f you live in East Lancashire and follow the news, particularly via social media, you may have seen the public reaction this week in response to a decision the Trust has made to stop the free hospital shuttle bus from the end of March.
I have no desire to reignite the emotions and disappointment we have seen and heard this week, but it would be remiss of me not to cover it in the blog, where I am always open and transparent about the challenges we are facing, week in week out.
As I have said in numerous statements, individual responses and to colleagues in the Trust already, it has been a difficult decision and one that has not been taken lightly or quickly. We have considered a number of options over a number of months – if not years – including charging for the service.
But I have also been honest about our current financial predicament and that we’re currently around £32million overspent for this year. We simply cannot afford it and as the current contract expires on March 31 it was a case of giving notice or committing to another three years, which just wasn’t in our gift to do.
I want to be direct when I say that it doesn’t mean we don’t recognise its importance for the passengers on board and a survey was carried between September to December last year to understand this so far as possible. The basic data suggested around 250 passengers were using the bus, regularly, with 241 saying they’d used it in the last six months and 35 of these being patients.
But, the bus is set up in a way that people are not expected to give a reason for being on it. Patients don’t need to prove an appointment, visitors don’t need to demonstrate who they are travelling to see, colleagues don’t need identification or any kind of pass to get onboard.
We do know that lots of people who have no connection to the Trust as patients, visitors or colleagues use it every day. Colleagues have regularly observed people alighting at the hospital doors but instead getting directly into a pre-ordered taxi for onward travel, presumably home, laden with shopping bags. It might feel like free travel, but every journey made equates to a cost to the Trust of about £4.
It runs every 30 minutes from about 6am to 9pm with more than one bus servicing a circular route between the front door of Royal Blackburn Teaching Hospital and Burnley General Teaching Hospital. It doesn’t pick up or stop off anywhere in between, albeit it routes over to Pendle Community hospital a couple of times a day too.
But it’s a well-run, prompt, extremely convenient and completely direct service and I understand passengers are upset about losing it.
What is also clear, though, is that the numbers of passengers don’t correlate in any way to the number of people who have commented or signed petitions. The size of the buses and data would support that from the 12,000 who want to keep it, only a tiny percentage have ever used it.
Let me explore the themes and sentiment of some of the responses too, because it’s important that we don’t confuse opinion and emotion with the facts of the matter in hand.
We cannot charge passengers a fare without becoming a transport operator and, even if we invested money in doing this, fares versus passenger numbers and the service timetable wouldn’t cover the costs without each person paying around £3,000 a year.
I want to provide a little bit of history around the service too, which was put in place in 2007 to assist people travelling from Burnley to Blackburn following service reconfiguration across the two hospitals. The agreement was to provide it for five years and this was delivered and paid for by the Primary Care Trust (PCT) which, in the complex world of the NHS, was another part of the system at the time and not ELHT itself.
In 2013, when it should have been decommissioned by colleagues, operation of the bus was instead moved to ELHT but, importantly, this did not come with the money to pay for it and we have been funding it ever since in good faith.
I have heard many times the understanding within the community that this service was put in place to support access to the A&E department in Royal Blackburn Teaching Hospital for Burnley people. This isn’t the case. Anyone who needs urgent, life-threatening care should not be taking a bus. Indeed, those making that journey for that reason should instead be utilising the Urgent Care Centre at Burnley General Teaching Hospital, which remains open 24 hours a day, seven days a week.
It’s worth noting also that to take the shuttle bus you have to get to Burnley or Blackburn hospitals in the first place.
On this point, the reaction to the decision has highlighted to others what the Trust already knew –that these current arrangements don’t represent a fair or equitable arrangement for all local communities or wider staff groups in East Lancashire.
The bus only offers hospital to hospital transport between Blackburn and Burnley. Patients travelling from or to – as well as staff working in – other significant populations such as Accrington, Clitheroe, areas of Pendle, Darwen and Rossendale do not have any such service, despite similar social challenges, deprivation and health equity.
This simply isn’t fair or sustainable and when people quote ‘social justice’ as a reason to keep the current bus going, it doesn’t really ring completely true. It isn’t means tested or mapped to the most challenged parts of our community. It simply takes whoever gets on from A to B, no matter the reason and that’s not always in the pursuit of healthcare.
That said, I accept completely there will be some legitimate passengers on board who require support from the Trust in managing this change, including colleagues, and I want to be clear we are doing everything we can on this. Patients who are struggling to travel to appointments can claim fares back if they meet eligibility criteria and we will also do everything to move appointments to nearer locations, online or to a community resource, if possible, to reduce the need to travel.
Already this week I know of a patient who raised issues and asked how she would get to appointments for cancer treatment when the bus no longer exists. I was pleased and heartened to hear we have already identified that she is eligible for alternative transport and put it in place. Better still, she has written to thank us for sorting it out.
This support is also in place for colleagues who are moving around at the request of the Trust to manage staffing and other issues too. We are working now to minimise the need to make these journeys through improved processes and to support people who may need to move locations or start/finish times to help them manage the impact of this change. I mean it when I say we will do everything we can.
What I cannot do is reverse this decision and commit to spending money that the Trust does not have. I want to be responsible and honest, giving people as much time as possible to make alternative arrangements. There is information on our website to help so please do start to consider your options now.
Thoughts that public pressure will bring about a change in this decision are misguided and the patient numbers clearly show that from the thousands of people who have commented on social media or signed the petition, very few have ever used the shuttle bus and probably don’t completely understand what it is, who it serves or why.
It will close on March 31 – unless of course a solution is found. I am grateful to those who have already stepped forward to try and help and contacted us with offers and ideas.
This includes any transport operator who may be able to provide this service and, whilst the Trust cannot fund any part of it, we will do everything we can to help.
I hope this update provides some important information as to why this decision was taken and evidence of the deep consideration it received beforehand and the commitment to supporting people with the change in place now.
I know it isn’t what anyone wanted but we continue to try our best for people across East Lancashire as ever.
Martin