Accessible Hospital Bus from Meath to Dublin

Description

This initiative was born from our Community Car Scheme. More and more people were getting appointments to attend hospital appointments and we didn’t have the capacity to meet the demands. Saying no to someone who has a hospital appointment is very difficult when you know how long they have waited to be seen.#
“DNA” – Did not attend. These appointments cost approximately €25 each in 2017 according to them Minister of State Catherine Byrne (1) . In terms of the cost per appointment now, it is a lot more. A report
Report from July 2024 (2) Over 500,000 public patients missed their appointments for one reason or another, and the cost of those appointments is estimated at €91.5Million. The reasons for missed appointments are very varied: not needing the appointment but not cancelling, but what we find here is that people just cannot get to the hospital – they cannot drive, or their carer does not feel comfortable driving in Dublin, parking in Dublin, person doesn’t want to ask someone again for a lift, or there is simply no one to give a lift.
As a society, we want people to live at home for longer. We know that it costs a lot less to care for someone at home than it does to put them into care facility – especially when they are well enough to be at home. The country is almost at full employment, with that means that older people or people with disabilities maybe don’t have a son or daughter that can bring them to their appointments, and also are not in a position to take the day from work – or just cannot handle driving to Dublin. It is for these reasons, that the hospital bus was born.
The bus is easy. Passengers wishing to travel phone the office when they get their hospital appointment and book a seat for themselves and for anyone else who wants to travel with them. If they have a walker, wheelchair – it doesn’t matter. They are booked in. When the bus is at capacity, that’s it. Seats can be booked weeks and months in advance. Coming closer to the time, we phone to make sure that they are still travelling, confirm the details and when all passengers are confirmed for travel, we let them know what time they will be picked up at and from where. The bus is lovely. They love their driver and they know that the bus will collect them. They also know that the bus will wait for them and bring them home. When you take away the stress of how to get to an appointment, it makes a huge difference to the wellbeing of an older person or someone who is stressed by needing whatever appointment they have. They sleep better.

Aim of Initiative

The premise of what we do is to make transport: Accessible, Affordable and Available.
Accessible
1.Freephone call to access transport where they speak to a human and not a chat-bot.
2.The vehicle is comfortable. There is an electric side step that extends when the door opens, extra grab rails, the ceiling is good and high so people can stand up straight at walk to their seat. There is plenty of leg room and seat belt extensions are available if needed. There is also a lift on the back of the vehicle for people who choose to use this – whether a wheelchair user, someone using a rollator or someone that doesn’t like using the step.

Affordable – at the most basic level.
•If you are on a state pension, it needs to stretch and allow you to live a basic life. The cost of the transport is between €10 and €20, return and the person with the appointment can bring someone with them. Passengers don’t have to choose between heating, eating and attending a hospital appointment

Available – This bus is available.
1.It stops in a town close by to where people live. We will also ensure that we facilitate all those wishing to travel on the bus. Where the bus is at capacity, we will keep a waiting list.
2.We check with all passengers the day before they travel to make sure appointments are still going ahead. Where appointments are cancelled and spaces become available, more passengers are facilitated.

Who is it aimed at

Everyone.
A person who can drive, but doesn’t feel comfortable driving to Dublin.
A person with a disability who wants to travel independently,
A person with a disability who cannot drive
A person who needs to feel safe
A person who cannot easily get into a car
A person who has no one to bring them to their appointment.

In 2024 almost 300,000 appointments were cancelled, and we see this on the bus too – in terms of people cancelling, and also passengers get “last minute” appointments “by phone”. This in itself can be a source of stress, as they then have to navigate a hospital without a physical letter.

3 Steps critical to success

1. Listening to people – who are they? Where do they want to go? What time are they looking to go? Why do they want to go? When are they looking to go?
   Listening to what Others are saying – no matter what discussion groups or forums we sit at, participate in, we are told, that access to hospital appointments is the biggest barrier to people accessing suitable healthcare.
2. Funding – This is not just a problem for the hospital, all these missed appointments have a knock on effect on wider society and where people don’t get specialist help, they will return back to their local doctors who are already at capacity, and will add additional strains onto the system.
   Working with the NTA, the HSE and County Council ensures that the pot
3. Trusted service – This service is trusted by the people that use it. The service is part of the family of Local Link services have been serving the people of county Meath for over 20 years (though under a different brand).
   The people working in the office are trusted – what time they will be picked up at, what there estimated arrival time at the hospital is and how many other people will be on the bus.
   The driver is trusted – being safe, arriving on time, making sure no one is left behind, giving the passenger enough time to safely get to their seat, giving the passenger their phone number in case of a delay, keeping in contact with them during the day and knowing that the driver will bring them home safely.
   Trusted Vehicle – The bus is nice, its comfortable, it meets the passengers needs.

3 Challenges in Planning / Delivery

1. There is no direct link between the bus service and the hospital in terms of appointment times and helping people to navigate around the hospital.
   Appointment times. In an ideal world, we would love to see a situation where the hospital identifies the person as travelling a distance from the countryside to the hospital and giving them an appropriate appointment time that fits with bus times ( appointment given between 9.30 and 11am) this would allow for us to support more people to attend appointments – making us also more efficient. It would make their systems work easier as well as they could identify passengers and clinics that would work well together.
   Support for getting around the hospital. Dublin hospitals are huge. They cover a massive amount of services and each day cater to see approx. 750 persons per day in the Mater, and about 600 passengers per day in Beaumount. Each person needs to get to the front door of the hospital and then navigate their way around a maze of corridors on many floors. There are not enough Wheelchairs available for use within the hospitals, nor is there enough support to help people find where they are going. This adds to a persons stress level when attending hospitals.
2. Saturday appointments were introduced for a while in 2024. At the time, a lot of appointments were given out. We were not in a situation to support these appointments. For the past 8 months, we haven’t received many phone calls for Saturday appointments…
3. In terms of funding, we have capacity for morning appointments, but do not have funding for afternoon appointments. As far as is practicable, we support this through our Community Car Scheme. Passengers find afternoon appointments quite difficult as more times than not, morning clinics run over, and this has a knock on affect the afternoon appointments. Wating times for afternoon appointments can be longer.

3 Outcomes / Benefits

1. Happier passengers – Passengers know the Local Link brand, and trust the brand. They know their driver. While they may not know the outcome of their appointment, their stress levels are reduced severely by the ongoing interaction between the passenger and the office and then the driver. They know they will be collected and they also know how much it will cost. Where passengers may require many appointments, we will always look to see if there is funding that person can get to cover transport costs. We will never leave anyone behind if they cannot afford
2. Less missed appointments – people can travel safely and independently to their appointments not relying as heavily on family member and less appointments are missed as a result. More times than not, a passenger will phone the office on the way home to book in their next appointment as given on their appointment card.
3. People can live at home for longer – with the introduction of the bus, people are living at home for longer. They are accessing additional supports to stay at home, and they are also living a more independent life. While maybe their spouse, an adult child, a neighbour or a carer travel with them, it means that people have a better chance of retaining the information given and also, with booking their next transport – it gives them a chance to ask questions. Giving a call and asking a question can sometimes mean that we can assist them with something else – whether it is linking them with their local meals on wheels or giving them information on another service, or being able to flag bigger issues.