More of a 'slow burn' than a big bang, the Total Transport pilots funded by the Department for Transport (DfT) exposed the continuing frustrations of silo working in the public sector.
in 2015, the DfT allocated £7.6m to 37 separate schemes run by 36 local authorities in England to pilot Total Transport solutions in their areas - a holistic approach to transport that would pool resources across public organisations to produce more efficient mobility based on desired outcomes.
A recently published review of the work found that: 'The pilots exposed some limitations in how local authorities and other organisations are able to interact, but also illuminated some ways of tackling this which can be taken forward by others.'
The pilots suggest there are substantial opportunities for joint working between clinical commissioning groups (CCGs) in health services and local authorities that have 'yet to be unlocked', but barriers to engagement had so far stymied efforts.
It found that 'more far-reaching measures are likely to depend on participants being willing to take part in an ‘invest to save’ approach' which could require a willingness to 'accept a degree of risk'.
The importance of relationships
The report states: 'The experience of the Total Transport pilots underlines the need for close and transparent relationships between stakeholders.
'Combining and realigning budgets between organisations has, perhaps understandably, led to worries in some quarters that budgets from one area of spending were being used to support spending in another.
'Concerns of this nature are best addressed by organisations engaging closely to ensure that there are no misunderstandings about the aims and nature of the process, and setting up clear goals and structures.'
Buidling these key personal relationships provded difficult as there was often no clear point of contact with large organisations like the NHS, even a local level.
'In many areas, it was difficult to engage with the health sector, not least because it was hard to find the right people with whom to engage. This is perhaps the single most significant barrier to the adoption of Total Transport.'
The report found that the experience in Herefordshire exemplified 'a common issue'
'While the health sector supported the initial bid, a number of staff changes led to the initial engagement being lost. Overall budget reductions and other priorities also diverted attention away from the pilot.'
In its findings the review states: 'It may be appropriate to look at setting up a structure for sharing NHS data, within appropriate boundaries and with safeguards. One way of approaching this could be to develop centrally a data sharing agreement template for use by CCGs and local authorities which conformed with the Caldicott principles.'
Another. so far untested, suggestion was to embed local authority transport professionals in CCGs or to devolve responsibility for non-emergency health sector transport to local authorities.
'Efforts so far have concentrated on persuading organisations to take part in the pilots through engagement at the local level. It may be that some degree of coercion might be appropriate to encourage organisations to participate that have so far declined to do so.'
Key themes:
- Tackling integration involves a degree of local knowledge;
- While some approaches may be transferable, there is no easy ‘one size fits all’ solution;
- Constructive local engagement is important and it can take time to find the right person to engage with in each organisation;
- There is more to do to unlock the opportunities for integration between transport provision in the health sector and local authorities;
- Financial savings are difficult to assess as many participants did not have access to reliable ‘before’ data, although some savings do appear to have been achieved;
- While the actual savings achieved so far may be considered relatively low, the process has led to improved services in some areas at similar cost, and uncovered potential savings and benefits for the longer term;
- The benefits of Total Transport are a mix of short, medium and long term. Some of the bigger savings will take time to be delivered and benefits from larger scale changes can take time to bed down;
- Some of the delivery models proposed do not easily fit the existing legal framework of bus services, taxis and private hire vehicles and have required careful development to allow them to operate;
- The process of bidding for funding acted as a stimulus to think about provision in a different way and gave the successful local authorities the resource to look at new ways of working that they would not have had the space to do under ‘business as usual’.
Case studies and savings
In North Yorkshire, the CCG took the opportunity provided by the Total Transport pilot to review its existing contract arrangements. Its re-specification enabled the CCG to save £200k per annum. The experience gained also allowed the CCG to challenge other contracts more robustly.
In Nottinghamshire they conducted a feasibility study to establish the potential for integration between non-emergency patient transport services (NEPTS), the community and voluntary sector and Nottinghamshire’s own transport fleet. This indicated that the best option for integration involved using the internal county council fleet for adult social care trips and maintaining NEPTS to and from the major hospitals in Nottinghamshire. This limited integration could realise savings of around £375k per annum. A further benefit would be a potential reduction in CO2 emissions of 118 tonnes per year. Including other hospital facilities and utilising external special educational needs contracts could potentially realise annual savings of over £1.1m. An average annual saving of £216k was also indicated if the county council fleet carried some renal dialysis patients making trips to the dialysis facility
East Riding were able to achieve a £565k financial efficiency in the context of ongoing £4m support for bus services. While there was a 4% reduction in overall bus network capacity, this was replaced by remodelled services which matched residents’ needs more closely and encompassed alternative forms of service delivery. They noted that the savings and practices from Total Transport take time to embed.
North Somerset was able to identify £600k of potential savings, with an initial medium term saving of £60k achieved for 2017/18. North Somerset intends to continue its Total Transport approach through a new Transport Commissioning Board which will also seek to cover social care transport.
Under their new contract model, Dorset targeted a £1.5m saving from its public transport budget in 2017/18, with a further £800k saving coming from mainstream home to school transport. This is in addition to the £600k saving from the public transport budget in 2016/17. Dorset’s work indicated potential for these savings to be maintained over the longer term.
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