Scotland’s recommendations, and with other colleagues I have been contributing to a short-life working group on how we might take that forward. Indeed, we await the group’s report and recommendations, which will be published imminently.

We have also been trying to be a bit more proactive by taking forward some pilot work and, to that end, we have been working in partnership with regional transport partnerships, health boards and councils right across Scotland, and in three areas in particular. An integrated transport pilot will go live in Lochaber in July, and as we speak another pilot programme is up and running and developing in Elgin for the north Aberdeenshire and Moray area. In those pilots, the partners are bringing together resources in those areas for those communities and providing a much more integrated solution for patients who need to access healthcare appointments. We are also in the process of scoping work with Strathclyde partnership for transport in the NHS Greater Glasgow and Clyde area.

In short, we have been progressing the recommendations in the Audit Scotland report and looking at how we use the resources that sit within communities and, indeed, the Scottish Ambulance Service and how we can collaborate and work in partnership to secure for patients much better and easier access to healthcare appointments. Although Scotland’s geographical landscape, the configuration of health boards and the relationships between health boards and councils make what we are doing quite challenging, I think that we are making good progress.

As we have heard, the Scottish Ambulance Service deals with different groups of people and, indeed, is more organised in that respect. In fact, your organisation got a tick from Audit Scotland in its briefing. However, is what you have described representative of what is happening across the country? Are the other people round the table seeing the same progress? Are the strategic partnerships coming together and are the needs of these groups being met?

First, I thank the committee for inviting me to give evidence. As senior service manager for the British Red Cross’s east Scotland area, which covers Perth, Tayside, the Forth valley, Fife, Lothian and the Borders, I cannot speak for the whole of Scotland, but I certainly know what is going on there.

We work in partnership with loads of organisations throughout Scotland. For example, we work with the Scottish Ambulance Service to deliver programmes and with the NHS, mainly in relation to our home-from-hospital and discharge schemes. We deal with discharges from St John’s hospital in Livingston, from the Borders general hospital and in the west of Scotland.

We also work in partnership with different voluntary organisations. With Macmillan Cancer Support, for example, we run a transport initiative that takes patients from the Scottish Borders to their chemotherapy sessions at the Western general hospital. We are willing to work in partnership; indeed, we believe that that is the way forward.

I work for Voluntary Action Scotland, which is the network body for third sector interfaces in Scotland. Members will probably know those interfaces better as centres for voluntary service, volunteer centres and so on.

What we have found—I mean this in a good way—is a patchwork of different solutions that meet the local need in the country. One of the downsides of that situation is that there is highly varied provision across the country. The voluntary action Lochaber example that Heather Kenney mentioned might be a model that could be considered elsewhere. Because of its connectedness with community groups, its relationship with community planning partners and so on, it is in a good position to broker local relationships and develop and run a community transport service in areas where the British Red Cross and others might not be present.

There are other examples of the third sector interface trying to develop that relationship. In Aberdeen, a model is being developed with support from the business school and other partners locally. That might offer a way forward. The feeling on the part of the third sector interface is that, although there is a backcloth of increasing demand given the ageing population, there is also an opportunity because, if community transport can be seen as part of the reshaping care agenda, we can see how improvements to accessibility and mobility could form part of the preventative approach. That area is extremely important for Voluntary Action Scotland.

I am head of operations for the Royal Voluntary Service, which was until recently the Women’s Royal Voluntary Service, so I am able to give an across-Scotland picture.

Community transport underpins absolutely everything that our organisation does in the services that we deliver for older people. There is a rising need across the country. There are areas in which partnership working is developing and showing signs of improving, but there are other areas where that is simply not happening. In two areas, I have had funding for transport services but I have had to pull them because I have not been able to get engaged in local partnership working and have therefore not been able to establish the service. One of those areas is Elgin. That is quite a disappointing situation to be in.

I am the director of emergency care and medicine at NHS Greater Glasgow and Clyde, and I lead for ambulance services in our health board. The Scottish Ambulance Service is the main provider of transport to and from hospital. However, we work closely with SPT on improving access and services for people in our health board area. We work with community transport on things such as our evening visitors service, and we engage with community transport providers to help people—particularly frail, elderly people—to get to services that we run such as community exercise classes. Further, as Tom Robson mentioned, we work with the Red Cross on an accident and emergency take-home service. There is a huge opportunity for more joint working but, again, the strategic direction at a regional level should allow the local variation that Calum Irving mentioned, because community transport providers are diverse.

The other issue concerns integration and the relationship with social care. As we move further towards an integrated health and social care service, particularly for older people, there is a huge opportunity for us to work closely with our social care partners who, in the main, fund community transport and are big providers of transport in the way that the Ambulance Service is for the NHS. That is another area in which regional collaboration would be hugely helpful. Within our area—actually, in your area, convener—we are about to do a piece of work with the community healthcare partnership to consider what opportunities there might be to use health transport for non-patient-related transport and social care transport, in order to help us with patient transport arrangements.

I am glad to hear that we are making some progress locally. There are lots of opportunities. I have been banging on about that for some time.

I am also from the recently renamed Royal Voluntary Service and I, too, thank you for inviting me here today.

Last month, I gave evidence to the Infrastructure and Capital Investment Committee on community transport, and the point was well taken at that meeting that there is a need for a strategic focus on the issue in health and social care integration. Until now, the debate on health and social care integration, although interesting, has focused on structures, and we think that thinking about services is a useful way to understand what the benefits of that integration will be. A key service that we do not think has received a great deal of consideration in that regard is community transport. At the risk of talking further about appointments, it is pretty clear that community transport is one of the best ways to ensure that appointments are not missed, which is a good way to prevent unnecessary costs. We are keen to be involved in that, but we feel that there needs to be a more strategic focus on the issue and that it needs to be built into the systems that are being created for health and social care integration.

12:15

The other question that came up in the Public Audit Committee was who pays for the service. That goes back to my experience of services going out, particularly at a time of change, in my community. Nobody had considered the impact of that. The health board was reluctant to take on a commitment to transport people from Greenock to Paisley to visit or support patients or for them to attend appointments.

At present, there is a patchwork quilt of arrangements that can be developed locally. One of the challenges is one-year funding, about which you will hear talk on other issues relating to the third sector. It is extremely difficult to develop and broker a decent quality of service that has a more strategic approach and builds relationships with only one-year funding for assets that relate to community transport. The fact that local authorities, as well as the Scottish Government, are going in that direction creates a significant challenge.

One benefit of involving the third sector in community transport is that there is a good supply of willing volunteers, cars and other vehicles in that sector. It is a matter of finding small amounts of support to be able to co-ordinate and focus that better in the longer term so that we are able to lever in the resources that exist in the community in a better and more co-ordinated way.

The reality is that the Scottish Ambulance Service and the NHS fund the transport for people who need it on medical and mobility grounds. Transport for people who need it on social or isolation grounds is funded in the main by local authorities. One of the challenges with an integrated model is to adopt a slightly different approach to funding. Although there are many pilots where we can do that flexibly, which I am sure Heather Kenney will describe, they tend to be on a small scale at present.

In NHS Greater Glasgow and Clyde, we have, on occasion, used our NHS funding to fund community transport when we have made a service change and recognised that it will impact on people’s ability to get to hospital. The Vale of Leven hospital is an example of where we funded additional ambulance services, worked with transport partners to ensure that public transport was available and put in place additional community transport.

We have a community engagement and transport manager who works with us when we make a service change to ensure that we consider and allow for the impact that it might have on people’s ability to travel.

Will the new clinical strategy from NHS Greater Glasgow and Clyde include a transport strategy for how you manage such change? It did not in the past.

Yes, it will. Any strategic change that any NHS organisation undertakes must include a transport needs assessment and impact assessment. That is required of us by the Government. Absolutely—we will have to do that.

Has the budget that is available in NHS Greater Glasgow and Clyde for transport gone up or down over the piece?

The budget is held by the Ambulance Service.

So access to that is not directly through your budget.

No.

How much does NHS Greater Glasgow and Clyde pay for taxis to take people from Inverclyde to Dumbarton, for example, or to take files all over the place?

I do not have that information with me, but I can certainly get it if it would be useful.

It would. Thanks.

Anne Harkness talked about volunteer car services. The Scottish Ambulance Service is funded primarily to take those patients who have a clinical and medical need for ambulance care and transport, but the committee must not lose sight of the fact that we still employ 200 volunteer car drivers. We do that because we recognise the difficulties that exist throughout Scotland for patients in remote communities and people who have real transport needs and need to get to a hospital. We try to focus that service primarily on ambulant patients who do not need care or assistance but have a social and geographical need for transport.

The number of patients who use the volunteer car service and the number of journeys that it provides have diminished over the past few years—there is no doubt about that. That is primarily a result of some changes that Her Majesty’s Revenue and Customs made in the guidelines on taxation. Volunteers drop out at a certain limit at which their payment reduces as a result of some of those guidelines.

For the volunteer car service, we need clear governance as regards the selection of patients, as we need to be careful that we do not select patients for the service who will probably need care and assistance en route to hospital. For that reason, we worked quite extensively with clinicians in the 14 health boards to develop the eligibility criteria, which some people will have heard of. Those criteria are not new but have been around for a long time, as they are based on guidance from the early 2000s—I think that the latest guidance is from 2007. We want to be clear that, from a clinical perspective, we truly understand the needs and care requirements of patients to ensure that we select the right mode of transport for them.

I stress that point because, in many debates on the provision of integrated solutions, people lose sight of the fact that we do not just provide a transport solution. We deal with many patients who have multiple comorbidities or long-term conditions and we often transport people who are on oxygen therapy or on a stretcher or who need complex assistance with moving and handling. I just wanted to reiterate that point.

On the issue of who pays, over the past four or five years, it has been quite clear that we can save money by preventing need, so getting patients to their appointments is a good way to save money. The costs involved in community transport are relatively small compared with the costs of missed appointments. Looking at the global cost of missed appointments may be one way in which to release more funding for community transport.

Similarly, on the use of taxis, we think that our services could replace some existing taxi services. Rather than just replace the point-to-point journey, we could provide additionality by providing a safe, warm and well check with individuals in their home and signposting them to other services. That could add value to the journey while almost certainly being cheaper than a taxi.

We are unsure whether work has been carried out on whether the availability of good-quality transport creates savings and reduces exclusion in respect of, say, admissions. Does anyone know whether any work has been done on that?

The Lochaber pilot flagged up that there is a lack of information. Although the committee heard in the previous evidence session that we have data coming out of our ears, for community transport networks and providers there is a real lack of accurate data on what resources are available in communities, how they are used and what volume of journeys is undertaken. To be fair, until a couple of years ago, the Scottish Ambulance Service’s data was not particularly robust either, but we have invested about £2 million in mobile technology to track vehicles so that, just as for our A and E service functions, every journey has a patient record attached to it.

The data gathering is getting better. That has been really beneficial in the Lochaber area, where people were happy to share their data and improve the data that they collected on what resources sat in the community, to what extent they were utilised and what potential there was to build a much more integrated solution in the community. That is probably where we would want to go, particularly in areas of high levels of deprivation or where there is a social and geographical challenge in commuting to hospital.

Alongside that, as well as working on transport solutions, we have developed really quite advanced thinking on the emergency side about how we might care for people in the community rather than transport them to hospital. For example, for out-patient programmes, we can sometimes take a patient 100 miles for a 10-minute consultation. We would like to work with the boards on how we might encourage such patients to be taken to their local community health centre to have that consultation done by telehealth or telecare. For some patient groups—although not all, I accept—that would be far more effective if the consultation is just a relatively simple conversation about a follow-up procedure.

Given that we are still moving patients around a lot for short, non-emergency consultations, part of our work programme is to work with the health boards on how we might encourage such developments. That would put much more resource back into the local community and help us to progress the integrated health and social care agenda, which is about providing care in the community. If those resources are not travelling long distances to transport small numbers of patients, they would be available to move people around in their communities.

That is an interesting point.

SPT is now involved in the west of Scotland community transport network, which brings together all the community transport providers in that region. That will allow us to co-ordinate resources better.

We produced a two-day snapshot of every journey that was made in NHS Greater Glasgow and Clyde by taxi and by our own NHS vans—not by the Scottish Ambulance Service—and we have shared that information with SPT. We are starting our work by looking at the synergies in order to pick up on the point about where the synergies are and where alternative and more cost-effective solutions could be used.

In the NHS—certainly in NHS Greater Glasgow and Clyde—we use taxis for patient journeys on occasion, but that would be in exceptional or emergency situations. We would not routinely use taxis for transfers to and from hospital on a planned basis—it would happen on a one-off basis to suit a particular individual circumstance.

It might be interesting for the committee to see that work, if it is available.

I do not have the detail, but I can check.

I would appreciate that. Does any of the other witnesses want to come in on that issue?

The main challenge that the British Red Cross faces is funding. In order to provide a quality service, as the Scottish Ambulance Service does, all the British Red Cross vehicles comply with Care Quality Commission standards. We have a range of vehicles, which includes all-wheel-drive and wheelchair-accessible vehicles. The volunteer vehicles and drivers’ licences are all checked, and the volunteers have all done their first-aid and moving-and-handling training. The service that they provide for people is excellent for a donation-based service. Unfortunately, however, it is not sustainable for us to keep on providing a donation-based service because it costs money to run the vehicles and to provide all the training that goes with such a service.

It is always better when witnesses have a conversation with one another rather than just answering the politicians’ questions, but I have a very specific question. Peter McColl spoke about how there is money in the system that can be taken out. For example, the cost to the NHS of missed appointments, whether those are general practitioner or community health appointments, is far greater than the cost of a modest increase in investment in community transport.

We heard this morning from the cabinet secretary about the various pressures on the NHS from in-patients and the knock-on effects of those pressures. For example, one reason for delayed discharge may be that consultants are not reviewing patients until the afternoon rotation rather than in the morning. The slowness of getting medication for patients on discharge and the lack of support at home or in a home-type setting are also factors.

One factor could be the lack of transport for taking home a patient who is fit to go home with the relevant support. Is that a particular problem? If so, how large a problem is it? More important, are there any on-going initiatives in any of the health boards—using change fund moneys or whatever—to work with the Scottish Ambulance Service and community transport partners to ease that problem? The knock-on effects from delayed discharge on A and E waiting times and everything else are significant. Such an initiative would be a way of taking the cost back out of the system and reinvesting it in community transport.

There are examples dotted around the country. The Royal Voluntary Service is involved in providing transport on discharge; for example, here in Edinburgh we run a scheme in which the discharge is organised in hospital and the volunteer drivers are available throughout the day, according to need, to take people home. That often links with another reason for which we would have a volunteer available—namely, so that when the person is discharged home, they get the necessary support. The Edinburgh scheme is funded via the NHS.

12:30

We are also working on change fund schemes to ensure that people get to appointments. We have an interesting scheme in East Lothian in which GPs refer patients whom they know require transport to get to GP, hospital or clinic appointments. That is an effective way of ensuring that appointments are not missed.

Those are just two examples; there are many others.

The Scottish Ambulance Service has also been working in Lothian, particularly with Edinburgh royal infirmary. We embarked on a five-year improvement programme for our patient transport service, which has been very successful. One of our primary aims is to support health boards with their acute discharges to keep the flow moving in hospitals. Patients who need ambulance assistance are high on our priority list. NHS Lothian also uses other services for patients who, although they are ambulant, need a transport solution to get home. However, it has been using private ambulances because of the pressure on demand. Over the past six months, NHS Lothian has developed an internal transport hub, in which we work in partnership. We jointly staff a health board liaison officer, who can help us to bridge the communication gap that often exists with regard to immediate requests.

Bob Doris is right that decision making in hospitals is sometimes under pressure. The demand for discharge from hospital on the day of treatment has increased over the past few months. We have focused on trying to assist with that issue, so that we can help our colleagues to keep moving. I would not like to mislead the committee by giving figures, because I do not have the up-to-date ones. I understand that our service has helped to reduce significantly the cost of private ambulances by increasing utilisation and productivity within the resources that we have around the Edinburgh royal infirmary. We want to spread that kind of work over the next year or so with some of our other colleagues. Glasgow, in particular, has significant challenges.

Our programme of work is incremental, but on-going. As well as working around patients with voluntary agencies so that they can provide those services, we are very keen to ensure that the Scottish Ambulance Service can increase its contribution with hospital discharges.

There is another example in Fife of the Red Cross getting patients to hospital; we escort people with blood-borne viruses to the Western general hospital for their treatment. The type of patient means that if the transport was not there to take them to hospital on a particular date, they would just not turn up.

We have similar projects. As part of our routine discharge arrangements, we have services from the Ambulance Service in the evening; as Bob Doris said, many people now go home in the early evening, following the change in hospital admission patterns whereby people are often admitted later in the day. We have ambulances routinely available to take people home from hospital and we are working with the Red Cross as one of our change fund projects in Glasgow.

In the south of Glasgow, the Red Cross helps us to take home A and E patients who do not need to be admitted to hospital; it then provides care and follow-up. As our RVS colleagues said, they ensure that people have something to eat and that their heating is on. Local change fund partnerships are looking at community transport with a care element that is much wider than just providing a vehicle. There are a range of options on how to do that. As we heard, a range of providers can provide that service.

That all sounds reassuring. I was going to say, “That structure sounds reassuring,” but flexibility seems to be the key word when we are working in partnership.

Are there examples of individual health boards, hospitals or wards that have identified transport as one of the reasons for routine delayed discharge? Are any of the partnership organisations asked to focus on certain areas, or to provide more volunteers to relieve those pressures?

One of the issues that we are looking at is your real-time responsiveness to pressures or pinchpoints that might arise in the system. I know that you do lots more, including getting patients to appointments, and I realise that I am looking very narrowly at a patient’s admission to hospital, but do you collect data in real time and say, “We need more resource here. Let’s talk to this or that partnership organisation, see whether they are top heavy in certain parts of the country and ask whether they can deploy some volunteers here”?

The short answer is probably no. We would look at our own local resources and see whether we had a shortage of, say, renal beds, which is a west of Scotland service. If there is particular pressure on renal beds, we will link with the Ambulance Service and prioritise getting people home from the renal unit rather than from another area. Our real-time responsiveness lies with the Ambulance Service or alternative providers. We do not have the same flexibility with community transport, which, with the exception of the Red Cross A and E service, provides a more scheduled service.

I should also point out that the Red Cross service was developed in response to feedback from patients, carers and clinicians that people were being admitted to hospital because we could not get them home. In some cases, we would not want to use a taxi because we would be worried that the person would not be safe when they got home. The fact that the Red Cross service was, as I have said, developed on the back of feedback from clinicians, particularly those in emergency departments, links back to the earlier conversation about year-round pressures and increases in admissions and attendances.

I do not know how the eligibility criteria for patient transport are set, particularly in relatively remote areas, but I know a constituent from a very small Aberdeenshire village who had to attend the eye department in Aberdeen a number of times but who was assessed as not requiring patient transport. He was able to drive to the hospital, but as the treatment involved pupil dilation he was unable to drive back home; however, the public transport in his area is pretty poor. How are such decisions made? Are they made centrally or by individual health boards? It struck me that that chap was getting a particularly raw deal.

I will not mislead you: we have faced some challenges with the new patient-focused booking system that we have introduced. Historically, GPs and hospital clinics booked patient transport for the patient. We consulted the public quite widely about a direct access patient self-booking system, but in the early days our call handlers’ skills in using the triage assessment tool varied and we found that some patients who absolutely required ambulance transport had fallen through the net. We are improving in that regard. We had a few months when the number of complaints that we received was a bit higher than we would have liked and patients were raising a number of challenges to the needs assessment and eligibility criteria, but we have done a lot of training and development with the staff. They used to be dispersed across 30 local offices around Scotland, but they are now embedded in three regional control centres and are supported by clinical advisers, who are either trained nurses or trained paramedics and who can give advice on screening patients.

We have developed the triage tool to ensure that we ask the right questions about, for example, the clinic that the patient is attending. Obviously, we do not want confidential information about a patient’s condition, so the questions have become much more conversational and focus on what their visit might entail. In some cases, a patient might not know at the outset that their treatment might affect their return journey, but in some areas—it is not an holistic approach across the country—we have embedded a request system in which we can flag up issues from the clinic to the control centre in order to identify patients who should have received ambulance transport. As a result, we have been able to put in place a feedback loop from the Crewe Road staff and the hospital clinics. We are trying to close that gap, because it is pretty important that we do so. It is certainly an issue for us.

I dealt with the constituent whom I mentioned about two or three years ago. Has that system been introduced since then? The person I was talking about would probably not need an ambulance, but they would need a car of some kind.

He is probably the kind of patient for whom we would use the volunteer car scheme. That system was introduced in the north of Scotland in April last year. We rolled it out to the east of Scotland in October, and the roll-out to the west of Scotland was in the middle—in June. We created the three call centres.

You mentioned the north and the east of Scotland. Is the north-east somewhere within that loop?

The north-east—the Grampian region—is in the north. The control centre is in Inverness.

I will make an observation about the nature of community transport, and I will be happy to hear comments about it. It is not possible to roll out the system across Scotland in the same way, given the diversity that is involved. The idea that Greater Glasgow and Clyde and the Highlands could operate a similar system seems impossible. Managing the greater Glasgow area alone requires a diverse community transport system. Given its nature, community transport must be locally focused and controlled. I am keen to hear whether people wish to contradict that.

My main point is about one of the pinchpoints for the third sector: the ability to use capital to replace vehicles. There are local authority and health service organisations, as well as public transport systems, in which some vehicles are not used during the day. Have the witnesses thought about that? Would it be possible to make use of such vehicles by allowing the third sector to use vehicles during what might be downtime for the organisations concerned?

I accept the point about diversity. You are quite correct in saying that different services are provided in different ways in different places, but we must not allow that to lead to a lack of a strategic, structured approach to encouraging the use of community transport where possible. Sometimes, the two things become conflated. Community transport is different everywhere, but that does not mean that such encouragement cannot be provided in some places, and it does not meant that we should not consider it in some places.

On your second point, about vehicles that are owned by public authorities, the WRVS—I apologise: it is now the Royal Voluntary Service—uses local authority vehicles in some circumstances, although councils are not necessarily very good at letting us know what vehicles they have or when they are available. Were the arrangements to be more structured, that would encourage the provision of a lot more community transport services and we would be able to deliver more in more areas.

When it comes to diversity, I take it that you are really looking for a blueprint, rather than control. Perhaps that would fit the bill as far as your comments are concerned.

Yes.

Part of the issue concerns expectations. The work and co-ordination in Aberdeen have come about partly because of frustration on the part of some third sector agencies that no community transport thinking was going into previously funded projects. To a degree, it is a matter of considering the case for community transport as part of the reshaping care agenda and health and social care integration, as we have been discussing.

It is not that services must be the same everywhere. However, community transport should be considered when people are planning services locally, because it underpins all the other health issues that the committee has been talking about. If such a view of community transport were sold better, for example in community planning circles, we would be able to think about how the third sector could step in and make the case for the resource sharing that would fill the gaps around Scotland.

12:45

Audit Scotland talked in its report about the benefits of integrated transport units. In that context, I want to talk about a project that has not been mentioned, which took place in part of the area that I represent. Dumfries and Galloway Council was one of the main partners in the rural transport solutions project, which is European Union funded, through the northern periphery programme, with partners from Finland, Sweden, Iceland and Shetland.

The project was piloted in Wigtownshire from May 2011 and was completed in December 2012. Partners included the south west of Scotland transport partnership, NHS Dumfries and Galloway and the Scottish Ambulance Service—I see that Heather Kenney is nodding. The partners worked closely with the local community transport provider, Wigtownshire Community Transport, to try to address transport issues in a vast remote and rural area, particularly in the context of health and social care services.

An evaluation report was published in February. It would probably be worth the committee’s while to look at the report, because it contains interesting conclusions. If the convener will bear with me, I think that it is important to share some of the conclusions. The report’s authors said:

“In providing transport through the project, WCT has increased its passenger and journey numbers as well as utilising the shared vehicles efficiently and significantly reducing vehicle downtime. Resources including vehicles and drivers have been shared between partner organisations to provide sustainable and flexible transport solutions. The central coordination of vehicles has provided the ability to service different sections of the community including ARCs, schools, community groups, youth groups and sports clubs in Wigtownshire. WCT has also secured an income source through delivering services”

for the partners that I mentioned. I understand from the report that

“It is intended that the RTS model be extended across Dumfries and Galloway, to include more community transport providers, bus operators and taxi firms, in addition to further involving the NHS Dumfries and Galloway and the Scottish Ambulance Service”,

and that

“Work is currently underway with all local partners to develop a detailed plan for rollout of RTS”—

that is, rural transport solutions—

“and some potential opportunities have been identified including assistance with transport to attend NHS appointments; transport to rehabilitation centres and transport for ‘out-of-hours’ patient releases. NHS Dumfries and Galloway has also indicated that funding support is available for co-ordination activities relating to RTS delivery.”

I was keen to get that on the record. Do the witnesses have comments on the model?

I apologise to Aileen McLeod; I should have mentioned the rural transport solutions pilot. The three pilots that I mentioned have taken place since the publication of the Audit Scotland report, and that work was under way beforehand. An interesting and helpful aspect of the rural transport solutions pilot was the work that NHS Dumfries and Galloway did around zoning patients and improving scheduling, so that we could better co-ordinate transport solutions in healthcare. We have built on an awful lot of the work in our thinking about how to work with other remote and rural communities. The project was particularly helpful.

This question probably falls into the Infrastructure and Capital Investment Committee’s remit. What is the impact of inadequate public transport and changes to public transport on the delivery of services to people who rely, or who perceive themselves to rely, on community transport? When you are bringing together people and coming up with an integrated strategy, what happens if there is a change in the public transport setting that means that more people contact the Ambulance Service—or any other point in the system—to say that they think that they will need community transport, not necessarily because of clinical need but because there is simply no other provision for them?

We do not have any studies on the impact of public transport on take-up of community transport, but we are aware of the impact on some older people of the availability of public transport and how to access it. There might be sufficient public transport in an area, with a bus running six times a day, providing an adequate means for people to get into their nearest populated area, and if they also want to go to the theatre there is a bus that will take them home. Often, the problem is that they cannot access the bus, because they cannot get to the bus stop or they are not able to use public transport. A community transport service might involve getting them there and buddying them on the public transport part of their journey, and that can be complicated. We have not made a specific study, but we develop and flex our services in response to the comments that we receive about the availability and accessibility of public transport.

That is primarily an issue for local authorities, and changes in public transport have led to more of a focus on community transport, either by subsidising bus routes or by looking at alternative solutions. We have done some joint work with local authorities in our area on bus routes that we are aware might not be profit making for the operator. The Vale of Leven bus that crosses the river from the Vale of Leven on the north of the Clyde to Paisley on the south of the Clyde is a public transport service that we jointly subsidise, because we provide health services both north and south of the Clyde. There are changes that have led to us looking at different solutions that involve both community transport and alternative public sector solutions.

In the Aberdeen pilot to which Gil Paterson referred, the Aberdeen dot.rural team at Aberdeen university has been working on a technology solution that can be made available to hospitals and clinics and to the information centre in Elgin to help people who phone up for information. It is like a more advanced version of Traveline Scotland, pulling in all the solutions in a local area to link journeys, so that if there is not one single solution but there is a combination that might help people to make their journey, that can be identified. The service can also give people information about variations in their journey and provide costings.

We are testing out that system with transport to the healthcare information centre in Elgin. We have a database, but it is not live yet, so we have not managed to set up the real-time information function but aim to get it embedded this year so that people can understand the transport options. Sometimes people do not know what transport solutions exist in their area, but, given a start point and an end point to their journey, we can help them to plan it and cost it.

I know from my casework that that is an important point. We always use the classic example of the family in which the grandfather had a terminal illness and was in the Inverclyde royal hospital at Paisley. The grandmother and their daughter were unemployed, the granddaughter was in part-time employment, and it cost that family £30 on a Saturday to visit that terminally ill grandfather in the IRH. The services were reconfigured; although the reconfiguration might have taken into account the issue of getting a patient to Paisley, it did not look at any of the other issues.

Anne Harkness is the only health board representative here, so I will put the question to her. Is one of the barriers to improvement the fact that, although there is a need to look at transport areas and at the impact of ambulance services and patient transport on patients, people do not want to get too involved because there may be budget implications? Do people in health boards feel that it is not their job to get people to hospital, other than in an emergency, and that it is the local authorities’ responsibility, although they are also reluctant to take it on? Is there a fear of claiming responsibility for this issue?

That example just illustrates why we need to address the issue in partnership. Health and social care integration and regional transport structures will help us do that, but there is no doubt that we need to work much more closely together and to link in the Scottish Ambulance Service.

Although it might not be our responsibility to ensure that people get their visitors, we take that into account in our transport assessment. In a recent exercise that I was involved in, we surveyed all the patients who had visitors on how the visitors got to the hospital and what mode of transport they used—whether they took public transport, walked, drove, or whether someone else brought them. All that information is presented to the NHS board and the Government so that we are absolutely clear about the implications and the arrangements that we would put in place to mitigate problems. The arrangements might include a community transport solution or work with a bus provider to ensure that a bus route is running later in the evening. We have to find a solution to any issue that we identify. Although transport is not our funding responsibility, that does not mean that we would not take it into account in our planning.

This is a bit of a hobby horse of mine. In my area—this is replicated in other areas, I am sure—we have out-and-out community transport, volunteers at the hospice who take cancer patients for treatment in Glasgow, and the Ambulance Service. We also have MyBus; depending on where you are, there might be a debate about whether the service will or will not take you to a hospital appointment or the doctor. I have heard that others, including the Royal Voluntary Service, also intervene.

All that is sustained by public money and voluntary contributions. Software is, and has been, available in the Strathclyde region that could ensure more effective use of those assets to cover all the instances that we have talked about today. Why do we need to push people to do what they are doing more effectively? Collectively, why has that not happened?

Nobody here knows.

Is there a worry, in that some voluntary providers do not want to be sucked in? Have they lost their ethos? Have they lost their volunteers or lost control of their charity or organisation?

I cannot speak for my third sector colleagues here, but from the point of view of third sector interfaces in their different guises, there is no such concern. For many years in previous guises, part of their job would have been to build those kinds of relationships with the statutory sector and to provide co-ordination, where that works. In some instances, it has for various reasons been a challenge to do that job.

I am afraid that sometimes it just comes down to resource. Although Scotland-wide there is funding for the core work of interfaces, in places such as Lochaber, other rural areas or even Glasgow itself, that funding is relatively small, so there is a limit on how much co-ordination and planning can be done. Part of my pitch is to say that if we want to do this in a different way, there is an infrastructure that could be better supported to provide the co-ordination function. We could then make the case to, for example, the SPT, the local authority or whoever to say, “Let’s share those resources.”

In Scotland, we expect a bigger role for the third sector, but the resources are not anywhere near realistic enough to achieve that. The third sector is still a relatively small feature in many of the things that you are talking about.

13:00

A lot of what you do is organising and planning journeys, which is pretty expensive. There is a software model in Strathclyde. An old lady who wants to go to the hospital to see the consultant will not care whether she goes by MyBus, the social work van or whatever, as long as the transport is efficient and of good quality, and as long as it gets her there. How much does it cost to run such organisations and to have the clerical staff behind the scenes to plan all the services? Those issues do not arise only in Inverclyde.

I am not an expert on community transport. I know that evidence to the Infrastructure and Capital Investment Committee has described barriers that providers have found in working with the statutory sector, relating to lots of technical detail about driving licences and so forth. There is no doubt that the next challenge for the regional transport hubs is to do exactly what the convener suggests and to more robustly challenge both the NHS-provided transport and the social care transport, and to link community transport to those. I do not know whether there are technical and legal barriers to that. You would need an expert to give evidence on that.

I declare an interest as a councillor in Fife; I am going to talk about Fife, so I thought that I should do that first.

We are discussing transport to healthcare, health and social care integration and health and wellbeing. It is also about people being able to get to the bingo, because that is important too. Colleagues might be aware that there is very little community transport in Fife, but lots of people are transported because the council runs the service in-house, for all the reasons that the convener alluded to—cost, co-ordination, the need for investment and the need to be able to track the spend.

I draw colleagues’ attention to the interesting data that are collected in Fife about where people go if they have the choice, and the costs of that. That might be useful to inform transport planning, if we discover that people are going to the bingo or to the hospital a lot, we can talk to Stagecoach about putting some routes on, for instance. There is a strong need to work together, but it costs a lot of money. Fife Council spends millions of pounds every year delivering door-to-door demand-responsive transport, which is what we are talking about. Cost is an issue and it is a barrier.

I was smiling earlier, because we have in Fife the software that was mentioned. It is a good way to make the most of all our resources, but it involves new partnerships, a lot of honesty and changed relationships.

I throw those comments into the mix. I am not trying to be controversial, but there are huge challenges. Today’s discussion has been about health, but it is really about people just getting where they need to go when they need to be there.

What Jayne Baxter said ties in with what Audit Scotland said to us this morning. It sees a need for central leadership and direction across Scotland to bring everything together.

I have a final question—I promise committee members—about the lack of information in the public sector, which has been alluded to. At my hospital, there is still no timetable for the buses that run there, despite people going on and on about that. That is also an issue with general practices and other places, but the people who run them say, “It’s nothing to do with me.”

How do people know how to get access? There is no co-ordination, even of what is currently available. Indeed, there is confusion about what MyBus, for instance, does. I have tried it, I have debated it, and I have phoned up. We did a straw poll of general practices in the Inverclyde area some time ago, and we got different answers. Some people said, “It’s nothing to do with me. That’s up to them.”

There is an issue, here and now, about whether people know what is available, so that they have a range of options for visiting a patient, for getting to an appointment in hospital, for going to their general practice and so on. There seems to be an absence of information. Is that a general thing, or is it just me getting a bee in my bonnet?

Within NHS Greater Glasgow and Clyde, the information that patients get when they are to be admitted to hospital or must attend an out-patient appointment should include information about transport options, information about eligibility for an ambulance and information about Traveline, which Heather Kenney mentioned, for journey planning. We make that information available in our patient information centres. Instead of publishing a timetable, it is a case of providing information on how to make a journey from A to B. As Heather Kenney said, sometimes that might involve two buses, a bus and a train or—in the case of Inverclyde—a bus and a ferry. We would use Traveline to provide that information. I cannot speak about the situation in GP surgeries, but I can certainly pick that up with the CHP director.

Such information is not provided when a person is told by their GP to take their child to the children’s ward at the IRH in Paisley. On one such occasion, it was the WRVS, through a connection with a social worker or whoever, in a network that was working, who came and picked up the person—who I think was a grandmother, rather than a parent—and the child and took them to Paisley. On such occasions, if people had a car, they would go in the car, but not everyone has a car.

All this points to two things: the first is to do with better relationships at the local level and the need to link services with technology, and the second is about structures. It is very welcome that the committee is looking at community transport in the contexts of health and social care integration and of reshaping care for older people, because those structures will allow us to create services that much better meet the needs that the convener is talking about.

It might be slightly unfair to say this, but for some time community transport has been a little bit of a Cinderella service; it has been at the end of the list of services that health boards and local authorities think about providing. Raising the profile of community transport and improving the relationships with it and the quality of thinking about it will lead us to better outcomes. Knowing who the right people are and having the right structures in place will deliver that.

No other members have questions, so I thank all the witnesses very much for their time and for their evidence.

13:07 Meeting suspended.

13:09 On resuming—