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Death by anecdote - Exeter LTN
My number one priority is the sweet hum of other people’s cars and vans swooshing past my house. From the outside, things aren’t going terribly well for the LTN trial in Exeter. It would be nice to hear, for example how this summer groups of kids went off on their bikes all day like we often did. A shame if it turns out to be a one-off. "Sorry, kids it's too dangerous for you to play in the street - we'll go to the park at the weekend, ok?"
In this news story, an emergency ambulance approaches a call-out location from the north, another from the south. A decision to convey a patient to hospital seems to have been made and the conclusion from the anecdote is “ambulances are being delayed, rip out the LTN”.
Interestingly I struggled to find a definitive map of the barriers. Wouldn’t it be nice if we could just put up a chicane that drivers would respect rather than physically blocking the road? Surprise, surprise we can’t because it doesn’t work that way.
I guess I’m in “the moon is made of cheese”/ “let me explain why that is horseshit” territory. But let’s try anyway. What follows has played on my mind a lot in winters past - stricken at some roadside, hit by a driver who may or may not decide to hang around, the light starting to fade...
I guess the anecdote we hear the least about is the effect of general congestion on all the emergency services’ blue light journeys. The issue gets next to no air time in corporate performance terms. The main factor usually cited in this regard is rurality.
If you look at the issues that ambulance services measure, it’s this range of factors:
- Response times in relation to the categorisation of calls (where an ambulance is sent, where a decision to convey to hospital is made)
- How many crewed ambulance hours you can put out (available staffing - vacancies, sickness) and to a very small extent, available vehicles
- Handover delays at hospital A&E sites - queued ambulances come out of the available resource
- Time taken to handle emergency calls - calls where a decision to send (as opposed to no-send) is made feed into “the stack”
Keeping on top of “the stack” is a, if not the, major operational issue day to day at sector level. Performance is affected by time of year (a lot worse in winter), and the time of day.
So if your condition is one of the “every second counts” Category 1 - national response time target 7 mins:
An immediate response to a life threatening condition, such as cardiac or respiratory arrest
you’ll likely wait 9 minutes in SWAST from when the decision to send is made, but it might be up to 18 minutes if you are unlucky.
If you are category 2, the national standard mean response time is 18 minutes, but you’ll likely wait 30-40 minutes in practice.
A serious condition, such as stroke or chest pain, which may require rapid assessment and/or urgent transport
So the ambulance crew arrive and make an assessment and take you to hospital, your troubles are over, right? Well, not quite - Ambulance handover times might be a problem - I guess the Category 1 cases continue to be prioritised, but the typical handover wait at the Royal Devon & Exeter is around 35 minutes. It’s a lot worse in Truro and Plymouth.
The 4 hour A&E target covers the time taken from handover either to treat, transfer or discharge you. Time to first consultant assessment is a useful one to know, but I can’t see it reported.
The RDE are meeting the national target (90%) in about half of their emergency attendances, so you could at times be on an A&E trolley awaiting admission to a ward for up to 12 hours. They see around 10,000 emergency presentations per month.
The TL:DR takeaway from all this is “bollocks” - bollocks to all the driver whingers opposing LTNs and speed limits for the sake of their own convenience and personal power, and bringing in instances like this as their proof.
https://www.devonlive.com/news/devon-news/bollards-force-exeter-paramedi...
https://www.swast.nhs.uk/assets/1/icpr_june_2023.pdf
https://www.neas.nhs.uk/our-services/accident-emergency/ambulance-respon...
https://royaldevon.nhs.uk/about-us/board-of-directors/board-meetings-pap...
https://www.nuffieldtrust.org.uk/qualitywatch/nhs-performance-summary (big picture summary e.g. 7.5m people waiting for hospital treatment.)
If you're new please join in and if you have questions pop them below and the forum regulars will answer as best we can.
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11 comments
I did a five-week internship in Exeter and cycled to work almost every day. Was hilly, but I enjoyed pushing myself. I understand that's not for everyone, though. Plus, I had secure(ish) cycle storage, showers and an airing-type cupboard to put any wet clothes.
After the first few times, I never cycled through the centre. So many cars, all going slowly. I used to take a longer, less busy route. Was hard work, but loved it. A little over 20mins each way at a push, more like 25–30 at a gentle pace. Just perfect for me. But, never through the centre!
Some diary dates for you here - you might want to avoid getting ill, injured or old around these times.
Consultants and trainees coming out on the same days has been a prospect for a while now - last quote I saw was NHS managers would be "staring into the abysss" in this scenario.
https://www.bbc.co.uk/news/health-66674058
With regards LTNs and ambulances and other emergency services - the mapping software used by the emergency services isn't updated as quickly as things like Google maps. So a brand-new LTN may still be shown as a through-road to the ambulance driver and controllers. Presumably this will diminish with time, and as the software is updated.
My understanding is that the main thing causing ambulance delays is the Handover Delays, and that the time spent driving to the patient is not a significant factor.
If I was cynical I might think that LTNs were being used as a convenient scapegoat.
The challenge with Exeter, and many other old cities is that the available infrastructure and geography are severely limiting when it comes to effective transport options.
There are minimal train services, and the road network is frankly awful. That is important, as anyone looking to use public transport is just opening themselves up to the same queues they experience in their cars, but now crammed in to a bus with yoofs and other undesirables.
However getting on your bike is not practical for many (although I'm sure many could if they really wanted), due to the hilly nature of the city.
So I totally get why those reliant on the motor car, who have spent literally years in traffic jams, and taken the time to find all the rat runs, are less than enamered at losing some of their key routes.
To many, LTN's simple make life harder, they penalise the masses for the benefits of the few. Unless that viewpoint is understood by those implementing LTN's and managed properly... rather than just shouting down / ignoring... opinions will not change.
I was reading something recently about the LTN posts being continually vandalised in Exeter. The comments were depressing, but in all honesty, totally predictable.
Think the fundamental challenge is "how can we overcome 'can't get there from here, mate'?"
As in - people don't like almost all changes, except limited changes they've chosen themselves. Even if they end up better off.
So it's going to be hard to sell any change which means that more than one thing changes (I drive less AND I ride a bike / walk more). Or where at least by some measures people see as clearly "worse".
Plus any change takes time. There are few (human, planned) changes which proceed by every step being better, for everyone. Even knocking down houses to build more roads will seriously annoy the house owners, and everyone else will likely be disrupted while the works are ongoing.
So yes - change is hard. But we do know that old cities or those with "geography" or even those which were overrun by cars can have different transport options, which "work" just fine for the inhabitants.
minimal train services in Exeter update. What could be making the buses so slow and infrequent?
Lol, what is that image supposed to be demonstrating? It's not a viable public transport network, I assure you!
What is making buses slow? That'll be the terrible infrastructure, the same infrastructure that makes traveling through the city in a car awful.
Everyone here is so blinkered and bias it makes discussion dificult. Not everyone wants to ride bikes, some for perfectly valid reasons, others less so, either way that is absolutely their choice.
To reduce reliance on the motor car, there needs to be other viable options than dressing up in spandex. It's easy for us to see the positive in LTN's and active travel measures, because we are already mentally there. Most people championing and implementing these schemes are already there too., which is a shame as with that, comes a failure to understand the wider viewpoint.
LTN delivery is seemingly pure 'stick'... 'Just make it harder to drive, that'll sort it'. And then people are incredulous when all this approach creates is resentment and backlash.
We all want better... we need to do better.
Not a network - but for the UK that doesn't look like a bad set of rail connections. (Of course, issues with availability, frequency and reliability can put paid to the best public transport...)
Problem is - even if you can build enough infra / make enough space for buses - AND stop cars slowing them down - are enough people going to leave their cars and use them? I'm going to guess "no" unless you also make driving much more difficult. Which is the sticking point you noted. Even then buses a) are not door to door and b) don't go when people want (even assuming you can finance a really frequent bus service, round the clock...)
There's a lot in there - but could I just ask - a) do you think change is needed (and if so, what would you like to see) and b) what is your idea to create change?
If the problem is "traffic" the answer has to involve less driving. But that is exactly the sticking point for people. They've built their lives around the car (even though for 90-something percent of the time it sits, parked and empty...). No matter how bad/expensive people think driving is if they are driving the majority of trips it must be still too easy relative to other modes.
The issue in terms of "understanding" others is that a lot of people are "no way, no how". There's no middle to meet in. Hopefully there is a "silent majority" which can be persuaded to adapt to small changes (with pull AND push). Especially when their lives do improve as a result. Even then too much and they'll dig their heels in.
The point about cycling is that it is simply the most efficient way of travelling. In terms of energy use, and it's one of the most space-efficient also. It's cheap relative to any other mode to provide for - whether infra or in buying and running a bike. You can start building bits of cycle infra without the level of disruption that re-engineering the roads (even just putting in effective "bus gates"...) or putting in a tram / railway requires. It's also a private, go-anywhere transport mode. Buses and trains don't do that. Buses and trains plus cycles however ...
Plus similar "normal" people of all ages in similar countries have been shown to do this. If we decide to make those changes.
Hey look, I get it - you don't like the ideas around active travel and you don't want to adopt them - you will keep putting obstacles in the way and minimising what is possible.
It takes effort, you don't want to make any; it requires thought, but that is too much to ask: taking the car is at individual level easy - we've spent the last 60 years making it so. Taking the car is easy so long as you do not become frail - in yourself or in your wallet; if you do succumb to frailty, can't keep up the payments, then you are thrown out of the club, left to feed on the scraps left by the rise of the car.
For what it's worth, Exeter has done pretty well in preserving its suburban train services - better than say Taunton, Guildford, Swindon as examples. I also get stuff like 'public transport is so expensive" - it's £2 by bus at the moment. Get a 1970s or 60s bus timetable book from Ebay for your locality - see for yourself what has been destroyed by cars.
Looking at Exeter... it's hilly but it is really compact. Yes - we've an aging population. It's a university town though so not everyone is old...
Not the easiest place then. I've not cycled there myself. I can see the height differerences are comparable to Edinburgh where I stay, or less. And we've got some pretty stiff gradients also (Ramsay Lane, Kaimes Road; the cycle route up Dublin Street is relaxed by comparison). Mind you, I'm a "cyclist". But looking on the map - just like Edinburgh - lots of routes go round the hills, or along the valleys at least.
Yes - it's a hard sell. Like many arguments it's going to look like "they are taking things from us / stopping us from living as normal!" That is highly salient, humans being very sensitive to loss AND perceived unfairness. And it's true! Yes - we need some serious incentives to pull people toward change (provide excellent alternatives) but we will also need a push. Driving needs to be less convenient, and the general taxpayer pay less of the "externalities" of driving e.g. costs of sickness, injury, pollution etc.
Why change at all? Otherwise many of us will just be sat miserably in the increasing traffic, awaiting the arrival of autonomous taxi-pods (or something) to fix it for us.