Case Studies on Transport Policy 5 (2017) 286–298

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Case Studies on Transport Policy

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Research Paper

The social and economic benefits of community transport in Scotland

John D. Nelsona,* , Steve Wrighta , Rachel Thomasb , Stephen Canningb
a
Centre for Transport Research, School of Engineering, University of Aberdeen, Aberdeen, AB24 3UE, UK
b
Peter Brett Associates, Exchange Place 3, Semple Street, Edinburgh, EH3 8BL, UK

A R T I C L E I N F O A B S T R A C T

Article history:
Received 19 August 2015 An inquiry by the Scottish Parliament Infrastructure and Capital Investment Committee launched in 2013
Received in revised form 12 January 2017 found that there is a lack of evidence on the social and economic benefits of community transport (CT) in
Accepted 22 January 2017 Scotland. This paper reports the outcome of research designed to identify the economic, social and health
Available online 24 January 2017 benefits generated by CT. Following a review of available literature on the benefits of CT, a primary
research programme was carried out with five case studies from across Scotland. Findings confirm that
Keywords: CT is a critically important service providing cross-cutting benefits across a range of policy areas,
Community transport including transport, health, social services and leisure, amongst others. It also plays an important role in
Economic benefits
tackling different types of inequality, an important issue on the policy agenda of many Governments.
Social benefits
© 2017 World Conference on Transport Research Society. Published by Elsevier Ltd. All rights reserved.

1. Introduction economic benefits of CT in Scotland. The report identified the lack

This paper investigates the social and economic benefits of
community transport (CT) in Scotland. CT provides a critical role in
meeting the transport needs of a wide range of groups where
conventional transport fails to do so. This may be because there is
not a commercial case (even where subsidised) for running a
traditional transport service or where the needs of users are such
that they cannot easily access conventional transport services. CT
operators conduct invaluable work in this area by filling gaps
where other public transport services are not possible or
appropriate for users.
The UK Community Transport Association (CTA) defines CT as:
“a wide range of transport solutions usually developed to cover
a specifically identified transport need, typically run by the
voluntary sector for the local community on a not for profit
basis” (CTA, 2012a).
Organisations providing CT are varied in both scale and scope.
For some, the provision of CT is their only activity, whilst for others,
CT is just one part of a wider remit. In terms of scale, CT providers
range from small to large and from those that rely entirely on
volunteers to those with large numbers of paid staff.
An inquiry by the Scottish Parliament Infrastructure and Capital
Investment Committee into CT provision in Scotland in 2013
(SPICIC, 2013) highlighted the lack of evidence on the social and
of information on CT provision and needs as being a key challenge.
Information gaps identified included the lack of baseline data on
CT, making it difficult to plan for future transport needs.
The key purpose of this paper is to investigate the social,
economic and health impacts of CT with the aim of identifying the
ongoing benefits. In particular, it is important from a funding
perspective to understand who is using CT and for what purpose. In
the absence of robust data and an understanding of the benefits of
CT, it is difficult to make the case for maintained or additional
funding for this essential form of transport provision. This study
addresses the gaps in existing data sources through the
identification and selection of a series of case studies designed
to cover the breadth of provision across Scotland. This approach
provides an understanding of the benefits of CT in different
geographic and urban-rural classifications.
2. Literature review
There are many benefits associated with CT provision. While
some of these are relatively easily quantified, such as the number
of journeys, many of the core elements which contribute to the
overall value of CT such as improved health and well-being and
higher levels of social interaction are more difficult to measure. In
particular, these social outcomes are often difficult to quantify and

* Corresponding author.
E-mail addresses: j.d.nelson@abdn.ac.uk (J.D. Nelson), s.d.wright@abdn.ac.uk (S. Wright), rmthomas@peterbrett.com (R. Thomas), scanning@peterbrett.com (S. Canning).

http://dx.doi.org/10.1016/j.cstp.2017.01.001
2213-624X/© 2017 World Conference on Transport Research Society. Published by Elsevier Ltd. All rights reserved.
 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298
are not easily assessed using conventional transport analysis
methods.
This section provides a review of existing literature, identifying
the key evidenced benefits.
2.1. Accessibility and social exclusion
There is much discussion in the literature as to the ability of CT
to improve accessibility and consequently reduce social exclusion
(Farrington and Farrington, 2005). Accessibility can be defined as
“the ease with which individuals can reach destinations” whilst
social exclusion can be understood broadly as the inability to
participate fully in society (Velaga et al., 2012).
Problems of accessibility and social exclusion can be particu-
larly acute amongst members of vulnerable groups, most of whom
do not have access to private transport and are therefore reliant on
public transport to access key services. These groups may include:
older and disabled people; unemployed people and those with low
incomes; and people in communities with limited public transport
provision (e.g. rural areas whose specific challenges for CT are
described by Schiefelbusch (2016); drawing on experience from
Germany). The provision of suitable transport for older people is a
significant issue since their specific accessibility requirements are
often not accommodated through traditional public transport
services (Mulley and Nelson, 2012). These include lower incomes,
an increased number of physical limitations and changes in trip
purpose (Alsnih and Hensher, 2003).
Through overcoming gaps in accessibility, CT services can
provide access, particularly amongst vulnerable groups, to key
destinations including employment, education, and health ser-
vices.
2.2. Social interaction and social capital
While generally less well understood than the economic
impacts, a lack of accessible transport can also result in significant
social impacts at both the individual and community level (Lucas,
2010). Individuals who are socially isolated as a result of distance,
infirmity or poverty can experience feelings of loneliness and
isolation. By providing a means to access key destinations such as
employment, education and leisure facilities, CT provides users
with the opportunity to get ‘out and about’ and interact socially
within their community.
The importance of the CT journey in providing an opportunity
for social interaction is identified by Martikke and Jeffs (2009) in
their research on CT providers in Manchester. They note that “low-
key interactions” with the driver can become “very significant and
something to look forward to” for those whose opportunities for
social interaction are limited. By providing an arena for social
interaction, the provision of CT can support social capital,
particularly in rural areas (Gray et al., 2006). Communities with
high levels of social capital generally have greater access to
resources, skills and influence and research indicates social capital
is positively associated with a range of positive social and
economic indicators, including perceptions of trust and participa-
tion in organisations (Spinney et al., 2009).
2.3. Well-Being, quality of life and mental health
Transport, mobility, social interaction and the ability to engage
more fully in community life are also important pre-conditions for
well-being and quality of life. While the link between CT and well-
being has not been explored in detail, studies have explored the
relationship between transport, mobility and well-being more
generally. Banister and Bowling (2004) examined the relationship
between mobility and quality of life amongst people over the age of
287
65 in Britain. They found a clear relationship between quality of
life, and both the availability of facilities such as health services and
shops and the number of social activities undertaken in the last
month, concluding that transport is important as it provides the
means to access local services and facilitates engagement in social
activities.
The relationship between transport, mobility and well-being
has also been examined by Vella-Brodrick and Stanley (2013).
Using survey responses from adults in Melbourne, Australia, they
assess how transport mobility helps to satisfy inherent psycho-
logical needs which are deemed necessary for well-being. These
include “relatedness needs”, i.e. having supportive and satisfying
relationships, “competence needs”, i.e. the belief that one has the
resources to achieve desired outcomes, and “autonomy needs”, i.e.
the perception of undertaking activities based on choice, volition
and self-determination. The study found that transport mobility
successfully predicted psychological well-being which in turn
predicted subjective well-being, with mobility providing the
means to “interact with the world” and generate “feelings of
connectedness, self-worth and competency”. Other studies have
identified that mobility-related factors can contribute to the
positive relationship that is known to exist between social
coherence/social community and mental health (Sugiyama et al.,
2008).
2.4. Supporting independence
CT can also support independent living and mental and physical
health. In their analysis of CT providers, DHC and TAS (2011) found
that many of the users of the organisations they assessed would
not be able to live independently without support from CT and
would therefore need to move house or into residential care
services. Such a move would result in significant additional costs.
The provision of transport and greater independence can also
have positive benefits for the families involved. A number of
sources note the reduced reliance and pressure on family and
friends to provide transport as a result of the availability of CT (Age
Scotland, 2013). This can have wider economic and social benefits
as a result of a reduction in days taken off work and can improve
the carer-patient relationship by providing carers with much
needed respite (Martikke and Jeffs, 2009). Furthermore, Alsnih and
Hensher (2003), in an international review, highlight that in future
families are less likely to be able to cater for the transport needs of
elderly relatives as a result of the growth in life expectancy as well
as general changes in lifestyle. As a result, they contend that an
increasing number of individuals will find it increasingly difficult
to meet their transport needs without improved public transport
provision which meets accessibility needs.
2.5. Health and lifestyle
The provision of CT has also been linked to earlier detection and
treatment of health conditions, with resultant benefits in terms of
quality of life for the individuals involved as well as significant
savings for the NHS (Age Scotland, 2013). In part this is likely to be
simply a result of improved access to health services, with the
greater availability of transport encouraging people to seek
medical advice when they might otherwise not have done so.
A number of sources also highlighted that involvement with CT
organisations can also act to provide an ‘early warning system’
when health problems arise. In their submission to the Infrastruc-
ture and Capital Investment Committee Report, the Highland
Council noted that “drivers may suggest to the health professionals
that there has been a change in circumstances and a visit may be
beneficial for the passenger‘s wellbeing”, with “most health
288 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298
professionals recognising that this is helping to reduce admissions
to hospital and care homes and that early intervention enabled by
Community Transport gives a net saving” (SPICIC, 2013).
The provision of CT and greater access to appropriate transport
for health appointments has also been linked to a reduction in the
number of health appointment Did Not Attends (DNAs) as well as a
reduction in required domiciliary provision (Countryside Agency,
2004). It is not clear to what extent a lack of transport contributes
to DNAs as quantitative data on the topic is generally limited.
The provision of CT can contribute to healthier and more active
lifestyles. In its analysis, Age Scotland (2013) argues that CT can
contribute to healthier eating and reduced levels of malnutrition as
a result of the opportunity it provides users to ‘shop around’. This is
echoed by Martikke and Jeffs (2009) who highlight the nutritional
benefits of being able to access supermarkets and lunch clubs as a
result of CT provision.
2.6. Employability, training and support for local businesses
CT organisations are important employers of both staff and
volunteers. According to the CTA, the 80 largest CT organisations in
Scotland employed around 400 people in 2012, of whom
approximately one third were full time employees (CTA, 2012b).
As well as the direct income provided to those employed, there are
wider multiplier effects within the local economy. In addition, the
CTA found that at least 2500 people volunteered their time,
providing a total of 278,500 h over the year period. If one hour of
volunteering is valued at the minimum wage rate, this equates to
£1.7 million on an annual basis. A recent US study calculated
volunteer driver hours at $1.4 billion (Independent Sector, 2013). In
Australia, it has been found that volunteers in CT come from a wide
range of age groups, challenging the common view that most
volunteers are retirees (Denmark and Stevens, 2016).
As significant employers and volunteer host organisations, CT
providers contribute to training and skills development, particu-
larly within the fields of transport and social care, with, for
example, many CT organisations providing training for minibus
drivers. Involvement in CT organisations can bring significant
benefits for volunteers including greater levels of physical activity,
opportunities for social interaction and a sense of purpose with
resultant positive impacts on mental health and well-being (CTA,
2014).
The provision of CT can also provide benefits for local
businesses through both increased access to employment and
increased revenue. Skerratt (2010) argues that the presence or
absence of transport services directly impact the vibrancy or
decline of rural areas. DHC and TAS (2011) demonstrate how local
businesses in the retail and service sector can benefit from
enhanced turnover as a result of sales from CT clients. Wright et al.
(2009) highlight that well designed community led transport
services in rural areas can provide benefits to employers on a
number of levels, including: wider recruitment pool; improved
staff retention; easier management of staff rotas; and a greater
likelihood of appointing staff from the local area.
2.7. Support for other services and groups
The provision of CT can also impact the operation and
sustainability of other voluntary organisations and groups, with
the viability of some services often dependent on the provision of
CT. Research undertaken by the CTA (2014) captured the benefits of
CT for older people, with many of the groups involved including
day services, lunch clubs, and care clubs, noting that without CT the
services would not be viable. Similarly, in their research with third
sector health and social care providers, Martikke and Jeffs (2009)
found transport to be a “defining issue”, with all of those
interviewed reporting that “take-up would be greater if transport
problems were eased and/or that take-up would be significantly
reduced if the organisation did not sort out its clients’ transport
issues”.
2.8. Summary
It is evident from the literature that CT provides a large number
of benefits which cover a number of different policy areas and as
such has the capacity to contribute to a cross section of different
policy goals including health, education, environment, community
and other social goals. Whilst previous literature has identified
these benefits, and several attempts have been made to quantify or
monetise some of these benefits from a funder’s perspective, many
of the core elements which contribute to the overall value of CT
such as improved health and well-bring and higher levels of social
interaction are more difficult to measure. Indeed there has been
little attempt to assess the importance of the identified benefits
from the user perspective.
The remainder of this paper details the findings of research
conducted to identify the extent to which CT in Scotland delivers
positive outcomes to both its passengers and to society in general.
3. Case study selection
The findings reported here are principally based on primary
research with five case study providers drawn from areas with
differing geography and demography. This approach allowed the
investigation to identify and understand in detail the benefits of CT
across the full breadth of operator types and services.
In terms of ensuring a demographically representative sample,
one case study was identified from each category (five in total)
within the Scottish Government’s urban/rural classification.1
The five case studies are shown in Table 1 and Fig. 1.

Community Transport Glasgow (CTG) has provided a wide
range of CT services across Glasgow since 2005. CTG has 20
vehicles.

Order of Malta Dial-a-Journey (OOM) provides transport
services in areas of Falkirk, Stirling and Clackmannanshire
Councils, primarily for people who have a mobility problem and
cannot use conventional public transport.

Annandale Transport Initiative (ATI) was established in 1999
and provides a range of CT services throughout Annandale and in
part of Eskdale in South West Scotland. The organisation has six
minibuses and two accessible community cars.

Buchan Dial-a-Community Bus (BDACB) has been providing
transport services in North East Aberdeenshire for over 15 years.
The organisation has 11 buses, over 1000 individual members
and 290 group members.

Badenoch & Strathspey Community Transport Company
(B&S) provides a range of accessible transport services for
people living in Badenoch and Strathspey who do not have
transport of their own or who are unable to access public
transport. They have 2 minibuses supported by a large
community car scheme with over 100 volunteer drivers.
1
Large urban areas – settlements of over 125,000 people; other urban areas –
settlements of 10,000–125,000 people; remote small towns – settlements of
between 3000 and 10,000 people and with a drive time of over 30 min to a
settlement of 10,000 or more; accessible rural  settlements of less than 3000
people and within a 30 min drive of a settlement of 10,000 or more; and remote
rural – settlements of less than 3000 people and with a drive time of over 30 min to
a settlement of 10,000 or more.
 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298 289

Table 1
Case Studies.

Preferred Case Study (Operator/Regional Transport Partnership)

Large Urban Areas Community Transport Glasgow (SPT)
Other Urban Areas Order of Malta Dial-a-Journey (TACTRAN)
Remote Small Towns Annandale Transport Initiative (SWestrans)
Accessible Rural Buchan Dial-a-Community Bus (NESTRANS)
Remote Rural Badenoch & Strathspey Community Transport Company (HITRANS)

Three telephone consultations were also included to address a
small number of gaps left by the above case studies:

Coalfields Community Transport (CCT) based in East Ayrshire
provides a range of transport services for eligible groups and
socially or economically disadvantaged individuals in the former
coalfield areas like Cumnock and Auchinleck.

Tagsa Uibhist (TU) is a voluntary organisation in the south of the
Outer Hebrides providing a range of services throughout the Uist
Chain to assist elderly and vulnerable populations in the local
community.

paper-based survey for users, bespoke to each provider; this was
RSVP East Renfrewshire provides a range of CT services
including a Voluntary Car Scheme which has been in operation
since 2000. The scheme is primarily provided by volunteers
using their own cars. Users are referred via their GP and the
majority are elderly.
4. Data collection materials
The data collection materials consisted of: (a) a self-completion
supplemented by a consistent web-based survey and the offer of a

Fig. 1. The five case study sites.

290 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298

Table 2
Case Study User Survey Returns.2

Case Study Provider Urban/Rural Classification No. of Surveys Returned % Total Across All Case Studies
Community Transport Glasgow (CTG) Large Urban Areas 42 20%
Order of Malta Dial-a-Journey (OOM) Other Urban Areas 82 39%
Annandale Transport Initiative (ATI) Remote Small Towns 35 16%
Buchan Dial-a-Community Bus (BDACB) Accessible Rural 40 19%
Badenoch & Strathspey Community Transport Company (B&S) Remote Rural 13 6%
Total 212

Table 3
Overview of survey respondent profiles across case study sites.

Case Study Provider Number of Gender Age of Affecting ability to Driving status Number in
responses Respondents travel Household

Male Female <60 60– >75 illness, disability or % who % with access 1 2 >2
74 mobility issue drive to car
Community Transport Glasgow (CTG) 42 20% 80% 38% 36% 26% 71% 15% 24% 33% 52% 15%
Order of Malta Dial-a-Journey (OOM) 82 37% 53% 23% 31% 42% 90% 14% 35% 54% 38% 7%
Annandale Transport Initiative (ATI) 35 31% 69% 13% 48% 39% 41% 41% 75% 29% 54% 18%
Buchan Dial-a-Community Bus (BDACB) 40 11% 89% 9% 21% 70% 58% 13% 28% 54% 27% 19%
Badenoch & Strathspey Community 13 31% 69% 15% 46% 38% 75% 23% 15% 58% 33% 8%
Transport Company (B&S)

telephone call-back service for questionnaire completion; (b) a
topic guide for CT case study management; and (c) a topic guide for
CT case study volunteers. Following feedback from providers, a
Group Leader Survey was added to the scope.
4.1. Self-Completion surveys
The self-completion surveys were issued to case study
providers in early December 2014. The providers issued the
surveys to their users through a combination of postal mail-outs
and driver hand-out. Questions asked about respondents’ use of
the service and their attitudes towards a range of potential benefits
arising from use of CT including accessibility, general well-being,
healthcare, healthier lifestyles, work, education or volunteering
and group travel. They were also asked about the financial value to
them of services they use. The only exception to the predominantly
self-completion approach was the B&S. The organisation expressed
concern that their users were often more vulnerable members of
society and would have difficulty completing the surveys
independently. Consequently, a professional interviewer was
employed to visit the provider. This, combined with the lower
number of registered users due to its deep rural nature of the area
served, explains the lower response rate from this provider.
In total, 212 completed questionnaires were received from 1213
questionnaires issued. Table 2 shows how this is split between the
five case study providers.
To adequately interpret the results from the user surveys, it was
important to understand the profile of the respondents and the
range and level of use of different services by those respondents. It
should be noted that the respondents to the user survey were
(typically) not users of the full range of CT services at each provider,
2
Not all user survey questions were answered by all respondents detailed in
Table 2 and, for each question, there were a number of ‘not applicable’ responses.
Therefore, when presenting the user survey results, we distinguish between ‘all
respondents’ (i.e. the numbers detailed in Table 2), ‘responses’ (the total number
who answered each question including ‘not applicable’ responses) and ‘applicable
responses’ (excludes ‘not applicable’ responses).
however the user sample provided a fair reflection of the extent to
which different CT services are utilised in each case study area. The
user survey respondent profiles at each case study site display only
subtle variations in terms of age, physical health/mobility,
household access to private cars and isolation (see Table 3). A
wide range of service types used by respondents is also evident
across the sites. Whilst this needs to be taken into account if
making direct comparisons between sites, it is important to note
that the mix of services taken as a whole reflects the diverse nature
of the CT sector in terms of services provided. At the nationwide
level the most common purposes for which CT is used are social
outings followed by shopping and access to health services (CTA,
2012b) – this is replicated in this study. Furthermore, although
there are variations in user profile across the sites (see Table 3),
overall the sample closely mirrors the CT user profile as identified
in the CTA State of Sector survey 2012 where more than 80% of CT
passengers were found to be older and/or disabled people – the
user survey sample in this study consists of 79% of respondents
being over 60 with a further 13% under 60 but with disability or a
long standing health problem.
4.2. Group leader survey
A short group leader survey was issued to each provider to
collect information on what group-based activities CT is used to
facilitate, the benefits of the service to users and the cost of the
service. In total, 45 completed surveys were received.
4.3. CT case study focus Groups/Interviews
Meetings with each case study provider on a one-to-one basis
generated additional in-depth information to underpin the
findings from the surveys. Issues of interest included understand-
ing the structure of the organisation; the services it provides;
staffing; clients; funding; the role of volunteers; and the perceived
benefits of the service.
 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298
A series of focus groups or one-to-one interviews (depending on
the preference of the case study provider) with staff and volunteers
were also held. The purpose of these sessions was to understand
the benefits of the services offered; the wider societal benefits of
the service; and the benefits accruing to staff and volunteers.
In addition to the consultation with the case study CT groups, a
number of telephone interviews were undertaken with represen-
tatives of other CT services and with a selection of local authorities/
funding providers. The primary aim was to gain an understanding
of the benefits of the services provided from the local authority/
funding body’s perspective.
The following two sections set out the economic, social and
health impacts of CT identified through the data collection.
Findings are drawn from the user and provider surveys,
supplemented where appropriate with information from pub-
lished data sources.
5. Economic benefits of CT
The literature review identified a series of potential economic
benefits which typically emerge from CT operations and informed
the data collection. This section sets out the economic benefits of
CT identified from the case study data.
5.1. Willingness to pay
Due to the elderly nature of the user survey sample, the vast
majority of respondents hold concessionary passes and about half
the respondents (n = 89) are entitled to free travel on the CT service
they use. This impacts on the ability to gauge willingness to pay for
a service when there is an entitlement and users are accustomed to
free travel. There was also a large variation in pricing policies
between different case study sites with concessionary passes being
valid on certain services but not others. Large variations in
distances travelled also affects the fares charged to those that do
pay for their trips. Nevertheless across all five case study sites there
was a willingness to pay more for their travel by a third of
respondents (n = 61). For those willing to pay more the average was
£1–1.50 per trip for CTG; £5 per trip for OOM; £2 per trip for ATI;
£3–£5 per trip for BDACB; £1 per trip for B&S.
The willingness to pay of CT users tends to vary by provider.
However, on balance, the survey evidence does appear to suggest
that the majority of CT users in both urban and rural areas feel that
the fare they pay is ‘about right’, whilst a significant minority
would be willing to pay more. This implies that, at a Scotland-wide
level, CT generates a social welfare benefit in terms of a consumer
surplus for users.
5.2. Access to employment
The user survey indicated little use of CT services to access
employment by respondents. This is mainly due to the largely
elderly sample. However, there was almost unanimous agreement
amongst those using CT to access employment that it allowed
them to consider a broader range of jobs/study opportunities and
helped them get employment which they would not have been
able to do otherwise. Several users also agreed it makes it easier for
them to get to their place of work/study and increases reliability for
the journey. Of those accessing employment, most are engaged in
voluntary work. Whilst the use of CT for access to employment is
small in absolute terms across the case studies, three of the
providers are in particularly rural areas where even supporting a
small number of journeys to work can have a positive benefit in
291
terms of supporting local businesses and sustaining the population
base.
5.3. Employment & training
All of the core case studies use a combination of paid staff and
volunteers. The use of published data sources3 suggests that the 75
paid staff members (dominated by the more urban providers)
across the five case studies generate earnings of £1.467 million per
annum, contributing £2.8 million to the Gross Value Added (GVA)4
of the Scottish economy each year.
All of the CT organisations provide training to both their staff
and volunteers. The five core case studies all provide MiDAS5
training, with BDACB also providing PATS to its escorts and ATI
offering MEET. The organisations also provide more general
training (e.g. on emergency first aid, disability awareness, winter
driving, telephony and database management). In addition to
providing training to their own staff members, each of the five case
studies also offer MiDAS (and PATS and MEET in the case of BDACB
and ATI respectively) to external organisations e.g. other voluntary
and community groups. A number of the organisations also
provide work experience placements which can lead to permanent
employment with other organisations.
Overall, it is clear that the social focus of CT providers
contributes economic benefits to the wider community over and
above that recorded by the fare-box. By providing training in
technical disciplines as well as supporting individuals in learning
‘soft skills’, CT providers are providing both direct employment and
preparing volunteers for entry into the workplace.
Staff members consulted identified a number of personal
benefits from working in the sector. Many highlighted that they
enjoyed the feeling of giving something back and helping others.
Job security was identified as an issue by staff members, a number
of whom were employed on short-term contracts.
5.4. Volunteering
All of the core case studies use volunteers in some capacity,
with volunteers taking up roles as drivers, passenger assistants,
clerical support staff and board members. Volunteers come from a
range of backgrounds but are generally older and retired. As a
result of the varied nature of the roles and different commitments
made by volunteers, volunteer hours are very variable, with some
individuals working on a weekly basis and others only volunteer-
ing once or twice per year.
A number of personal benefits for volunteers were identified.
Several commented that their involvement in the organisation
provided them with a focus to their day. Whilst many volunteers
participate for their own reasons, there is a net economic benefit to
society in terms of the additional (uncompensated) productivity/
value added to the economy. Volunteers also emphasised the social
benefits of being involved and the opportunities it provides to
meet and interact with others in the community including staff
3
The Annual Survey of Household Earnings (ASHE), suggests that the annual
median wage in “Human Health & Social Work Activities”, which we see as the most
relevant comparator here, is £19,559. Assuming pay at this level, the 75 paid staff
members would generate around £1.467 million in direct earnings each year. The
Scottish Input-Output tables suggests that the “Type II Multipliers” (which takes
account of direct, indirect and induced spending) for this type of activity is 1.9. This
suggests that the total jobs provided across the five case studies contribute gross
(i.e. net of displacement) GVA of almost £2.8 million to the Scottish economy each
year.
4
Gross Value Added is a measure of the value of all goods and services produced
in an area, industry or sector of an economy.
5
MiDAS (Minibus Driver Awareness Scheme); PATS (Passenger Assistant Training
Scheme); MEET (Minibus Emergency Evacuation Training).
292 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298

Table 4
Weighted average scores for importance of trip purpose.6

Get to medical Access personal services, e.g. the Access support Shopping Leisure Visiting Work Education Day Just to Other
appointments bank, post office, hairdressers, services, e.g. day care family/ trips get out
library, etc. centres friends
Aggregate 0.97 0.62 0.59 1.02 0.75 0.65 0.00 0.02 0.94 1.11 1.21
CT 1.38 0.62 0.73 0.72 0.50 1.13 0.44 0.20 0.18 0.79 1.38
Glasgow
Order of 1.12 0.81 0.75 1.16 0.88 0.86 0.07 0.05 0.79 1.10 1.44
Malta
Buchan 1.06 0.81 0.53 1.23 0.33 0.62 0.20 0.07 1.33 1.24 2.00
Annandale 0.18 0.41 0.16 0.15 0.60 0.00 0.25 0.31 1.07 0.90 0.50
Badenoch 1.00 0.92 0.46 1.62 1.15 0.15 0.00 0.00 1.38 1.67 0.00
&
Strathspey

Table 5
Weighted average scores for Accessibility Benefits of CT Services.7

The vehicles are much The drivers are good at handling I appreciate I find regular public transport I would struggle to I would struggle to
easier for me to get into/ my requirements (either medical, the door- very difficult to use because of use taxis all the get lifts from family/
out of than other public physical, communication needs, to-door the distance to/from the stops/ time because of the friends/neighbours
transport etc) service stations cost
Aggregate 1.20 1.45 1.53 1.03 1.13 1.04
CT 1.53 1.64 1.68 1.31 1.43 1.43
Glasgow
Order of 1.38 1.39 1.53 1.12 1.18 1.08
Malta
Buchan 1.47 1.67 1.67 1.28 1.31 1.23
Annandale 0.29 0.94 1.00 0.36 0.63 0.45
Badenoch 0.54 2.00 2.00 0.85 0.85 0.62
&
Strathspey

members, other volunteers and the users of the services.
Volunteering also acted as a support to some individuals.
Providers emphasised that using volunteers reduces the cost of
the journeys compared to that of commercial operators and this
has a consequent benefit for users. The benefits in terms of training
were also noted and a number of the CT organisations were able to
provide examples where individuals started as volunteers and
eventually moved into paid employment either within the
organisation or externally.
The data are not sufficiently granular or standardised across
providers to measure and monetise the impact of some of the
above benefits. However, it is clear that CT providers make a
significant contribution to the economy through enhanced
productivity, engagement with vulnerable groups and individuals
and providing a pathway to employment (with consequent cost
savings for the government).
5.5. Funding & cost savings
The funding of services, management operations, vehicle
renewal and office premises comes from a variety of sources
across the 5 sites. In general the largest source of funding of
services and management operations is from the relevant Local
Authorities in the form of block grants and through service level
agreements for certain specific services. While the block grants
tend to come from the public transport departments within the
6
A value of zero represents a neutral view on the importance, a value of 1
represents fairly important and a value of 2 represents very important. Similarly
1 = fairly unimportant and 2 = not at all important.
7
The value of zero represents a neutral view on the statement, a value of 1
represents slight agreement and a value of 2 represents a strong agreement with the
statement; similarly, 1 = slightly disagree and 2 = strongly disagree.
local authority, service level agreements can additionally stem
from social work, education or even NHS health budgets (although
these are not commonplace). Central Government provide
operational grants through Bus Service Operators Grant (paying
approx. 14p per mile or 1.61 km) for both Section 22 and Section 19
services as well as concessionary fares reimbursements (approx.
60% of single adult fare) for passengers over 60 on Section 22
services. In some cases they have also provided capital funding for
new vehicles through the Bus Investment Fund. Other funding
sources include charitable foundations and trusts which tend to
provide grants which can be used for infrastructure and capital
costs as well as supporting operations. The final source of funding
is through local fundraising and donations, fares and vehicle hires.
Two operators noted that they have experienced a decline in the
level of funding provided by local authorities in recent years and
this has reduced the capacity of the organisations to grow and
develop their services. The majority of the funding streams are
provided on an annual basis and this was felt to make long-term
planning difficult. Two operators suggested that a more centralised
funding mechanism would be preferable. The local authority
funding they receive is generally provided via the local authority
transport departments.
At a time when a number of local authorities are consulting on
making efficiency savings, CT is offering a ready-made solution to
the often unsustainably high costs of conventional transport. Were
it not for the presence of CT providers, it is not inconceivable that
some areas (particularly rural) would suffer transport and
accessibility poverty, potentially undermining community sus-
tainability. However, while the wider social and health benefits of
CT were recognised, on the whole there did not appear to be high
levels of integration between the transport and social work/
healthcare departments. Overall, the general absence of such a
joined-up approach means that CT funding (both in terms of the
 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298
Fig. 2. Importance of CT Services to Levels of Independence at each Site.
Table 6
Weighted average scores for importance of the service(s) to current level of independence.8
Aggregate
CT Glasgow
Order of Malta
Buchan
Annandale
Badenoch & Strathspey
absolute level and means of distribution) can often ‘slip through
the cracks’.
6. Social & health benefits of CT
Whilst the social and health benefits of CT are difficult to
quantify they are critically important across a range of policy areas
including transport, health, social care, rural sustainability and
general well-being.
6.1. Accessibility & social inclusion
The user survey elicited responses on the importance of CT
services in accessing services/activities such as medical appoint-
ments, shopping, work/education and social interactions with
friends/family and days out. It also considered the physical
accessibility benefits that the CT services provide. Overall, the
use of CT to access shopping is reported to be important by most
respondents, followed by access to medical appointments and day
trips. The importance of CT to ‘just get out’ is also very high,
highlighting the social inclusion benefits of CT (see Table 4).
Respondents in the most rural case study area (Badenoch &
Strathspey) are most likely to use multiple different CT services for
a range of trip purposes while those in the most densely populated
case study area (CTG) are most likely to only use a single CT service
for a specific purpose. This emphasises the importance of CT
providers in remote rural areas where they act as a lifeline provider
for all access needs as opposed to a more specialist service as
evident in more populated areas.
Respondents were asked how they would access activities if the
CT service they currently use did not exist. Across all case studies, at
8
A value of zero represents a neutral view on the importance, a value of 1
represents fairly important and a value of 2 represents very important. Similarly
1 = fairly unimportant and 2 = not at all important.
293
Importance of the service(s) to current level of independence
1.50
1.77
1.61
1.75
0.39
1.83
least 50% of responses indicated that the trip could not be made or
would be made much less often. For essential activities such as
medical appointments respondents were more prepared to find a
way of making the trip.
When considering physical access, the door-to-door nature of
the CT services and the understanding and assistance offered by
drivers were consistently viewed as being important by most
respondents (over 75%) across all case studies (see Table 5).
Improving accessibility and social inclusion were also seen as
key benefits by the staff and volunteers at each case study who
emphasised that they offered a higher quality of service compared
to commercial bus and taxi services, with drivers (and where
relevant passenger assistants) providing users with additional
assistance where required. This was felt to make a huge difference
to those with disabilities who may not be able to get out without
such support.
6.2. Social interaction & social capital
At three case study sites (OOM, BDACB and B&S), over half of the
respondents live on their own. At CTG the figure is a third and just
over a quarter for ATI. The CT services provide one of the few means
for many isolated members of their communities to interact
socially. Providing opportunities for social interaction was seen by
staff and volunteers as a key benefit of CT. The driver’s role in
facilitating interaction with and amongst users was seen as
particularly important and a fundamental element of the services
provided. Staff and volunteers at each organisation noted that
individuals often make friends through their use of the services
and this helps build confidence. The links between greater levels of
social interaction and improved mental health were also emphas-
ised.
294 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298

Table 7
Weighted average scores for Level of Independence Enabled by CT Services.10

I don’t have to rely on family/ I feel bad about The service allows me to The service allows me to do things The service helps The service
friends/neighbours as much for imposing upon keep my independence when I want to and not just when me keep living in saves me
lifts now I use this service others for a lift and do things for myself family/friends/neighbours have time my own home money
Aggregate 1.14 0.99 1.16 1.12 0.83 1.00
CT 1.46 1.38 1.00 1.06 0.79 1.00
Glasgow
Order of 1.15 0.99 1.30 1.24 0.95 1.08
Malta
Buchan 1.48 1.38 1.33 1.25 1.06 0.94
Annandale 0.36 0.35 0.65 0.56 0.19 1.10
Badenoch 1.08 0.31 1.54 1.38 1.00 0.54
&
Strathspey

Table 8
Savings for Social Services  Example 1: Reducing Costs of Residential Care.

Background data From the user surveys Calculations

(sources of figures footnoted)

Cost of residential care bed  £530 per week =
£27,500 per person per annum for residential care.11

Care provided in the home ranges between 20% (10 h
one to one care) to 50% (25 h one to one care) of
residential care costs depending on number of one to
one hours received in the home.12

Maximum costs of care in own home  £13,750 per
annum.

There are 100,000 total users of CT services in
Scotland (30,000 individual registered users and
70,000 group users).13

13,213 admissions to residential care each year in
Scotland  vast majority are over 75.14

Over 75 population in Scotland = 398,000

47% of all responses strongly agreed that the CT
service helps them keep living in their own home
(note the% of over 750 s is higher).

43% of CT users were over 75

Using total CT users nationwide (100,000) we
estimate 43,000 CT users at national level in
Scotland are over 75.

13,213/398,000 = 3.32% of over 750 s admitted to
residential care each year

CT users over 75 typically admitted to residential
care each year = 3.32% * 43,000 = 1428.

If 47% of the over750 s using CT defer residential care
for 1 year as a result of the CT service then 671 CT
users likely to defer admission.

Based on maximum home care costs (25 h one to one
care) for those continuing to live at home, then the
cost savings to social services if 1 individual is
deferred from residential care = £13,750 per annum.

Savings to social services = 671 x £13,750 = £9.06 m/
annum

6.3. Supporting independence
When asked how important the CT services were to their
current level of independence, 70% (n = 109) of responses indicated
them to be ‘very important’ and 19% (n = 30) to be ‘fairly important’.
Fig. 2 and Table 6 shows all sites with the exception of Annandale
align with these aggregate results. Responses from Annandale are
probably explained by the far higher levels of access to private cars
(75%) compared to the other sites (ranging from 17% to 36%).
Table 7 illustrates variations between case study sites in terms
of reasons why the CT service contributes to levels of indepen-
dence. It is clear that CT supports independence in a variety of
almost equally important ways, ranging from allowing people to
stay in their own home to reducing dependence on family, friends
and others for assistance with travel. Savings to social services
through reducing costs of residential care are estimated to total
£9.06 m per annum across Scotland (see Table 8). By providing
access to day care services, CT is also reducing the need for one to
one home care costs for a sizeable proportion of CT users. Day care
services typically cost less than 40% of home care costs.9 If 10% (of
those in strong agreement that the CT service helps them keep
living in their own home) utilise day care services rather than
requiring home care this would result in additional savings to
social services of £26 m per annum.
The total annual savings to social services costs based on these
calculations would be equivalent to over ten times the level of
9
http://www.pssru.ac.uk/pdf/uc/uc2011/uc2011.pdf p109.
funding that the CT sector receives from statutory bodies each year
in Scotland.
6.4. Wellbeing, quality of life & mental health
Transport, mobility, social interaction and the ability to engage
more fully in community life are also important requirements for
well-being and quality of life. The user surveys demonstrate the
value of CT in contributing to this as illustrated in Table 9.
CT services act as an enabler to get people out of their houses.
Moreover, the act of travelling on the bus is seen as a social
experience in its own right with over two thirds of respondents
agreeing that they like to socialise with other passengers and/or
the driver during the journey. CT services are generally viewed as
more important for accessing services and activities (shopping,
medical appointments) than for accessing destinations where
users can then socialise. This emphasises the importance of the CT
service itself as an environment for stimulating social interaction.
The CT services provide more and quicker access to activities
and services: more than half of all responses (3/4 of applicable
10
The value of zero represents a neutral view on the statement, a value of 1
represents slight agreement and a value of 2 represents a strong agreement with the
statement; similarly, 1 = slightly disagree and 2 = strongly disagree.
11
http://www.theguardian.com/society/2014/jun/11/social-care-old-people-
hospital-longer.
12
http://www.mycaremyhome.co.uk/handling-the-cost-of-care/.
13
CTA (2012a,b) State of the Sector Report for Scotland 2012.
14
http://www.isdscotland.org/Health-Topics/Health-and-Social-Community-
Care/Publications/2015-10-20/2015-10-20-CHCensus-Report.pdf?.
 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298 295

Table 9
Weighted average scores for wellbeing and quality of life benefits.15

The service I like to socialise with This service is vital Without this service I Using this service generally reduces the My physical health is
allows me to get other passengers and/or in helping me meet would find it difficult time needed to travel to and/or waiting better because I use
out of the house driver during the journey friends and family to access activities times once at the surgery/hospital this service
Aggregate 1.27 1.21 0.84 1.05 0.53 0.89
CT 1.11 1.36 1.13 1.11 1.06 0.97
Glasgow
Order of 1.40 1.18 1.19 1.39 1.11 1.02
Malta
Buchan 1.65 1.58 1.06 1.21 0.31 1.35
Annandale 1.00 0.97 0.34 0.46 0.14 0.36
Badenoch 1.69 1.85 0.38 1.08 0.46 1.46
&
Strathspey

Table 10
Weighted average scores for healthier Lifestyles benefits.16

This service allows me to access a wider range This service allows me to access This service helps me stay more This service allows me to get out
of food and drink options for shopping healthier food and drink options for active as it gets me out and about and about and enjoy the great
shopping more outdoors
Aggregate 0.66 0.55 0.91 0.74
CT Glasgow 0.76 0.69 0.91 0.82
Order of 0.49 0.38 0.89 0.54
Malta
Buchan 1.18 1.07 1.26 1.20
Annandale 0.42 0.38 0.47 0.65
Badenoch & 0.54 0.31 1.08 0.69
Strathspey

responses) agreed that the CT service they used was vital in helping
meet friends and family and 65% of all responses (>3/4 applicable
responses) agreed that without the service they would find it
difficult to access activities. While only a third of all responses
agreed that the service reduced the time spent travelling and/or
waiting times once at their appointment, the figure was over 75%
when only considering respondents who felt the CT service to be
important to them in accessing medical appointments. Almost half
of all respondents ‘strongly agree’ that their physical health is
better because they use the CT service.
CT service to be important to them in accessing medical appoint-
ments, these proportions increase almost threefold to 46% and 14%
respectively. Almost 10% of all respondents strongly agreed, and 4%
slightly agreed that the CT service makes it much easier for them to
get their medication; considering only those respondents that felt
the CT service to be important to them in accessing medical
appointments these proportions increase to 28% and 11%
respectively. During focus groups and interviews CT providers
recalled a number of instances where drivers had noticed changes
in the health of individuals and were able to act accordingly.

6.5. Healthier lifestyles
The user surveys indicate that CT services make an important
contribution towards healthier lifestyles and improving the health
of its users. The main healthier lifestyles benefit relates to the CT
services enabling about half of all respondents to stay more active
and get out and about more (see Table 10). CT services were also
found to allow access to a wider range of food and drink options
and, to healthier food and drink options for about a third of all
respondents.
6.6. Earlier detection and treatment
The user surveys indicated that 16% of all respondents strongly
agreed that they now see the Doctor quicker and/or more often
because of the CT service they use. A further 5% slightly agreed with
this statement. If considering only those respondents that felt the
15
The value of zero represents a neutral view on the statement, a value of 1
represents slight agreement and a value of 2 represents a strong agreement with the
statement; similarly, 1 = slightly disagree and 2 = strongly disagree.
16
The value of zero represents a neutral view on the statement, a value of 1
represents slight agreement and a value of 2 represents a strong agreement with the
statement; similarly, 1 = slightly disagree and 2 = strongly disagree.
6.7. Reductions in missed health appointments and domiciliary
provision
The user surveys indicate that 23% of all responses (n = 172)
agreed (15% strongly and 8% slightly) that the CT service they use
has reduced the number of medical appointments they have
missed. The figure varies by case study from 6% in Annandale
(where the main purpose of respondents using the CT service was
for day trips and group hire to 40% of respondents in Glasgow). An
even greater proportion of responses indicated that the CT service
used has made it easier to arrange suitable medical appointments
with an average across all case studies of 22% strongly agreeing and
6% slightly agreeing (n = 174).
Almost a third of all responses (n = 174) strongly agreed that
they no longer worry about how they are going to get to their
medical appointments due to the existence of the CT service. A
further 16% of all responses (n = 171) strongly agreed that they have
less need for home visits from the GP or nurse and another 7%
slightly agreed with this. The proportion of respondents who felt
the CT service to be important to them in accessing medical
appointments was 72 out of 172 responses or about two fifths of all
responses to these questions. If we consider healthcare benefits of
the CT service to only these passengers who actually use the
service for accessing medical appointments then the percentages
296 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298

Table 11
Savings for the NHS – Example 1: Reducing costs of Did Not Attends (DNAs).

In Scotland there are 4.5 million out-patient
appointments per annum.

Approximately 10% of outpatient appointments
are Did Not Attends

Sources differ widely (10% to 69%) on the
proportion of DNAs attributable, directly or
indirectly, to transport problems. It is not
unreasonable to assume that for elderly and in
rural areas it is at the upper end of this range.

Audit Scotland.19 estimate an average cost of
£112 for each outpatient appointment (£126 in
2015 prices20 )

There are 30,000 individual registered CT users
across Scotland (and up to 100,000 users in
total)21

41% (72 out of 172 responses) use CT to access
health appointments. This correlates with sev-
eral other CT surveys which found around 40% of
CT passengers used CT services to access health
appointments.22,23

Those accessing health appointments do so 3
times per year using CT.

36% of respondents accessing medical appoint-
ments strongly agreed the CT service reduced
number of missed appointments and 18% slightly
agreed.

Based on the survey data: 30,000  41% = 12,300 use CT to
access medical appointments.

Based on 3 appointments per year per passenger gives
36,900 appointments per year accessed through CT services
nationwide across Scotland.
Assume a reduction in missed appointments in 2 out of 3 cases
for respondents strongly agreeing that the CT service reduced
number of missed appointments, and a reduction in 1 out of 3
appointments for those slightly agreeing.

(36% x 36,900  2/3) + (18% x 36,900  1/3) = 11,070 less
missed appointments.

Using Audit Scotland figure of £126 per appointment =
£1.4 m per annum reduction in costs to NHS.

quoted above increase by a factor of 2.5 for these passengers; e.g.
57% of passengers who use CT to access health appointments
agreed that the CT service they use has reduced the number of
medical appointments they have missed.
There was a general feeling amongst staff and volunteers that
CT services provided savings for the NHS. However, there is limited
robust data to prove this. Calculated savings of reduced costs of Did
Not Attends from this study aggregated across Scotland amount to
over £1.4 m per annum (see Table 11). This is around half the £3 m
in total grants received annually by the CT sector in Scotland from
all statutory bodies17 and more than three times the level of funding
that the CT sector currently receives from health bodies.18
Table 12 presents calculations for estimating Scotland-wide
savings in the cost of home visits by GP and nursing staff as a result
of CT services. These savings are estimated to total almost £3/4m per
annum which equates to about twice the level of funding that the
CT sector currently receives from health bodies in Scotland.24
7. Conclusions
The evidence collected as part of this study has clearly
demonstrated that CT offers a wide range of economic, social
and health benefits. The findings should assist in plugging some of
the gaps in the Scotland-specific evidence base and will provide
information required to make more informed decisions on future
CT policy.
The review of the literature and subsequent data collection
demonstrated the wide ranging benefits of CT. As well as
promoting accessibility and social inclusion, social interaction,
17
CTA (2012b) State of the Sector Report for Scotland 2012.
18
Audit Scotland (2011) Transport for Health and Social Care Available at: http://
www.audit-scotland.gov.uk/docs/health/2011/nr_110804_transport_health.pdf.
19
Audit Scotland (2011) Transport for Health and Social Care. Available at: http://
www.audit-scotland.gov.uk/docs/health/2011/nr_110804_transport_health.pdf.
20
Rate of inflation for services from: http://www.ons.gov.uk/ons/rel/cpi/consum-
er-price-indices/december-2014/consumer-price-inflation-summary-december-
2014.html.
21
CTA (2012b) State of the Sector Report for Scotland 2012.
22
https://www.herefordshire.gov.uk/media/6587426/results_of_the_communi-
ty_transport_consultation_2011.pdf.
23
Report on Community Transport in the West of Scotland, SYSTRA for Strathclyde
Partnership for Transport, May 2014. (In total 33 out of 83 CT groups (40%) indicated
they provide community transport to access health appointments.) http://www.spt.
co.uk/community-transport/wp-content/uploads/2014/05/CT-Mapping-Exercise-
Report.pdfhttp://www.spt.co.uk/community-transport/wp-content/uploads/2014/
05/CT-Mapping-Exercise-Report.pdf
24
Audit Scotland (2011) Transport for Health and Social Care. Available at: http://
www.audit-scotland.gov.uk/docs/health/2011/nr_110804_transport_health.pdf.
independence, rural sustainability and other policy areas, CT
providers themselves act as employers and local buyers, support-
ing the whole community in which they operate. As such CT has
the potential to contribute to a cross-section of different policy
goals.
From an economic perspective, the potential cost savings
provided to social services, the NHS and local authorities,
combined with the unremunerated productive hours offered by
volunteers, suggests that CT generates significant economic
benefits. The willingness to pay analysis identified the value of
the CT services examined. The majority of CT users feel that the
price they pay for their service is ‘about right’ with a not
insignificant minority indicating that they would be willing to pay
more. This suggests that CT generates extensive consumer surplus.
The volunteering aspect of CT also provides significant productivity
gains to the Scottish economy, in that a substantial number of
uncompensated hours are being worked, often by people who
would officially be defined as ‘economically inactive’. Volunteering
helps to make most if not all CT services viable and provides
significant cost savings for local authorities through providing
services which would be expensive to procure.
From a social perspective, the contribution of CT across a wide
range of policy areas is clearly beneficial. The summary table of
results (Table 13) shows that users across all sites demonstrated
strongest agreement that the CT services increase accessibility, but
that the reasons for using CT services varied by site. The
importance of the CT service “just to get out” was highlighted
across all sites. Additionally, the CT services examined show the
importance of, for example, social interaction on the bus and the
role CT plays in encouraging often vulnerable people to attend
medical and other appointments they would not otherwise make.
This suggests that CT is much more than a transport provider to
access specific services; it is a form of social service supporting
independent and healthier lifestyles.
The wider funding picture remains a challenge for the CT sector
internationally. Whilst the findings reported here support the view
that CT offers substantial cost savings for local authorities, it is not
immune from the increasing pressures on public sector funding,
particularly in terms of revenue budgets. Associated with this is the
absence of certainty and the inability to plan long-term as a result
of time limited funding streams. This ties back to the point that CT
is fundamentally viewed as a transport service and supports the
argument that the cost burden should be shared across all policy
areas which benefit. Ultimately though, it can be concluded that CT
in Scotland delivers clear positive outcomes to both its passengers
and to society in general.
 J.D. Nelson et al. / Case Studies on Transport Policy 5 (2017) 286–298 297

Table 12
Savings for the NHS  Example 2: Reducing home visits by GP and nursing staff.

Background data From the user surveys Calculations

(sources of figures footnoted)

A community or district nurse costs £64/h for home
Of the respondents using CT to access medical
Based on the survey data: 30,000  41% = 12,300 use
visits with an average home visit lasting 52 min appointments 38% strongly agreed and 17% slightly CT to access medical appointments.
(including travel time). So each nurse home visit agreed that use of the CT service had reduced home Assume those in strong agreement require 2 less home
25
costs £55 (or £63 in rural areas). visits by GP or Nurse. visits per year and those in slight agreement require 1 less

A GP based nurse costs £44 per hour face to face home visit per year.
contact and average surgery consultations last Also assume that half home visits are by GP and half by
15.5 min26 = £11 per consultation. district nurse.

NHS savings = 12,300 x ((38% x 2 x (£69 + £44)/2) +

Additional cost of nurse home visit = £55–£11 = £44
(17% x 1 x (£69 + £44)/2)) = £646,303 per annum
(or £52 in rural areas).
(2011 prices) or £730,868 per annum (2015

GP costs per home visit lasting 23.4 min (including
prices)30 (or £976,647 in rural areas)
12 min travel time) = £99.27

19 min travel time in rural areas28 = £130 per GP
home visit

GP costs per surgery consultation = £30

Additional cost of GP home visit = £99  £30 = £69
(or £100 in rural areas)

There are 30,000 individual registered CT users
across Scotland29

Table 13
Summary of results from user surveys relating to social and health benefits of CT services.

Site Ranked importance of trip purpose Weighted average scores31 that CT service enhances

1 2 3 Level of independence Accessibility Wellbeing & Quality of Life Healthcare

CT Glasgow Medical appts Visit family/friends Just to get out 1.11 1.50 1.12 0.77
Order of Malta Shopping Medical appts Just to get out 1.12 1.28 1.22 0.38
Buchan Day trips Just to get out Shopping 1.24 1.44 1.19 0.34
Annandale Day trips Just to get out Leisure 0.53 0.61 0.55 0.09
Badenoch & Strathspey Just to get out Shopping Day trips 0.97 1.14 1.15 0.31
Aggregate across sites 1.04 1.23 0.97 0.39

Acknowledgements
The study reported in this paper was funded by the Scottish
Government.
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