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Independent Travel and Access Assessment

Changes to adult planned orthopaedic services in North Central London

10 January 2020

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Independent Travel and Access Assessment

Changes to adult planned orthopaedic services in North Central London

10 January 2020

Mott MacDonald | Independent Travel and Access Assessment Changes to adult planned orthopaedic services in North Central London

V3 | 10 January 2020

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Contents

Executive summary 1

1 Introduction 5

1.1 Background to the programme of change 5

1.2 Scope and objectives of the travel and access impact assessment 7

1.3 Geographic study area for the assessment 8

1.4 Approach to the travel and access assessment 9

1.4.1 Cleansing of patient activity data 10

1.4.2 Patient activity data analysis – planned orthopaedic services requiring an overnight stay 11

1.4.3 Patient activity data analysis – day case services 11

1.4.4 Deriving the travel analysis impacts 11

1.5 Methodological assumptions and limitations 12

2 Current travel times 13

2.1 Profile of patient admissions 13

2.2 Public transport: Current travel times for planned orthopaedic services requiring an overnight stay 13

2.3 Car: Current travel times for planned orthopaedic services requiring an overnight stay 14

3 Impact of change on patient journey times under the proposals 16

3.1 Public Transport (PT): Journey time changes for patient access to planned orthopaedic services requiring an overnight stay 16

3.2 Private Car: Journey time for patient access to planned orthopaedic services requiring an overnight stay 17

3.3 Future choice for patients 18

4 Day Case services 21

4.1 Public transport 21

4.2 Car 22

5 Impact on protected characteristic groups 24

5.1 Impact when travelling by public transport 24

5.2 Impact when travelling by car 27

6 Transportation cost and accessibility of planned orthopaedics 29

6.1 Availability of public transport 29

6.1.1 Transport links within the North Middlesex/Royal Free Partnership 30

6.1.2 Transport links for the UCLH/Whittington Health Partnership 32



6.2 Additional travel costs 35

6.3 Cost and availability of parking 36

6.3.1 Chase Farm Hospital car parking 36

6.3.2 UCLH and Whittington Health car parking 37

7 Impact assessment 38

8 Travel and access mitigations 41

Mott MacDonald | Confidential | Travel and Access Impact Assessment

Changes to adult elective orthopaedic services in North Central London

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Executive summary

To ensure that North London Partners has fully considered the implications of their proposed

preferred model of care for orthopaedic services, Mott MacDonald has been commissioned to

undertake an independent travel and access impact assessment. The purpose of this

assessment is to identify and assess the effect of the proposals on travel and access for the

local community. This assessment focusses on the travel and access impacts for patients,

carers, visitors and staff.

Introduction

North London Partners is a partnership of health and care organisations from the five London boroughs of Barnet,

Camden, Enfield, Haringey and Islington, working together to improve the health of local people through the

sustainability and transformation partnership (STP).

Responding to the variation in quality of care for adult planned orthopaedic services, and in line with evidence from

the UK and elsewhere, North London Partners are now working together to transform planned orthopaedic care

across north London. Under the consultation proposals, planned (elective) orthopaedic services would be

delivered under a single network across north central London (the Partnership for Orthopaedic Excellence: North

London) with two dedicated, state of the art planned orthopaedic centres, and local outpatient and day surgery

facilities. North London Partners considers that this proposal would deliver the best care for people who require

orthopaedic surgery.

Planned orthopaedic surgery treats damage to bones, joints, ligaments, tendons, muscles and nerves (the

musculoskeletal system). Patients may be referred to an orthopaedic surgeon for a long-term condition that has

developed over many years, such as osteoarthritis or other non-emergency damage. Surgery, such as hip and

knee replacements, are the best-known kind of orthopaedic surgery offered in the NHS. However, other surgery of

hips, knees, shoulders, elbows, feet, ankles and hands also falls under this heading.

Locally, two partnerships have been formed by local NHS hospital trusts – with University College London

Hospitals (UCLH) and Whittington Health working together, and North Middlesex University Hospital (North Mid)

working with The Royal Free London (Royal Free, Barnet Hospital, Chase Farm Hospital). The partnerships would

offer two hospitals with dedicated operating theatres and beds for patients who need to stay overnight after their

operation. They would offer a greater choice of hospitals for day surgery, outpatient appointments and education

classes for patients prior to their surgery.

Currently, adult planned orthopaedics is delivered across 10 NHS and private sector sites in north central London

(NCL). The preferred model of care is for the two specialist elective inpatient centres to be located at Chase Farm

Hospital and UCLH. Day surgery services would be provided at Chase Farm Hospital, North Middlesex, the

Whittington Health and UCLH. In addition to this, pre and post-operative outpatient care would continue to be

provided at all the above sites and at Barnet and the Royal Free Hospitals, which would represent no change from

the current service offering. This is shown below in Figure 1.



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Figure 1: The locations for orthopaedic care in north central London under the proposals

Source: North London Partners

Throughout the development of these proposals, engagement has been undertaken with local residents, patients,

carers and clinical staff. As highlighted by the independent evaluation of the pre-consultation engagement (August

2018 to October 2018), a key issue was the potential impact on travel and access as patients requiring surgery

with an overnight stay may have to travel to and from a hospital which is different from where they receive their pre

and post-operative outpatient care. There was a concern that this could mean longer travel times, more

complicated journeys and increased travel costs.

Mott MacDonald has undertaken an independent analysis of travel time changes and focused primarily on

the main changes within the service proposals; planned orthopaedic surgery services requiring an overnight

stay and day case surgery. For both of these services, changes in journey times should only impact patients once

(or twice) in the patient’s care pathway.

Our Findings

Based on the proposals, we have assessed public transport and car travel impacts for patients who may

be required to access a different hospital site for planned orthopaedic surgery requiring an overnight stay

at either Chase Farm Hospital or UCLH and for those patients in the UCLH/Whittington Health partnership

who may be required to access a different site for their day surgery.

Planned orthopaedic services requiring an overnight stay

By public transport, 76% of current patients in north central London can access planned orthopaedic

services requiring an overnight stay within 45 minutes, with almost 9 out of 10 patients able to access

services within 60 minutes (87%). The majority of patients in Camden and Islington can access planned

orthopaedic services requiring an overnight stay by public transport within 30 minutes, while for those patients



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living in Enfield and Haringey, the majority currently experience a maximum journey time of within 45 minutes.

Barnet patients currently experience the longest journey times (29% are unable to access planned orthopaedic

services requiring an overnight stay using public transport within 60 minutes).

Under the proposed future service model for planned orthopaedic services requiring an overnight stay,

and assuming that patients are referred to the overnight service within the two partnerships, 80% of patients are

likely to be able to access these services using public transport within 45 minutes (compared with 76%

under the current arrangements). The proportion of patients likely to be able to access services using public

transport within 30 minutes reduces by nine percentage points (55% to 46%).

Under the current arrangements, within the Royal Free London, the majority of patients who have outpatient care

at the Royal Free and patients at Barnet Hospital already have their surgery at Chase Farm Hospital.

Consequently, when looking at the impact across the north central London, in Barnet and Camden, only a small

proportion of patients are likely to be affected and experience a longer journey time than is currently the case.

Across Enfield, Haringey and Islington, there is a change to journey times:

● In Enfield, some patients will have to travel across the borough and as such a smaller proportion will likely

be able to access this service within 30 minutes using public transport (50% can currently access

services within 30 minutes which is likely to drop to 38%).

● Patients living in Haringey are likely to experience the most significant journey time increases with a 30%

decrease in the proportion of patients who can access a hospital for planned orthopaedic services requiring an

overnight stay within 30 minutes via public transport (currently 60% can access services within 30 minutes

which is expected to reduce to 30%). However, a large proportion of these patients in Haringey (84%) will be

able to access services within 45 minutes, with most experiencing a maximum increase in journey time of 15

minutes.

● For those living in Islington and choosing to have their care in the UCLH/Whittington Health partnership,

the proportion of patients who can access services within 15 minutes is likely to reduce from 27% of patients in

the area to 15%. However, 98% of patients within Islington will be able to access services within 30 minutes

(compared to 93% under current arrangements), so under the proposed changes patients would see their

journey time using public transport increase by a maximum of 15 minutes.

By car, 91% of current patients can access planned orthopaedic services requiring an overnight stay

within 30 minutes, with almost all (99%) being able to access services within 45 minutes.

Under the proposals, the majority of patients (89%) are expected to continue to be able to access these

services by car within 30 minutes (compared to 91% under current arrangements). The proportion of patients in

north central London who are likely to be able to access planned orthopaedic services requiring an overnight stay

by car within 15 minutes drops by 16 percentage points (48% to 32%).

When looking at the impact across north central London, there is a similar picture compared to public transport:

● For patients living in Haringey and choosing to have their care in the North Middlesex/Royal Free London

partnership, it is expected that patients will be unable to access planned orthopaedic services requiring an

overnight stay by car within 15 minutes. However, the majority of patients from Haringey (86%) will

continue be able to access these services by car within 30 minutes, with the maximum increase to

journey times likely to be 15 minutes.

● For patients living in Enfield and choosing to have their care in the North Middlesex/Royal Free London

partnership, there will be a reduction in those patients who can access services by car within 15 minutes (56%

to 41%). However, the majority of patients will be able to access services within 30 minutes.

● For patients living in Islington and choosing to have their care in the UCLH/Whittington Health partnership,

there will be a reduction in the number of patients who can access services by car within 15 minutes (63% to

43%). However, the majority of patients (99%) will be able to access services within 30 minutes.



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● Patients living in Camden are likely to experience very limited change in journey time, with only two

percent of patients no longer able to access services by car within 15 minutes. The same proportion of patients

will be able to access services by car within 30 minutes as under current arrangements.

Day case surgery services

For the proposed changes to day case surgery services between UCLH and Whittington Health, a small

proportion of patients who travel to the Whittington Hospital by public transport may experience increased

journey times. The average increase to these journey times is likely to be 10 minutes. For some patients

travelling from Barnet or Haringey, journey times could improve.

By car, the proposed changes between UCLH and the Whittington Health will mean that the average

journey time could be shorter.

Impact on equality groups

When looking at the key equality groups that have been identified to be disproportionately impacted when

travelling by public transport, the proportion of those living in the most deprived areas who can currently access

services within 30 minutes will likely decrease by 41 percentage points (from 90% currently to 49%). This

compares with a likely decrease of 26% for the population as a whole north central London. The proportion of

Black residents who can currently access services within 30 minutes will likely decrease by 38 percentage points

and the proportion of Turkish residents who can access within the same time period will likely decrease by 48

percentage points.

Conclusions

When looking at both public transport and car journeys, for those living in Islington and Camden, the most

significant movement in journey time will be for patients with a less than 15 minute journey which may

move into a journey which is between 15-30 minutes. For those patients living in Haringey and Enfield and

for some in Barnet, when travelling by public transport the most significant movement in journey time will

be for those who currently have a journey time which is within 30 minutes. Under the proposals, this will

change to a journey time of 30-45 minutes (although for some parts of Haringey there will also be a group of

patients whose journey will change into just under an hour). When looking at car travel for these boroughs, the

change in journey time is most likely to increase from less than 15 minutes into 15-30 minutes.

For patients having surgery and needing an overnight stay in hospital, these proposals may add complexity to their

journey to and from the operation. For some, this may mean travelling on unfamiliar routes and services and

may result in additional travel costs when compared with previous arrangements. For those travelling by car, a

concern beyond the travel route itself is the availability and cost of car parking at these hospitals.

Whilst recognising that some hospital sites have already introduced measures to support the improvement in travel

and access, Chapter 6 of this report sets out a range of additional mitigating actions that the North London

Partners could consider. These actions are focussed around:

● Capacity building of community transport options

● Promoting personalised support to patients

● Working with local councils and transport providers

● Accessibility of the hospital sites

● Travel planning

● Communication and awareness raising around patient choice and transport arrangement options.



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1 Introduction

The following outlines the scope and purpose of this travel and access impact assessment of proposed changes

to the delivery of adult planned (elective) orthopaedics services in north central London.

1.1 Background to the programme of change

North London Partners is a partnership of health and care organisations from the five London boroughs of Barnet,

Camden, Enfield, Haringey and Islington, working together to improve the health of local people through the

sustainability and transformation partnership (STP).

Responding to the variation in quality of care for adult planned services, and in line with evidence from the UK and

elsewhere, the North London Partners is now working together to transform planned (elective) orthopaedic care

across north London. Under the consultation proposals, planned (elective) orthopaedic services would be

delivered under a single network across north central London (the Partnership for Orthopaedic Excellence: North

London) with two dedicated, state of the art planned orthopaedic centres, and local outpatient and day surgery

facilities. North London Partners considers that this would deliver the best care for people who require orthopaedic

surgery.

Planned orthopaedic surgery treats damage to bones, joints, ligaments, tendons, muscles and nerves (the

musculoskeletal system). Patients may be referred to an orthopaedic surgeon for a long-term condition that has

developed over many years, such as osteoarthritis or other non-emergency damage. Surgery, such as hip and

knee replacements, is the best-known kind of orthopaedic surgery offered in the NHS. However, other surgery of

hips, knees, shoulders, elbows, feet, ankles and hands also falls under this heading.

Locally, two partnerships have been formed by local NHS hospital trusts – with University College London

Hospitals (UCLH) and Whittington Health working together, and North Middlesex University Hospital (North Mid)

working with The Royal Free London (Royal Free, Barnet Hospital, Chase Farm Hospital). The partnerships would

offer two hospitals with dedicated operating theatres and beds for patients who need to stay overnight after their

operation. They would offer a greater choice of hospitals for day surgery, outpatient appointments and education

classes for patients prior to their surgery.

Currently, adult planned orthopaedics is delivered across 10 NHS and private sector sites in north central London

(NCL). The preferred model of care is for the two specialist elective inpatient centres to be located at Chase Farm

Hospital and UCLH. Day surgery services would be provided at Chase Farm Hospital, North Mid, Whittington

Health and UCLH. In addition to this, pre and post-operative outpatient care would continue to be provided at all

the above sites and at Barnet and the Royal Free Hospitals, which would represent no change from the current

service offering.

Figure 2 shows the proposed locations for services under the preferred future configuration of orthopaedic

services.



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Figure 2: The locations for orthopaedic care in north central London under the proposals

Source: North London Partners

Details of the preferred model of care are described below in Table 1.

Table 1: Detail of the preferred model of care

North Middlesex University Hospital NHS Trust/The Royal Free London NHS Foundation Trust partnership

University College London Hospitals NHS Foundation Trust/Whittington Health NHS Trust partnership

Inpatient planned orthopaedic surgery

A change: all inpatient orthopaedic care would take place at an elective orthopaedic centre on the Chase Farm site.

Approximate annual number of patients impacted by the changes:

• 400 inpatients who currently use the North Middlesex will in the future have their surgery at Chase Farm Hospital

• 225 patients referred to the RNOH for non-specialist care will be referred to the most appropriate planned orthopaedic surgery partnership

• Up to 560 patients a year currently treated in the private sector would over time have their treatment in the NHS.

A change: all inpatient orthopaedic care would take place in an elective orthopaedic centre specialising in inpatient care at UCLH’s new building on Tottenham Court Road (known at the moment as phase 4).


• 360 inpatients a year who use Whittington Health would in future have their surgery at UCLH

• 75 patients referred to the RNOH for non-specialist care could be suitable for treatment in the elective centres

• Up to 40 patients a year currently treated in the private sector would over time have their treatment in the NHS.

Day-case orthopaedic surgery

A change: day surgery will continue to take place at both at North Middlesex and Chase Farm hospitals.

A change: as part of the partnership approach, Whittington Health would become a centre specialising in day-case orthopaedic surgery, with some day-case



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North Middlesex University Hospital NHS Trust/The Royal Free London NHS Foundation Trust partnership

University College London Hospitals NHS Foundation Trust/Whittington Health NHS Trust partnership


• Up to 1,020 patients a year currently treated in the private sector would over time have their treatment in the NHS as part of the new model of care.

surgery moving from UCLH to Whittington Health.


• Approximately 360 day-cases would move from UCLH and have their surgery at Whittington Health

• Day-surgery would also continue to be carried out at UCLH

• 80 patients currently treated in the private sector would over time have their treatment in the NHS as part of the new model of care.

Pre-operative and post-operative outpatient care.

No change: patients would continue to be seen at the three Royal Free hospital sites and North Middlesex hospital both pre- and post-operatively.

No change: patients would be seen at UCLH and Whittington Health both pre- and post-operatively.

Pre-operative and post-operative outpatient care

No change: patients would continue to be seen at the three Royal Free hospital sites and North Middlesex hospital both pre- and post-operatively.

No change: patients would be seen at UCLH and Whittington Health both pre- and post-operatively.

Trauma – emergency orthopaedic care

No change: would continue to take place as now at both the North Middlesex, Royal Free and Barnet hospital sites.

No change: would continue to take place as now at both UCLH and Whittington Health hospitals.

1.2 Scope and objectives of the travel and access impact assessment

Throughout the development of the proposals, engagement has been undertaken with local residents, patients,

carers and clinical staff. As highlighted by the independent evaluation of the pre-consultation engagement (August

2018 to October 2018), a key issue was the potential impact on travel and access as patients requiring surgery

with an overnight stay may have to travel to and from a hospital which is different from where they receive their pre

and post-operative outpatient care. There was a concern that this could mean longer travel times, more

complicated journeys and increased travel costs. Linked to these concerns are the potential impact on those with

vulnerabilities, mobility impairments and/or economically deprived residents.

To ensure that North London Partners has fully considered the implications of delivering services from different

locations, Mott MacDonald has been commissioned to undertake an independent travel and access impact

assessment. The purpose of this assessment is to identify and assess the impact of the proposals on travel and

access for the local community. This assessment focusses on the travel and access impacts for patients, visitors

and staff. Mott MacDonald is an engineering, management and development consultancy with a dedicated

transportation unit with access to industry leading travel time datasets and software analysis tools. These datasets

are used through our work with transport agencies, including Transport for London and have also been used to

support other independent impact assessment for healthcare clients across the UK.

In line with statutory requirements a separate Health Inequality and Health Equality Impact Assessment is being

conducted by Verve Communications1. This enables any impact of the proposals in relation to the nine protected

characteristics plus another two groups, (carers and social depravation) and unintended consequences,

particularly in relation to travel, to be identified. When exploring the impact on equality groups, this report has

focused on those protected characteristic groups who have been identified as part of the Health Inequality and



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Health Equality Impact Assessment1 as having a disproportionate or differential2 need for planned orthopaedic

services in North London. As such, the report has explored the impact on the following equality groups:

● Older people (65 and over)

● People with a long term health condition

● Gender reassignment

● Race and ethnicity – specifically Asian, Black and White

● Carers

● People living in deprived areas.

It is important to note that the principal purpose of this impact assessment is not to determine the decision about

proceeding with the change; rather to assist decision-makers by giving them better information on how best they

can promote and protect the wellbeing of the local communities they serve and in identifying mitigations that could

be put in place to address any negative impact of the proposed change.

This travel and access impact assessment analysis has been undertaken for the patient population but also

highlights if and where certain sections of the population will be affected, either geographical communities or

certain socio-economic or equality groups3. The assessment explores the positive and negative consequences of

the change to the commissioning of planned orthopaedic services and produces a set of evidence based, practical

recommendations. These recommendations can then be used by decision-makers to maximise the positive

impacts and mitigate any negative impacts of the proposed change.

Assessment of impacts and recommendations for opportunities and mitigations are based on the participation of

relevant and informed stakeholders, thereby giving the impact assessment independence and democratic

legitimacy3.

The findings from this assessment will be published as part of public consultation to support adequate discussion

and consideration of impact.

1.3 Geographic study area for the assessment

The geographical study area which is subject to the proposed changes to planned orthopaedic services and this

impact assessment is that of the five partnership boroughs (Barnet, Camden, Enfield, Haringey and Islington) and

covers the following hospital sites which are currently providing these services:

● Chase Farm Hospital (NHS hospital)

● North Middlesex Hospital (NHS hospital)

● Royal Free Hospital (NHS Hospital)

● Royal National Orthopaedic Hospital (RNOH) (Super specialist hospital – out of scope for review)

● University College Hospital (NHS Hospital)

● Whittington Health (NHS hospital)

● National Hospital for Neurology and Neurosurgery (Super specialist hospital – out of scope for review)

● The Cavell Hospital (private hospital)

● Highgate Private Hospital (private hospital)

1 3Department of Health (2010) ‘Health Impact Assessment of Government Policy’. Available at:

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216009/dh_120110.pdf

2 A disproportionate need refers to a need for the service/treatment over and above the general population. A differential need refers to a group that has different types of need for the service during delivery

3 NHS Executive London (2006) ‘A short guide to Health Impact Assessment: Informing health decisions’. Available at: https://www.who.int/hia/examples/en/HIA_londonHealth.pdf?ua=1

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/216009/dh_120110.pdf

https://www.who.int/hia/examples/en/HIA_londonHealth.pdf?ua=1



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● The Kings Oak Hospital (private hospital).

However, this report has also considered a wider study area, recognising that there is a small patient population

who travel into the study area to use the services provided by the hospital trusts in north central London. This is

set out in more detail below.

Both the National Hospital for Neurology and Neurosurgery and RNOH are considered super specialist and

therefore out of scope for this review.

1.4 Approach to the travel and access assessment

The quantitative travel and access assessment has been produced via two distinct pieces of analysis.

The first has been an analysis of recent patient activity data, provided by the programme in the form of hospital

episode statistics (HES) data. This has been used to demonstrate how changes may affect the current users of the

services through changes to existing provision.

The second has been a qualitative assessment of other travel related impacts that cannot be modelled. This

includes analysis of transport availability, ease of parking, and the cost of travel for patients and visitors.

Table 2 illustrates where under the proposals that have been developed for consultation patients would go for

different elements of their care and this has formed the basis for our modelling.

Table 2: Description of where patients would access different elements of their care



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To undertake the analysis, journey times from the Lower Super Output Area (LSOA4) population weighted

centroids to each of the 10 hospital sites were calculated for car and public transport55 AM peak (07:00 to 09:00)

and inter-peak periods (10:00 to 16:00) based on travel on a weekday. Given the nature of the services under

review, it is expected that patients would be attending services on appointment and therefore arriving by car or

public transport. For this reason, an assessment of blue light ambulance travel times has been scoped out of this

travel and access analysis. These model runs provide the shortest possible journey time from each LSOA centroid

to the hospital at any point during the specified time period and mode of travel. Detailed information on the

methodology and parameters used in the journey time modelling can be found in the technical note at Annex A.

1.4.1 Cleansing of patient activity data

The HES data provided included all adult orthopaedic inpatient (requiring an overnight stay) and day case activity

recorded at the four NHS Trusts (North Middlesex, Royal Free, Whittington Health, and UCLH) for the period

January 2018 to March 2019. HES data for private hospitals in the Study Area was also incorporated into the

database. Before the data was used, a number of cleansing processes were conducted to ensure the data was

appropriate for the study and the services under consideration. This included the following:

● Removal of records for patients aged under 18

● Removal of records where the admission method was not EL (elective inpatients) and DC (day case)

● Removal of records covering spinal procedures

● Removal of NHS referrals to private hospitals with the exception of Highgate Hospital, BMI Cavell, and BMI

Kings Oak, which provide the majority of the planned (elective) orthopaedic workload that is commissioned

locally by CCGs

● For EL data, activity recorded at Barnet Hospital was assigned to Chase Farm Hospital to reflect the changes in

the patient flow of workload between these sites during 2018.

Based on analysis of patient data and discussion with the programme, a study area has been established

comprising of the five core local authorities of Barnet, Camden, Enfield, Haringey and Islington, as well as

additional ‘out of area’ LSOAs where patient data indicated that there were two or more instances of day case or

elective inpatient patient activity after removing isolated outliers. This is shown in Figure 3.

4 A Lower Super Output Area (LSOA) is a small area grography used in statistical planning. LSOAs usually contain approximately 1500 residents.

5 Car analysis derived from TM Speeds 2018 and public transport data derived from Association of Train Operating Companies and Traveline, 2019 Quarter three.



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Figure 3 : Study area and population density map

Source: 2018 Mid-Year population estimates

1.4.2 Patient activity data analysis – planned orthopaedic services requiring an overnight stay

Subsequent to the HES data cleansing and processing as detailed above, analysis was undertaken in Excel which

joined the travel time data to the LSOA patient record, based on the site the patient was seen at, and also the

future travel time they will likely experience to their new nominated site within the partnerships.

For the private hospitals not excluded from the analysis, these patients were instead assigned to the nearest NHS

site that will be carrying out this activity under the proposals. Once this data was consolidated, travel time tables

were produced for each mode and time period, for current and future provision.

1.4.3 Patient activity data analysis – day case services

The analysis of day case travel time changes was made more complex by the fact that UCLH is not completely

ceasing day case procedures at the site, and only a proportion of its activity will be moving to Whittington Health.

To model potential changes for residents in the study area who will be moving from UCLH to Whittington Health in

the future, an average travel time exercise was undertaken to avoid over exaggerating the impact. This looked at

the average travel time by mode and time period to access current day case services at sites and what this would

be if moved to Whittington Health.

1.4.4 Deriving the travel analysis impacts

Based on these model runs, minimum travel times to the hospitals specified in Table 2 were calculated, and the

proportions of all residents and those from the protected characteristic groups who would be able to access a

hospital site within 15, 30, 45, 60 and 90 minutes were calculated for those within the study area.



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| | | | 17 December 2019

1.5 Methodological assumptions and limitations

The following methodological assumptions and limitations should be considered whilst reading this assessment:

● The purpose of this report is not to produce a set of firm conclusions; rather to highlight the impacts of the

proposed change. Through doing this, the report should act as a means of outlining which groups may

experience potential travel and access impacts and highlight issues that need to be further investigated and for

which mitigation measures may be needed.

● This report is based on review and analysis of available secondary data and stakeholder engagement.

● Socio-demographic analysis has been undertaken to provide an insight into the geographical distribution of

certain key populations. This profiling concentrates on the population groups most sensitive to the proposed

changes i.e. those who have been identified as having a ‘disproportionate need’ for the services under review;

as identified by the Health Inequality and Health Equality Impact Assessment undertaken by Verve.

● A combination of 2011 Census, 2018 mid-year population estimates, and 2019 Indices of Multiple deprivation

data has been used to determine the population within the study area. Analysis of ethnic group population,

number of unpaid carers and those with a LTHD, the most up to date data available was used based on the

2011 Census, however this data may not be completely representative of the demographic profile of the study

area at present.

● The travel modelling parameters are intended to provide an indication of typical journeys for residents. The

journey times allocated for all residents within an LSOA is based on the location of the LSOA centroid, and

therefore will not be entirely representative of all possible journeys from within the LSOA. Individual patient

experiences may therefore not completely align with analysis presented here.

● The travel modelling for patient journeys is based on patient level data for Jan 2018 and March 2019 and

therefore reflects patient need and usage at a particular point in time. It does not represent future usage and

health need.

● When using the patient level data, the baselining has included patients who were directed to private hospitals.

● The modelling in the baselining assumes that historic planned orthopaedic activity undertaken at Barnet

Hospital is already transferred to Chase Farm Hospital.

● The modelling in the baselining assumes that historic planned orthopaedic activity undertaken at Royal Free

Hospital has already transferred to Chase Farm Hospital. However, there will continue to be a small cohort of

patients who will still be treated at the Royal Free Hospital. These are medically complex patients, for example

those with haemophilia, or those who might require level 3 ITU support, who would remain at the Royal Free

hospital for their surgery. As such the modelling for patient data has assumed that these patients would be

treated by Royal Free Hospital in the baselining and future.

● When outlining the travel time changes for day case surgery between the Whittington Health and UCLH,

average travel times for the core borough areas have been used. This is because, only a proportion of patients

will be directed from UCLH to the Whittington Health (with UCLH continuing to deliver day case surgery for all

other patients). It has not yet been agreed how patients will be selected to go to the Whittington Health and

therefore it is not possible to identify from where the patients would be travelling. To give an indication of travel

time change, we have therefore shown how journey travel times may change on average for a full borough area

rather than reflecting on proportionate change in travel time for residents.

● Assessment of disproportionate impacts on equality groups for travel time changes has been based on those

groups seeing a +/- five-percentage point difference to the total population in terms of the percentage of those

who will no longer be able to access orthopaedic services within the 15 minute or 30 minute time bands.

The following chapters, Chapter 2 and Chapter 3, identify the impact of change on travel times by both private and

public transport modes. Chapter 2 presents the current pattern of patients accessing services between January

2018 through to March 2019 whilst Chapter 3 highlights the impact of change in travel times under the future

proposals.



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| | | | 17 December 2019

2 Current travel times

Under the current configuration of services, many hospitals in the study area provide planned orthopaedic

services requiring an overnight stay. This chapter identifies the current travel times being experienced by

patients, either by public transport or by car, from each borough to each of the current provider hospitals.

2.1 Profile of patient admissions

Based on admissions presenting between January 2018 to March 2019, Table 3 shows the breakdown between

borough and hospital provider. This shows that there is a spread of admissions across the boroughs to the current

hospital sites. For example, for those living in Barnet, 60% of current planned overnight admissions are at Chase

Farm Hospital with the remainder of residents making use of services at the Royal Free and Whittington Health. In

contrast, around 60% of patients living in both Camden and Islington have accessed services at UCLH.

For patients living in Enfield and Haringey, the profile of admissions is more spread across hospitals. In Enfield,

40% of patients access services at Chase Farm Hospital while a further 21% accessed services at the North

Middlesex Hospital. Whilst a similar proportion of patients living in Haringey had their surgery at North Middlesex

(25%), a more significant proportion of patients living in this borough accessed services at Whittington Health.

Table 3: Profile of current patient admissions

Borough Chase Farm North

Middlesex Royal

Free Whittington

Health UCLH Private

hospital

Barnet 60% 0% 14% 11% 10% 3%

Camden 14% 0% 22% 4% 59% 0%

Enfield 40% 21% 2% 4% 6% 28%

Haringey 8% 25% 2% 42% 12% 10%

Islington 1% 0% 2% 38% 56% 3%

Out of Area 54% 5% 8% 3% 29% 1%

Source: Hospital Episode Statistics provided by the programme

It is this pattern of admissions which underpins our analysis of current travel times.

2.2 Public transport: Current travel times for planned orthopaedic services requiring an

overnight stay

Based on the travel modelling, Table 4 outlines for the full study area, the cumulative proportion of patient

admissions who can to access planned orthopaedic services requiring an overnight stay within each of the 15

minute time bands using public transport (PT). This indicates that a large proportion of patients (76%) can access

these services within 45 minutes via public transport, with almost 9 out of 10 patients able to access within 60

minutes (87%).

Table 4: Cumulative proportion of patients, across the whole study area, who can access planned orthopaedic services requiring an overnight stay via PT for 15 minute time bands

Travel mode Less than 15

minutes

Less than 30

minutes

Less than 45

minutes

Less than 60

minutes

PT AM 15% 51% 76% 87%

Source: Mott MacDonald based on Association of Train Operating Companies and Traveline National Dataset



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| | | | 17 December 2019

Breaking this analysis down and looking across the core catchment boroughs (Table 5), travel times vary. The

majority of patients in Camden and Islington have likely been able to access planned orthopaedic services

requiring an overnight stay via public transport within 30 minutes while for those patients living in Enfield and

Haringey, the majority experience a maximum journey time of within 45 minutes. Barnet patients are the most

likely to experience the longest journey times (29% can access planned orthopaedic services requiring an

overnight stay via public transport within 60 minutes).

Table 5: Cumulative proportion of patients, across the boroughs, who can access planned orthopaedic services requiring an overnight stay via PT for 15 minute time bands

Travel mode and

area

Less than 15

minutes

Less than 30

minutes

Less than 45

minutes

Less than 60

minutes

Barnet 0% 18% 54% 71%

Camden 55% 84% 86% 90%

Enfield 14% 51% 86% 99%

Haringey 10% 60% 92% 100%

Islington 27% 93% 99% 100%

Total within core

study area 17% 54% 80% 91%

Those coming from

outside of core

borough area

4%

31%

49%

65%


2.3 Car: Current travel times for planned orthopaedic services requiring an overnight stay

Based on the travel modelling, Table 6 outlines the cumulative proportion of patients who can access planned

orthopaedic inpatient services within each of the 15 minute time bands by car. Across the study area, this indicates

that the majority of the patients (91%) can access these services within 30 minutes by car, with almost all of

patients being able to access within 45 minutes (99%).

Table 6: Cumulative proportion of patients who can access planned orthopaedic services requiring an overnight stay via car for 15 minute time bands

Travel mode Less than 15 minutes Less than 30 minutes Less than 45 minutes

Car AM 43% 91% 99%

Source: Mott MacDonald based on TM Speed Data

Amongst the core catchment boroughs, the proportion of patients who can travel by car within 15 minutes varies

by borough. However, across all the boroughs, the majority of patients have been able to access this service within

30 minutes (see Table 7).

Those patients who travelled from Barnet and outside of the core borough areas appear to have been the least

likely to be able to access services within 15 minutes (17% in Barnet and 13% from outside core borough area).

Camden, Enfield, Haringey and Islington, all appear to have had better access with over half (and the majority

within Camden) being able to access planned orthopaedic services requiring an overnight stay within 15 minutes

(76%, 56%, 52% and 63% respectively). 93% of those patients living within the boroughs of the core study area

are able to access planned orthopaedic services requiring an overnight stay within 30 minutes and almost all

within 45 minutes.



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| | | | 17 December 2019

Table 7: Cumulative proportion of patients, across the boroughs, who can access planned orthopaedic services requiring an overnight stay via car for 15 minute time bands

Travel mode and

area

Less than 15

minutes

Less than 30

minutes

Less than 45

minutes

Less than 60

minutes

Barnet 17% 92% 100% 100%

Camden 76% 86% 100% 100%

Enfield 56% 92% 99% 100%

Haringey 52% 96% 100% 100%

Islington 63% 99% 100% 100%

Total within core

study area

49% 93% 100% 100%

Those coming from

outside of core

borough area

13% 80% 95% 100%




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| | | | 17 December 2019

3 Impact of change on patient journey times under

the proposals

This chapter outlines the expected impact on journey times for patients as a result of the proposals. Analysis

was undertaken on patient level data covering January 2018 to March 2019 and has explored travel midweek at

AM peak times (07:00-09:00) as well as travel during inter-peak (IP) times (10:00-16:00). As the AM peak time

represents the most congested period of time to travel, the following analysis focused on AM travel. Full

analysis for both time periods can be found in the appendices.

Importantly, it should be noted that patients will be treated pre and post operatively at a choice of hospitals. This

analysis is therefore focused on the journey patients will be required to make when receiving their

orthopaedic surgery only. Therefore, for the majority of patients, this will comprise of one or two journeys to the

site performing their orthopaedic surgery with advanced notice of the appointment given, allowing for journey

planning and preparation.

In addition, under the proposals, not all patients will experience a change in hospital provider and hence a change

in travel time. Patients who currently access planned orthopaedic surgery requiring an overnight stay at either

Chase Farm hospital or UCLH would experience no change. It is predominantly only those patients using existing

services at North Middlesex Hospital under the North Middlesex/Royal Free partnership and those at Whittington

Health under the UCLH/Whittington Health partnership who would experience a change in the service location and

provider under the proposals where services would be transferred to Chase Farm Hospital and UCLH under each

of the respective partnerships.

This analysis of travel time changes reflects this service change; realigning patients presenting within each

partnership who require planned orthopaedic services requiring an overnight stay to the respective hospital

provider under the proposals.

The chapter is split into two sub-sections, public transport journey times and car journey times.

3.1 Public Transport (PT): Journey time changes for patient access to planned orthopaedic

services requiring an overnight stay

Considering the future proposed changes, the cumulative proportion of patients who would be able to access

services via public transport within 15 minute time bands is shown in Table 8; compared against the baseline

position shown in Table 5. This is profiled for each of the boroughs of interest and the full study area.

Table 8: Cumulative proportion of patients who can access planned orthopaedic services requiring an overnight stay via PT for 15 minute time bands under the option for change

Travel

mode and

area

Less

than 15

minutes

%

change

from

baseline

Less

than-30

minutes

%

change

from

baseline

Less

than 45

minutes

%

change

from

baseline

Less

than 60

minutes

%

change

from

baseline

Barnet 0% 0% 13% -5% 55% 1% 72% 1%

Camden 54% -1% 84% 0% 86% 0% 90% 0%

Enfield 10% -4% 38% -13% 87% 1% 100% 1%

Haringey 0% -10% 30% -30% 84% -8% 100% 0%

Islington 15% -12% 98% 5% 99% 0% 100% 0%



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| | | | 17 December 2019

Total within

core study

area

12%

-5%

46%

-8%

80%

0%

91%

0%

Those coming

from outside of

core study

area

4%

0%

29%

-2%

47%

-2%

64%

-1%


Under the future configuration of planned orthopaedic services requiring an overnight stay, the proportion of

patients across the core study area who are likely to be able to access a hospital delivering planned

orthopaedic inpatient services via public transport within 30 minutes drops by eight percentage points

(54% to 46%). However, a similar proportion as currently are likely to be able to access the service via

public transport within 45 minutes (80% under the proposed option compared with 80% under the baseline).

Within the Royal Free London group of hospitals both Barnet and Royal Free Hospitals have already been

directing patients to Chase Farm Hospital and so the vast majority of patients in the area are already making the

journey they would be required to make under the proposals. Consequently, when looking at the impact of these

proposals across the core boroughs, in Barnet and Camden, only a small proportion of patients are likely to be

affected and experience a longer journey time than currently. In Barnet, those who can access services within 30

minutes will drop by five percentage points (18% currently to 13% under the option for change). However, 84% of

patients in Camden will be able to access planned orthopaedic services requiring an overnight stay within 30

minutes, which is the same as currently.

Across Enfield, Haringey and Islington, the likely increase in journey time as a result of these proposals is

more significant. In Enfield, patients will have to travel across the borough and as such a decreasing proportion

will likely be able to access this service within 30 minutes via public transport (51% can currently access services

within 30 minutes which is likely to drop to 38%). For those former patients living in Haringey, they are likely to

experience the most significant journey time increases as they will no longer be able to access either the

Whittington Health or North Middlesex Hospital and as such, the area is expected to see a 30% decrease in the

proportion of patients who can access a hospital within 30 minutes via public transport (current 60% can access

services within 30 minutes which is expected to reduce to 30%). However, 84% of these patients would experience

a maximum travel time of within 45 minutes. For those living in Islington, the proportion of patients who can access

within 15 minutes is likely to reduce from 27% of patients in the area to 15%. However, these patients are only

likely to see their journey time via public transport increase at most by 15 minutes as the proportion who can

access within 30 minutes is likely to increase from 93% currently to 98% following delivery of the option for

change.6

3.2 Private Car: Journey time for patient access to planned orthopaedic services requiring an

overnight stay

Under the future option for change, Table 9 outlines for each of the boroughs of interest and the full study area, the

cumulative proportion of patients who would be able to access planned orthopaedic services requiring an

overnight stay via car within 15 minute time bands. This is compared against the baseline position (Table 7).

6 Where patients see a decrease in journey time from 30 minutes plus, this is likely to cover patients who, in the data set, were sent to a private hospital for their

treatment.



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| | | | 17 December 2019

Table 9: Cumulative proportion of patients who can access planned orthopaedic services requiring an overnight stay via car for 15 minute time bands under the option for change

Travel

mode and

area

Less

than 15

minutes

%

change

from

baseline

Less

than 30

minutes

%

change

from

baseline

Less

than45

minutes

%

change

from

baseline

Less

than 60

minutes

%

change

from

baseline

Barnet 14% -3% 89% -3% 100% 0% 100% 0%

Camden 74% -2% 86% 0% 100% 0% 100% 0%

Enfield 41% -14% 89% -3% 98% -1% 100% 0%

Haringey 0% -52% 86% -10% 100% 0% 100% 0%

Islington 43% -20% 99% 0% 100% 0% 100% 0%

Total within

core study

area

32% -16% 89% -3% 99% 0% 100% 0%

Those

coming from

outside of

core study

area

11% -2% 79% -1% 95% 0% 100% 0%


Under the option for change, the proportion of patients across the core study area who are likely to be able to

access a hospital delivering planned orthopaedic services requiring an overnight stay via car within 15 minutes

drops by 16 percentage points (48% to 32%). However, the majority of patients (89%) are expected to

continue to be able to access orthopaedic inpatient services within 30 minutes, with only a three percentage

point decrease in the proportion able to access within 30 minutes under the option for change.

When looking at the impact across the core boroughs, there is a similar picture compared to public transport:

● For patients living in Haringey, it is expected that none of the patients who could access planned orthopaedic

services requiring an overnight stay within 15 minutes will be able to do so. However, it is likely that for most of

these patients their journey time will increase at most by 15 minutes, as the majority of patients will

continue to be able to access planned orthopaedic services requiring an overnight stay within 30

minutes.

● Patients from Enfield will see a reduction in those patients who can access within 15 minutes (56% to 41%).

However, the majority of patients will be able to access within 30 minutes.

● Patients living in Islington will see a reduction in those patients who can access within 15 minutes (63% to

43%). However, the majority of patients will be able to access within 30 minutes.

● Those patients who live in Camden are likely to experience very limited change in journey time, with

only two percent no longer able to access planned orthopaedic services requiring an overnight stay within 15

minutes and the same proportion as currently able to access services within 30 minutes.

3.3 Future choice for patients

Whilst the proposals set out the future partnership arrangements between hospital sites across north central

London, patients do retain the right to exercise choice in where they have their planned orthopaedic surgery

requiring an overnight stay; either Chase Farm Hospital or UCLH.

Therefore, in addition to modelling the way in which journey times are expected to change when accessing

planned orthopaedic services requiring an overnight stay under the partnerships, modelling has also been

undertaken to identify where patients may have a choice of hospitals following the implementation of the

proposals. The figures below outline for each mode of transport, the areas where the travel times to each of the



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| | | | 17 December 2019

two hospitals is the shortest. The shaded areas identify those areas where the travel time to each hospital is within

5 minutes of the travel time to the other.

The public transport map shows an area which is not linear as it takes into account the availability of direct routes

and train stations.

Overall, this shows that for those travelling by public transport, the travel time to UCLH is the shortest for those

living in Camden and Islington and for those living in the southern end of Haringey and Barnet. For patients living

in Enfield, Chase Farm Hospital is closest is closest. For those living in the northern parts of Barnet and Haringey,

the travel times to each of the two hospitals is similar.

For travel by car, travel time to UCLH is the shortest for those living in Camden and Islington and closet to Chase

Farm Hospital for those living in Enfield. For those living in Barnet and Haringey, the boroughs are almost equally

split in terms of travel times to each hospital and for many there will be a choice where there is little or no

difference in travel times between each hospital site.

The maps indicate that if patients exercise choice in future when considering a location for orthopaedic

services, potential journey time increases can be mitigated against for patients in a number of areas,

Figure 4: Travel by public transport: areas (shaded) where the travel times

between the locations of the proposed planned orthopaedic services requiring

an overnight stay under each partnership are similar




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| | | | 17 December 2019

Figure 5: Travel by car: areas (shaded) where the travel times between the locations of the proposed planned orthopaedic services requiring an overnight stay under each partnership are similar




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| | | | 17 December 2019

4 Day Case services

Under the day case option for change within the UCLH/Whittington Health partnership, a proportion of patients

(c.14%) who currently access UCLH will be required instead to travel to the Whittington Health for their day

services. All other patients will continue to receive day case services at UCLH. There are no proposed changes to

day case surgery in North Middlesex/Royal Free London partnership.

The way in which patients will be allocated to the Whittington Health would need to be finalised as part of

implementation planning and therefore the modelling is not able to identify where patients will be coming from in

order to calculate the proportion of patients who will see journey time changes across the boroughs.

However, to provide an indication of the likely journey time impact for the proportion of patients who would have

had their surgery at the Whittington Health, the modelling has instead calculated the average journey time for

patients who accessed day case services at UCLH across each of the boroughs and compared with against what

the average journey time would be if all of these patients moved to the Whittington Health. Alongside this, the

maximum and minimum journey times have been modelled to help better understand what is the most, and least,

amount of time a patient may have to travel under the proposed option for change.

The following analysis profiles the potential impact of these proposals for patients when travelling by public

transport or by car.

4.1 Public transport

Table 10 outlines the findings for patients assumed to travel via public transport.

Table 10: Average journey time (minutes) during the AM peak via public transport for orthopaedic day case patients currently being treated at UCLH

Baseline (travel to

UCLH)

Future (travel to the

Whittington Health)

Difference

Barnet 34 31 -4

Camden 14 20 6

Enfield 45 53 7

Haringey 30 27 -3

Islington 19 23 5

Out of area 30 41 11


When using public transport, the modelling suggests that for Enfield, Camden and Islington, the average journey

time to travel to the Whittington Health will be longer than the average journey time to UCLH. This indicates that,

for the small proportion of patient who will be required to travel to the Whittington, they may experience

increased journey times (although this does not appear to exceed an average of 10 minutes extra travel).

For those patients living in Barnet and Haringey, their average travel times via public transport would

reduce. This is likely linked to their closer proximity and availability of public transport.

Also, when looking at the longest and shortest time for existing patients, not all patients will experience an

increase. In addition to some of those patients living in Barnet and Haringey, the minimum travel times for those

patients living in Islington would also experience in reduction in travel times (see Table 11).



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| | | | 17 December 2019

Table 11: Minimum and Maximum journey times (minutes) via public transport for day case patients currently access services within the study area.

Baseline (travel to

UCLH)


Whittington Health)

Difference

Min travel

time

Max travel

time

Min travel

time

Max travel

time

Min

difference

Max

difference

Barnet 19 52 12 55 -7 3

Camden 3 34 4 36 1 3

Enfield 27 57 37 68 10 11

Haringey 17 48 7 49 -11 1

Islington 9 28 2 37 -7 8

Out of

area 6 74 20 87 14 12


Patients travelling from outside of the study area will likely be impacted by the greatest journey time increases with

average journey times from these areas increasing by 11 minutes (Table 10). However, it is assumed that these

patients will already be choosing to travel longer journeys rather than drawing on the services which are within

their CCG catchment area.

4.2 Car

Table 12 outlines the findings for patients travelling to day case surgery services via car.

Table 12: Average journey time (minutes) during the AM peak via car for day case patients currently being treated at UCLH

Baseline (travel to

UCLH)


Whittington Health)

Difference

Barnet 29 20 -9

Camden 11 14 2

Enfield 40 29 -11

Haringey 27 14 -12

Islington 15 15 -1

Out of area 24 26 1


By car, the modelling suggests that the average journey time to travel to Whittington Health will be shorter than

travelling to UCLH for the small proportion of patients required to travel to this hospital rather than UCLH. For

example, in Haringey the average journey time will decrease from 27 minutes to 14 minutes. Only Camden and the

out of area patients are likely to see an increase in average journey time, although this sits around one to two

minute longer average journey times than the current average to UCLH. This is also reflected in the maximum and

minimum journey times where generally a movement to Whittington Health would likely result in reduced maximum

and minimum journey times (see Table 13). This is due to Whittington being located in a less urbanised and

congested area.



23

| | | | 17 December 2019

Table 13: Minimum and Maximum journey times (minutes) via car for patients currently access services within the study area.

Baseline (travel to

UCLH)


Whittington Health) Difference

Min travel

time

Max travel

time

Min travel

time

Max travel

time

Min

difference

Max

difference

Barnet 18 39 11 33 -7 -6

Camden 2 20 3 23 1 3

Enfield 32 49 20 42 -12 -8

Haringey 19 35 4 25 -15 -10

Islington 9 22 2 25 -7 3

Out of

area 5 58 13 49 8 -9




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| | | | 17 December 2019

5 Impact on protected characteristic groups

The previous chapter has assessed the overall impact on travel time changes for the total patient volumes.

However, it is recognised that there are some groups who may be disproportionately impacted by the changes

being proposed particularly, in relation to travel.

When looking at the key equality groups within the study area the following have been identified to be

disproportionately impacted under the option for change:

● Top quintiles of deprivation

● Top quintiles of health deprivation

● BAME

5.1 Impact when travelling by public transport

For the top quintiles of deprivation, the proportion who can currently access services within 30 minutes

will likely decrease by 41 percentage points (from 90% currently to 49% under the option for change). This

compares with a likely decrease of 26% for the population as a whole within the study area and is linked to large

densities of this group residing in Haringey, the edges of Enfield and Waltham Forest which are all areas affected

by longer journey times (with the majority of people no longer being able to access within 15 minutes).

Figure 6: Index of Multiple Deprivation – Overall deprivation quintiles

Source: MHCLG 2019



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| | | | 17 December 2019

Whilst small in absolute numbers, the population in the top quintiles of health deprivation tend to mostly be

located around Whittington Health and North Middlesex Hospitals. Consequently, when looking at travel

within 15 minutes via PT, this group is likely to experience a disproportionate impact compared to the

population. For example, eight percent are expected to be able to access within 15 minutes under the option for

change which represents a 38 percentage point decrease (46% currently). However, as these hospitals are

relatively closely located to Chase Farm and UCLH, this group, whilst seeing a decrease in the proportion who can

access within 15 minutes, may actually experience better accessibility within 30 minutes when compared to the

population as a whole. Nearly all under the option for change (78%) will likely be able to access within 30 minutes

compared to just over half (56%) of the population as a whole.

Figure 7: Index of Multiple Deprivation – Health deprivation quintiles

Source: MHCLG 2019



26

| | | | 17 December 2019

The proportion of Black residents who can currently access within 30 minutes will likely decrease by 38 percentage

points and the proportion of Turkish residents who can access within the same time period will likely decrease by

48 percentage points. This is due to greater concentrations of these demographic groups in east Haringey and

south Enfield. Current 84% of Black residents within the study area can access planned orthopaedic inpatient

services within 30 minutes which is expected to drop to 46% under the option for change.

Figure 8: Population density of Black residents

Source: Census 2011



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| | | | 17 December 2019

For Turkish residents, 86% can current access within 30 minutes while under the option for change this is likely to

drop to 38%. These groups are more densely located around Enfield, Haringey and Islington and, as such, while

their journey time will increase because of the relative location of those proposed hospitals providing overnight

stays under the option for change, will only see journey times increase by at most 15 minutes.

Figure 9: Population density of Turkish residents

Source: Census 2011

5.2 Impact when travelling by car

The proportion of those living in the top quintiles of deprivation who can currently access within 15 minutes will

likely decrease by 57 percentage points (from 81% currently to 24% under the option for change). This compared

with a likely decrease of 39 percentage points for the population as a whole within the core study area (from 68%

currently to 28% under the option for change). However, the entire group is likely to continue be able to attend

planned impatient orthopaedic services via car within 30 minutes, suggesting that at most these residents

will see a 15 minute increase in journey time. This group tends to be more densely located around Enfield,

Haringey and Islington which are most likely to experience increases in journey time.

As with public transport, those in the top quintiles of health deprivation is expected to be disproportionately

impacted by longer journey times. Under the option for change the proportion who are expected to be able to

access planned orthopaedic services requiring an overnight stay within 15 minutes is expected to drop by 47

percentage points (currently 79%, under the option for change 32%). This compares with a 39 percentage point

decrease in the proportion who can access within 15 minutes for the population as a whole (68% can currently

access compared with 28% under the option for change). However, it expected that all patients with a health

deprivation within the study area will be able to access this service within 30 minutes.



28

| | | | 17 December 2019

The proportion of Black residents who can currently access within 15 minutes via car will likely decrease by 53

percentage points and the portion of Turkish residents who can access within this time period will likely decrease

by 61 percentage points. Current 73% of Black residents within the study area can access planned orthopaedic

services requiring an overnight stay within 15 minutes which is expected to drop to 21% under the option for

change. For Turkish residents, 78% can current access within 15 minutes while under the option for change this is

likely to drop to 17%. As with the above groups, residents from within these groups are all expected to be able to

access planned inpatient services within 30 minutes.

Detailed tables presenting the full analysis of the protected characteristic group analysis can be found in the

appendices.



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| | | | 17 December 2019

6 Transportation cost and accessibility of planned

orthopaedics

The chapter outlines the accessibility of each of the hospitals which in the proposed model will provide elective

orthopaedic services. It also considers the cost of any change in travel to the future sites.

It should be noted that, when reviewing the following chapter analysis, due to the elective nature of the services,

adverse health outcomes are not identified as being a direct result of increased journey times. Patients using these

services will know in advance that a certain procedure is required, and this procedure will be booked for a specific

date with the agreement of the patient. Further, patients will be able to receive both their pre and post-operative

care at their nearest hospital. As such, for those patients for whom the hospital providing overnight stays is not

their nearest hospital, they will likely only be required to travel to the centre once for their operation; all other care

will be received at their closest hospital.

6.1 Availability of public transport

Where residents are required to travel to a hospital site which is further away than the current site they would

travel to, a negative impact may be experienced in terms of the cost, availability and therefore accessibility of

public transport.

To help assess the accessibility of London areas, Transport for London (TfL) has developed a Public Transport

Accessibility Level (PTAL) measure. PTALs are a measure of connectivity by public transport. It suggests how well

a selected place is connected to public transport services. PTAL values range from zero to six, where the highest

value represents the best connectivity. The PTAL scores for the all hospitals currently providing planned

orthopaedic services within the study area is outlined in Table 14. It should be noted that these scores do not

identify accessibility for other forms of transport, such as ambulance and cars.

Table 14: PTALs for key hospital locations

Hospital PTAL Description

North Middlesex/Royal Free partnership

Chase Farm 2 Poor

Royal Free Hospital 4 Good

Barnet Hospital 2 Poor

North Middlesex University Hospital 3 Moderate

UCLH/Whittington Health partnership

Whittington Health 6a Very good

University College London Hospital

(UCLH)

6b Excellent

Private Hospitals

The Kings Oak Hospital 1b Very poor

The Cavell Hospital 1b Very poor

Highgate Private Hospital 2 Poor

Source: TfL WebCAT

Under the proposed North Middlesex/Royal Free partnership, patients will be directed to Chase Farm Hospital for

surgery requiring an overnight stay.



30

| | | | 17 December 2019

Setting aside the private hospital providers, Chase Farm Hospital scores poor; similar to Barnet Hospital and

worse than the Royal Free and North Middlesex University Hospitals. Therefore, those residents who currently use

public transport to travel to a local hospital and, under the proposed model, will be required to travel instead to

Chase Farm Hospital, will likely find the journey to be less accessible than previously.

Reviewing the PTAL scores for the UCLH/Whittington Health partnership, UCLH has one of the highest PTAL

scores for public transport accessibility. Therefore, it may be that some residents following the change will find

accessing planned orthopaedics easier via public transport then they may otherwise have found when accessing

the Whittington Health or one of the private hospitals in the catchment area.

The option for change would over time make focus care at the two partnerships. Consequently, where residents

are currently required to travel to private hospitals, the transfer of planned orthopaedic services requiring an

overnight stay may result in a more positive impact in terms of accessibility and costs within the UCLH/Whittington

Health partnership although limited improvement for those accessing Chase Farm Hospital in the North

Middlesex/Royal Free partnership.

6.1.1 Transport links within the North Middlesex/Royal Free Partnership

Reflecting its PTAL score, Chase Farm Hospital has only three buses which stop close to the hospital site (see

Figure 10).

Figure 10: Bus routes directly serving Chase Farm

Source: Mott Macdonald based on Association of Train Operating Companies and Traveline National Dataset

The nearest train station is Gordon Hill which is a 15 minute walk (assuming a fully mobile individual) from the

station to the hospital or an 8 minute bus journey. Gordon Hill also does not provide step free access making it

inaccessible to many people with mobility issues which is likely to be relatively high amongst the patient

population given the nature of the service under review. Some patients may qualify for patient transport services

although this has not been quantified. Another option for patients in the Haringey and Enfield areas is to get the



31

| | | | 17 December 2019

train to Enfield Town, which has step free access, and then get a bus to the site. The W9 and 313 buses take

approximately 15 minutes for this last leg of the journey.

Similarly, the nearest tube, Oakwood (Piccadilly line), is also likely to be relatively inaccessible or costly for those

with mobility issues. While having step free access it is a 52 minute walk from the hospital7, a 44 minute bus

journey (requiring two buses) or a 10 minute taxi journey.

Further, for those patients in the study area who are seeking to take the tube to the site but do not live on the

Piccadilly line, it is likely that they will be required to travel down into either zone 1 or 2 to join the Piccadilly line,

therefore creating an additional cost for their journey.

The frequency of these public transport services is also variable. Figure 11 below shows the frequency of stops

per hour serving the hospital sites within the study area between 5am and 7am. For patients required to attend

appointments before or at 7am, the low frequency of service to this site can be expected to make travel difficult.

This is particularly likely to affect those areas with low levels of car ownership (see Figure 12) which also correlate

with the highest densities of deprivation and BAME groups. As such, these groups may particularly struggle with

travelling to appointments which are scheduled for early morning.

Figure 11: Number of PT services per Hour at stops between 5:00 and 7:00


The above analysis indicates that some patients when travelling to Chase Farm Hospital via public transport may

experience relatively complex journeys, using multiple forms of transport to access the hospital site. The

requirement to use more than one form of transport is also likely to increase the cost of the journey for these

patients. This is particularly likely to be the case for those who live on the periphery of the catchment area for the

hospital site which are not serviced by direct buses to the hospital. Where residents choose to use alternative

transport service to buses, they will also likely have to walk some distance in order to access the hospital site or

use another mode of transport to complete their journey. These issues may have a disproportionate impact on

those who are older, have a disability, a mental health condition, or are from an area of high deprivation,



32

| | | | 17 December 2019

and whom may find the new route significantly affects their ability to travel to the site because they have difficulty

managing more complex, costly journeys and/or cannot manage sustained periods of walking. This is also likely to

impact on those patients whose orthopaedic need limits their mobility.

Across the study area, those most likely to be impacted by changes to public transport routes and journeys are

those located near the southern fringe of Enfield. Figure 12 identifies low car ownership in these areas and

therefore these patients are likely to be more dependent on public transport to access the services. These areas

tend to have higher densities of people from BAME backgrounds and be areas of higher deprivation,

suggesting that both groups are also likely to be disproportionately impacted.

Some patients may be eligible for reimbursement of their travel costs, particularly those from deprived

communities although, at this stage of the proposals, the proportion of patients who may be eligible is not known.

Figure 12: Car ownership within the study area

Source: Census 2011

As outlined earlier, it should be noted that patients will be treated pre and post operatively at their local hospital

and as such the travel concerns outlined above are only likely to occur when accessing planned orthopaedic

services requiring an overnight stay.

6.1.2 Transport links for the UCLH/Whittington Health Partnership

6.1.2.1 UCLH

Of the hospitals in north central London, UCLH is the best served by public transport, reflecting its high PTAL

score. There are approximately 16 direct bus routes which stop next to or within 5-10 minute walk8 of the site and

which extend close to five residential centres (see Figure 13).



33

Figure 13: Bus routes directly serving UCLH


There are two tube stations within 5 minute walk from the hospital9

; Warren Street (Northern and

Victoria lines) and Euston Square (Circle, Hammersmith & City and Metropolitan lines). There

are also a number of tube stations which are a 15-20 minute walk away, including Goodge

Street, Russell Square and Euston. Euston train station and King’s Cross are also within a

reasonable proximity to the site with bus services available from the station to the hospital. It

should be noted that Warren Street does not have step free access which is likely to impact on

those with limited mobility, although surrounding stations such as Euston, Euston Square, and

King’s Cross do have some level of step free access.

In addition to the availability of public transport services, Figure 13 also exemplifies that the

public transport services running to the site operate under a high level of frequency. This would

suggest that waiting times for public transport when accessing the site are relatively short and

as such, minimal preparation may be needed as patients will not need plan around a limited

service.

The high availability of public transport may make travel for local residents easier when

travelling for orthopaedic services through potentially opening up more direct routes to patients.

This may support a range of more vulnerable groups through providing more direct and less

complex routes via public transport.

6.1.2.2 The Whittington Health

Public transport availability to the Whittington Health while not as strong as UCLH, is still good

(Figure 14). There are around 14 bus routes which directly serve the hospital with stops within a

short walking distance of the hospital site which go out to several residential centres.



34

Figure 14: Bus routes directly serving Whittington Health


Archway is the nearest tube station and is an 8 to 11 minute walk7 to the hospital. There is also

a bus service from the tube station to the hospital which takes a similar amount of time to get to

the hospital as walking.

The nearest train station is Upper Holloway, a similar walking and bus distance as with the tube

(11 and 8 minutes respectively). Tufnell Park is also available to access the hospital but

requires a longer walk of around 20 minutes.

In terms of the frequency of stops to the Whittington Health, while during the period 5am to 7am

the frequency of stops is generally lower than UCLH and similar to that of Chase Farm Hospital,

between 7am and 4pm the site is generally well served by a high frequency service (Figure 15).

Consequently, residents travelling to the site may find that there is less waiting and need for

planning when travelling after 7am but may have more complex journeys prior to this time. As

discussed earlier, car ownership levels suggests that the groups most likely to be affected by

more complex travel for early morning appoints are those from BAME backgrounds and areas

of high deprivation.

7 Assuming a fully mobile individual



35

Figure 15: Number of PT services per hour at stops between 7:00 and 9:00


Where day case orthopaedic services moves from UCLH to the Whittington Health, given the

requirement for a reasonable distance of walking or secondary use of a bus from train links to

the hospital, those who experience mobility issues or anxiety around new or more complex

journeys may experience difficulties in travelling to a different hospital site for their surgery. This

may disproportionately affect those with a disability, older people and those with a mental

health condition who are all more likely to struggle with complex journeys and who may also

be likely to experience access issues in terms of driving to the site because parking on site is

unavailable (although there are a small number of disabled parking spots available). Given the

nature of the service, a number of patients may experience mobility issues and therefore be

particularly impacted in any reduction of the physical accessibility of the site.

6.2 Additional travel costs

While in the majority of cases the increased journey time is likely to amount to 15 minutes

maximum, any additional distance to travel to an alternative hospital site is likely to result in

additional costs for some patients, visitors and staff when accessing planned orthopaedic

services.

The additional journey time for some patient, visitors and staff, and across all modes of

transport, will likely result in additional costs for those required to travel to orthopaedic services

at a location which is not currently their closest hospital. For those travelling via car, additional

petrol costs are likely to be experienced. Where patients, staff and visitors are accessing

orthopaedic services at Chase Farm Hospital by car, when other modes of transport may

previously have been used, additional parking costs can be expected.11 Further, for those



36

travelling to UCLH by car from outside of the ULEZ and Congestion Zone, these charges may

also be incurred.

Car ownership data for the study area (outlined in Figure 12) indicates that those living in the

more northern part of the study area around Barnet, Enfield and above these boroughs, are

more likely to be impacted by parking and petrol costs as they are more likely to own a car and

therefore drive to hospital.

In addition to costs associated with driving, those who will need to use public transport or

taxis/private hire vehicles to access the planned orthopaedic centres can be expected to

experience an increase in costs associated with travelling to the site.

Those who may be required to travel to Chase Farm Hospital under the option for change will

likely see some of the most significant increases in costs when travelling by taxi or private hire.

For example, those from the edges of Enfield and Haringey who are required to travel to Chase

Farm Hospital for planned orthopaedic services requiring an overnight stay could see an

increase of cost of c.£19 to access the site via private hire, or around 40% more than this cost if

using black taxi cabs8 (£31).

However, in the majority of cases, this travel will not exceed an additional journey time of 15

minutes and for patients and visitors will likely only cover a small number of trips as pre and

post-operative care will be delivered at a choice of hospitals.

Those from more deprived areas are likely to be disproportionately impacted by any rise in

costs to access services. Across the study area, high densities of BAME groups and those with

a long term condition are often resident in more deprived areas, suggesting that these groups

are also likely to be disproportionately impacted by increased costs.

6.3 Cost and availability of parking

A key concern around the option for change which has come out of discussion with the local

community has been around the availability and cost of parking. It has been suggested that

there is limited available parking at the sites and this can cause difficulties when accessing the

hospitals, particularly for those with mobility issues or who struggle with using public

transport linked to mental health.

6.3.1 Chase Farm Hospital car parking

The cost of car parking at Chase Farm is detailed in Table 15.

Table 15: Parking costs at Chase Farm Hospital

Time Cost

Up to 1 hour £2

1 to 3 hours £3

3 to 4 hours £4

4 to 6 hours £7

6 hour up to 24 hours (maximum length of stay) £10

Source: Royal Free Trust website

8 Black cab costs sourced from www.worldtaximeter.com/london

http://www.worldtaximeter.com/london



37

While considerably higher than other parts of England (UK average for 1 hour is £1.10),149 the

hourly cost of parking is in line with the London average and is slightly cheaper than the

car parking charges at the North Middlesex Hospital site. The cost of parking can

sometimes restrict some residents from driving to the site, such as those from areas of high

deprivation (although these areas generally have lower levels of car ownership). Chase Farm

Hospital does, however, provide a 20 minute drop off zone outside of the main entrance and car

parking is available in the local area, to support further access. This may help mitigate some of

the parking issues. Those with a disability or mental health illness and are most likely to need

this support, may therefore be disproportionately impacted.

The availability of parking is not a significant issue at Chase Farm hospital due to a large

provision of spaces for patients. The car parks at the site have disabled parking and blue badge

holders can park free of change, for up to four hours, for one year from the date of registration.

This may help to make the site more accessible for those with a disability, however, there

are likely to be a number of patients who do not qualify for a blue badge but who have

significant mobility issues which make walking certain distances from the parking areas a

challenge.

6.3.2 UCLH and Whittington Health car parking

Neither UCLH nor Whittington Health currently provide patient or visitor parking on site,

although a small amount of blue badge parking is available next to the hospital for day case

services only. These are free of charge, but patients have to register their blue badge at the site.

Across both sites there are some pay and display parking options on roads near the site, but

these are not provided by the hospital. There are drop off and collection points located at the

hospital which may act in part to mitigate against the lack of parking, but these are both limited

in capacity and will not be able to support those who require those driving them to stay with

them at the hospital sites. As discussed earlier, this is likely to disproportionately impact on

those with disability or mental health illness.

While a lack of parking may indicate a disproportionate impact for those with a mobility issue or

who struggle with using public transport because of a mental health issue, it should be noted

that as parking is currently not available at either site within the UCLH/Whittington Health

partnership, it is expected that under the option for change those already accessing orthopaedic

services at these hospitals will be used to using alternative means to private car to access the

sites and so the scale of the impact may not be as great. Further, the low car ownership levels

in the areas surrounding these two sites (see Figure 12) indicates that the majority of those

visiting these sites are likely to be drawing on public transport, suggesting again that the scale

and magnitude of any impact around the availability of parking is likely to be low.

9 Research into average parking in UK cities conducted by Citybase using data from every city council and available here:

https://www.citybaseapartments.com/blog/uk-car-park-index/

https://www.citybaseapartments.com/blog/uk-car-park-index/



38

7 Impact assessment

The analysis has looked at the potential impact of the option for change on travel times for both a specific cohort of patients and for the population

as a whole. While the population analysis indicates a more significant shift in the proportions who will move into longer journey time bands, both

analyses identify that for the majority of those accessing the sites the increased journey time is likely to be at most 15 minutes.

When looking at both public transport and car journeys, for those living in Islington and Camden, the most significant movement in journey time will

be for patients with a less than 15 minute journey which may move into a journey which sits within 15-30 minute journey. For those residing within

Barnet , Haringey and Enfield, when travelling via public transport the more significant movement in journey time will be for patients who currently

have a journey time which is within 30 minutes that under the option for change will move into a journey time of 30-45 minutes (although for some

parts of Haringey there will also be a group of residents who will move into just under an hour journey). When looking at car travel for these

boroughs the movement is more in line with Islington and Camden where any journey time increase is most likely to push travel from less than 15

minutes into 15-30 minutes.

Table 16: Impact assessment

Impact area Likelihood Magnitude Duration

Longer journey times for patients, visitors and staff

High – some hospital will stop providing orthopaedic inpatient services and as such there will be a requirement for patients, staff and visitors to travel to an alternative hospital site for surgical procedure

Moderate adverse – At least a few minutes increase in journey time is expected for the majority of residents across the study area. However, for most residents the increase in journey time are likely to be at most 15 minutes and for patients and visitors this journey is only likely to be required on one or two occasions as both pre and post-operative care will be delivered at the nearest base hospital.

For staff the impact could be more significant but is likely to be countered by more consistent rotas meaning less travel during the day between sites.

Long term – a move to a model of two hospitals providing planned orthopaedic services requiring an overnight stay is not intended to be a short term measure and will therefore have an extended impact on journey times.



39


Availability of public transport

High for the North Middlesex/Royal Free partnership – As the North Middlesex hospital will be directing patients, staff and visitors to Chase Farm Hospital for planned orthopaedic services requiring an overnight stay, there will be a requirement for these residents to draw on public transport services to Chase Farm Hospital which has been identified as being less accessible to the other hospitals within the northern partnership. (Referrals for orthopaedic surgery requiring an overnight stay from Barnet and Royal Free Hospitals are already going to Chase Farm Hospital and so represent no change.)

Medium for the UCLH/Whittington Health partnership

– Patients will be directed to UCLH for planned inpatient surgery and some will be directed to Whittington Health for day case surgery. UCLH has been identified as having strong public transport routes to the site and so some residents may find journeying to this location easier. However, the Whittington Health while having a good transport network, has a low frequency of service in the morning, as such, for any residents required to travel to this site for early morning appointment, they may experience issues in the accessibility of service.

Moderate adverse for the North Middlesex/Royal Free partnership – At least a few minutes increase in journey time is expected for residents across the study area. This will mean that some patients will be required to travel on alternative modes of transport or undertake new routes to access orthopaedic services. Given the low accessibility of public transport services to Chase Farm Hospital, some residents may struggle with this journey.

This may particularly effect those with a disability, a mental health condition, those from BAME backgrounds and those from more deprived areas.

However, it should be noted that the journey is only likely to be required on one or two occasions as both pre and post-operative care will be delivered at the nearest base hospital.


Minor adverse for the UCLH/Whittington Health partnership – the requirement for some patients to travel to Whittington Health for day case surgery may mean that certain residents may experience issues around accessibility of public transport to the site. While the site has good transport links available to it, there are some requirements around walking to the site from certain transport and the frequency of service means that some patients may struggle to access the site. As with the North Middlesex/Royal Free Partnership the residents most likely to be impacted by this are effect those with a disability, a mental health condition, those from BAME backgrounds and those from more deprived areas.

However, it should be noted that the journey is only likely to be required on one or two occasions as both pre and post-operative care will be delivered at the nearest base hospital.

For staff the impact could be more significant but is likely to be countered by more consistent rotas meaning less travel during the day between sites

Long term – a move to a model of two hospitals providing planned orthopaedic services requiring an overnight stay is not intended to be a short term measure and will therefore have an extended impact on the cost and accessibility of travel.

However, should any mitigation action be implemented there is potential for the temporality of this impact to be reduced.



40


Additional travel costs High – some hospitals will stop providing planned orthopaedic services requiring an overnight stay and as such there will be a requirement for patients, staff and visitors to travel to an alternative hospital site for surgical procedure. It has been identified that this will result in some patient experiencing longer journey times and as such additional costs will likely be experienced.

Minor adverse - At least a few minutes increase in journey time is expected for the majority of residents across the study area. However, for most residents the increase in journey time are likely to be at most 15 minutes and for patients and visitors this journey is only likely to be required on one or two occasions as both pre and post-operative care will be delivered at the nearest base hospital. As such, any additional costs are expected to only be experience on a limited number of cases. However, where they are experienced this is likely to impact those from more deprived communities, those with longer terms conditions and some BAME groups more significantly.



Cost and availability of parking

Medium – some hospital will stop providing planned orthopaedic services requiring an overnight stay and as such there will be a requirement for patients, staff and visitors to travel to an alternative hospital site for surgical procedure. Additionally, patients traveling to the Chase Farm Hospital site will put pressure on available parking. For those who require parking and who are required to travel to UCLH and the Whittington Health, they may be likely experience difficulty due to the lack of parking available on site. However, both sites do offer alternative services and careful planning may reduce the potential for the impact to be experience by those accessing the site.

Minor adverse – within the North Middlesex/Royal Free partnership, parking is as available at all sites at the same cost, as such the cost of parking will not change for those required to travel to Chase Farm Hospital instead of one of the other hospital sites. However, it has been identified by Chase Farm Hospital that parking is limited and an increase in patients accessing the site is likely to impact on the availability of parking. Yet it should be noted that it is expected that patients will receive both their pre and post-operative care at their base site and as the surgery will be a scheduled event patients, visitors and staff will have the opportunity to plan their journey around this impact.

For the UCLH/Whittington Health partnership, parking (apart from a small amount of blue badge and staff parking) is not available on the sites and as such those who require parking may experience difficulties with accessing the sites, such as those with a mobility issue. However, as neither site has parking, residents who fall within this catchment are expected to be used to the lack of parking. Further, as mentioned for the North Middlesex/Royal Free partnership, it should be noted that both inpatient and day case surgery is a scheduled event which patients, visitors and staff will have the opportunity to plan their journey around to mitigate this impact.




41

8 Travel and access mitigations

The previous chapters have outlined the key travel and access impacts likely to be experience

by the local community, covering patients, staff and visitors. Coming out of the impact areas

identified are a set of current actions and recommended future actions which may mitigate or

reduce the effect of potential negative impacts and enhance positive impacts. The following puts

forward mitigation actions which should be considered by the Trusts and Programme when

reviewing their option for change and as part of the implementation process.

Action 1: Accessibility of the hospital sites

● Chase Farm Hospital provide a vehicle which will collect patients from Hunters Way bus stop

and Clocktower bus stop, both of which are located close to the car parks. This service runs

every 15 minutes and may go some way in supporting those with mobility issues to better

access the site. Chase Farm should consider whether this service can be extended to other

areas to further support patients.

● Chase Farm Hospital could consider implementing a car parking management strategy to

ensure that fair consideration is given to parking capacity on the site and the ability to grow

this capacity. If parking cannot be increased, consideration should be given to innovative

approaches to increase patient and visitor parking. For example, flexible scheduling of

appointments to avoid peak parking times within the Trust, allowing for optimisation of

parking. Particular, consideration should be given to disabled parking and ensuring

appropriate access to this.

● Chase Farm Hospital provides some staff parking and has introduced set parking spaces

which are designated to staff for short stay only (up to 5 hours). These spaces have been

introduced for staff who frequently work across trust sites. This provision may therefore act

to support staff who are required to travel with patients from their base hospital to Chase

Farm Hospital for surgery. As increasing numbers of staff are expected to be required to

move between sites as part of the option for change, Chase Farm should review whether the

number of these staff parking spaces is sufficient to meet future demand.

Action 2: Support development and capacity building of community transport options and make the community aware of the options available to them

● Across UCLH, Whittington Health and Chase Farm hospital sites which will provide

planned inpatient and day case orthopaedic services, there are a number of

community transport schemes available to support patients in accessing the hospital

sites. These services are generally targeted at those who have been identified as

likely to have particular difficulty with travel to the sites: older people; disabled

people; those with a mental health condition; and those from deprived areas. Table

17 below outlines the key schemes available in each hospital.



42

Table 17: Local transport schemes and support available across hospitals

Chase Farm UCLH Whittington Health

● Dial a ride

● Patient transport service is

available for patients who are

unable to attend hospital

appointments by public

transport or any other means

due to a medical condition.

Royal Free London is part of a

single multi-provider contract.

● Dial a ride







UCLH has a standalone

contract for this.

● Dial a ride







Whittington Health is part of a

single multi-provider contract.

Source: Mott MacDonald

● With some patients required to travel further and undertake more complex journeys to

access inpatient or day case orthopaedic services, schemes such as those listed above will

be essential in supporting some of these patients to access the service. The Trusts, Local

Authorities and the Programme should work together to promote these services more widely

to the community and encourage their further expansion.

● In addition to the above, there are some very localised/specialised support service available

to patients such as Hatzola10, Groundswell Homeless Health11 and a patient taxi service from

Harlow (currently only providing a service to cancer patients) which provide some support to

patients in attending hospitals.

● More generally, there needs to be clearer information provided about the potential transport

options available, including those transport services identified above as well as public

transport and car travel. This could be supported through the Care Coordinators who could

help plan a patient’s journey to the centres; particularly those more vulnerable individuals.

Additional details of this are also set out in Chapter 6.2.

● There is an opportunity to develop some clinical guidance specific to orthopaedic surgery to

support call handlers when assessing eligibility.

Action 3: Explore the possibility of ensuring more personalised support to patients in promoting clarity around, and comfort in, using available transport options and accessing the hospital sites

● Acknowledging the difficulties some patients have with accessing hospital sites for planned

services, the Trusts in the partnerships already support a number of activities aimed at

providing more personalised care which might act to mitigate some of the impacts outlined in

this report. Under the proposals, Care Coordinators are part of the future plans to facilitate

the plans for travel and access with patients; particularly those who are most vulnerable to

the proposed changes.

● UCLH currently has a number of rooms (Cotton Rooms) which provide overnight

accommodation for patients who have long journeys or difficulty going home due to weather

etc. There is a strict criteria around usage. Currently they are generally used for oncology

patients and as such consideration could be given to whether these could be broadened out

to cover other patients.

10 https://hatzola.org/

11 https://groundswell.org.uk/care-navigation/

https://hatzola.org/

https://groundswell.org.uk/care-navigation/



43

● Chase Farm and UCLH both support carers to stay overnight and accompany those for

whom they have a caring responsibility.

● In addition to the actions above, at the initial pre-operative assessment, the Trusts could also

work with patients to ensure that appointment times best suit their travel needs. However,

consideration could be given to staggering admissions to reflect the distance patients will be

travelling – e.g. those patients who will be travelling longer distances will be placed at a later

spot on the list. Although if staggering, the Trusts are mindful that too much staggering could

lead to risks in terms of gaps in services and inefficiencies.

Action 4: Work with local councils and transport providers

● In supporting some of the challenges around travel and access, there needs to be closer

working with and across the various Trusts, local councils, public health authorities and

transport providers.

● Detailed consideration of the public transport routes will need to be undertaken to ensure

that people are able to access the services in their new locations across the two

partnerships. The Trusts could work with TfL to understand if there is sufficient changes in

patient flows to justify modifying bus routes to better support accessibility to the hospital

sites. This is particularly relevant for Chase Farm where the Trust could work with TfL to see

whether PTAL scores could be improved.

● The various organisations should also ensure that their local strategies are joined up and

promote local accessibility.

Action 5: Accessibility of the hospital sites

● At Chase Farm Hospital, improvements have been put into place to better support the

accessibility of the site. This includes moving bus stops to the new main entrance to reduce

walking distances for those with mobility issues although these are yet to become

operational. As mentioned earlier in the report, they also provide a charity mini bus to pick

patient up from the existing bus stops and take them to the main entrance. These actions

should help to support patients in accessing the site.

● The Trusts should also consider what other hospitals are doing to support travel where

physical access to the site limited. They should consider other infrastructure, planned or

existing, in the areas surrounding the hospital sites which may impact on accessibility to the

site now and in the future. This should feed in to any travel planning (see action 6).

● The Trusts should also continue to encourage and support staff to take up alternative modes

of transport such as cycling through action such as, increasing the number of bike racks,

minimising the need for staff to travel between sites via rota allocations and ensuring

sufficient washing and locker facilities are available to all staff. Through encouraging staff to

use alternative travel modes, parking spaces may be freed for patients and visitors.

Action 6: Continuous review of accessibility through a travel plan

● Development of a travel plan. A travel plan is a package of measures designed to manage

the access to an establishment (e.g. a hospital site). While the hospitals in the partnership

may already have travel plans, these should be reviewed in light of the option for change. In

particular, the travel plans should include consideration around:

– How staff currently travel to the site

– How patients and visitors are travelling to the site

– The travel needs of different patient groups

– The travel needs of different visiting groups

– Current accessibility of the hospital site

– Future developments which may affect accessibility



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– Additional sources of funding to support new transport offerings

– What other hospitals and Trusts are doing to support accessibility

● As part of developing the travel plan, staff, patients and visitors should be engaged with to

understand their current experiences and difficulties with travel, this could be done through a

travel survey or via focus groups and in-depth interviews.

Action 7: Effective communication of patient choice and transport options to staff, patients and visitors

● As part of the planned option for change, it has been suggested that work will be done to

ensure that GPs and referrers, such as physiotherapists, working as first contact

practitioners, have the right information to support patients to make decisions with full

knowledge of potential travel implications and help exercise choice of partnership.

● However, any potential increase in travel time for planned services will also need to be

communicated well to patients, carers, surgeons, staff and visitors by the Trust and

individual hospitals. Additionally, the Trusts should seek to ensure that patients fully

understand the benefits of a planned procedure and the extent to which this can offset

increase in travel for the procedure. Further, the Trusts should seek to clearly communicate

to patients the benefits of ring fenced beds in terms of waiting times and the positive impact

on health outcomes.

● To support patients, carers, visitors and staff with traveling potentially longer and more

complex journeys, stakeholders have identified that, prominent information should be

provided on how to travel to, around, and from the hospital sites providing planned inpatient

and day case orthopaedic services. This information should cover:

– Timetables for public transport

– Route suggestions to access the hospital sites

– Information about the accessible options to access the sites

● Information around schemes and support available to help access the sites. Stakeholders in

early engagement have highlighted that this information should be provided in a way which is

accessible to all and therefore should be presented in Plain English with easy read, sign

language, large print, translated, audio and braille copies made available to patients who

may require these formats. They also felt there should be support provided to staff so that

they are also aware of the available options to patients and can articulate this clearly to

patients when asked.

● In addition, to the information above, stakeholders also suggested that there should be better

communication of the patient transport service and how to contact this to understand

eligibility for support and the support available to them.

● Stakeholders have also suggested that more could be done to make patients aware of the

possibility of later admissions or overnight stays the night before their surgery. This was felt

to be particularly relevant for more vulnerable patients.

● It was further felt that it should be made clear to patients that they should talk about their

travel needs and can request a change in appointment time if it does not work with their

needs. Including these key points of communication within the pre-operative checklist was

believed to be a key way to ensure that these conversations were undertaken with patients.

Alongside this, clearer information about what the patient schedule was likely to cover (e.g.

initial referral through to discharge and how many appointments needed including time in

hospital) was felt to help patient better understand where they might be expected to

undertake longer travel.



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