Written evidence submitted by Living Streets (SRI0038)

Introduction

1. We are Living Streets, the UK charity for everyday walking. We want a nation where walking is the natural choice for local everyday journeys, free from congested roads and pollution, reducing the risk of preventable illnesses and social isolation and making walking the natural choice. We believe that a walking nation means progress for everyone. Our ambition is to get people of all generations to enjoy the benefits that this simple act brings and to ensure all our streets are fit for walking.

We have 56,361 supporters and 75 local groups.

Summary

2. Living Streets fully supports the response to this call for evidence by the Local Government Technical Advisers Group (LGTAG). Instead of reiterating their words, this response draws on new research by Living Streets[1] to suggest that the current and forthcoming road investment programme is not meeting current and future needs of its consumers – road users.

3. Local authority roads comprise 98% of the network and receive a fraction of roads spending. The Annual Local Authority Road Maintenance (ALARM) survey indicates local roads repair backlog tops £12 billion and would take a decade to complete. Similarly, a survey of 35,000 miles of footway England by GAIST in 2021 concludes that £1.69bn would be needed to address poor footway condition or preserve it in its current condition and prevent further deterioration. Against this backdrop, Living Streets’ forthcoming report on the causes, impact, scale and cost of pedestrian falls outdoors estimates that the poor condition of our pavements could be costing English taxpayers an additional £0.5bn a year in health and social care. This illustrates a clear and compelling need to bring existing carriageway and footway (for the benefit of all road users) into good condition ahead of building more new roads and creating more traffic.

Is the Government’s current and forthcoming roads investment programme is meeting the current and future needs of consumers and business?

4. No. People are fed up with the poor condition of their local roads and footways. It makes absolutely no sense to invest to build more roads and induce more traffic (increasing congestion, decreasing air quality etc.) when local authorities do not have adequate resources to maintain the existing highway network. New research by Living Streets highlights the hidden costs of personal injury claims, health and social care resulting from pedestrian falls – and why highway maintenance should be Government’s top priority.

5. Local authority roads comprise 98% of the network and receive a fraction of roads spending – £2.76bn (the combined total of potholes funding, Highways Maintenance Block (HMB) needs element, HMB incentive element and the Integrated Transport Block) for 2022-2025 in contrast to the £27.4bn for the strategic road network 2020-2025. The Annual Local Authority Road Maintenance (ALARM) survey indicates that local roads repair backlog tops £12 billion and would take a decade to complete[2].

6. In 2016, the Department for Transport endorsed a new code of practice ‘Well Managed Highway Infrastructure’ and required its adoption by local authorities. A key recommendation was that ‘a risk-based approach should be adopted for all aspects of highway maintenance, including setting levels of service, inspections, resilience, priorities and programmes’. Crucially, the Code allowed for the adoption of local levels of service (as opposed to national standards) based on local needs, priorities and affordability. A practical outcome of this risk-based approach is that high risk, high use footways are inspected more often and repaired more quickly. Conversely, low use, low risk footways are inspected less often and potentially repaired less urgently. With diminishing transport budgets, footway maintenance drops in priority

7. A comprehensive assessment of the nation’s footways carried in 2019 and again in 2021 by Gaist[3] on behalf of the Department of Transport. In 2019, a small but significant percentage of footways were found to be functionally or structurally impaired, presenting uneven surfaces and potential trip hazards for pedestrians. Two years later, analysis of images of 35,101 miles of footway in rural, semi-urban, urban and ultra-urban settings concluded that footway condition has continued to decline across all settings. Gaist estimate that the total cost to ‘of all maintenance operations that would need to be carried out to either address poor condition on a footway or to preserve the footway in its current condition and prevent further deterioration’ in England (excluding London) ranges from £1.649bn and £1.742bn with a mean estimate of £1.695bn.

8. As part of our project to study the extent and cost of pedestrian falls, Living Streets surveyed local authorities in England. Extrapolating the responses to our survey suggests that over two and a half million footway faults were reported in England in 2020. The survey asked about the number of reported falls and the number of personal injury claims resulting from pedestrian falls on a footway. Some local authorities only record the falls that result in personal injury claims. More than half of reported falls resulted in personal injury claims. Fewer than 20% of these claims were settled. We estimate that the cost of falls ranged from approximately £15.6 million in 2018 to £7.3 million in 2020 in England.

9. There could be as many as a million outdoor falls among older adults (65+) in England each year[4]. Local authorities aim for a ‘Section 58 defence’ to defend against claims by demonstrating that they have done all that was reasonably necessary to make the road safe for users. Nevertheless, healthcare costs (that are not factored into decisions about footway maintenance) may still be incurred by local NHS Trusts and local authorities in support of older injured residents. We reviewed hospital admissions data for pedestrian falls.

10. On average 30,000 people were admitted to hospital (involving an overnight stay) because of outdoor falls in England in 2018 and again in 2019. This fell significantly with Covid lockdown restrictions in 2020. The data did not include A&E presentations where the patient was sent home (e.g. with a sprained ankle) or outpatient attendance (from a GP referral) from falls injuries. The minimum cost of emergency (non-elective) short stay admissions in 2019 based on the unit cost of a Finished Consultant Episode was £22.7 million. The maximum potential cost of emergency admissions in 2019 was £98.7 million and the cost of elective admissions was £9.3 million.

11. As expected, admissions increase significantly with age of the population. The injury profile remains the same by sex until the age of 50. The most frequent injury resulting in hospital admissions is a fracture of the lower leg, including ankle. Over 54, the most frequent injury resulting in hospital admission for women is a fractured forearm and over 70 a fractured femur (hip) – linked to lower bone mineral density from menopause. For men over 50 the most frequent injury resulting in hospital admission is an open wound to the head followed closely by a fractured femur.

12. A 2013 study[5] explored the system-wide cost of falls treatment for older people in Torbay. Its findings suggest that savings made on the roads budget are offset by costs elsewhere in the local authority budget. It found that the cost of hospital, community and social care services for each patient who fell were almost four times as much in the 12 months after admission for a fall as the costs of the admission itself. Taking the Torbay results as a guide, a fourfold increase in hospital, community and social care services post admission brings the bill for health and social care costs for pedestrian falls in 2019 to an additional £394.8 million[1]. The startling conclusion is that pedestrian falls could be costing English taxpayers as much as £0.5bn a year.

13. Of course, if all pavements were well maintained some falls would still happen. However, the case for bringing up and keeping footways in good condition at a total cost of £1.695bn is substantially strengthened by reductions in health and social care costs of up to £0.5bn a year.

February 2023

Endnotes