Mobility management at Colchester General Hospital

Location

The site of Colchester General Hospital is located about 2.5 km to the north of Colchester city centre, in Essex. Colchester has a population of around 80,000 but the hospital serves a much wider area. As well as medical facilities, the site has associated buildings such as some nurses’ accommodation. The hospital is set in quite extensive grounds and consists of largely single or two storey buildings, with car parks to sides and back of many of them. 

The area of Essex is around 3,600 sq km, and its population around 1.5 million. At its longest and widest it is about 80km from east to west and 50km from north to south. Depending on treatment needed, much of the population of east Essex (Colchester, Chelmsford, Clacton and Harwich and surrounding towns and extensive and quite densely-populated rural areas, with a total population of around 700,000) must travel to Colchester General for medical attention.

Accessibility profile

The hospital is linked by two bus services (total of 12 buses per hour per direction) with the town centre and to a housing area on the northeast side of the city, as shown on the County bus map – click here for a copy. Connections to the rest of the city are available in the city centre and also at the railway station which is served by the buses that run past the hospital. Bus services call at main entrance, right outside the hospital front door. Rail services as follows:

• To Harwich - hourly
• To Walton on the Naze and Clacton - hourly
• To Ipswich – roughly three trains per hour
• To Chelmsford and London – five trains per hour
• To Braintree – one per hour (involves a change)

Rail services run basically east-west through the county, so north-south public transport is largely bus-based. The hospital is around 2 km to the south of the A12, the main high speed road (grade separated dual carriageway) across Essex from east to west. Roads to the north and south of Colchester follow largely historic routes and have in the main not been upgraded.

Mobility profile

Numbers of travellers
Estimates from monitoring surveys carried out by Essex County Council indicate that the hospital has 2000-2500 visitors per day, and approx 2200 patients, made up of in-patients and out-patients; and some 3000 staff.

Origins of travellers
According to the hospital’s Estates Manager, the majority of hospital staff live in the Colchester area since peak hour congestion on roads and public transport puts many other potential residential areas outside a 45 minute travel time (one-way). A significant proportion lives in small towns and villages, which are difficult to serve by public transport. 
Patients and visitors, however, must often travel from much further.

Travel survey results (for full report, click here) show that in 2005 68% of staff but only 43% of patients and visitors lived within 10km of the hospital.

Modal split and awareness of mobility management measures
The mode share for all travellers is shown below in percent, measured in July 2005 and then a year later. Due to sample sizes there is no statistically significant difference between the before and after survey results.

Both surveys showed that dissatisfaction with the reliability, availability and price of public transport services was a much more significant concern to staff and visitors than the availability of public transport information. However, the number of complaints about the lack of public transport information fell in the after survey compared with the before, possibly indicating that the TMS had had a positive effect. For more information see the travel survey report.

Institutional context

There are three levels of government in Essex (national, sub-regional (County) and local (District). The latter has no transport functions but controls land-use planning (giving planning permission). The County Council plans and delivers local roads, walking and cycling and co-ordinates public transport, but buses are provided by private sector, and railways by private companies under contract to national government. Hospitals are run by appointed Trusts responsible directly to national government. This makes co-ordination difficult.

The TMS concept was developed at a time when it was planned that the hospital would go through a major redevelopment on the PFI model, with changes in and likely concentration of medical services at the site. The proposed PFI redevelopment is not now going ahead.

Typically when a developer applies for permission in Essex (as in other parts of the UK) to build a new or expanded development, the Council asks the developer, through an agreement called a planning obligation, to make financial contributions to on- and off-site infrastructure and services, including transport; funding TMS could be part of such an obligation.

Motivations for mobility management

Mobility management was first considered in relation to the planned expansion of hospital and need to maximise/retain accessibility in the context of a concentration of services on the site, and large numbers of people travelling from quite far away to use these services. There were also, at the outset of the project, quite severe parking problems. Managing travel to and from hospital sites was also a government priority during the initial stages of the project, and it was also a political issue. The project also related to overall objectives of the County Council’s transport policy at time the project began, in terms of seeking to provide a choice of modes, reduce congestion and enhance accessibility.

During the period of the project the priorities for the hospital (and wider Health Service) changed considerably, such that managing travel to and from hospitals became less important and at Essex hospitals more parking was provided. Thus the need for mobility management reduced considerably. Finally, although TMS was adopted to help to mitigate accessibility problems, the Council came to the conclusion that this particular system could be specified, above others, as a mobility management tool as part of future planning obligations – that is, should the hospital require further planning approvals in the future, the adoption by them of the TMS would not necessarily be of any greater assistance to them than proposing any other type of accessibility improvements. This reduced the motivation to pursue this particular form of mobility management.

Combining solutions

Website
The main transport improvement tested in the Essex demonstration project for OPTIMUM² was a travel information tool called Get There, also known as the Travel Management System (TMS). To view TMS, go to

http://www.getthereontheweb.org/index.shtml    (link live in April 2008).

This provides detailed travel and journey planning information (by all modes) for travellers to and from the hospital, including information on parking and the internal layout of the site. The information can be accessed on the internet or from one of three kiosks that were installed on the site. It was also originally intended to link the system to outpatient bookings to allow appointments to be made for times when it was possible for patients to reach the hospital by public transport but, due to considerable delays with the NHS’ computing system for appointment booking, this element of TMS was not delivered.

Mobility management process

The process was project-managed by staff at Essex County Council and, initially, Colchester General Hospital. The TMS was developed by Atkins for this client team. As in all IT projects, TMS took longer to develop than anticipated, although it was delivered largely on time, and to budget.

There is interest from other hospitals that are keen to use the system, however due to tight financial constraints they are unable to invest in the Travel Management System. UK hospitals and the NHS have extremely tight budgets and most can not warrant spending money on Travel Management when there is not enough money for patient care. The Hospital Partner in the project in Colchester was in the process of a Public Finance Initiative (PFI) expansion when the project started. This subsequently failed, leading to abortive expense for the hospital Partner, and a review of their financial priorities. This came about at the same time as national NHS emphasis on travel to and from hospitals was reducing. Together, these factors reduced support for TMS within the hospital.

The system was not cheap, at €700,000 in total for development and implementation, and would not have gone ahead, were it not for the finance available through OPTIMUM². Even though the system is now developed, the set-up cost for installing it in another hospital would be €120k for the front-end software and €18k for each terminal.

Instigating a step change in travel management is difficult but coupled with the fact that the chosen location was a hospital it proved very difficult to encourage people to use modes of travel other than a car. People often have bigger concerns on their mind when travelling to and from hospital and the easiest way to travel is by private car. Additionally, public transport did not offer a very attractive alternative in many cases due to the need to change services for a journey and poor frequencies from many parts of the County.

Parking problems are of little concern as if need be there is always somewhere to park a vehicle, although not necessarily legally. Some hospitals are now providing additional parking facilities as income providers, this was not the case when we first looked at this issue and this represents a change in emphasis for the hospital operators.

Not everyone is able to use a computer, in fact hospitals will see a larger proportion of elderly people than average and it is often the elderly generation who are not used to modern technology; an internet based Travel Management System will for some not be an option. Additionally, there was still customer reluctance to actually use the Kiosks; many people will not go near it for fear of breaking it or not understanding it.

Marketing and communication

Promotion of the Travel Management System comprised a 3-month media advertising campaign in July-Sept 06, along with a poster and pen distribution. An introduction pack for new staff was also distributed for a period whilst the kiosks were operational.

 

Key lessons from the project

There are a number of key lessons that the County Council drew from this project, which are mainly related to project planning and implementation:

• As a mobility management measure for a site, the Get There system was perhaps less flexible than it could have been. As an IT project, it required specific IT input, and it required support from the hospital partner. Because the project took some time to develop, it could not keep pace with the requirements of the hospital partner, and this meant that when the Get There system was ready for use, the hospital partner was less interested in it than they had been at the outset, due to changing priorities set for them by government.
• The County Council as instigator of the scheme believe that it would have been useful to have had a more formal and binding agreement with the hospital partner in terms of the input that the hospital would provide. In addition, it would have been useful to have had a "Plan B" and a risk assessment at the outset so that risks were identified and if things changed – as they did – then a project could still be implemented successfully. The risk assessment could, perhaps, have identified a key problem that did crop up, which was that of the kiosks used to deliver the system in the hospital – it proved difficult to attract people to use them and hospital staff were reluctant to assist with even basic servicing (e.g. adding new paper to the printer).
• The Get There system is a travel infomation system and the only mobility management measure for this site in OPTIMUM². However it became clear from the site that information is not all that travellers require – they also need good services and, for many of those who travel to Colchester General Hospital from the surrounding rural and semi-urban areas, the public transport option is either very very slow, or non-existent. Therefore, Get There was "part of the recipe, but not the whole meal".

Nonetheless, as a product, Get There works, so there is scope to disseminate it to other hospitals and large sites, but probably to keep it as a web-based only platform, as this reduces implementation and operating costs. Further information – see Atkins (IT Consultants) paper on Get There.

Contact

Would you like to know more about mobility management at Colchester General Hospital?

Please contact:  Emma Butler (emma.butler@essexcc.gov.uk)

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