Planning for Better Access to Health
J Sanchez, E Seagriff, Transport for London, UK
The development of policy to consider changes to healthcare provision and its impact on strategic land use and transport planning including improving accessibility and promoting public health - the experience of London for other European cities.
London is likely to grow by a further 1.3 million people over the next twenty years, it will need to accommodate a large number of new homes. Furthermore, London is an extremely unequal city with massive health inequalities. The social infrastructure needed to support growth and provide better health services, particularly in London?s deprived areas will require new ways of delivering healthcare. Healthcare in London is undergoing both reform and reconfiguration which is resulting in greater specialisation, more choice and more services delivered within the community. These changes should lead to reduced health inequalities and better health outcomes including longer life expectancy and better survival rates. Transport for London works in partnership with NHS London to consider the challenges of population growth, health inequalities and health service reform strategically, to integrate land use and transport planning when considering healthcare provision in order to promote more sustainable journeys and better access.
NHS London the strategic health authority, is looking to increase the number of GP?s in the capital and thus improve access to healthcare. The model it has chosen to develop is based on Poly-systems (as developed in other European countries such as Spain). This involves developing new larger clinics which can serve a population of between 20-50,000 people by offering more of an integrated service by moving some services which are currently provided in hospitals to the clinic. For example patients who currently have to make additional journeys to their local hospitals to get blood tests and x-rays would no longer need to make additional journeys. Therefore some patients may have increased journey times to access health services, but the net result could be fewer overall journeys.
Understanding the transport impacts of healthcare reconfiguration and reform are an important part of transport and land use planning. There is the potential to explore different approaches to this issue. Firstly to get a better understanding of accessibility to inform policy development by promoting access to healthcare and also to encourage travel by the most sustainable modes.
The work has involved developing a relationship with stakeholders to understand the challenge, analysing the impacts of proposed changes and modelling different scenarios to understand the impacts of changes on different socio-demographic groups. TfL has developed a model called the Health Services Travel Analysis Tool (HSTAT) which takes data from the UK census super output areas, these contain between 40 and 100 addresses. The tool is able to assess scenarios of different locations to assess journey times to new polyclinics. The analysis is used by health service providers to help with their decisions on locating new facilities and providing better local care.
However, as well as attempting to influence the location of new or enhanced healthcare facilities, a key principal in improving accessibility is to consider the health impacts of improvements to the transport system. Better connectivity and an improved urban realm to make walking and cycling more attractive are also part of the policy mix. Therefore by understanding the transport impacts of health care reconfiguration, together with long term strategic transport planning, a transport authority such as TfL is able to consider how best to meet its strategic objectives and plan changes to existing services in order to respond to new and increased demands for travel.
Travel to health services represents around 1 million journeys per day in London, which is around 5% of the total. Understanding the relationship between heath and transport has the potential for a number of benefits, including ensuring that good walking and cycling routes are considered in urban regeneration; removing barriers to accessing healthcare and reducing traffic and congestion. The experience of planning for better health by improving the accessibility of the transport system and urban realm may have lessons for other European cities which want to reduce health inequalities, remove barriers to accessing healthcare and promote public transport, walking and cycling.
Association for European Transport