A SCHEME that has provided more than 216,000 journeys in the past year to help people living in isolated rural areas, including the elderly and those with disabilities, is under threat due to Stormont cuts and policy change.
More than 24,000 health appointments were attended in the last year by people with no access to public transport or a car – thanks to the door-to-door transport scheme run by 11 Rural Community Transport Partnerships across Northern Ireland.
The service’s main government funding has been cut by 33% since 2014, wiping more than £1million from the overall community transport budget for Northern Ireland.
Now two Stormont departments - Infrastructure and Agriculture - have told Detail Data they cannot guarantee that further cuts won't be made.
Tim Cairns, director of policy and public affairs at the Community Transport Association Northern Ireland and who until recently worked at the heart of government as a special advisor to the First Minister, said: “I know what is wasted across government, it is little wonder people get angry at how decisions are made and money is squandered in their area.
“I think across the voluntary sector government has chosen a lot of low hanging fruit when they’re making cuts. It’s easier to cut from the voluntary sector than it is to make tough choices in government."
New data has revealed how the not-for-profit community service known as Dial-A-Lift ensured that some of the most vulnerable members of society could attend medical appointments, as well as routine shopping trips and outings credited with combating isolation.
Dial-A-Lift is run by 11 Rural Community Transport Partnerships operating in eight areas across Northern Ireland.
It is funded mainly by Stormont's Department for Infrastructure (DfI), with support from the Department of Agriculture, Environment and Rural Affairs (DAERA), though supporters argue that the service reduces the burden on the health sector.
Both the Infrastructure and Health departments are controlled by Sinn Fein ministers, Chris Hazzard and Michelle O'Neill.
Mr Cairns said: “It’s absolutely scandalous that the Department of Health get the biggest benefit from community transport and yet pay nothing from their budget for the operating cost of this service.”
Infrastructure Minister Chris Hazzard told Detail Data: "I recently wrote to the Health Minister, Michelle O'Neill to suggest a meeting to discuss the potential for her department and the health trusts to consider helping to part grant fund the Rural Community Transport Partnerships.
"This request was based on the increasing demand on Rural Community Transport Providers to help with the emerging requirements for health related transport. I hope to meet with Michelle O'Neill in the near future on this issue."
However, a Department of Health spokesperson said: "The department is aware of the valuable service which Rural Community Transport organisations provide to people living in areas where regular transport links are difficult to access.
"The HSC itself commits substantial funding from its scarce resources to provide transport for patients and social care service users. Any additional commitments could only be met by reducing resources for front line service across health and social care and this is not feasible."
In total 216,000 trips covering 2.5 million miles were facilitated by community transport providers across Northern Ireland in the year up to April 2016.
Community transport, which currently receives a £2.4million annual grant from the Department for Infrastructure (DfI) through the Rural Transport Fund (RTF), uses a fleet of minibuses and voluntary car drivers to give people in rural areas access to work, education, healthcare, shopping and recreational activities.
However, the vital provision - which is predominantly used by the elderly and people with disabilities to access a wide range of services - is under review as part of Stormont proposals to change how public transport is delivered here.
Previously unpublished data obtained from DfI by Detail Data shows the lifeline that the 11 rural community transport partnerships are providing for members.
Figures covering the period from April 2015 to the end of March 2016 reveal:
- 34% of trips were provided by a network of unpaid volunteers, the majority using their own cars to take people on trips including collecting benefits, getting shopping and visiting loved ones in nursing homes.
- Almost 31,000 trips were to enable people, many with learning disabilities, to access education, training or employment.
- 58% of all trips taken were by elderly users.
- Almost half of all trips were made by people with disabilities.
- Three out of four trips were taken by women.
- Almost 6,000 trips were for hospital appointments.
To see detailed figures and more information on each of the rural community transport providers click here.
During our shadowing of the service providers Detail Data also saw users supporting the local economy by spending money in chemists, grocery stores, tearooms, post offices, newsagents and using local health services.
Detail Data has also tracked and mapped all the journeys made by Fermanagh Community Transport vehicles on a day in October to highlight the service it is providing in one of the most rural parts of Northern Ireland.
Anita Flanagan, manager of Fermanagh Community Transport, said: “Our services are vital to people who live in deep rural areas. Without Fermanagh Community Transport many of our members would be unable to access basic services such as shops, post office and chemist. Many people would have to ring for an ambulance if they were unable to access Fermanagh Community Transport services to see the GP.
“As local services close and rural banks/post offices and health related services become more centralised, our members are finding it even more difficult to access essential services.”
Out and About manager Ashley Keane said: “For most of our users it’s a real lifeline. Where people live there is no bus running past their door like you would have in the urban centres every five, 10, 15 minutes.
“With recent cuts by Translink even some of those rural services have been cut dramatically or completely.
“We provide so much more than just the transport. It’s a listening ear, a befriending service. There are a lot of elderly people who don’t have family members, there’s no car sitting outside the door so there is no other option for them.”
Community transport users we met include an elderly woman in Maghera who lives alone, miles from her nearest bus stop and is recovering from a hip replacement; a Lisnaskea woman who can’t drive but depends on the minibus to take her to the home of her 98-year-old mother whom she cares for and a young Roslea woman with learning disabilities who makes the 50-mile round trip to her nearest further education college in Enniskillen.
May McCaffrey (78) lives three-quarters of a mile up a lane of a minor road near Derrygonnelly and told us “without Fermanagh Community Transport I would not get out of the house from Sunday to Sunday”.
Thomas Miller, who has sight problems, stated the service is “vital” because of the lack of public transport. The Castledawson pensioner added: “It’s the company more than anything else.”
Detail Data has learned that doubts hang over the future of the cross-community based service because of Stormont proposals for an integrated public transport service.
This would involve co-ordinating transport provision across health, education and infrastructure to achieve efficiencies.
The Community Transport Network NI (CTNNI) has raised concerns about the “direction of travel” of government policy directly with the Infrastructure Minister including the potential development of a procurement based or commercial model for future community transport services.
Documents submitted to DfI by the Community Transport Network NI (CTNNI) warn a commercial model would prohibit the use of community based volunteers using their own cars and “probably bring to an end more than 15 years of local community transport” provided by the current Rural Community Transport Partnerships (RCTP) across Northern Ireland.
In its response to the Department CTNNI states: “There has been insufficient recognition of the successful model already in place and the current network’s successful track record in delivering local, integrated demand and responsive services.
“CTNNI remain opposed to any procurement model for community transport services which will invariably mean loss of community based provision since the key metric will be ‘best value’ if community transport services are procured, putting at risk an established community transport network and the volunteering ethos so critical to our work.”
Responding to the concerns the minister told Detail Data: "My department is currently leading a cross-organisational project to examine how all of the resources that are available for passenger transport services, including community transport services, can be used more effectively.
"The project is examining the options to better integrate the various passenger transport services that are currently operated separately by Translink, the Education Authority, the Health and Social Care Trusts, the Rural Community Transport Partnerships and Disability Action Transport.
"In addition to achieving improved value for money, there are potentially significant social benefits from integrating these resources, including for people living in rural areas through the more flexible deployment of all publicly funded minibuses during the off peak periods.
"This should help to address the travel needs of people with learning difficulties attending day opportunities and further education colleges, as well as the growing number of elderly people which is projected to grow further in the coming decades.
"No decision has been made about how operators will be appointed to deliver integrated services."
An analysis of data for the most recent year of community transport highlights the contribution being made by voluntary drivers to rural communities.
In 2015/16 volunteers facilitated 72,917 trips - one in three of all community transport journeys.
In doing so they gave 30,000 unpaid hours to assist those in need in their community. That equates to a social contribution of almost £217,000 based on them being paid the minimum wage for their time.
Of those trips 54,287 were provided by volunteers driving their own cars through a social car scheme.
One such volunteer with Fermanagh Community Transport is Angela Flanagan. For 15 years she has been using her own car to take people without access to public transport or a car into their local villages and towns to access services there.
She stresses a key part of the service is the social contact: “I think they like talking to someone. I brought a man this morning and he will not talk to anyone now till he sees me again at 3.30pm.”
A typical day for Angela includes taking people with learning disabilities to a day centre, elderly people to the hairdressers in Garrison, a woman waiting on cataract surgery to medical appointments in Enniskillen and a pensioner to Belleek to collect her pension and groceries.
Angela said: “Being a volunteer driver is great because you are giving a service and it does help people.”
Another volunteer is retired school teacher Marie Kilpatrick who helps with Out and About Community Transport in Magherafelt.
One of the people she collects is pensioner Mary Duffy, who lives more than two miles from her closest bus stop. She is also recovering from a hip replacement and is awaiting further surgery.
Mary explained the service “means a terrible lot” and without it because of her rural location she would be “stranded”.
Another benefit for people living alone like Mary is that community transport assists them to live independently in the community by accessing vital services and social contact.
Marie said: “It’s not until you are out on the road, going to lift the like of Mary you realise just how great the service is. Government talk about how important it is for the people to be in their own houses but they need to get out as well so it’s very important they have this service as well.”
Commenting on the role of volunteer drivers the Infrastructure Minister said: " I have made it clear that I value the important role that they play within the community transport sector and I want to ensure that they continue to play a key role in the future."
More than 18,600 community transport trips made in 2015/16 were for local health services – such as GP visits across Northern Ireland.
Ciaran Brady, who owns Brady’s Pharmacy in Florencecourt which is situated beside Benaughlin Health Centre, explained the importance of isolated people having transport options to access health services.
“We do provide a delivery service but we are acutely aware that people have transport problems in a rural area,” he said.
“We can’t provide a service to get people to the surgery for their doctor’s appointment so that is where Fermanagh Rural Transport come in because where else are they going to turn if they haven’t got family and friends?
“If people can’t get to the doctor for their weekly/monthly check up for blood pressure or diabetes checks and in that month there is a problem with cholesterol or their glucose levels being controlled they could have a critical event that leads to more emergency admissions.”
Mr Brady added: “You need people to be treated in the community where they live. That’s the most financially efficient and the most beneficial to the patient.”
GETTING TO THE HOSPITAL
The DfI data also indicates community transport is providing a vital service taking people to hospital appointments.
In 2015/16 community transport providers made more than 100 trips every week to local hospital appointments across Northern Ireland.
A joint research project by the Patient and Client Council and Consumer Council (2013) ‘Transport Issues in Accessing Health and Social Care Services’ found one fifth of 366 people who completed a questionnaire said they missed an appointment in the past due to issues with transport and almost a quarter said they had cancelled an appointment due to problems with travel.
The report said: “Missed appointments or stressful journeys caused by transport issues have a negative impact on the health and wellbeing of people who are often already frail and vulnerable and also come at a significant financial cost to health and social care services.
“The economic consequences of missed and cancelled appointments are considerable. In a time of stretched resources, time and energy invested in addressing the transport issues people experience would be beneficial not only to the people accessing the services but service providers also.”
The latest Northern Ireland Hospital Statistics (consultant led outpatient activity) show in 2015/16 that 671 appointments were cancelled by the health service because hospital transport was not available.
A further 166,417 appointments across Northern Ireland were cancelled by patients – but it is not known how many of those cancellations were because of transport difficulties.
But based on the Patient and Client Council and Consumer Council findings, we have calculated that missed appointments due to transport issues could be costing the health service an estimated £4.5million per year. The Department of Health estimates the cost of each missed appointment at £108.
A Department of Health spokesperson said it and the trusts "currently provide a range of transport directly to eligible HSC (health and social care) service users. For example, the Ambulance Service’s Patient Care Service provides more than 200,000 non-emergency patient journeys annually, taking eligible patients (where the patient has a medical need confirmed by a medical practitioner) to hospital appointments.
“HSC Trusts also provide transport to eligible social care service users, whose need has been assessed and determined by a social worker, for social care services such as day care, community clinics or vocational and independence promoting programmes.
“The Department of Health also has a hospital travel costs scheme which provides help with the cost of travel to hospital appointments for people who are on a low income or in receipt of certain qualifying social security benefits."
The Department of Agriculture, Environment and Rural Affairs (DAERA) already supplements the Dial-A-Lift scheme through the Assisted Rural Travel Scheme (ARTS) which allows Smart Pass holders to use community transport free of charge or at a discounted rate. Smart Passes are available to pensioners and people with disabilities.
According to DfI data there were 193,141 ARTS trips made in 2015/16 – 89% of all community transport trips. The remaining passengers pay for the service for example a journey of up to five miles will cost no more than £2.50 whereas a 25-30 mile trip is £8.
CTA’s Tim Cairns said: "The ARTS funding has been cut in recent years. Given the vital nature of this funding and also because of the equality issues at stake for older people in rural areas, this funding must be guaranteed and increased going forward.
“In rural communities people simply do not have proximity to public transport. What good is a Smart Pass for older people who live long distances from bus stops?”
When Detail Data asked DAERA about the future of ARTS, a spokesperson said: "Funding for ARTS, delivered in conjunction with the Department for Infrastructure is in place until March 2017. Once the Executive agrees the parameters for the Budget 2016 exercise, DAERA will firm up our proposals for all programmes including this one."
In light of significant government funding cuts, community transport providers are calling for an injection of funding from the Department of Health.
Northern Ireland Statistics and Research Agency (NISRA) forecasts indicate the number of people aged over 65 is projected to increase by 50% between 2015 and 2026 so there will be even more elderly people living in the community in need of health services.
Mr Cairns added: “I think the Department of Health needs to start examining how community transport is going to help them.
“Community transport isn’t like other transport sectors in Northern Ireland – community transport doesn’t say no.
“Going forward the Department of Health needs to recognise that community transport is providing a vital service for them. They need to be funding community transport if they’re really concerned about transforming the care of people in Northern Ireland and if they’re really concerned about old people staying in their homes for longer.”
Fermanagh and Out and About Community Transport both report an increasing number of people with learning difficulties using the service and more people using it to access health appointments.
Anita Flanagan, manager of Fermanagh Community Transport, explained approximately 30% of its work is transporting people with learning disabilities to colleges, day centres and work placements.
She said: “The Rural Transport Fund has been cut, which represented a cut of 39% in Fermanagh Community Transport. That was £225,000 in two years. This was a huge loss to our budget.
“We are using some of our reserves but that can only go on for a certain length of time until we are in a situation where we will not be able to deliver so we need government to look at how they can get more money into the pot. We would like to see more money coming from health.
“If the people who depend on our service weren’t able to get out and about, able to access community transport, weren’t able to meet people, then the cost to government overall would be a lot more than the cost of community transport provision.
“The new Programme for Government talks about outcomes – we have already proven that rural transport can provide outcomes.”
Historically, DfI’s Rural Transport Fund also offered support by subsidising new rural services provided by Translink which were deemed to be economically unviable but socially necessary. But this funding ceased in 2015.
In 2014/15 community transport government funding was £3.6million; it was reduced to £2.8million in 2015/16 and has been further cut to £2.4million in 2016/17. It now equates to 0.7% of the department’s budget.
Community transport organisers believe there is a direct correlation between the funding cuts and the 11% fall in the number of trips (25,892) they provided between 2014/15 and 2015/16.
Minister Hazzard acknowledged the work done by the rural transport providers but stated he could not safeguard their funding.
He said: "This transport option for people living in rural areas who are unable to, or have difficulty accessing local basic services helps to overcome barriers to social interaction. I commend the work they do and support the services they provide.
"Whilst I would underline my support for the rural transport partnerships, the final budget for 2017/18 has not been decided. Due to the overall financial climate across the public sector, including the unknown impact of Brexit it would not be prudent to ring fence funding at this time.”
He added: "To meet the needs of the most vulnerable and rurally isolated in our society requires collaborative working throughout government. My department is one of a number who provide support to the rural community transport partnerships."
Although community transport providers currently receive a grant through the Rural Transport Fund it does not cover their running costs, which they subsidise by hiring out their minibuses to voluntary organisations including youth groups outside the normal Monday to Friday 8am to 6pm hours of operation. When those journeys are included the rural community transport providers delivered approximately 410,000 trips to their 10,000 members in 2015/16.
Four community transport operators including Out and About have recently secured £822,000 through The Executive Office Social Investment Fund (SIF) to extend their hours of operation to evenings and weekends.
The SIF money will allow the service to run until 8pm on weekdays and from 9am to 5pm on Saturdays and Sundays for three years until autumn 2019.
Out and About’s Ashley Keane said: “We had recognised that there was a gap in terms of the service that we could deliver when we were restricted from Monday to Friday from eight am to six pm.
“With the change in the health care system there’s a lot more evening and weekend appointments and people were absolutely at a loss trying to access those appointments.”
The extended service came into operation on September 1st and by the end of that month Out and About alone had facilitated 230 evening or weekend passenger trips – the majority health related.
SUPPORTING LOCAL BUSINESS
Local businesses have also explained how community transport is benefiting the rural economy.
Ciaran Brady, owner of Brady’s Pharmacy in Florencecourt, said: “We would see the transport bus here regularly, a couple of times a day. You would notice it going up past the door and then people would come in from the surgery to collect their prescriptions.”
Roisin Flanagan, owner of True Colours hair salon in Garrison, said: “There would be at least three or four of my clients that would not be able to come here on a Thursday morning without community transport.
“They pick them up at the door, drop them off here and come back as soon as they are ready to go home. They would be completely lost without it as there is no other bus transport in Garrison other than a Thursday morning to Enniskillen.
“They are keeping me going as a local business. They also go over to the shop, into the chemist and pop in for a coffee and a scone so there’s three or four business benefiting.”
To access the data click here http://data.nicva.org/dataset/community-transport-partnerships
To contact a rural community transport operator in your area go to https://www.nidirect.gov.uk/contacts/rural-community-transport-partnerships