Every year, CTA members deliver more than half a million journeys to health- and social care-related destinations, from GP surgeries and hospitals to day care centres and residential homes. Beyond trips, Community Transport keeps older and disabled people active, connected and independent through prescription deliveries, active travel projects and befriending networks.

Back in 2019, the Scottish Parliament recognised gaps in provision and passed new legislation imposing duties on all NHS Boards to deliver community benefit and work with Community Transport operators in non-emergency patient transport. Since then, NHS Scotland has published its Climate Emergency & Sustainability Strategy (2022), secondary legislation has been enacted (2023) and the Scottish Government has created a Transport to Health Delivery Plan (2024) to bring transport planning and health planning together.

Meanwhile, it has become a political priority with the First Minister of Scotland promising a more accessible, patient-centred NHS with transport support for those who need it. But how much has changed—for patients, passengers and Community Transport operators? In March 2025, we launched a new research project to find out.

Our Research

As part of the next stage of our Healthy Communities programme, we sought answers to three questions:

• How are NHS Boards complying with their 2019 legal duties?
• How are Community Transport operators making Scotland healthier and what challenges do they face?
• What is the value of Community Transport for passengers who rely on our sector to access health & social care?

Key elements of the research:

• Worked with South West Community Transport (Glasgow) to bring members’ work to life via a video case study.
• Submitted Freedom of Information (FoI) requests to Scotland’s 14 regional NHS Boards.
• Secured 82 responses (≈45% of Scotland’s Community Transport sector) to an operator survey.
• Partnered with Borders Wheels (Borders), Partnerships for Wellbeing (Highland) and Portlethen & District Voluntary Community Ambulance (Aberdeenshire) to pilot a new passenger survey.

References:

• Transport (Scotland) Act 2019
• NHS Scotland Climate Emergency & Sustainability Strategy (2022–2026)
• Transport to Health Delivery Plan (2024)
• First Minister’s speech: improving public services and NHS renewal
• CTA: Healthy Communities in Scotland

Our Findings

Community Transport is playing a major role in improving access to health & social care. Using data from the new operator survey and our 2022 State of the Sector report, we estimate around 329,000 journeys to health-related destinations and ~200,000 journeys to social care-related destinations each year.

These services are increasingly important due to Scotland’s ageing population and limited capacity in non-emergency patient transport. Since 2017/18, patient transport trips delivered by the Scottish Ambulance Service have fallen by nearly 64%.

For individuals, the impact is tangible: passengers told us that having Community Transport available brings peace of mind and, in some cases, is “life-saving.” 39% of passenger survey respondents said they would not be able to make their journey without Community Transport.

Demand is rising: 72% of operators report increased demand over the last 12 months and 49% ‘often’ or ‘sometimes’ have to refuse requests for support. Yet despite preventing missed appointments and helping to tackle NHS waiting lists, services remain underfunded and undervalued: only 28% receive funding for health journeys from NHS Boards or Health & Social Care Partnerships, and just 16% receive funding for social care journeys.

There is a serious risk of lifeline services being lost due to a lack of funding, rising costs, growing demand and recruitment challenges: 26% of operators are not confident they will survive the next three years, while 53% report driver or volunteer shortages.

Compliance with the law is poor: we found that just 5 out of 14 NHS Boards are complying with their duty to deliver community benefit, and only 2 out of 14 are complying with their duty to work with Community Transport. Some Boards were unaware of the Act until our FoI, while others denied responsibility.

Collaboration is lacking: 80% of operators say they are not connected with their NHS Board and 87% are not involved in local decision-making or policymaking.

Meanwhile, NHS Boards are more likely to work with private taxi firms on an ad-hoc basis—leading to worse outcomes for patients and higher costs for taxpayers. Over the last five years, Boards spent more than £20.6m on taxis for non-emergency patient transport—six times more than was invested in non-profit Community Transport over the same period.

Conclusions & Recommendations

Community Transport is at the heart of healthy communities across Scotland but not at the heart of our health & social care system. Non-emergency patient transport delivered by charities, community groups and social enterprises does not receive the recognition, funding or support it needs. Most NHS Boards are failing to comply with their 2019 legal duties. More than six years on, Community Transport operators are still struggling and passengers are still waiting.

We’re calling for:

• Investment in Community Transport to save lifeline services, meet rising demand and prepare for an ageing population.
• Prevention first: harness community solutions to public health challenges to protect the NHS, improve outcomes, and reduce costs.
• Partnership: a new agreement between Community Transport, the NHS and the Scottish Ambulance Service to prevent missed appointments, reduce waiting lists and end delayed discharge.

Find out more

Download the full report with findings and analysis.

Watch our video case study or download our FoI responses from our Healthy Communities Research page.

Questions about this research or our Healthy Communities programme? Email scotland@ctauk.org.