Community Transport

Discrepancies in health outcomes between rural and urban populations are well documented in broad health categories but less clear in relation to cancer care and outcomes. Those living in a rural or remote area are faced not only with the trauma of the diagnosis but may also need to have treatment at a specialist metropolitan centre, entailing relocation for at least some of the treatment time. This study was conducted in three phases to examine and clarify the issues of concern to patients from rural and remote areas undergoing cancer treatment in a metropolitan setting. Secondary data analysis of cancer registry and government reports showed that the incidence of cancer was 4% lower for rural residents compared with metropolitan residents. A significant survival advantage was demonstrated for urban residents in 10 types of cancer. There were differences in the prevalence of some risk factors that appeared to favour the rural population, with rural residents indicating a higher participation in Pap smear screening and greater use of precautions against sun damage. A focused literature review was conducted to investigate research on rural and remote patients receiving cancer treatment in the metropolitan setting. This identified potential issues related to rural residents with cancer including: the need for travel; psychosocial concerns; information and communication; financial costs; and accommodation while away from home. Overall the research in the Australian setting was limited in number and mostly conducted with disease specific groups. In the third phase, a survey of 96 patients from rural and remote areas undergoing cancer treatment in the metropolitan setting showed that participants were satisfied with their treatment but there appeared to be a tendency to understate problems related to treatment. This study identified that for many participants, attending for treatment without their partner or spouse was inconceivable and the lack of routine financial support for this was problematic. In relation to health care, participants being treated in the private sector were less likely to see a dietician or a social worker. Barriers were also seen in the lack of coordination of treatment, lack of reimbursement for psychosocial support, inadequate information provision and lack of appropriate practical support in accommodation and transport. Interviews with health care professionals complemented these findings and showed support for strategies to improve psychosocial support. iii This study showed that the lack of financial support for a companion during treatment was an important contributory factor affecting satisfaction with care. To ensure an equitable and acceptable degree of quality of care, financial support should be routinely provided to enable rural residents to be accompanied by a support person when travelling to access cancer treatment. Investigation of the process of treatment itself is also needed to ensure that all the supports designed to ensure access for rural residents are appropriate and suited to their needs.

Novel approaches to service bundling in the passenger transportation market are enabled by technology driven innovations and give rise to so called "Mobility as a Service" (MaaS) concepts. These approaches promise to increase service quality of existing public transportation, decrease car ownership, reduce private vehicle miles and lower the environmental burden of the transportation system. However, the potential effects of service bundles in the passenger transportation market are still largely unclear. In a competitive market, the potential success of transportation service bundles follows consumer valuation of the bundles as compared to valuation of stand-alone services. Thus, the difference between the bundle and sum-of-parts willingness to pay (WTP) is an indicator of service integration valuation, which effects the competitiveness of the service bundles. In this study, several discrete choice experiments were conducted to indirectly estimate consumers' WTP and service integration valuation. The results indicate that public transportation, car-sharing, and park and ride services are valuated significantly higher when offered in a bundle instead of as a stand-alone service. Bicycle-sharing, electrical bicycle (e-bike) sharing and taxi services are valuated lower. Potential consumers also exhibit a high WTP for a smartphone application that integrates the services and manages ticketing and payment. Consequently, pure bundles for all transportation modes may not the

Mobility as a Service (MaaS) is seen as a transition from mobility being satisfied by a dominant car ownership model to a service model where mobility needs are met by a multimodal suite of services. The research environment of MaaS is heavily driven by the younger generation's travel behaviour which appears to be less dominated by car ownership (following the peak car literature) and by their interest in all things technological, particularly their smart phones. However, this paper is looking at a different but very specific segment of the population in Australia that have their accessibility provided by Community Transport (CT), focusing specifically on New South Wales (NSW) and Queensland (QLD). Arguably, this population segment is the complete antithesis of the younger generation in terms of chasing technological change but in other ways, for example, a lack of access to private cars, shows some similarities. This paper is motivated by likely changes in funding for CT providers. Currently CT providers receive a supply side subsidy but there are plans to introduce funding to be placed directly with clients, in the form of person centred funding (PCF). Clients will then have a single budget to purchase mobility along with other services they require. The paper investigates the mobility services which comprise bundles that CT clients would be willing to pay in the new era of PCF. Five participating CT providers from a cross section of operating areas recruited clients to take part in a stated choice experiment, processed by a computer assisted personal interview (CAPI). Advanced choice models are used to develop models using the behavioural data collected by the CAPI and estimates of a CT client's 2 willingness to pay (WTP) for the MaaS bundle are presented. WTP provides a ceiling for pricing the elements within a MaaS bundle which is an important part of the CT providers' future strategy. The WTP estimates were much smaller than the CT providers' unit costs of providing the service. This poses a challenge for CT providers in the creation of mobiltiy bundles which cover costs, suggesting that the possible transition to PCF using MaaS bundles will not be an easy process and will require significant education as to the cost of provision. The paper concludes with some suggestions as to how CT providers could make the transition to PCF building on the evidence of this research.

Mobility as a Service (MaaS) is seen as a transition from mobility being satisfied by a dominant car ownership model to a service model where mobility needs are met by a multimodal suite of services. The research environment of MaaS is heavily driven by the younger generation's travel behaviour which appears to be less dominated by car ownership (following the peak car literature) and by their interest in all things technological, particularly their smart phones. However, this paper is looking at a different but very specific segment of the population in Australia that have their accessibility provided by Community Transport (CT), focusing specifically on New South Wales (NSW) and Queensland (QLD). Arguably, this population segment is the complete antithesis of the younger generation in terms of chasing technological change but in other ways, for example, a lack of access to private cars, shows some similarities. This paper is motivated by likely changes in funding for CT providers. Currently CT providers receive a supply side subsidy but there are plans to introduce funding to be placed directly with clients, in the form of person centred funding (PCF). Clients will then have a single budget to purchase mobility along with other services they require. The paper investigates the mobility services which comprise bundles that CT clients would be willing to pay in the new era of PCF. Five participating CT providers from a cross section of operating areas recruited clients to take part in a stated choice experiment, processed by a computer assisted personal interview (CAPI). Advanced choice models are used to develop models using the behavioural data collected by the CAPI and estimates of a CT client's 2 willingness to pay (WTP) for the MaaS bundle are presented. WTP provides a ceiling for pricing the elements within a MaaS bundle which is an important part of the CT providers' future strategy. The WTP estimates were much smaller than the CT providers' unit costs of providing the service. This poses a challenge for CT providers in the creation of mobiltiy bundles which cover costs, suggesting that the possible transition to PCF using MaaS bundles will not be an easy process and will require significant education as to the cost of provision. The paper concludes with some suggestions as to how CT providers could make the transition to PCF building on the evidence of this research.

The growth of ridesharing and other "new mobility services (NMS)" poses challenges for traditional public transport operators because they create an environment where consumers can demand an "integrated mobility" from different transport modes and improved accessibility (information, booking, payment systems etc). More recently the discussion about how to deliver "integrated mobility" has led to the emerging "Mobility as a Service (MaaS)" concept. MaaS is variously defined but the essential idea is to see transport or mobility not as a physical asset to purchase (e.g. a car) but as a single service available on demand and incorporating all transport services from cars to buses to rail and on-demand services. The paper's principal consideration is on how MaaS is relevant to public transport. The idea of how MaaS might be used in the Community Transport (CT) sector provides a casestudy. The CT sector is unusual in providing mobility for a user group which typically does not see mobility as a physical asset to purchase. Following a review of relevant literature, the paper describes the outcome of a study with five Australian CT operators. A semistructured conversation followed by a discussion type meeting brought CEOs together to explore the concept of mobility as a service and the types of package that might be offered. Findings indicate a strong enthusiasm amongst CT operators for offering packages of mobility services to their current users and to investigate delivery of packages to nonusers/new users.

Digital technology is seen as a panacea to meeting the financial and operational challenges faced by voluntary and community sector organisations (VCSOs), through delivering efficiencies and cost-saving, alongside improving quality of service. However, according to recent assessments in the UK, the rate of digital adoption is slow compared with other sectors. This article identifies how a VCSO in a period of austerity prioritises its social mission over functionality and efficiency gains from digital technology. Employing the heuristic of phronesis, we argue that VCSOs seeking to implement digital innovations need to strike a balance between instrumental rationality (that is, what is possible to achieve with technology) and value rationality (that is, what is desirable to pursue by VCSOs). Our key argument is that theories of value rationality provide a new explanation for the slow adoption of digital technology among VCSOs.

We thank the participants in this project-the patients, carers and staff in hospitals, support services, primary health care and aged care settings throughout South Australia-who have generously contributed their insights and experiences. The research team is also grateful to our industry partners, and to members of the Project Management Group, which has functioned as a true sounding board for our emerging ideas and as a dynamic source of advice about the 'two worlds' we have explored.

The starting point for this project was the proposition that safe and sufficient transport should be accessible to everyone, and that a lack of safety can be a consequence of insufficient or inadequate transport. The study themes and approach were informed by a series of forums held in 2005, 2006 and 2007, involving representatives of Aboriginal organisations and officers of government agencies. Consultations with focus groups and personal interviews were conducted, and case studies recorded, in several Aboriginal communities (Adelaide and the far west coast region of South Australia). Literature reviews were conducted in the areas of driver licensing, seatbelt and restraint use, and the transport issues related to Aboriginal health and disability. The availability of safe and sufficient transport has diverse implications for safety, health and welfare. Recommendations were made in relation to improving driver licensing, seatbelt and restraint use, provision of public transport and programs to address the problems of drink driving and driving while affected by drugs.

The starting point for this project was the proposition that safe and sufficient transport should be accessible to everyone, and that a lack of safety can be a consequence of insufficient or inadequate transport. The study themes and approach were informed by a series of forums held in 2005, 2006 and 2007, involving representatives of Aboriginal organisations and officers of government agencies. Consultations with focus groups and personal interviews were conducted, and case studies recorded, in several Aboriginal communities (Adelaide and the far west coast region of South Australia). Literature reviews were conducted in the areas of driver licensing, seatbelt and restraint use, and the transport issues related to Aboriginal health and disability. The availability of safe and sufficient transport has diverse implications for safety, health and welfare. Recommendations were made in relation to improving driver licensing, seatbelt and restraint use, provision of public transport and programs to address the problems of drink driving and driving while affected by drugs.

Flexible Transport Services is an emerging term in passenger transport which covers a range of mobility offers including Demand Responsive Transport, where services are flexible in one or more of the dimensions of route, vehicle allocation, vehicle operator, type of payment and passenger category. Although flexible transport services are used increasingly in Europe and the US as part of the public transport mix in areas where demand is too low to support conventional public transport, there are few sustained examples of these services in Australia. Through a series of semi-structured interviews with key stakeholders in NSW including service providers, peak organisations, users, regulators and policy-makers, the paper identifies barriers to greater use of flexible transport services in NSW. Barriers include institutional frameworks such as policy and regulation; economic issues of funding and fares; operational issues of fleet and vehicles; as well as operator and community attitudes; and information and education. The paper makes recommendations to enable and encourage greater use of flexible transport services by transport service planners and providers.

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