Making Travel Plans Work: Evidence from the NHS in England

1. Making Travel Plans Work: Evidence from the NHS (in England) Dr Adrian Davis Transport and Health Consultant adrian.davis@phonecoop.coop 0117 9245 603

2. The Estates Return Information Collection system of NHS Estates had reported that latest figure for 2003/4 is 233 or 41.5% of responding trustsindicated they have a transport plan (the response rate was 97% or 561trusts) Likely to be more incentives for acute trusts in urban locations than rural sites 115 NHS Trusts have requested SSA through the Transport Energy programme funded by DfT over the past 4 years.The Estates Return Information Collection system of NHS Estates had reported that latest figure for 2003/4 is 233 or 41.5% of responding trustsindicated they have a transport plan (the response rate was 97% or 561trusts) Likely to be more incentives for acute trusts in urban locations than rural sites 115 NHS Trusts have requested SSA through the Transport Energy programme funded by DfT over the past 4 years.

3. Main Diagnosis History of laissez-faire approach/free for all Lack of attention to NHS �lifestyle� and corporate citizenship role Inefficient and inequitable use of scarce resources Trust failing to meet NHS policy commitments and so to promote health through transport Yet signs that travel plan work is being assimilated � partly due to planning controls Yet signs that travel plan work is being assimilated � partly due to planning controls - as seems to be the case here in Glasgow!Yet signs that travel plan work is being assimilated � partly due to planning controls - as seems to be the case here in Glasgow!

4. Examples of Good Practice at Large Acute NHS Sites Oxford Radcliffe Hospitals Nottingham City Hospital Royal Devon and Exeter Hospital Some of good and some best practice is to be found at � but I�m not going to cover the most successful (I�m only showing these slides because Wyn will cover the most successful NHS Travel Plan in England) �and all these started because of the need to meet planning requirements step by the local planning authority � S.106 Agreements as opposed to S.75 The first 2 appear in the DfT Best Practice guide Making Travel Plans Work published a couple of years ago. Some of good and some best practice is to be found at � but I�m not going to cover the most successful (I�m only showing these slides because Wyn will cover the most successful NHS Travel Plan in England) �and all these started because of the need to meet planning requirements step by the local planning authority � S.106 Agreements as opposed to S.75 The first 2 appear in the DfT Best Practice guide Making Travel Plans Work published a couple of years ago.

5. Why do we need a Travel Plan ? Because we ought to Health � NHS leading by example Culture change - pressure groups Environment - congestion, emissions Because we have to National Policy - PPG13 & Transport Policy NHS - Estatecode / Estate Strategy Planning permission for development A tale of 2 cities part 1 � Oxford (since you�ll here about the other city from Wyn)A tale of 2 cities part 1 � Oxford (since you�ll here about the other city from Wyn)

6. Why did we need a Travel Plan? Plan to expand site (+ 1400 staff; 250 beds; 20,000 inpatients; 150,000 outpatients; 50,000 other treatment episodes) 2400 cars chasing 2000 spaces & lack of funds to build permitted new ones (JR Hospital) Everyone says we have a problem�oh and the simple answer is a big new multi-storey car park Without a Travel Plan we would not get planning permission for hospital relocation & development

7. Travel Plan: strategic objectives Manage car parking and commuting

8. Measures implemented Travel Zone based on level of bus services Better buses & access Permits based on need not status: in theory � End to free unrestricted parking Annual renewal @ �60 parking permit (�90 @ �30K +) Subsidised bus tickets More for Cyclists & Peds. Information and publicity Car share system Radcliffe Hospitals have put charges up to �60 (if earning up to �30k) and �90 for above that.� Lots of trouble, even though not as 'bad' as the original proposal of 0.4% salary.� They plan a daily charge as soon as we can that will start at about �1/day and go up to �2+ and will = the P&R cost. Radcliffe Hospitals have put charges up to �60 (if earning up to �30k) and �90 for above that.� Lots of trouble, even though not as 'bad' as the original proposal of 0.4% salary.� They plan a daily charge as soon as we can that will start at about �1/day and go up to �2+ and will = the P&R cost.

9. What have been the benefits? Modal shift 2000 2002 2005 Single occupant car: 58% ? 54% ? 52% Car share / passenger: 8% ? 9% ? 9% Bus / P&R: 8% ? 10% ? 12% Walk: 13% ? 14% ? 14% Cycle: 12% ? 12% ? 13% Interestingly, the modal split figure for cycling is lower than for cycling within Oxford City itself � 16%. Bus including park and ride appears to be the most important elements at the Radcliffe Hospitals.Interestingly, the modal split figure for cycling is lower than for cycling within Oxford City itself � 16%. Bus including park and ride appears to be the most important elements at the Radcliffe Hospitals.

10. Underlying Factors for success Widespread acceptance of a problem Recognition that it means life-style shift External force (others are really to blame) Agreement that it�s �least worst� way forward Real alternatives and funding for them Flexibility, adaptability (without giving in) Set an example (do what you preach)

11. Making it work � information & communication Travel Surveys Management / staff-side working party Staff newsletter, payslips �On The Move� transport news Open meetings (road shows) Email, intranet ? don�t be dogmatic or crusading

12. What has worked� or will More buses, bigger ticket discounts + tighter parking restrictions + pool cars and bikes Realistic Parking charge (according to income) Parking restrictions + existing buses + discounted tickets + inter-site vehicles Bonus (parking cash out) for choosing alternatives (C �200 p.a.) Transport information, marketing, publicity etc. Cycle routes (safe / traffic free) + secure parking / storage Assisted cycle purchase Car sharing (unless there�s a financial incentive + priority parking) Showers & changing (unless local to work station + secure lockers) BUG, cyclists breakfasts etc unless part of continuing campaign everywhere is different, but: AND Only just getting the County Council to recognise that they have a role / responsibility re better bus / P&R services and CPZs around the sites.�Issues are tough indeed.�everywhere is different, but: AND Only just getting the County Council to recognise that they have a role / responsibility re better bus / P&R services and CPZs around the sites.�Issues are tough indeed.�

13. Nottingham City Hospital 1997 � 72% by car (alone) 2000 � 55% 1997 � 2% car (share) 2000 � 11% 1997 � 11% by bus 2000 � 19% 1993 � 13% walk/cycle 2000 � 13% Ring fencing of car parking charges Communication programme with staff Investment in cycle infrastructure Car sharing scheme Improved public transport provision and information (inc on site buses) Park and Ride Nottingham City Hospital appears in the Guide so the details are there but here�s an overview. Main focus on car parking charges and buses on site. 17% reduction in solo car particularly achieved through informal and formal care share and service buses. Sept 2001 � all students banned from parking on site Still notable fly-parking Modal split as of 2004 reported to be a approximately the same (but note lack of repeat survey � which is troubling�)Nottingham City Hospital appears in the Guide so the details are there but here�s an overview. Main focus on car parking charges and buses on site. 17% reduction in solo car particularly achieved through informal and formal care share and service buses. Sept 2001 � all students banned from parking on site Still notable fly-parking Modal split as of 2004 reported to be a approximately the same (but note lack of repeat survey � which is troubling�)

14. Installed additional cycle lockers (now 120) Introduction of Link 4 Free internal bus service - 9 stop points on site: services the 2 major roads on edge of site Introduction of Medilink free bus service - linking with QMC university hospital �19,000 showering facilities upgrade Purchase of LED self illuminating speed signs Introduction of Bicycle Leasing Scheme Introduction of Car Sharing Scheme 4 on site touch screen travel information kiosks Subsidised travel tickets for staff (for use on all buses, trains and tram) The Nottingham example is useful at least in showing the range of measures that can be applied. Getting public buses onto the site was disproportionately important, however.The Nottingham example is useful at least in showing the range of measures that can be applied. Getting public buses onto the site was disproportionately important, however.

15. 1996 1800 parking permit holders Concentrating and expanding service onto single site 1997 salary-related parking permits excluding most day-time staff living within city boundary Ring-fenced parking revenue Discounted bus fares and on-site service by 2000 Dedicated Park and Ride Cycle infrastructure improvements 2003 EU Optimum project funding for travel bureau and on-line travel information www.optimum2.org/ Currently two sites but moving towards just the main site at Wonford New Medical School site opened in 2004, a new maternity complex will open in 2006, and a new treatment centre in 2008. P&R / Bus information leaflet are sent out to all local health centres, libraries, other healthcare sites and displayed at main entrances of the hospital. Central information point Travel bureau/website will possibly re-locate to the main entrance. The hospital is talking with the bus company Stagecoach about the introduction of real time information in the entrance hall. Public Transport Initiatives � 9.3 The following schemes have been implemented in partnership with local public transport providers: �������� 1997: Stagecoach Devon offer 20% discount to all RDEH staff on annual Freedom and Megarider Tickets for Exeter city and East Devon bus network. Staff may pay monthly/ weekly via pay deduction. �������� 1998: One-third discount for any member of staff on all single and return tickets on any Stagecoach Devon route at any time on production of ID badge. �������� 1998: Improvements to Stagecoach "H" bus service (connecting hospital main site with City Centre) - larger buses; circular route within RDEH (Wonford) site. �������� 2001: Dedicated park-and-ride service from Digby to RDEH (Wonford) site �200+ return journeys each day. Park and Ride Devon County Council has made the Digby Park & Ride site available to the RDEH Trust for an indefinite period - The service is heavily subsidised from the pay�&�display car parks at RDEH (Wonford). Thus patients and visitors pay only 50 pence return fare, while staff can use the service for half the price of the normal annual staff parking permit. In order to achieve this, the number of staff permit spaces has been reduced so as to increase the pay�&�display capacity. Run at 10 min intervals at peak times and 15 minutes otherwise 2002: Bus shelter provided adjacent to Diabetes Centre. 1/3 off single and return tickets with Stagecoach Devon Late shift car park for 60 cars 2002: Commitment of funds from car park income towards revenue costs of increased external CCTV coverage at the Wonford & Heavitree sites, and the construction of a central monitoring station in partnership with the Police, Local Authorities and business concerns. Travel bureau -(part of Interreg�IIIb framework) The Exeter component of the project is principally concerned with: ��������� establishment of travel bureau and on-line travel information; ��������� promotion of park-and-ride service to patients and visitors; ��������� improvements for cyclists; ��������� improvements for pedestrians; ��������� marketing and publicity; monitoring and research. Currently two sites but moving towards just the main site at Wonford New Medical School site opened in 2004, a new maternity complex will open in 2006, and a new treatment centre in 2008. P&R / Bus information leaflet are sent out to all local health centres, libraries, other healthcare sites and displayed at main entrances of the hospital. Central information point Travel bureau/website will possibly re-locate to the main entrance. The hospital is talking with the bus company Stagecoach about the introduction of real time information in the entrance hall. Public Transport Initiatives � 9.3 The following schemes have been implemented in partnership with local public transport providers: �������� 1997: Stagecoach Devon offer 20% discount to all RDEH staff on annual Freedom and Megarider Tickets for Exeter city and East Devon bus network. Staff may pay monthly/ weekly via pay deduction. �������� 1998: One-third discount for any member of staff on all single and return tickets on any Stagecoach Devon route at any time on production of ID badge. �������� 1998: Improvements to Stagecoach "H" bus service (connecting hospital main site with City Centre) - larger buses; circular route within RDEH (Wonford) site. �������� 2001: Dedicated park-and-ride service from Digby to RDEH (Wonford) site �200+ return journeys each day. Park and Ride Devon County Council has made the Digby Park & Ride site available to the RDEH Trust for an indefinite period - The service is heavily subsidised from the pay�&�display car parks at RDEH (Wonford). Thus patients and visitors pay only 50 pence return fare, while staff can use the service for half the price of the normal annual staff parking permit. In order to achieve this, the number of staff permit spaces has been reduced so as to increase the pay�&�display capacity. Run at 10 min intervals at peak times and 15 minutes otherwise 2002: Bus shelter provided adjacent to Diabetes Centre. 1/3 off single and return tickets with Stagecoach Devon Late shift car park for 60 cars 2002: Commitment of funds from car park income towards revenue costs of increased external CCTV coverage at the Wonford & Heavitree sites, and the construction of a central monitoring station in partnership with the Police, Local Authorities and business concerns. Travel bureau -(part of Interreg�IIIb framework) The Exeter component of the project is principally concerned with: ��������� establishment of travel bureau and on-line travel information; ��������� promotion of park-and-ride service to patients and visitors; ��������� improvements for cyclists; ��������� improvements for pedestrians; ��������� marketing and publicity; monitoring and research.

16. Objections to P + R Staff will leave and work somewhere where they can park We need our cars on site so that we have somewhere to go in lunch hour We will get wet walking to and from the bus � nowhere to put dripping coats �I bet managers will never use it� Cars will be vandalised In the wrong place Buses will be too infrequent, overcrowded, late, take too long, drivers will be rude etc� Just a selection�Just a selection�

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18. Outcomes Reduction by 500 in permits issued to staff since 1997/98 - down to 1300 Gradual increase in P+R uptake Since P+R, pay and display car parks always have some capacity Staff parking still over-subscribed More informal car share Car use down from 72% in 1996 to 60% in 2004 Service bus stable at 7% but further 7% now P+R County Council�s own travel plan nearby which was linked to residential parking permits has also helped. Tips and lessons from Exeter � Ensure board level support; involve staff; expect the unexpected; never say die; people will come round in the endCounty Council�s own travel plan nearby which was linked to residential parking permits has also helped. Tips and lessons from Exeter � Ensure board level support; involve staff; expect the unexpected; never say die; people will come round in the end

19. Travel Plan key elements Financial incentives Financial disincentives Parking restraint Travel Plan Coordinator Emphasis on widening travel plan choice (accessibility) Clear communication strategy (widely distributed and transparent) Board level engagement + working group + travel plan coordinator (not a junior) Can be broken down into processes, principals and mode specific measures. Processes � travel surveys, site audits, steering and working groups, employing a travel plan Coordinator Principals � setting objectives and targets, developing a package of measures, selling as �increased travel choice� not �anti-car�, and linking with complimentary policies such as Improving Working Lives Mode specific measures � encouragements to walk, cycle, use public transport and car share eg on-site bus routes, interest free loans for season tickets in tandem with reduced fares for staff negotiated with operators, clear signing for pedestrians and cyclists, and accessible and clear information on travel choices � widely distributed eg for interviewees and in all induction packs.Can be broken down into processes, principals and mode specific measures. Processes � travel surveys, site audits, steering and working groups, employing a travel plan Coordinator Principals � setting objectives and targets, developing a package of measures, selling as �increased travel choice� not �anti-car�, and linking with complimentary policies such as Improving Working Lives Mode specific measures � encouragements to walk, cycle, use public transport and car share eg on-site bus routes, interest free loans for season tickets in tandem with reduced fares for staff negotiated with operators, clear signing for pedestrians and cyclists, and accessible and clear information on travel choices � widely distributed eg for interviewees and in all induction packs.

20. Travel Plan Costs to Employers Example of indicative costs Travel Coordinator Salary + on costs �40K Surveys �5K Publicity and promotions �5-15K Incentives to staff for 100 staff �50K Average annual running cost per employee �47 Annual running cost of surface-level car parking space �300-�500 Source: Department for Transport, 2002 Making Travel Plans Work I won�t go into the health issues in terms of benefits to staff and employers from healthier workforces other than to say that the evidence shows: Reduced absenteeism Lower turnover rates Improved productivity and employee morale Lower health care costs The Sustrans Active Travel and Healthy Workplaces Information Sheet � in your pack covers that.I won�t go into the health issues in terms of benefits to staff and employers from healthier workforces other than to say that the evidence shows: Reduced absenteeism Lower turnover rates Improved productivity and employee morale Lower health care costs The Sustrans Active Travel and Healthy Workplaces Information Sheet � in your pack covers that.