HSTAT ? Towards a Better Understanding of the Impact of Accessibility on Healthcare Reconfiguration Policies
P Bartlett, Jacobs Consultancy, UK
HSTAT ? Towards a better understanding of the impact of Accessibility on Healthcare Reconfiguration Policies
Transport and Health
"The concept of accessibility and social exclusion (or transport poverty as it is also referred to) is a fundamental issue not just in the UK and developed world but also for developing countries alike. Against the rapid growth in population and economic activity in cities throughout the world ? particularly places such as India, Africa and emerging East European economies ? the need for sustainable development and transport solutions has never been more acute.
The derived nature of demand for transport, means that the planning and provision of transport infrastructure and formulation of appropriate transport policy is sometimes an afterthought, or is not given the attention it deserves. However, the problems of poor transport accessibility ? barriers and inequalities created because of poor access to services ? are noticeable and acutely felt by those in need of such services. This often relates to older people and especially those with disabilities. Planning decisions which allow large developments, and hence generators of travel, in areas of poor public transport accessibility contribute to and exacerbate social exclusion.
The Health Sector is not remote from these problems ? access to healthcare is a necessity for every community and hence access issues are significant. This is compounded by the fact that, in many places, the population is not only increasing but also ageing as improvements in health and healthcare allow for an increased life expectancy. There is, therefore, a greater emphasis on accessbility planning to consider the needs of various population groups. Despite the overall high quality of the UK NHS, there are noticeable inequalities in terms of healthcare provision and access. The Social Exclusion Unit?s 2003 report ?Making the Connections?, estimated that over the course of one year, at least 1.4 million people in the UK miss, turn down or do not even seek hospital appointments because of problems with transport. This is not just about inconvenience ? it affects personal health by allowing an untreated illness to potentially develop into a more severe case and it also imposes additional financial burdens on the NHS and society as a whole.
In London, it is estimated that there are approximately one million health related journeys made, each day. This is significant, as where health services are located and how they are accessed has a notable impact on travel patterns in London.
These facts are worthwhile incentives to tackle the problems of poor accessibility and social exclusion. Recent UK healthcare policy acknowledged this in that one of the key objectives to emerge from the review by Lord Darzi on healthcare provision was that of ?Access? to healthcare services. It is only through research and a better understanding of social exclusion and access to healthcare, that the damaging and discriminatory effects of transport poverty can be eased or even eradicated.
There are a wide range of measures, techniques and tools with which to analyse accessibility, but what do they actually reveal and how informative are they? Can such measures be effectively used by healthcare practitioners to shape and improve healthcare policy?
The development of a Health Service Travel Analysis Tool (HSTAT) ? a GIS based Accessibility Calculator developed on behalf of NHS London and Transport for London ? seeks to address these issues by assisting decision makers on healthcare reconfiguration proposals to gain an insight into the issues and impacts of accessibility. HSTAT provides an integrated and consistent method of measuring the accessibility of healthcare site locations by any transport mode and provides inputs into the evaluation, appraisal and business case development process. It is a flexible tool, equally well suited for city wide analysis of hospital sites or the more local impact of a polyclinic. The main strength of HSTAT is that it draws together travel time information, socio-demographic, health facility and health usage data and provides a comprehesive and flexible tool. The use of powerful map based outputs as well as other reports and tabulations, enables a clear visual image to be seen and understood by both healthcare practitioners and the general public at large.
This paper will look at HSTAT, its structure and compnents and the types of information it provides and how it has been used in recent healthcare reconfiguration strategies. The paper will also consider and how HSTAT techniques may be applied to different places, including rural locations in the developing world, where transport access to healthcare is a rather different problem."
Association for European Transport