1. Measuring the Health impacts of NHS travel
Measuring the Health impacts of NHS travel
Health Outcomes of Travel Tool Rick Lomax NHS England / Public Health England
Sustainable Development Unit
Mike Holland
EMRC

2. Sustainable Development Unit
Supports organisations across health and care sector to embed and promote sustainable development in order to reduce emissions, save money and improve the health of people and communities. The SDU develops tools, policy and research to promote sustainable development and adapt to climate change within the Health and social care sector.

3. Measuring impacts of travel
As a system we are very good at calculating CO2e / Greenhouse Gases of travel. Travel represents 13% of all Health and Social Care sector emissions;
Travel being;
Owned fleet
Grey fleet
Patient transport services
Patient travel
Staff commute
Ambulances

4. Measuring impacts of travel
Royal College of Physicians
Every breath we take: the lifelong impact of air pollution report
40,000 deaths are attributable to exposure to outdoor air pollution
Cost of air pollution to the UK annually is over £20bn
NHS Constitution;
All staff should “do all you can to protect patients from avoidable harm”

5. Virtuous circle – Health and Travel
Less air pollution,
less road trauma,
more physical activity, fewer overweight/obese people
e.g. more sustainable transport systems
More investment in health promoting systems + public infrastructure
Lower levels of long term, multiple preventable conditions
FIVE YEAR FORWARD VIEW!!!!
Adds more life to years, not just years to life
Less dependence of formal health and social care system
Improves public health, reduces inequalities

6. The Health Outcomes of Travel Tool
Objectives
To quantify the total health effects from travel related to the NHS from:
Air pollution
Traffic accidents
Noise
Greenhouse gases
Active transport
To enable NHS organisations to calculate:
Their own impacts
The benefits of plans for improving transport

7. Scope m Things that move because of the NHS
Ambulances
Patients
Visitors
Staff
Goods
Burdens on health and the environment
Local / regional air pollution
Air pollution
Traffic accidents
Noise
Greenhouse gases
Inactive transport
Timeframe

8. Structure of HOTT Series of Excel worksheets, as follows: Title
User interfaces for different types of organisation:
Ambulance Trusts
Hospital, mental health and other Trusts
Primary care (by CCG)
Background calculations for each type of organisation
Data from external sources
Staff numbers, business mileage, accident rates, emission factors, etc.

9. User interfaces

10. User interfaces

11. Background calculations

12. Background calculations

13. Data from external sources

14. Data from external sources

15. Impact calculations Air pollution emissions
Calculated using DfT and NAEI emission factors per vehicle km for diesel, petrol, electric
Adjustments provided for future years as technology improves

16. Impact calculations Air pollution impacts
Activities of each Trust (etc.) allocated to specific area types adopted by Defra’s damage per tonne estimates for transport
Note: these values are incomplete and subject to revision

17. Impact calculations Air pollution impacts
Emissions multiplied by damage per tonne estimates specific to the area type for each Trust, CCG, etc.
Deaths, life years lost, hospital admissions back-calculated from the damage costs
Quality rating: Medium. Several uncertainties, but constrained by national estimates.

18. Impact calculations Greenhouse gas burdens Quality rating:
Fuel consumption (diesel, petrol, electric) calculated from mileage
Factors applied to reflect:
Changes in vehicle fleet to 2030
Changes in vehicle efficiency to 2030
Fuel consumption multiplied by well to wheel emission factors (including changes to 2030)
Emissions multiplied by DECC non-traded values per tonne
No QALY estimate
Quality rating:
Medium-high: Emissions linked closely to fuel use, DECC values accepted in Government

19. Impact calculations Accidents Quality rating:
DfT data on fatalities, serious injuries, minor injuries, vehicle km
By Local Authority
Averaged over last 5 years
Conversion to QALYs and £ using DfT factors
Accident rates per v.km assumed constant to 2030
Quality rating:
High overall, based on detailed statistics, would be improved by specific data from Ambulance Trusts

20. Impact calculations Noise Quality rating:
Application of single damage cost per v.km for non-rural travel from DfT
Back-calculate to derive estimate of QALYs , using £/QALY data from DfT
Quality rating:
Low, but estimated impacts are small

21. Impact calculations
Fitness benefits of Active Travel (cycling, walking)
Applied to staff commuting only
DfT data on % of healthcare staff travelling by different modes
Response functions from WHO HEAT Tool applied to distance travelled
Valued using DfT £/QALY estimate
Quality rating:
Medium-low: Available travel data are highly aggregated

22. Indicative results (not final)
Economic values, all burdens combined (air, GHGs, accidents, noise)

23. Indicative results (not final)
QALYs, all burdens combined (air, accidents, noise) except GHGs

24. Indicative results (not final)
Share of total economic value by impact category

25. How indicative are these results?
Have yet to be thoroughly checked
Some additional activities are yet to be factored in
Some commuting
Primary care business travel
Delivery of goods

26. Final comments
The UK’s health sector accounts for between 3 and 5% of traffic
This generates a significant burden on society, so we need to understand the problem and optimise
Opportunity to influence other sectors: interest of some local authorities has been noted