9. Recommendations for improved joined up working - an action plan
Key recommendations
9.1 We have produced a set of recommendations on how to improve joined up working between transport and health in the future, at the policy and practice level. These recommendations are based on our key findings on joined up working between health and transport, the barriers and opportunities for improved joined up working in the future ( see section 8 of this report).
9.2 Overall, it is clear that there needs to be some fundamental features in place for joined up working to happen, that is:
- A strong policy framework, one that is statutory, and clearly states the need to link health improvement with transport policies and projects.
- A requirement to monitor, to ensure that progress is achieved and lessons can be learnt from what is working or not working.
- Secured and long-term resources to assist with the above, and to make progress on the ground, both in terms of staff and funding.
9.3 Furthermore, a message emerged from the Expert Panel seminar held as part of this research ( see Appendix D) that there may not be the desire for another initiative to emerge from the Scottish Executive, in this case, a health and transport initiative - given the range of initiatives that health boards and local authorities already deal with. Moreover, there is clearly a need to better incorporate the links between transport and wider quality of life and well-being issues through existing frameworks - that is, to mainstream the links between transport and health.
The planning system - a note
9.4 It should be borne in mind that the focus of this research was on transport and health, and therefore the land use planning system was not incorporated into this research in-depth (and therefore no detailed recommendations have been made for the planning system). It is clear however that there are many integral links between the topics research and the land use planning system, particularly in the planning and design of new developments to promote access by healthy modes, and in the field of travel planning (which cuts across both transport and planning sectors). There are also critical links between the land use planning system and the developing (and now statutory) outdoor access agenda, which has a key role in promoting health through physical activity.
Table 9.1 Recommendations and lead responsibilities for action
| Category | Link to barrier identified in report (section 8) | Recommendation | Other considerations | Lead responsibility |
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Good practice / information dissemination | Guidance and definition issues Lack of info and good practice dissemination | Good practice guide from this research, to promote the positive elements and lessons that are being learnt from existing initiatives | | Scottish Executive Project Advisory Group |
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Policy and guidance | Guidance and definition issues Lack of strategic lead on these issues Political will and priorities Lack of political priority for small-scale, local projects | Ensure that National Transport Strategy (in development, due 2006) will provide a strategic direction on how transport can contribute to health improvement, as per the 2004 Transport White Paper objective of protecting our environment and improving health, and not focus solely on access to healthcare facilities | | Scottish Executive Transport Divisions |
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Policy and guidance | Guidance and definition issues Lack of strategic lead on these issues Political will and priorities Lack of political priority for small-scale, local projects | Develop wider range of transport indicators and targets at a national level (which also includes cycling and walking) | | Scottish Executive Transport Divisions |
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Policy and guidance Good practice dissemination | Guidance and definition issues | Better guidance on how to monitor cross-sector initiatives, linking in with a range of existing data sources and indicators across sectors, as well as making monitoring of LTSs a formal requirement, with specific indicators for walking and cycling. Showcase some good practice evaluations already carried out in good practice guidance in this area | Sustrans are currently working with Paths to Health on monitoring approaches | Scottish Executive Transport Divisions and general |
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Policy and guidance | Guidance and definition issues Lack of requirement to demonstrate joined up working | If making LTSs statutory documents is not a feasible option (although this would be desirable), with meaningful monitoring requirements, it is certainly desirable for meaningful monitoring to be built into the new statutory RTSs, so that a baseline of data can be developed and progress monitored on an annual basis, including targets for walking and cycling. | RTS guidance is due out for consultation in autumn 2005 | Scottish Executive Transport Divisions |
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Policy and guidance | Guidance and definition issues Lack of strategic, high-level lead | Produce final Walking Strategy (Scottish Executive) with targets, or if this is not to be provided, provide clarity on direction of national walking policy. | | Scottish Executive Transport Divisions |
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Policy and guidance Good practice / information dissemination | Guidance and definition issues Lack of info and good practice dissemination ("reinventing the wheel") | Specific guidance on school travel plans and on the development of school travel packs (bearing in mind that many authorities have already begun the process of developing their own packs in the absence of a central resource), including role of Active Schools and Health Promoting Schools, including how to incorporate active travel and links that can be made with health - can draw on examples already developed by local authorities across Scotland. Consideration of 'School Well-being Partnership' - partnership of School Travel Plan Coordinator(s), Active Schools, Health Promoting Schools, Education Department, walking / cycling officer and public transport officer. | Await outcome of existing Scottish Executive research on effectiveness of school travel plan coordinators | Scottish Executive Transport Divisions, Education and Health departments |
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Policy and guidance | Guidance and definition issues Differing definitions or perceptions of what constitutes physical activity (often a focus on sport and leisure) | Basis for promoting physical activity as a wide-ranging concept is there in the national physical activity strategy - work is needed to continue to get this message across to policy makers and decision makers on the ground through implementation of the national strategy | | Scottish Physical Activity and Health Alliance / Council |
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Good Practice and information dissemination | Guidance and definition issues Staffing and management issues | Increase awareness of the fact that a Physical Activity coordinator post is ongoing in the Scottish Executive (our research suggested that most individuals perceived this to be a temporary post), and the existence of the new National Physical Activity Alliance | National PA Alliance has formed since the start of this research, and secondment of Mary Allison as PA coordinator ended during the research | Scottish Executive Health Department |
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Good Practice and information dissemination | Guidance and definition issues Staffing and management issues | Monitor progress of development of Physical Activity Strategies and Forums across Scotland, and provide more prescription on how this can be achieved, with monitoring requirements linked to funding, and Community Planning process | | Scottish Physical Activity and Health Alliance / Council |
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Policy and guidance / Good Practice and information dissemination | Guidance and definition issues | Specific updated design guidance on how to better incorporate walking and cycling into new development, urban design, travel planning etc. for a wide range of audiences and everyone with a role to play in how people access services/facilities, and use public space. Potential to review and draw on local authority guidelines illustrating good practice approaches (such as Fife) | Recently published guidance on Transport Assessment provides some guidance, but not on a detailed level. "Cycling by Design" has been produced in 2000, but in consultation form only | Scottish Executive Transport and Planning Divisions |
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Good practice dissemination | Guidance and definition issues | Showcasing of a medical referral scheme that is widening the scope of referral to include walking and cycling schemes, as well as advice on building activity into everyday life e.g. Linlithgow. | This could be built into a good practice guide based on this research | Scottish Executive Project Advisory Group |
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Policy and guidance Funding and appraisal | Guidance and definition issues Funding issues Political will and priorities | Incorporate focus on health improvement into assessment of transport policies, including forthcoming Regional Transport Strategy guidance, any updated Local Transport Strategy guidance, and Strategic Environmental Assessment guidance, potentially making direct links with the health sector's Performance Assessment Framework field of "health improvement and reducing inequalities (New requirement to consult health authorities in development of RTSs will assist, although Transport Act Scotland mentions only access to health service, and not wider contribution to health improvement) | Scottish Executive SEERAD currently developing guidance on SEA which will include section on health | Scottish Executive SEERAD in partnership with Scottish HIA network including representatives from NHS Health Scotland Scottish Executive Health Department and Transport Divisions |
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Policy and guidance Funding and appraisal | Guidance and definition issues | Provide guidance on HIA related specifically to transport, including quick desktop method and more in-depth method. Providing funding for pilot HIAs on development of LTSs and RTSs (building on the SEA health element, which is currently potentially too narrow to take into account the impact of transport on quality of life and well-being, although SEA application to transport strategies is still in its early stages)". | | Scottish Executive Health Department and Transport Divisions, NHS Health Scotland |
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Funding and appraisal | Guidance and definition issues Funding issues | Make health a stronger consideration in appraisal of transport schemes through STAG (which should be applied to any transport strategy, plan or project requiring public funding), with consideration of additional Physical Fitness sub-objective within appraisal of environment in English transport appraisal 104 in any updated STAG. Most appropriate location for an indicator based on physical fitness impacts may be within STAG environment objective, although consideration should be given by Scottish Executive staff as to the appropriateness of this compared to the objective of accessibility and social inclusion | | Scottish Executive Transport Divisions |
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Funding | Funding issues | Building on Cycling Scotland's recent review of local authorities expenditure and performance on cycling, funded research on outputs and outcomes in areas of walking and cycling and links to levels of expenditure on cycling and walking initiatives, to understand how local authorities are funding such initiatives through non-ringfenced funding pots | | Scottish Executive |
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Funding | Funding issues | Give strong consideration to continuation of funding for Paths to Health Project in the long-term, and provide longer term funding for support and training to progress local initiatives | May need to be subject to a full evaluation of the Paths to Health Project outcomes | Scottish Executive and SNH (as core funders of Paths to Health) |
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Funding | Funding issues | Build on work which Paths for Health Project and Living Streets have begun on work with local authorities and communities to carry out community street audits - since the research began, Living Streets Scotland have appointed a coordinator, and indeed received funding from Paths for All to deliver a series of community street audit workshops and audits in Scotland. | | Scottish Executive and SNH (as core funders of Paths for All) |
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Funding / Good Practice and information dissemination | Funding issues | Provide funding to disseminate good practice tools that already exist, but which are becoming increasingly hard to access, namely the Walk in to Work Out pack from Glasgow, 105 which is now subject to a charge (was free previously), and other tools as determined suitable by the Scottish Executive | Walk in to Work Out pack is now the subject of a Sustrans project in partnership with Paths to Health, funded by the Scottish Executive Health Department | Scottish Executive Health Department and Transport Divisions |
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Funding | Funding issues | Revisit short-term funding cycles in place for various posts and initiatives (such as Paths to Health projects), as three year funding terms stultify progress and development, and could lead to staff retention issues | | Scottish Executive |
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Good Practice and information dissemination | Staffing and management issues Lack of coordination across roles | Improve coordination of posts carrying out work in areas of overlap - e.g. school travel is potentially covered by Health Promoting Schools, Active Schools, School Travel Coordinators. Establish pilot healthy schools forums at a local level, involving partnership across all these posts and linking to Community Planning | | Scottish Executive Health, Education and Transport Departments/ Divisions |
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Good Practice and information dissemination | Guidance and definition issues Lack of strategic lead | Requirement for all public bodies (local authorities and health boards) to produce a travel plan, to lead by example. | | Scottish Executive Health Department and Transport Divisions |
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Summary of key opportunities for the future
9.5 The community planning process is an opportunity for joined up working across sectors, including transport and health. Its key strength however may be in setting a policy framework in place for decision-makers to act upon, as opposed to setting up initiatives on the ground, although this may change as the process becomes better developed in the future.
9.6 Local Transport Strategies are not statutory documents, and therefore not considered by developers. There is also no formal requirement to monitor the progress of these strategies or to link them to funding. However, a second round of LTSs are being prepared by authorities across Scotland, and the current guidance released by the Scottish Executive does encourage authorities to take account of "healthy modes" in their LTSs.
9.7 LTSs are not however linked to funding, although the principles of STAG should be applied in the development of them. The key opportunity therefore may be in how transport initiatives emerging from them are appraised and assessed in funding awards, through the application of STAG in particular, and through how they relate to Regional and National Transport Strategy priorities (see next point).
9.8 Statutory Regional Transport Strategies meanwhile will have to be developed by new Regional Transport Partnerships covering the whole of Scotland from March 2006 (many replacing existing voluntary structures, albeit with some changes). However, the Transport (Scotland) Act 2005 makes specific reference only to the requirement for RTPs to consider access to healthcare, and does not mention health improvement. It is hoped that RTSs will indeed consider the impacts of transport on health improvement, and that forthcoming guidance on the RTSs from the Scottish Executive takes this into consideration.
9.9 The National Transport Strategy is being developed with a view to publication in summer 2006. It is intended that the NTS will provide direction and context for national transport policy in Scotland, which will in turn direct decisions at the regional and local level. It will build on existing policy objectives for transport, as per Scotland's Transport Future, the 2004 Transport White Paper, one of which includes a commitment "to protect our environment and improve health". It is hoped that the NTS will provide a focus on the need for transport decision makers to contribute to health improvement, and not only provide a focus on access to healthcare.
9.10 Core Path Planning is a key opportunity to link transport with health, a requirement from the Land Reform Act 2003, and related to the development of Access Strategies through Local Access Forums, and new posts of Outdoor Access Officers. Prior to the funding for these posts and the change in legislation, a view has been expressed in our research that many local path networks were unavailable. The Outdoor Access Officers have been able to bring about material changes in local path networks - whilst this may appear to be related to leisure travel mainly, there may be opportunities to link this with day-to-day journeys to work, education, and so on. Furthermore, promoting walking and cycling in leisure time is an important step to normalising this behaviour in everyday activity. The work of the Outdoor Access Officers in some local authorities, such as East Ayrshire, is multifaceted and has established good links with various agencies, such as healthcare providers and leisure services.
9.11 A continuation of Outdoor Access Officer posts, in association with recommendations discussed above, has the potential to strengthen and reinforce this joint working to the benefit of those most in need of physical activity in communities. However, as discussed in this research, it is at the local authority's discretion whether to fund a permanent Access Officer post, using non-ringfenced funding from central government.
9.12 The Paths for All Partnership, and Paths to Health Project is a further key opportunity, linked to the issue of outdoor access and promotion of physical activity through local walking initiatives. Paths to Health funds local schemes to promote activity with health benefits (with a focus on walking in particular). The Paths to Health Project has amassed a wealth of knowledge and experience in supporting local schemes. This knowledge and experience should be capitalised upon by the Scottish Executive, and so potentially all communities. Paths to Health should be supported in development opportunities to build upon their own best practice in partnership working with local communities and other agencies, such as local authorities and local NHS Boards. Their recent work with Living Streets Scotland on promoting the concept of community street audits could also provide a key opportunity for promoting health-enhancing environments at the local level, provided that adequate training and support is given to both communities and local authority officers on how to carry out and deliver on such audits.
9.13 There are a number of transport funding opportunities by which health and transport links can be made. Specifically related to transport is the Cycling, Walking and Safer Routes funding allocations ( CWSS) - although there is a danger this is being predominantly used for school travel at a loss to non-school related cycling and walking schemes, as observed in one of the case studies researched for this project. The Integrated Transport Fund ( ITF) may be an opportunity for funding for cycling and walking in the future, as confirmed in a Ministerial written answer in 2004, although guidance is needed for local authorities on this issue 106, and clarity is required (potentially through guidance) on what ITF can indeed be used for.
9.14 With regards to non-transport funding, there are a number of opportunities to access support for local initiatives that can promote physical activity in local communities, such as the Fresh Futures programme through the New Opportunities Fund funds organisations such as Glasgow and Clyde Valley Greenspace Trust 107, and access initiatives. Sustainable Action Grants 108 are available through the Scottish Executive, with the objective of funding research, demonstration projects and other relevant activities in support of sustainable development in Scotland. Such grants have in the past funded initiatives related to promoting walking and cycling.
9.15 There are clearly opportunities in utilising frontline health care staff in the promotion of physical activity, particularly where this can be linked into sustainable transport and travel behaviour change programmes led by the local authority. GP and other medical referral schemes are increasingly moving away from traditional leisure-centre based models, towards a more "active living" approach (as identified in our Glasgow and Highland case studies).
9.16 Programmes for travel behaviour change which work through local communities are an important opportunity to promote the health improvement potential of transport. The Scottish Executive Step change programme is a crucial opportunity in this regard, having been carried out in numerous communities across Scotland already, with expertise being built up in communities and amongst local authority staff. Other related initiatives that promote the health benefits of physical activity through travel planning (employee and school) are further important opportunities to build on for the future.
9.17 Overall, the progress to date through the development of a national physical activity strategy must be built upon, with further development of local strategies and forums at a local level.