Journal of Physics: Complexity · 2025, Vol 6, 025017

The geography of inequalities in access to healthcare across England: the role of bus travel time variability

Zihao Chen & Federico Botta

“How reliable is your bus to hospital?” — It depends on where you live.

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The Core Concept

What is Travel Time Variability?

Most studies of healthcare access focus on the average travel time. This paper asks a different question: how much does your journey time change throughout the day? This variation — called Travel Time Variability (TTV) — is measured as the standard deviation of travel times calculated at nine hourly departure points from 09:00 to 17:00.

Urban area

Bus to nearest hospital — times across the day

TTV ≈ 3.3 min (SD)

Journey times tend to be higher during morning and afternoon rush hours, with a quieter midday period. Still far more predictable than rural routes. Shape is illustrative; SD from paper data.

Rural area

Bus to nearest hospital — times across the day

TTV ≈ 9.6 min (SD)

Sparse, irregular services create huge swings in journey time. A missed bus might mean a 40-minute wait for the next one. Shape is illustrative; SD from paper data.

Why does this matter? A high TTV means your bus journey time is unpredictable — difficult to plan appointments around. For someone managing a chronic condition who needs regular hospital visits, this uncertainty compounds existing disadvantage. Unlike average travel time, TTV captures the lived experience of public transport.

The Scale of the Study

England-wide analysis

Travel times were calculated by querying real public transport timetables using OpenTripPlanner, covering every Lower layer Super Output Area (LSOA) in England.

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LSOAs (small areas)
analysed across England

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222
+ 6,308

Hospitals + GP surgeries
as destinations

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Areas that cannot reach
their nearest hospital by bus in 2h

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Departure times measured
(09:00 – 17:00 hourly)

The Urban–Rural Divide

Rural areas face far greater unpredictability

Mean TTV was computed for urban and rural LSOAs separately, revealing stark differences in service reliability. The gap is even more pronounced for GP access than for hospitals.

Hospital access — mean TTV (min)

Urban

3.29 min

Rural

9.57 min

0 min 5 min 9.6 min

GP access — mean TTV (min)

Urban

0.76 min

Rural

5.80 min

0 min 3 min 5.8 min

Urban LSOAs

Rural LSOAs

Rural areas face nearly 3× higher TTV when travelling to hospital (9.57 vs 3.29 min), and a striking 7.6× higher TTV for GP access (5.80 vs 0.76 min). The correlation between mean TTV and mean travel time is r = 0.76 for hospitals and r = 0.90 for GPs, suggesting areas with long journeys also suffer the most unpredictability. These patterns were stable across three different dates tested (pairwise correlations all > 0.87).

Deprivation + Unreliability

A double burden for the most vulnerable

The paper classifies LSOAs into four quadrants based on whether they fall in the top 30% for TTV and/or for deprivation (Index of Multiple Deprivation). Click a quadrant or its description to explore.

High TTV + High Deprivation Most urgent

These areas face a double burden: long, unpredictable bus journeys AND high socioeconomic disadvantage. Residents are less able to afford alternatives (taxis, cars) and more likely to rely on NHS services. Concentrated in the North of England, these areas represent the most pressing policy concern.

High TTV + Low Deprivation Often rural

Typically rural areas where buses are infrequent because demand is low. While residents here may have lower socioeconomic deprivation on average, they still face unpredictable access — and may be more car-dependent, leaving older or non-driving residents particularly exposed.

Low TTV + High Deprivation City centres

Deprived urban neighbourhoods that benefit from frequent, consistent bus services. City centres often have high deprivation alongside good transport links. Access is reliable even if other dimensions of disadvantage persist.

Low TTV + Low Deprivation Doing well

The ideal scenario: reliable bus access and lower overall deprivation. Policy recommendation: maintain current service levels and monitor. Nottingham stands out here — it has arguably the best bus service outside London, with an extensive low-TTV cluster across the city.

Notable Findings

What the map reveals

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Nottingham

Arguably the best bus service outside London — almost the entire city shows low-TTV clusters for both hospital and GP access. An extensive, well-integrated network keeps journey times consistent throughout the day.

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London’s commuter belt

Areas just outside Greater London show high-high TTV clusters (high TTV, high deprivation). Good rail links into the capital mask poor local bus connections. Four inner London boroughs — Hackney, Hammersmith & Fulham, Kensington & Chelsea, and Camden — show the highest GP TTV inequality (Gini coefficient).

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52 vs 708

708

Just 52 areas cannot reach their nearest GP by bus within two hours. For hospitals, that number leaps to 708. This reflects the more dispersed geography of hospital provision and the critical importance of reliable bus services for specialist care.

Citation

Full paper & data

Zihao Chen and Federico Botta (2025).
"The geography of inequalities in access to healthcare across England: the role of bus travel time variability."
Journal of Physics: Complexity, Vol 6, 025017.
DOI: 10.1088/2632-072X/ade587

Full paper → Data on Zenodo →

Data underlying this study is openly available via Zenodo: https://doi.org/10.5281/zenodo.15459184
Published open access under CC BY 4.0.