Poor public transport a 'significant contributory factor' in missed NHS appointments costing millions
Patients’ travel “should be at the heart of care”
Poor public transport is a "significant contributory factor" in missed NHS appointments which cost the health service millions of pounds a year, a new report has found.
The study, covering the south east of Scotland, showed patients failed to attend nearly 140,000 appointments - almost one in ten - in the year to September 2024 - at a cost of between £4 million and £31m.
The equivalent cost across Scotland, although not in the report, could be as high as £90m, but this is uncertain because health boards have different estimates for the cost of missed appointments.
The South East of Scotland Transport Partnership co-ordinating body (Sestran) said one in three of the 1,500 people it surveyed for the report had missed or delayed appointments because of transport problems, which increased to more than 40 per cent in Fife.
It found that using buses and other public transport took up to four times as long to get to hospitals as by car, and up to three times as long to reach GP surgeries.
The Transport for Health - Case for Change report said: “Although transport is not the only reason for non attendance, it is recognised as a significant contributing factor.”
Hurdles included infrequent buses and having to change, including long waits between them.
Sestran, which covers the NHS Lothian, Borders, Fife and Forth Valley areas, called for more direct services to hospitals and health centres, better co-ordination between different services and clearer travel information.
One patient in the Borders said: “I cannot rely on public transport for any appointments as it is not frequent enough through my village.
“To get to the local hospital it takes over two hours on a bus and are so infrequent it would cause a lot of waiting around.”
Another, in Edinburgh, said: “There is no direct bus from Leith to the Western General. My partner is not up to walking between bus stops or sitting waiting for the connecting bus.”
Sestran strategy manager Rachael Murphy said: “Access to healthcare starts with the journey.
“Improving outcomes will require a more co-ordinated approach that puts the journey at the heart of care.”
A Sestran spokesperson added: “While transport is not the sole cause of non-attendance, respondents consistently linked missed or delayed appointments to unreliable or infrequent public transport, traffic congestion, accessibility and mobility challenges, and difficulties aligning appointment times with available services.
“The reason that people miss appointments isn't recorded by the NHS, so it's hard to say definitely that transport is the main cause, but our public consultation suggests that it is one of the main factors.”
Paul White, director of the Confederation of Passenger Transport Scotland (CPT), which represents bus operators, said: “Local bus services play an important role in enabling people get to GP surgeries, hospitals, pharmacies and care appointments affordably and independently.
“To support this, CPT Scotland has consistently called for long-term investment in bus services, better bus priority measures and closer coordination between local authorities, NHS boards and public transport operators.
“There are opportunities for closer collaboration in areas such as auditing local health, education and transport needs to better serve communities, the provision of public transport information with appointments, or the designation of services that allow for healthcare access as socially necessary.
“Investment in improving bus service access and reliability helps people reach the care they require and maintain independent lives, potentially reducing healthcare costs in the longer term.”
A Transport Scotland spokesperson said: “The report reflects our previous work in the second Strategic Transport Projects Review, which identified the challenges of accessing healthcare facilities by public transport across the Edinburgh and south east Scotland region.
“We are now working with partners to develop proposals for a mass transit system for the region, led by Sestran.
“Improving access to healthcare will be a key consideration for this work.”
The Scottish Government agency said the mass transit system could include tram and “bus rapid transit” where buses have dedicated lanes or priority over other traffic.
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