“A Road to Health”
The final item of business is a member’s business debate on motion S4M-01763, in the name of Alex Fergusson, on “A Road to Health”. The debate will be concluded without any question being put.
Motion debated,
That the Parliament commends the Dumfries and Galloway Third Sector Forum for its participation in the Parliament’s Third Community Partnerships Project and the report on its public consultation entitled Road to Health, which has identified a number of issues relating to the transport of older people to and from hospital and clinical appointments; notes that the forum’s conclusions highlight a belief that there is a need for NHS boards and local authorities to work together to maximise the effectiveness of transport for older patients and their carers attending hospital appointments and day care centres, and that adequate transport provision in remote and rural areas is vital for the health and wellbeing of older citizens; further notes the findings of the report that different regions of Scotland have different approaches to this issue, and believes that there is a need to develop a national strategy with best practice guidelines for the adequate provision of such transport to address the issues highlighted in Road to Health as soon as is practicable.
17:05
I am grateful to have the opportunity to bring this debate to the chamber. I am beginning to wish that I had entitled the motion slightly differently, because I see one of the health ministers here when the debate is more about transport than health. I have no doubt that the minister will pass on any comments to his colleagues if required, although health issues will also be discussed.
In March 2011, Dumfries and Galloway third sector forum encouraged a small team of volunteers—I am delighted to see some of them in the gallery this evening—to come together under the Parliament’s community partnerships project to see what might be done to improve the provision of rural transport within the region for older people and their carers to maintain and, hopefully, improve their health and wellbeing.
The group states, in the summary of its excellent report, “A Road to Health”, which was published in March this year:
“We are seeking to influence the Scottish Government and Local Authorities by making them aware of the transport issues faced by older people and by presenting compelling arguments for changing practices in Dumfries and Galloway.”
That is exactly why the Parliament established the community partnerships programmes—to encourage communities to engage with this institution and, in doing so, to empower those same communities in seeking to drive and influence change when they had identified a need for it. That is a true, bottom-up approach to policy making. I fully understand the budgetary constraints that have led to the CPP being wound up, but I, for one, very much regret its passing.
Nonetheless, through “A Road to Health”, the CPP is going out with a bang, because those volunteers who did the work have no intentions of resting on their laurels having published their report. They are to be greatly commended for their on-going commitment to bringing about the changes that they identified. That commitment stems almost entirely from what they discovered as they went about the project.
The project began with a questionnaire being widely distributed through a range of organisations. More than 1,000 were distributed, and a healthy number of 325 were returned from a remarkably even spread across the region’s postcodes. The questionnaire had been split into two parts, the first of which was on travel relating to healthcare, while the second was on travel relating to wellbeing.
In the section on travel relating to healthcare, the findings were that 91 per cent of respondents had to travel for healthcare appointments; 69 per cent of them had to travel more than 10 miles and 14 per cent had to travel more than 50 miles to attend their appointment. Such is the rural nature of Dumfries and Galloway and of other regions, and I do not suppose that those statistics come as any great surprise.
However, 29 per cent reported that they found the travel arrangements to and from their appointments either stressful or very stressful. That should come as a surprise to us and we should sit up and listen to that statistic.
More worrying surprises appear in the section on travel related to wellbeing. I can do no better than quote from my contribution to Jim Hume’s recent debate on community transport, in which I summed up a lot of the work in Dumfries and Galloway by saying that the survey
“found that more than 40 per cent of older people had difficulty getting out of their houses and that nearly half of that group found it almost impossible to get out. Finally, it found that a quarter of older people did not get out of their houses at all in a month—I find that staggering.”—[Official Report, 29 March 2012; c 8025.]
When those figures are extrapolated across the region, they become stark, suggesting that 15,000 older people in Dumfries and Galloway cannot do their own shopping; that 3,000 older people live more than 10 miles from shops; that 18,000 older people have trouble getting out; and—this is the one that really hits me—more than 10,000 people get out of their houses less frequently than once a month. That is close to imprisonment.
Presiding Officer, not even the authors of this excellent report would argue that the survey was scientific, but even if we halve the figures, they are alarming in the extreme and should demand our attention.
What is to be done about the issue in these difficult economic times? Again, I refer to Jim Hume’s debate, in which Claudia Beamish, Elaine Murray, Aileen McLeod and I all made mention of the rural transport solutions pilot scheme in Wigtownshire. The scheme has encouraged out-of-the-box and joined-up thinking that has, for instance, freed up the school transport fleet for wider use when it is not required for its primary function.
Before the pilot project began, the entire fleet in Wigtownshire was in use for two and a half hours a day during the school term. In the first four months of the scheme, the fleet travelled an extra 22,000 miles, carrying 8,000 non-school passengers who would otherwise have had no public transport options. Commercial opportunities have been identified to allow Wigtownshire Community Transport to operate scheduled services, giving older people access to shops and amenities that they could previously only dream about.
That approach indicates a way forward and a way to alleviate some of the problems that are identified in “A Road to Health”. During Jim Hume’s debate, Aileen McLeod said of the initiative:
“I am not suggesting that that precise model could or should be rolled out across the country”.—[Official Report, 29 March 2012; c 8023.]
I do not disagree with Dr McLeod, but I think that the scheme should—indeed, it must—be looked at by the Scottish Government as a way forward in providing our older citizens in rural areas with a transport system that can genuinely be referred to as a road to health.
17:11
I congratulate Alex Fergusson on securing the debate, which highlights an important piece of research that was conducted by nine volunteers working on behalf of the Dumfries and Galloway third sector forum. The topic spans transport and health, and the Labour Party has spokespeople from both teams present. I congratulate the members of the third sector forum on their excellent report.
In last week’s Finance Committee debate on fiscal sustainability, I referred to the evidence from Dr James McCormick of the Joseph Rowntree Foundation that the cost of emergency admissions to hospital among the over-70s in Scotland is around four times the entire budget for personal care for older people. Therefore, interventions that help to keep older people well and reduce emergency hospital admissions are to be welcomed. The research, which looked at travel to healthcare and travel that promotes the wellbeing of older people, is significant in the debate on preventative spend.
Those of us who live in and represent rural communities know that there are problems with travel for both purposes. Outside the main towns, bus travel can be sporadic. The entitlement to concessionary bus transport is meaningless if there is no bus to travel on. Many older people can no longer afford to run a car or might not be medically fit enough to drive.
Even for those of us who think that we are aware of the problems, the case studies that are referred to in the publication, which was produced under the community partnerships project, are startling. For example, an 82-year-old man from Kirkconnel was taken to Dumfries and Galloway royal infirmary via Stranraer. Going directly from Kirkconnel to DGRI takes around an hour, but going via Stranraer would add three to four hours to the journey time. The report does not state why that happened or who picked up the patient to be transported, but I presume that another patient had to be picked up in Stranraer. I do not imagine that the situation was similar to that of the probationary teacher from Glasgow whom I heard of who was rather late on his first day at Stranraer academy having travelled down to Dumfries and turned right. I hope that it was not a mistake of that type. However, such an extended journey can hardly have helped the elderly patient who was involved.
That is perhaps an extreme example but, as Alex Fergusson said, almost one in three of those who responded to the survey described travel to and from their medical appointments as stressful or very stressful. The forum is keen to stress that the issue is not just about travel to healthcare; it is also about the ability to get out and about to leisure facilities and shops and about what we now term wellbeing. Again, Alex Fergusson gave statistics on that. If people are to remain healthy as they get older, they need to be able to retain their independence as far as possible and to get out to enjoy a variety of experiences, meet friends, have a social life and do all the things that we take for granted. One respondent said:
“We should be doing things we’re able to do and treated as equal citizens”.
One of the things that is striking about the report is that the forum is not just demanding money; it wants to see resources that agencies already possess being used more effectively and efficiently. The forum has already met officers from Dumfries and Galloway Council who are working on the rural transport solutions initiative, which Alex Fergusson mentioned.
One example is that a number of agencies have vehicles—school buses, or vehicles at transport resource centres—that spend much of their time not being used. Better partnership working between public sector agencies such as the Scottish Ambulance Service, the national health service, councils and the third sector can result in more effective use of the transport resources that are already available and in a truly joined-up approach being taken to help older people maintain good health.
Of course, there will be examples of good practice across the country, which need to be shared. As Alex Fergusson said, and as Aileen McLeod said in her speech in Jim Hume’s recent debate, good practice is not necessarily transferable, but when resources are tight, learning from each other can be particularly useful.
17:16
I, too, congratulate Alex Fergusson on securing the debate. I welcome some of the authors of the report to the gallery. I also congratulate Alex Fergusson on the hard work that he has done with the volunteers over his terms in Parliament.
The Dumfries and Galloway third sector forum’s excellent report “A Road to Health” comes at an important juncture in Scotland’s policy-making process, coming as it does at a time when we as a Parliament recognise fully the importance of preventative measures and support for community actions in our ageing society. The report sets out very clearly the argument that the NHS and local authorities need to work together to maximise the effectiveness of transport for older patients in remote and rural areas. That is a sentiment that I could not agree with more and it is a priority that I hope local authorities across Scotland take on board.
However, I am sure that everyone in the chamber will be prepared for the standard argument that prohibitive costs often make such transport options difficult. I fully appreciate that the costs of fuel, staffing and vehicle maintenance make many such ventures very expensive before they are even operational. However, I also believe that we have a duty to overcome those obstacles and find solutions with our colleagues in the NHS and local authorities so that we can provide the standard of transport that patients in rural areas need and deserve and which is crucial to the communities that we serve.
I appreciate that every patient will have his or her individual experience of attending a medical appointment to recount and that all MSPs will receive various sorts of feedback. In addition to what Alex Fergusson has said, I will set out some of the challenges that face patients in rural areas, as reported by the community partnerships project volunteers.
As Alex Fergusson rightly pointed out, 69 per cent of respondents to the report travel more than 10 miles for an appointment, with 14 per cent travelling between 50 and 100 miles. That is the equivalent of travelling from Edinburgh to Paisley and back, and is unacceptable.
The report also points out that 16 per cent of respondents had appointments before 10 am and that 29 per cent said that they found travelling to and from appointments stressful or very stressful. That only adds to the anxiety of attending a medical appointment in the first place.
As I said, we are always prepared to hear why solutions cannot be found. For that reason, I congratulate the Dumfries and Galloway third sector forum on including in its report ways in which we might overcome the challenge. The engagement with the forum of council officials who are leading the rural transport solutions initiative is extremely encouraging. I know that colleagues across the Highlands and Islands, Aberdeenshire and other rural areas face similar issues with rural patient transport, so I hope that what is happening in the south-west will give them hope that progress can be made.
The way in which the RTS pilot was run in conjunction with Wigtownshire Community Transport, which provided transport for the adult resource centre in Stranraer, is exemplary. Having identified the exact needs of the scheme, an extremely effective system was put in place. Co-ordinating the use of the vehicles and scheduling pick-ups and drop-offs meant that activities could be maximised, the system was more cost effective and the quality of the service improved.
As I said in the debate that was held in the chamber in March on Jim Hume’s motion, the report published by the Christie commission last year provides
“a comprehensive statement of the principles that should inform our approach to community transport. In particular, transport services have to be designed around the needs of older and vulnerable people who live in our rural communities.”—[Official Report, 29 March 2012; c 8024.]
I fully support the forum in its endeavours to have a co-ordinated approach and other good practice methods reproduced and adopted throughout Scotland. I congratulate all involved in the Dumfries and Galloway third sector forum on their efforts in pioneering a programme to be built up and made fit for purpose by other community transport initiatives. I am keen to ensure that all their hard work pays off. In that regard, I look forward to continuing to work with them and with colleagues across this chamber to support our older and vulnerable citizens.
17:20
I join in the congratulations to Alex Fergusson on securing the debate. Transport matters to us all at the best of times, and it matters even more when we have to get to and from lifeline services. Nowhere is it more important than in relation to access to local health services.
I was struck by the report of the Dumfries and Galloway third sector forum, which highlights the importance of travel for our older people. I join other members in congratulating the forum on the public consultation that it undertook. There is much to learn from the forum’s conclusions about planning transport services more generally in rural areas, but members will forgive me if I focus predominantly on the challenges for health services.
Many communities in Scotland experience the issues that the report raises. I know that an argument is often—rightly—made about rurality, but the issues are also challenging in parts of urban Scotland. I will relate my experience with constituents from the Vale of Leven hospital catchment area who have had to travel to the Royal Alexandra hospital in Paisley for key services.
When the service change was made, travelling to the RAH—which I inform members from other parts of Scotland is on the other side of the River Clyde from the Vale of Leven hospital—meant a two and a half hour journey that involved two trains, a bus and a bit of walking in between. That was just one way, so getting back home doubled the time. That route, which took people into the centre of Glasgow and back out on the other side of the river, passed five hospitals. I am sure that members will agree that that was a ridiculous situation that defied understanding—it also shows some of the challenges in getting our transport right in urban Scotland, never mind rural Scotland.
Despite all our protestations about the lack of accessibility of services, the health board considered our concerns to be largely second order. Health board views on health service configurations tend to drive change, and any commonsense consideration, such as “For goodness’ sake—how do you get there?”, does not feature in boards’ thinking.
A previous Labour Administration put in place legislation to require boards to consider transport arrangements in any proposal for change. The current Government party supported that, and the measure is welcome, but health boards have not always translated it into adequate service provision.
We now have a bus service from the Vale of Leven to the RAH that is subsidised by the health board and Strathclyde partnership for transport. It did not have the best start, but much progress has been made, so such services can be introduced. Now, people are not offered appointments at times before the bus service starts in the morning; the service is timetabled to link with bus services from outlying areas; it has even extended its area of operation; and more people are using it. There will always be room for improvement, but the key lesson is that the service was shaped by the experience of people in their community. I pay tribute to Helensburgh community council for its work on the issue. Another key lesson, which has yet to be properly learned, is that a transport service must be in place when a service changes and not two, three or four months afterwards.
The provision of patient transport is a matter for the Scottish Ambulance Service, which is often regarded as a Cinderella service but which is essential for getting people to appointments and to hospital. I know that one complaint from my constituents is echoed elsewhere. They say that, when they get on patient transport, they sometimes have to drive round for a couple of hours while everybody else is picked up, and then the same thing happens in reverse. I know that the Scottish Ambulance Service is now operating a new system that is much more demand responsive and I look forward to hearing how that has panned out, because that offers hope for the future.
Patients sometimes experience difficulty in securing transport because access is determined by their general practitioner on the basis of clinical need, which is not always well known, and because patients are reluctant to ask. The assumption is made that people somehow have their own transport.
In my area, the voluntary sector plays a critical role. The Red Cross provides transport and community transport schemes assist people in getting to where they need to be. More can be done to enable such flexible transport options that are community based. I hope that the minister will reflect on that further with Keith Brown, the transport minister.
I will make a general point in conclusion. The debate reflects positively not only on the group from Dumfries and Galloway and the work that it has done but on the Parliament. The Parliament’s community partnerships project was—I believe—an innovation of Alex Fergusson’s when he was the Presiding Officer. It is very welcome and is to be commended to voluntary groups across Scotland.
17:25
Like others, I congratulate Alex Fergusson on securing the debate, notwithstanding his slight disappointment that it is a health minister who is responding to it. However, I will do my very best to—
Will the minister give way?
Of course.
Whatever I expressed, it was not meant to be disappointment.
I am very grateful for that, and I will try my best to respond to the points that have been raised.
I agree with Alex Fergusson that the Scottish Parliament’s community partnerships project has proved to be highly successful. In this case, the Dumfries and Galloway third sector forum has proved to be an excellent example of the benefits that can be gained from that type of collaborative working between voluntary organisations and public bodies. It is something of a regret that, for financial reasons, it is unable to continue. It was very much a bottom-up approach to trying to engage with those who may not engage with the political process.
“A Road to Health” highlights a number of issues that are recognised not only in Dumfries and Galloway but throughout the country. As Jackie Baillie said, such issues are not exclusive to remote and rural areas. The underlying issues are challenging and are not unique to healthcare—they cover a number of areas of public service provision. Many of the relevant bodies need to recognise that challenge.
I am sure that members understand that it can be very challenging for planners and service providers to configure services, and the transport needs around those services, to ensure that they address the needs of communities effectively, particularly in remote and rural areas. I do not underestimate the huge challenge that some of them face in that respect.
Importantly, providers need to ensure not only that they are innovative in their provision of transport services but that they try to identify unique arrangements to ensure that they address the needs of local residents. The Wigtownshire pilot is a good example of such thinking outside the box and of a more effective utilisation of existing resources.
The issues surrounding transport to healthcare services are well recognised, and a significant amount of work has been done over recent years to try to address them. It may be helpful if I highlight to members some of the actions that have taken place over the past couple of years in that respect.
In 2009, a healthcare transport framework was issued, providing guidance to all NHS boards in Scotland, which were responsible for preparing local plans on improving access to major healthcare facilities and for developing capacity to respond to the need for and deliver the necessary improvements to transportation.
A recent update highlighted a variety of approaches that have been adopted by health boards, often reflecting their individual local circumstances. A good example of that is at Forth Valley royal hospital in my constituency, which has configured the bus transportation service to help staff and patients to access that newly built facility.
More recently, the regional transport partnerships asked the Scottish Government to review the delivery of effective patient transport to healthcare services. As a result of that request, last year we established a short-life working group on transport for health. I can advise members that the group’s report is being finalised and will be brought before ministers shortly. Although I cannot pre-empt its findings and recommendations, I assure members that we will consider those findings and recommendations very carefully.
However, I know that one of the aims was to examine how stakeholders might work together more effectively. That echoes some of the recommendations and findings in “A Road to Health.” I emphasise that if we are to realise the integration that we wish to see in relation to transport, it is absolutely vital that all the relevant bodies are prepared to work together collectively to achieve that improvement.
“A Road to Health” includes a range of negative experiences that people have found in using patient transport services. I know of the variety of experiences of the service from my constituents’ representations. I confirm that the Scottish Ambulance Service acknowledges the difficulties, which is why it is running an improvement programme that aims to make the service more reliable and responsive. There are already some signs of improvement gains as a result of the approach taken by the Scottish Ambulance Service.
Members may be aware that, in the north of Scotland, patients who are eligible to use the patient transport service can utilise a new direct booking and management system that started up just last month. The system allows individuals to book ambulance transport directly through a dedicated call centre in Inverness, and they can talk to a trained member of staff when requesting patient transport. That can be done up to 28 days before transport is required. Some of the findings so far indicate positive responses from patients who are using the system.
The contact centre also looks at the other forms of transportation that may be available in the area, which patients can be advised of if they wish to make use of that transport for non-clinical purposes.
Members will be aware of the 2011 Audit Scotland report, which highlighted a number of areas that require further improvement. The Scottish Ambulance Service is considering what further progress it can make to ensure that some of the concerns are addressed. For example, it is considering using technology in vehicles to maximise punctuality and plan routes more efficiently so that patients do not find themselves going round the block time and again when they are being transported to hospital.
I recognise that the area is one where, for a variety of different reasons, there are considerable complexities in different parts of the country. From the health point of view, the Scottish Ambulance Service recognises the challenges. We, as a Government, recognise that there are benefits in establishing more partnership working across the health sector, and across local authority and other service providers, to make sure that we utilise the available transport resources more efficiently and effectively to ensure that, collectively, we improve peoples’ health and wellbeing.
Meeting closed at 17:32.