Serious concern about the future of Leitrim Community Car Scheme

“The true measure of any society can be found in how it treats its most vulnerable members.” - Mahatma Gandhi.

Following the Covid pandemic it was very clear who were the most vulnerable in our Society. The desperate need for a Social Car Scheme was highlighted. As one of the most rural counties in the country, it is very difficult for people to get to medical appointments and to access essential services.

Since the start of Covid, the Civil Defence had been facilitating elderly people in rural areas who need to attend doctor or hospital appointments, however, since restrictions eased, the Civil Defence have returned to their normal duties and do not have the time or resources to continue to carry out this work.

Almost all the calls that came through the Community Call scheme during the pandemic had been requests from elderly and vulnerable people looking for transport to hospital appointments.

The Leitrim Volunteer Centre introduced a Community Car Scheme in March 2022 on a trial basis to assist with supporting vulnerable and isolated persons to attend hospital appointments, pharmacy pick-ups, shopping and other transport needs within the county. To date the scheme has been very successful with over 500 trips carried out in the short time the initiative has been in operation.

The Centre has reviewed the operation of the community scheme and the vast majority (90%+) of appointments being facilitated are hospital appointments in Sligo, Roscommon, Dublin, Cavan, Manorhamilton and Galway hospitals and more recently Derry and Belfast.

The appointments being made are varied and run from tests to ongoing treatment and in some cases to hospital discharges. For the past year Volunteer Community Drivers have been providing a vital service to the older, vulnerable patients in the HSE system including providing emotional support and in many cases bringing people back to their homes, ensuring their safety and making sure that the home is warm, and food is provided for the people they have transported.

Most of the referrals are now coming from the Public Health Nurses, Social Workers or Public Health Clinics in Leitrim and the Scheme has become a go-to support system for the HSE staff to bring people to appointments where no public transport option is available.

This service has been ensuring that hospital appointments are attended, thereby reducing costs to the HSE of DNAs (Did Not Attend) in the hospital system. In a 2015 study by IGEES (Irish Government Economic and Evaluation Service), the increasing number of DNAs was investigated, and a lack of transport was identified as a huge issue for many patients of the HSE leading to extensive financial losses to the organisation.

The Community Car Scheme has most certainly greatly reduced the DNAs (from County Leitrim) in hospitals and treatment centres. We had hoped to continue this scheme in County Leitrim over the next number of years. The increase in numbers participating, mostly referred from HSE systems, however, has exceeded the anticipated number of users of this scheme.

The Leitrim Volunteer Centre is unable to guarantee the continuation of this service, at the increased rate of usage, without identifying funding to support this vital service to our older and isolated vulnerable citizens. As it is we have had to significantly scale back the service.

We requested that the HSE contribute to ensure the continuation and growth of this service in 2023. We anticipated that the costs of the initiative would be approximately €50,000 per year including the cost of a Coordinator which we have secured through our own resources. We asked that the HSE allocate €20,000 to this initiative in 2023 to ensure that we continue and grow the service to the many needy patients in the Leitrim area. The €30,000 which we have already raised has involved a great effort in such a small county but having seen the reaction and gratitude from our clients, we were committed to doing all we could to continue this service in the future.

The Leitrim Volunteer Centre offered to provide any necessary paperwork required to ensure that we work in partnership to address the transport issue which is blocking attendance at hospital appointments and causing an ongoing administrative headache to the Public Health Nurses and Clinical staff across the County. The response that we got was that “that HSE do not get involved in the provision of transport”.

However, following a recent meeting with TFI/Local Link we have become aware that the HSE do have a contract with TFI/Local link, and we have been told in no uncertain terms by representatives from the group that hospital services are responsible for the transport of patients while they are in their care.
TFI/Local Link are contracted by the HSE to transport people to day services and to transport people with Sensory and Physical disabilities and people with Mental Health issues to medical appointments.

It was recommended that we refer people to the Community Welfare officer for exceptional needs payments if they need to get a taxi and cannot afford it.

We were informed that Community Car Schemes do not come within the remit of Public Transport and those that are already involved in other areas of the country are in the process of withdrawing services because of the hugely onerous task of dealing with governance and compliance issues.

Leitrim Volunteer Centres are also finding this to be a massive responsibility because we are not a transport organisation, and our role is to provide Volunteers to the various schemes around the county as opposed to running them.

If the TFI/Local link were willing to take on the running of the service, we would be more than willing to provide the Volunteers. However, we were informed that this was not an option and that the TFI/Local Link already provide a flexible door to door service every Friday morning.
We met with local and national politicians who made genuine efforts on our behalf but unfortunately to no avail. We have followed through on their suggestions such as applying for a Social Economy Programme, however we do not qualify for this as there is a requirement that organisations be trading for at least three years, sadly we do not meet this criterion, the other issue with this programme is that it does not provide running costs which is what we really need. We have applied to the County Council for a Community Support Grant, and we have applied for a small grant to the HSE National Lottery Funds and are awaiting the results.

The effort that goes into applying for small grants is hugely time consuming and takes away from the running of the services. A guaranteed annual revenue stream is what we need to run the community car scheme. €20,000 a year is an absolute pittance compared to the amount of money lost on missed appointments.

While the local link provide very good services, they do not meet the needs of people who find it difficult to get to the bus stop and for the most part the schedule does not suit people who have medical appointments that do not fit in with the bus schedule.

In preparation of the Age Friendly Strategy for Leitrim 2022 - 2025, extensive consultation was carried out with older people in Leitrim and members of the Age Friendly Alliance identified and highlighted the need for transport that was safe, accessible and appropriate.

The need was highlighted for reliable transport services and infrastructure for the Active Age groups living in their own homes that would enable them to maintain their mobility, independence and connections as they get older so that older people in Co Leitrim can get where they want to go and when they want to go.

A sample of the feedback from older persons stated the following:
“Current transport services don’t suit hospital or medical appointments – no point in going to appointment by public transport and then to wait hours for a bus to bring me home”.

“I live in an isolated area where there is no public transport. I use a walking stick and have very bad balance which makes me quite nervous when alone out walking or at home.”

“Elderly people require bus services to attend appointments for health services, banks services, cinemas, leisure activities and day to day activities and shopping”

“Nobody realises how difficult it can be when you live in the country and not in a village. Not for shopping and stuff, there is the rural link which is fantastic. I can do all my shopping and the driver of the bus is very helpful. But can’t go to Dublin for appointments in the hospital.”

The Age Friendly Strategy is a requirement under, Age Friendly Ireland as part the World Health Organization's Age Friendly Cities and Communities Programme as a response to population ageing. The World Health Organization has identified eight key age friendly themes, one of which is Transportation.

On a positive note, the Leitrim Volunteer Centre will have the use of a new Corsa-e for its daily trips as part of a new community electric vehicle (EV) pilot rolled out by ESB and supported by Leitrim County Council.

The six-month pilot involves the installation of a new charge point at The Hive, Carrick-on-Shannon by Leitrim County Council with the infrastructure remaining in place after the programme is completed.

The aim of this 6-month project is to assess the needs and demands of community and rural EV-sharing initiatives, and to develop electric transport solutions to complement the plans recently set out in the revised Climate Action Plan.

For more information follow the link: https://volunteerleitrim.ie/communityev/

Article submitted by Josephine Stroker, Manager, Leitrim Volunteer Centre