Our Other Key Activities

Work with the Scottish Government on Transport to Health and Social Care

MACS has been working closely with the Scottish Government Primary Care Team and Transport Scotland's Accessibility Team to work towards the implementation of our recommendations from our Phase 1 work within our Transport to Health and Social Care report mentioned earlier. MACS took part in a workshop session late last year, hosted by the Scottish Government Primary Care Team, to look at which areas of our report could be tackled in the short, medium and long term and also to what the role and remit of the Strategic Advisory Board should be.

In 2019 during a discussion with the Health Minister and other Cabinet Secretaries, MACS were asked to take a more in-depth look at Transport to Health and Social Care, mainly because, in our advocacy role, we were hearing (strongly) about the issues disabled people and older people were having when trying to get transport to access health and social care appointments. At our request Disability Equality Scotland reached out to their members (disabled people) and ran a snapshot weekly poll (August 2019) asking if people faced transport barriers when accessing medical appointments.

The weekly poll received nearly 1,000 responses, the highest-ever return to this style of poll, running over just seven days, showing how critical and emotive an issue this was. Of the near 1,000 returns 98% responded stating they had faced barriers. Many described these barriers and the detrimental impact this had on their life, health and wellbeing and ability to access the medical and social care services they needed.

This led to MACS facilitating a multi-organisation roundtable discussion, with participants including the following:

Disabled People and their Organisations
Access Panels
NHS Boards
NHS Board Equality and Diversity Leads
Integration Authorities
Regional Transport Partnerships
Transport Scotland
Scottish Government Health and Social Care Directorates
The Scottish Ambulance Service
Transport Service and Infrastructure Providers
Regulators Including the Equality and Human Rights Commission
The University of Edinburgh

At the same time we engaged separately with several other organisations such as the EHRC, Audit Scotland, the Poverty and Inequality Commission, Transport Scotland's Accessible Travel Team and those leading on the NTS2 (with the new strategy imminent at the time), and the team leading on the Strategic Transport Projects Review (STPR2), to name a few. We also conducted desktop research looking at hospital websites, hospital travel reimbursements schemes, Traveline Scotland's website, healthcare opinion polls and Local Authority "Local Outcomes Improvement Plans".

The Community Transport Association (CTA) in Scotland also ran a poll for us with interesting and similar results, which showed a heavy reliance (outstripping resources) on CTA to take people to medical appointments.

Our first roundtable discussion followed in November 2019 and resulted in a report and 27 recommendations. This was made available widely and in March 2020, just before lockdown. We held a second roundtable to look at the recommendations, prioritise and theme them. This resulted in a shorter, more focused report with nine themed recommendations as follows:

Transport should be built in as an integral part of the care pathway. There needs to be better joined-up care planning and working with NHS, Local Authorities and the Scottish Ambulance Service (SAS), with CTA recognised as key partners in the planning and care pathway.
Missed health appointments should be seen as a priority for this work. Missed appointments that have resulted from transport barriers have a cost to the health service as well as to the individuals and their carers (including being detrimental to their condition through delayed treatment). Ideally this would be quantified to identify financial implications, health and wellbeing complications and the potential for the patient's condition to deteriorate while waiting longer for treatment.
Transport should be designed around access to health and social care. Organisations must engage with getting disabled and older people to their services. Transport resources and budgets should be shared between the NHS, Local Authorities, SAS and CTAs (with those budgets ring-fenced).
One organisation needs to take the strategic lead for planning of the cross-sector transport to health service. This must ensure that ambulance, hospital, community and public transport provision meets demand and is accessible, available and affordable to all. Local transport providers should be involved in the planning of transport particularly in rural areas.
Disabled and older people should be given more influence on transport to health services and the planning and design of buses, bus routes, bus stops, information points and public toilets to ensure they are geared towards disabled people and older people accessing health services. Transport Scotland should consider including plus one on bus passes for those on PIP.
Online booking of patient transport services should be explored by SAS. A booking system like Passenger Assistance on public services, which is a needs-based and person-centred process. The SAS, hospitals and GPs need to take responsibility for proactively giving information on what is available locally for transport to health, including what's available should the person not qualify for patient transport. Information should be in accessible forms and suitable to the population it serves. This would include both online and printed form.
People report issues with accessible parking at healthcare, especially hospitals. Blue Badge holders report insufficient Blue Badge spaces and those available being used by non-Blue Badge holders. This also results in missed appointments and there are situations when people are asking for patient transport because they cannot park even when they have transport. This needs to be addressed and prioritised to ensure enough spaces and that these spaces are monitored to eliminate misuse.
All local authorities should have an accessible transport strategy that encourages and facilitates more disabled people and older people being able to access public transport.
Improve discharge or waiting hubs to be more like a social and shared space to improve social connection and reduce loneliness. NHS providers should involve patient groups in the design of these.

During further discussions with MACS, Scottish Ministers agreed that their officials would set up a "Strategic Advisory Group" to look at these recommendations and how they could be progressed, asking MACS to remain involved and report back as part of their remit to offer Ministers independent advice.

In 2021 MACS engaged more frequently with our Scottish Government Health and Social Care colleagues (Out of Hours, Transport and Rural) who have agreed to lead on taking this work forward to progress MACS recommendations running a further roundtable in September 2021 and producing a work plan by the end of the year.

Transport Scotland's Accessible Travel Policy Team also agreed to include Transport to Health and Social Care within the Accessible Travel Framework Annual Delivery Plan from 2021.

Public Service Vehicle Accessibility Regulations 2000 (PSVAR)

In relation to PSVAR current short-term exemptions for rail replacement and home-to-school services are due to expire on 30 June 2022 and 31 July 2022 respectively. The Department for Transport in the UK Government have made the decision to bring forward Medium-Term Exemptions (MTEs) pending their planned review of the Regulations by the end of 2023. More recent communications now suggest that these exemptions will be further extended to 2026. MACS has opposed these continued exemptions and although whilst not a devolved issue, MACS has asked Transport Scotland if there is anything they can do to address this position.

Discussion on the ongoing review of the Reference Size Wheelchair

The Department for Transport (DfT) appointed Atkins Jacobs Joint Venture (AJJV) to undertake a review of the reference wheelchair and its specification used in the definition of accessible transport vehicles and transport infrastructure. The aim of the review was to understand the modern day needs of mobility-aid users.

A Steering Group was formed which included representatives from MACS and DPTAC as well as representatives covering the various modes of public transport. In addition, two separate surveys were undertaken to capture the perspective of mobility-aid users and industry stakeholders.

The research has recently been completed and DfT published the report on 29 March 2022. The report can be found via Reference wheelchair standard and transport design - GOV.UK (www.gov.uk)

DfT advise that there are many potential uses for the findings of this research. It will be considered, for example, during the review of the Public Sector Vehicle Accessibility Regulations (PSVAR).

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