Poor Transport Links Linked to Thousands of Missed NHS Appointments, Report Finds

Inadequate public transport is playing a major role in patients missing healthcare appointments across south-east Scotland, according to a new report that warns the issue is costing the NHS millions of pounds each year.

Research commissioned by the South East of Scotland Transport Partnership (SEStran) found that transport difficulties are contributing to a substantial number of missed or delayed medical appointments. During the year to September 2024, almost 140,000 appointments across the region were not attended, representing close to one in every ten bookings.

The financial impact is significant. Estimates suggest the cost of missed appointments in the SEStran area alone ranges between £4 million and £31 million annually. Extrapolated nationally, the figure could potentially approach £90 million, although variations in how health boards calculate non-attendance costs make precise comparisons difficult.

The findings are based on a survey of around 1,500 residents living within the NHS Lothian, Borders, Fife and Forth Valley regions. Approximately one-third of respondents reported that transport challenges had caused them to miss or postpone healthcare appointments. In Fife, that proportion rose to more than 40 per cent.

One of the key issues identified was the disparity between travel times by public transport and private car. Journeys to hospitals were found to take as much as four times longer by bus or other public transport services, while trips to GP practices could take up to three times longer.

The report highlights a range of barriers affecting patients, including infrequent services, multiple connections, lengthy waiting times between buses, traffic congestion and accessibility difficulties. Many respondents described public transport options that were either unreliable or impractical for attending healthcare appointments.

A resident from the Scottish Borders explained that local bus services were too infrequent to be dependable for hospital visits. Travelling to the nearest hospital required more than two hours by bus and often involved extensive waiting times. Similarly, an Edinburgh resident pointed to the lack of a direct route between Leith and the Western General Hospital, creating additional challenges for passengers with mobility difficulties.

SEStran believes improvements to transport planning could significantly enhance access to healthcare. Recommendations include introducing more direct routes to hospitals and health centres, improving coordination between transport providers, and ensuring clearer travel information is available to patients when appointments are arranged.

Rachael Murphy, Strategy Manager at SEStran, said healthcare access begins long before a patient enters a clinic or hospital.

“Access to healthcare starts with the journey,” she said. “Improving outcomes will require a more coordinated approach that puts the journey at the heart of care.”

The organisation stressed that while transport is unlikely to be the sole reason appointments are missed, public consultation consistently highlighted travel difficulties as a major contributing factor. Because NHS systems do not routinely record reasons for non-attendance, the full scale of transport-related issues remains difficult to quantify.

The Confederation of Passenger Transport Scotland (CPT), which represents bus operators, said the findings underline the importance of investing in local bus networks. Director Paul White argued that reliable bus services are essential for enabling people to access hospitals, GP surgeries, pharmacies and other healthcare facilities independently and affordably.

He called for greater collaboration between local authorities, transport providers and NHS boards to ensure healthcare access is considered when planning public transport services. Suggestions included providing travel information alongside appointment letters, assessing local transport and healthcare needs together, and recognising certain routes as socially essential services.

According to White, better bus services not only improve access to treatment but can also help reduce healthcare costs over time by supporting independent living and preventing missed appointments.

Transport Scotland acknowledged the challenges identified in the report, noting that previous strategic transport studies had already highlighted difficulties accessing healthcare facilities by public transport across the Edinburgh and south-east Scotland region.

The agency confirmed it is working with regional partners on proposals for a future mass transit system, led by SEStran. Potential options include modern tram networks and bus rapid transit systems, where buses operate in dedicated lanes or receive priority over other traffic.

Transport Scotland said improving access to healthcare will be an important consideration as plans for the new transport network continue to develop.

The report adds weight to growing calls for transport and healthcare planning to be considered together. With thousands of appointments missed every year and millions of pounds at stake, campaigners argue that improving public transport could deliver benefits not only for passengers but also for the efficiency and financial sustainability of Scotland’s healthcare system.