The Hidden Barrier to Healthcare: Understanding Travel Challenges in South East Scotland

For many people, transport can play a crucial role in determining how easily they can attend healthcare appointments. That is why Urban Foresight has been working with the South East of Scotland Transport Partnership (SEStran) to produce a Transport to Health Case for Change.

Developed in partnership with NHS Borders, NHS Fife, NHS Forth Valley and NHS Lothian, the report provides the region’s first comprehensive evidence base on how transport affects access to healthcare. It also marks the first step towards a coordinated Regional Transport to Health Strategy, supporting delivery of the Scottish Government’s national Transport to Health Delivery Plan.

What the evidence shows

The study combined demographic and socio-economic analysis, GIS travel-time mapping, partner engagement and a public consultation. Overall, more than 1,500 people from across eight local authority areas shared their experiences, generating a clear picture of how transport affects access to healthcare across the region.

Most people can easily reach their GP and other local health services. But transport barriers to hospital and specialist care are widespread, unevenly distributed, and fall hardest on people without a car. For example:

• Public transport journeys to hospital are typically two to four times longer than the same trip by car, often involving multiple interchanges and long waits.
• Around a third of those who gave feedback for the study had missed or delayed a healthcare appointment because of transport, rising to over 40% in NHS Fife.
• Accessibility issues, hospital parking pressures and limited coordination between community transport services and healthcare providers compound the problem for older people, disabled people and carers.
• The barrier tracks deprivation closely. In the most deprived areas, at least 44% of households do not have access to a car, leaving those with the greatest health needs most reliant on the least convenient services.
• Across the region, an estimated 130,000 outpatient appointments are missed each year. This is an estimated annual cost to the NHS of between £4.1 million and £31.3 million,  though transport is only one of several contributing factors.

Behind the numbers are recurring experiences. These include cumulative travel costs for people attending regular oncology, dialysis or physiotherapy; long walks to poorly maintained bus stops; and parking pressures that leave even car drivers arriving late.

“Where you live and how you travel should not determine your ability to access healthcare. This work highlights the practical barriers people face and provides a foundation for addressing them.” Claire Colquhoun, Consultant at Urban Foresight

Drawing on input from the SEStran Transport to Health Learning Network and aligned with Scottish Transport Appraisal Guidance, the report identifies priorities for improving journey times, reducing travel barriers and expanding transport options for accessing healthcare.

This evidence now provides the foundation for the next stage: a Regional Transport to Health Strategy that will address these issues directly.

The Transport to Health Case for Change reflects Urban Foresight’s wider expertise in addressing complex social and health challenges through evidence-led research. Recent projects have included evaluating approaches to tackling health inequalities in Wales and developing a blueprint for tackling child poverty in Inverclyde.