Project: Transport and Access to Health Care - The Potential of New Information Technology C46

Reference: STP 14/5/24

Last update: 31/12/2009 10:13:34


The objectives of the research are to map the existing transport facilities supported by public agencies and the voluntary sector and ascertain their costs, to map the transport services needed to enable people to access health care facilities, to compare the existing provision with transport needs and establish revised models for the provision of transport to improve access.


A key barrier to improved health and well-being is access to health services. Some ten per cent of hospital outpatient appointments are currently missed and it is speculated that many of these cancellations are related to transport problems. Moreover it is widely acknowledged that current provision of health care transport is inefficient. The aim of the project is to compare the existing provision of transport facilities with needs and develop a revised model of transport provision studying the potential for on-line communications and demand-responsive tranport.

The project will be centred on a case study of the Oxford Radcliffe Hospitals. Following a review of existing literature aspecially commissioned survey will be undertaken to inform a new model for health care transport provision to the hospitals.


University of Oxford
Research Services Office, University Offices, Oxford, OX1 2JD

Contract details

Cost to the Department: £48,018.00

Actual start date: 01 January 2003

Actual completion date: 18 March 2004


Transport and Access to Health Care: The Potential of New Information Technology - Report on Literature Review
Author: Raje, F., Brand, C., Preston, J. and Grieco, M
Publication date: 01/04/2003
Working Paper 945
Source: Transport Studies Unit, Oxford
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Transport and Access to Health Care: The Potential of New Information Technology - Report on Transport and Health Profiles
Author: Raje, F., Brand, C., Preston, J. and Grieco, M
Publication date: 01/08/2003
Working Paper 952
Source: Transport Studies Unit, Oxford
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Transport and Access to Health Care: The Potential of New Information Technology - Report on Software Review
Author: Brand, C
Publication date: 01/11/2003
Working Paper 967
Source: Transport Studies Unit, Oxford
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Summary of results

  1. This work focuses on the potential for demand responsive transport (DRT) solutions to facilitate easier access. DRT services provide transport "on demand" from passengers using fleets of vehicles scheduled to pick up and drop off people in accordance with their needs. DRT is an intermediate form of transport, somewhere between bus and taxi and covers a wide range of transport services ranging from less formal community transport through to area-wide service networks. In recent years, the ability of DRT concepts to provide efficient, viable transport services has been greatly enhanced by the use of transport telematics software and hardware.

    There appears to be relatively little written about the links between transport and health care access. Recent policy review by the Government and bodies such as the National Health Service (NHS), Audit Commission and Social Exclusion Unit have started to refer to the concept of hospital and general practitioner (GP) access in relation to transport issues. In Section 2, this report summarises the evidence collated and analysed in the literature review (RajÚ et al, 2003a), grouped into key themes of policy and practice:

    - The need for new perspectives on transport and health;
    - Missed appointments and transport;
    - Transport as a determinant of health;
    - Non-emergency patient transport - the need for action;
    - The emergence of the demand responsive transport option;
    - The expansion of demand responsive transport schemes;
    - Telematics and demand responsive transport;
    - Demand responsive transport, health and social inclusion; and
    - The role of the community in designing appropriate access solutions.

    Section 3 summarises the findings of a two-pronged approach to developing an overview of current health care and transport provision in Oxfordshire (RajÚ et al, 2003b). It provides information obtained from secondary sources on public transport services and health care facilities in a number of geographical locations in the county and also provides the findings of primary research carried out to ascertain in greater detail how people access the John Radcliffe and Churchill Hospitals in Oxford as well as general practitioner services in West Oxfordshire District, Cherwell District and the City of Oxford.

    The empirical research was designed to fill what appears to be a gap in available data which was underlined in the literature review process: although there is a large body of literature available on transport and health, it is mainly focused on the health impacts of transport such as emissions and accidents. Separate questionnaires were used for the hospital and GP elements of the survey. The hospital questionnaires sought information on non-staff travel and the GP questionnaires on patient travel. A total of 1366 questionnaires were distributed, of which 221 hospital questionnaires and 144 GP questionnaires were returned and analysed.

    From this it appears that journeys to the hospitals at Headington can be quite complex, requiring interchanges in public transport, coordination with other family members and friends and the use of taxis. Nearly all areas have some form of community transport service available but there are often restrictions on these services and some people are unsure about their eligibility for such services. There is also an apparent need for information about available transport services to hospitals. As may be expected, travel to GP facilities appears to pose rather less difficulties than travel to hospital. Other key results were:
    - The most frequent problems described by respondents in travelling to hospital were parking problems, difficult/impossible to get there/back by public transport, traffic congestion and having to rely on someone else to take them.
    - Most people (almost half) reported driving to and from hospital and the median travel time in either direction was 30 minutes.
    - The hospital survey indicates that the greatest number of arrivals appear to have been between 0900 and 1100. Times of departure from hospital appear to peak between 1100 and 1300.
    - The median total cost for a round trip to hospital was £5.00, although costs varied between £0.40 and £31.00.
    - Most patients drove to their GPs while just over a quarter walked.
    - Visits to/from the GP appear to have involved a median travel time of about 10 minutes.
    - The average total travel time to and from a GP surgery was 20 minutes and total cost was estimated at £2.00.
    The main and solely new part of this report is presented in Section 4. This specifically addresses study objective number 3 by comparing the existing provision with transport needs and establishing a revised model for the provision of transport to improve access. The Mobirouter DRT software package was used to develop this model employing a range of flexible demand responsive transport services. These services are viewed as being both supplementary and an alternative to existing service provision such as taxi, bus, ambulance patient transport services and private motoring. The software tool allows for testing a range of service definitions and scenarios on a 'what if' basis. The model represents a first step towards an alternative health care transport plan for Oxfordshire.

    The main results of the modelling exercise are:

    - Overall, about 40% of the hospital orders were assigned to a service route within a 20-minute time window for this initial setup. Note the same 'success rate' applies to the GP surgery services developed separately from the hospital ones.

    - For non-car drivers and/or the elderly, the DRT service routes have significant accessibility benefits. This is particularly true where access to public transport is poor.

    - The £5 per average single DRT trip compares favourably to complex public transport journeys, some car journeys (incl. parking charges) and most taxi trips.

    - The picture is not entirely clear when assessing DRT journey time savings compared to actual journey times reported by the hospital patients/visitors, with a wide range of time savings and increases for individual passengers. Savings can be significant when compared to journeys involving existing public transport, intra- or inter-modal transfers, walking and waiting. Again, the picture is similar for trips to/from GP surgeries.

    - The improved reliability of transport to hospital is likely to show significant benefits of lowering number of missed appointments. However, this could not be verified in this work.

    - The 215 completed surveys amount to 10.8% of the daily hospital patronage with destinations in the study area of 2,000 (SDG, 2001). This is slightly more than the share of respondents without access to a car (8.8%) and substantially less than respondents' 'expression of interest' for DRT (27.4%).

    - Given the uncertainty in estimating potential demand for DRT, three demand scenarios were tested in terms of financial viability: a CENTRAL market share for DRT of 5%, and LOW and HIGH market shares of 2.5% and 7.5%. In light of the empirical evidence of this study and other sources (e.g. Grosso et al, 2002; Jones, 2002; RajÚ et al, 2003a; Brand, 2003), this range of demand figures appears to be a reasonable for the purpose of this demonstration. The financial feasibility analysis provides a range of net present values for the three market shares. According to this analysis, the 'breakeven demand' for zero profit/loss is about 34 passengers per vehicle per day (or 6% of total demand) based on an average passenger charge of £5.

    - The model has the potential to introduce greater equity of transport access.

    The average charge per passenger was chosen here somewhere between bus and taxi charges. It lies well in the range of charges observed for existing DRT schemes in the UK. If replacing subsidised services such as community transport or non-emergency Patient Transport Services, a subsidy for DRT could significantly lower this charge to levels comparable to, for example, parking charges that are most 'visible' to the patient/visitor. Furthermore, the above demand figures are for hospital users only. It may be beneficial to combine demand and service supply with GP surgery demand. This might be tested in future work.

    The demand figures employed are well within the usage figures reported by CfIT (2002), ranging from 10 to 51 passengers per vehicle per day for flexible DRT services with similar service frequencies and daily coverage. However, more detailed demand forecasting work will be required to substantiate the case for DRT services for health care services in the area.

    Given the demonstrative nature of the model, there was insufficient time for the level of iteration necessary to make the services truly efficient. Further iterations would be required to make this a more efficient setup, with higher 'FLEX success rates' expected. Real world applications have shown that timings have to be fine tuned on a regular basis, reflecting weekly and seasonal differences in demand patterns. Indeed, this flexible approach can be seen as one of the strengths of DRT services and is most suitable to transport to health care provision.

    Further work is required to test the feasibility of closely linking any DRT services with existing public transport provision (as feeder services) and major private transport interchanges (e.g. P&R). This would demonstrate a truly integrated transport provision, not only for transport to health care but supplementary to other forms of transport such as taxi, community transport, bus, rail etc.

    Last but not least, the authors believe that modern DRT services have an important role to play in areas of poor provision, which in turn could contribute to the NHS' founding principle of providing access to care to all on the basis of need.