Just how far the volunteer drivers of Wokingham Borough go.

Transcription

1 Just how far the volunteer drivers of Wokingham Borough go. The value of voluntary transport January 2015 ] Healthwatch Wokingham Borough 2015 Page: 1 of 17

2 Table of Contents 1. Executive Summary Acknowledgements Patient Transport Overview & Background The current provision The Healthcare Travel Costs Scheme (HTCS) Wokingham Borough Bus Pass Scheme Wokingham Borough Funding GPs Healthwatch Commentary Summary Information and research sources Background Numbers Transport Providers Volunteer Drivers Other Transport Providers Journeys to the RBH Main providers of NHS care to Wokingham Clinical Commissioning Group 2011/ Outpatients Appointments and : RBH total from all areas Wokingham CCG; total medical episodes Attendances at Hospital for 2010: Wokingham CCG Analysis of patient transport to RBH for Wokingham CCG Visits made by Wokingham Transport Forum members Total number of journeys where WBC have contributed to the cost Southern Counties Ambulance Service (SCAS) Overall patient transport activity by SCAS for 12 months: Analysis of SCAS journeys for Wokingham Clinical commissioning Group Background Information Healthwatch Wokingham Borough Wokingham Clinical Commissioning Group Feedback Form Healthwatch Wokingham Borough 2015 Page: 2 of 17

3 1. Executive Summary Healthwatch Wokingham Borough is one of 148 local Healthwatch organisations that were established throughout England in 2013, under the provisions of the Health and Social Care Act The dual role of local Healthwatch is to champion the rights of users of health and social care services and to hold the system to account for how well it engages with the public. This document seeks to quantify the value that the voluntary transport providers bring to Wokingham Borough citizens, and suggest ways on how to support their activities and the strong volunteering ethics that underpin many of them. We believe that this is the first attempt to bring together this information in one place to permit analysis and comment by stakeholders. There is a multiplicity of service providers and volunteers who all play a role in transporting patients to and from hospitals, clinics and other health units (NHS and private) Providers include: voluntary organisations providing transport in private cars, minibus and other vehicles. taxi services ambulance services who transport patients Readibus and Keep Mobile The Wokingham Transport Forum has recently been set up to develop co-ordination between all the volunteer transport groups for the benefit of all users of their services. Healthwatch Wokingham Borough acknowledges the value of separate organisations but would encourage joint working in order to achieve greater efficiencies and a better customer experience. This does not have to detract from local involvement and volunteer choice. The volunteer drivers give up their time for a whole raft of reasons but mainly to take time to really help Wokingham residents on an individual basis. A system that ultimately takes account of local residents needs and make best use of volunteer time and skills would be beneficial. From initial research, Healthwatch Wokingham Borough has identified the following: 170,000 patient visits from the borough to Royal Berkshire Hospital annually 130,000 visitors make their own way 24,000 A & E emergency admissions 16,000 visits are assisted non A & E o 3500 (22%) of these are made by volunteers from the Wokingham Transport Forum o 350 volunteer drivers and 80 support staff deliver these journeys o A further 16,100 journeys, which are social and medical are delivered by Wokingham Transport Forum volunteers to other locations o We estimate an additional 500+ journeys may also be made by other providers Some of these journeys will be in mini buses with multiple passengers. Therefore the number of patients transported will be higher than the journey numbers Even without full commercial evidence, it appears to Healthwatch that the Wokingham Transport Forum volunteers contribute a significant cost saving over other transport providers. And this financial benefit must flow through to other activities that Wokingham Borough residents receive. Therefore further benefits, both financial and social could be achieved by expanding the volunteer driver community and in developing support systems to maximize their efforts and goodwill. Healthwatch Wokingham Borough 2015 Page: 3 of 17

4 2. Acknowledgements Healthwatch Wokingham Borough thanks all the members of the Transport Forum for providing information and corrections to this report. And for their support All the Research was conducted by Roger Kemp, Healthwatch Volunteer 3. Patient Transport Overview & Background Non-emergency transport to and from hospital has probably never been a top priority for many hospital trust boards. The patient transport service can be only around 1% of hospital budgets and may be a major source of complaints by patients not arriving for appointments on time or being discharged unexpectedly. A recent survey looking at patient transport services in Yorkshire showed that response times were by far the most common reason for complaints, generating more than half the complaints about the ambulance service, with some patients arriving more than 90 minutes before their appointment time or an hour late. In many areas these services are subject to competitiveness tendering and moving from NHS ambulance services to private transport companies. While the number of patients entitled to transport may be low as a percentage, they will often be frequent users of hospital services; many with severe health problems. The voluntary sector provides a high quality service for patients, who are often elderly or disabled and do not want to have long waits to get home after treatment or appointments. Late arrivals at clinics can have knock-on effects on the whole hospital, with outpatient clinics forced to run late, potentially affecting clinicians other commitments later in the day. Shinfield Voluntary Car Service told Healthwatch there are difficulties in recruitment for Voluntary Car Services Wokingham Borough, so any expansion proposals would require careful strategy. We also consider it unreasonable that volunteers should be expected to provide core services. A poor experience with patient transport can also affect patient s opinion of their whole hospital visit. Patient choice is becoming more important and this can affect the reputation of the hospital and lead to lost income. 4. The current provision 4.1. The Healthcare Travel Costs Scheme (HTCS) A small percentage of patients are entitled to free transport to and from hospital and hospital trusts will all have hospital transport schemes which are usually run in conjunction with their ambulance provider To qualify for help with travel costs under the HTCS, patients must meet three conditions: 1. At the time of their appointment, the patient or partner (including civil partners) must be receiving one of the qualifying benefits or allowances, or meet the eligibility criteria of the NHS Low Income Scheme. 2. The journey must be made to receive NHS funded non-primary medical or non-primary dental care services, to which they have been referred to by a GP, dentist or hospital consultant. 3 Referrals made by a primary practitioner such as a GP or dentist must be provided on a different day and in premises other than those occupied by the practitioner who made the referral. Healthwatch Wokingham Borough 2015 Page: 4 of 17

5 The qualifying benefits and allowances are: Income Support Income-based Jobseeker s Allowance Income-related Employment and Support Allowance Pension Credit Guarantee Credit, or NHS tax credit exemption certificate Awarded Universal Credit 4.2. Wokingham Borough Bus Pass Scheme Wokingham Borough Council operates a bus pass scheme which is open to all retired residents enabling free use of buses during off peak times. It can also be used to claim free transport for medical journeys offered by a number of organisations. This is an important contributor to the finances of these organisations. The bus pass scheme is nationwide and is ultimately funded by the government. It is intended to assist retired people with travel expenses, and improve the quality of life of the elderly Wokingham Borough Funding Wokingham Borough Council are funding some of the journeys made by volunteer schemes. Some organisations have a charging system and are not reliant on the Council in anyway. Wokingham Borough contributes towards the cost of 5 voluntary providers and has separate financial arrangements with each organisation which are commercially confidential. The saving made to the community is difficult to quantify but is substantial. Wokingham Borough provided funding for 7237 journeys last year GPs GPs do not have a responsibility for patient transport. They can request emergency transport for admissions to hospital, but do not have a formal budget for transport for non-urgent attendances. Some surgeries have an emergency fund which can be accessed for the needy. Trust hospitals have transport departments and will arrange transport for qualifying patients. GP surgeries are aware of the local voluntary organisations and will refer patients to local services. The majority of patients will make their own way to hospital. 5. Healthwatch Commentary Some of the areas to be considered are below. South Central Ambulance Service (SCAS) plays a major role in patient transport providing the emergency ambulance service and transporting non urgent patients for in stay and outpatient appointments. There is no regular dialogue between the voluntary groups and SCAS who would probably like to work closer with the voluntary sector. Some voluntary car schemes do not consider it practicable to offer support to the Ambulance Service. Changes in use of hospital resources to use 24/7 will put a strain on ambulance and voluntary transport services and it may be beneficial to examine proposed changes in detail to see what impact they will have on transport services. Establishing a liaison group which can consider the interests of all parties. Voluntary schemes need financial support: if this is not forthcoming they will have to charge an economic rate. The bus pass payments from WBC are necessary for some organisations, who would find it difficult to continue without the subsidy. Healthwatch Wokingham Borough 2015 Page: 5 of 17

6 Each of the voluntary sector transport organisations are independent charities and as such, the first requirement placed on them is by charity law and the Charity Commission is to manage the charity properly. The recent establishment of the Transport Forum shows good will to co-operate. However there do appear to be genuine concerns about sharing what is commercially sensitive financial data without having any control over where it may go when it left the Forum. GPs do not play a significant role in arranging patient transport and should GP s and hospital staff consider transport options when arranging appointments? The inevitable coming together of social services and health will offer challenges in need and budgets. There does not seem to be one body that plans and budgets for patient transport and consider the most cost efficient methods and what is best for the patient. Efficient patient transport improves the flow of patients at the hospital helping to reduce the number of missed appointments and reducing bed blocking. The voluntary sector offers a high level of service with excellent patient feedback and gives particularly the elderly a sense of security. Volunteer groups report that car parking for volunteers is an issue and can discourage drivers from volunteering, so any measures which can make visiting the larger hospitals an easy experience for volunteer drivers would be worthy of consideration. Healthwatch Wokingham Borough have been instrumental in bringing to the attention of the Estates Director the value in providing a designated car parking space at the Royal Berkshire Hospital for volunteers. The volunteer sector plays a significant role in the transporting of Renal and Cancer patients who need regular transport to clinics. There may be a way in which the Clinical Commissioning Group (CCG) could fund volunteer organisations with extra money based on a commitment to transport patients who may have to make 3-6 trips each week, and also have to spend a significant amount of time having treatment. It is likely that hospital staff are not aware of the various means of transporting patients so some form of publicity giving details of transport schemes may be worthy of consideration. It may be worthwhile undertaking a cost analysis of ambulance transport against volunteer transport, which may lead to allocating some of the patient transport budget to the voluntary sector against a commitment to transport patients. There are potential contractual issues which would need to be resolved so that the burden is not too high for the voluntary sector to accept. SCAS operate with a mix of paid and volunteers and it may be something which the voluntary sector could consider. There may be a case for considering social exclusions issues and eligibility in detail. Should patient transport be available to visit doctor s, dentist etc.? This happens in some instances. The report has not investigated the role of taxis in patient transport and this may be worthy of further consideration. Is there a case for an additional payment for anti-social time journeys? Is it possible to tailor some bus services so that they stop outside the hospital, and extend the time the bus pass is free for patients. Does the hospital booking department consider transport when arranging appointments, and could they arrange appointments which suit vulnerable patients who need transport more effectively. Healthwatch Wokingham Borough 2015 Page: 6 of 17

7 6. Summary Healthwatch Wokingham Borough believes that those funders of 19,600 volunteer trips should investigate how to expand this capability by: Funding and encouraging more volunteers co-ordinating the availability of volunteer drivers to maximise service and increase cost savings producing the one stop point of information for transport for use by providers and consumers transport sign posting/brokerage service to identify the best transport provider for a particular client or need sponsoring of recruitment Healthwatch is aware that the suggestion to centralize the management, co-ordination and scheduling of drivers is a contentious one. One of the great advantages of individual transport schemes is that they are focused on the needs of their local communities. Also, drivers, bookings officers and other team members all draw upon extensive in-depth local knowledge to maximise the effective running of the service. But even something like a coordinated signposting system could ensure that these resources are maximised This report is only a first step in considering better joint working and improved patient outcomes 7. Information and research sources The report was conducted by a combination of desk research, telephone contact and visits to stakeholders and service providers. 8. Background Numbers The following tables give a range of back ground data on the provision of patient transport and also there is also data on the total number of patients dealt with at local hospitals Transport Providers Eddie Brown, Sandy Smith Table 3: Transport services in Wokingham Borough shinvol@googl .com SHINFIELD VOLUNTARY pretx@btinternet.com CAR SERVICE Elaine Spratling, Mary Blusin EARLEY VOLUNTEER DRIVERS BUREAU elain2spratling@aol.com Mark Parker, Sally Gibson KEEP MOBILE sally@keepmobile.org.uk Peter Absolon READIBUS PeterAbsolon@readibus.co.uk Martin Smith, Katy Satchwill Christine Knox, Elizabeth Summers, Phil Evans TWYFORD/WARGRAVE AND DISTRICT VOLUNTEER CENTRE twadvc@yahoo.co.uk WOKINGHAM VOLUNTEER CENTRE wok-vol@btconnect.com; pje.roebuck@btinternet.com; wok-voladmin@btconnect.com Healthwatch Wokingham Borough 2015 Page: 7 of 17

8 Karen Todd WOODLEY VOLUNTEER CENTRE o.uk; David Hobbs Brian Hoare Sue Hester CROWTHORNE COMMUNITY MINIBUS EARLEYBUS CROWTHORNE GOOD NEIGHBOURS Antony Sharma McLachlan, Bob Sutcliffe SOUTH CENTRAL AMBULANCE SERVICE (SCAS) Source: Wokingham Transport Forum Members 8.2. Volunteer Drivers Table 4: Volunteer Driver Schemes Crowthorne Good Neighbours Mon to Fri 10am 12pm 55 7 Shinfield Voluntary Car Service 7 days per week 9.30am 12.30pm 14 8 Mon/Wed/Fri South Central Ambulance Service 7 days per week 8am - 8pm 2 55 paid drivers Readibus 7 days per week paid staff Woodley Volunteer Centre Mon to Fri 10am 12pm standby Earley Volunteer Drivers Bureau Mon to Fri 9.30am 12.15pm Keep Mobile Mon to Fri 22 paid, 10 vol person assistants Twyford/ Wargrave & District Volunteer Centre Mon to Fri 9.30am 12pm Wokingham Volunteer Centre Car Service Mon to Fri 9.30am 12.30pm standby Earlybus Mon to Fri 9.30am 5pm variable 6 9 Healthwatch Wokingham Borough 2015 Page: 8 of 17

9 Table 5: Summary of transport services in Wokingham Borough No of Volunteer Volunteer office support Total no of patient and organisations drivers staff social journeys Total Source: Wokingham Transport Forum 8.3. Other Transport Providers The British Red Cross can provide transport support for medical appointments and essential daily needs, normally asking for a contribution towards the costs, but no one will be refused a service because they cannot pay. The Royal Voluntary Service can help older people maintain their independence and stay involved in the local community, and has volunteers across Berkshire who offer help and support so older people can stay independent at home in Reading, Wokingham, Ascot, Maidenhead, Windsor, Slough, Bracknell, Newbury, Thatcham and the surrounding areas 8.4. Journeys to the RBH The following table shows the number of journeys undertaken by the voluntary sector compared with other methods of getting to and from hospital. Table 6: Analysis of patient transport for Wokingham Clinical to RBH Wokingham Clinical Commissioning Group No of assisted % of patient journeys total A&E Emergency ambulance transits by SCAS % of assisted non urgent journeys Non-emergency admissions arranged by NHS transport schemes Journeys completed by voluntary organisations for outpatients, day procedures and for extended hospitals stays Self-journeys Estimate of journeys completed by other providers and other ambulance services less 8 Total Source: Estimate by Healthwatch from statistics provided by participating organisations Main providers of NHS care to Wokingham Clinical Commissioning Group Table 7: Main providers of NHS care to Wokingham Clinical Commissioning Group Provider No of admissions (%) % Royal Berkshire Frimley Hospital Healthwatch Wokingham Borough 2015 Page: 9 of 17

10 Oxford University Hospitals Basingstoke & North Hants 189 Less than 1% Other Total Source: NHS Wokingham CCG Commission Plan presented to Health & Wellbeing Board The major provider of hospital services in Wokingham is the Royal Berkshire Hospital Trust based in Reading and Bracknell. Outpatients are the main category of patients served by the voluntary sector. Most voluntary schemes cannot respond to emergencies, but can deal with day operations where the volunteer driver will deposit the patient and collect at an agreed pick up time later in the day. Discharges after a prolonged stay are not generally handled by volunteers 8.6. Outpatients Appointments and : RBH total from all areas Table 8: Outpatients Appointments and : Royal Berkshire Hospital : total for all areas Total appointments 543, ,164 Males 234,260 44,468 Females 309,675 60,460 Attendances 506, ,627 Males 216,290 40,757 Females 290,337 56,520 Did not attends 37,301 47,415 Males 17,964 3,701 Females 19,335 3,910 Patient cancellations * 55,530 Males * - Females * - Hospital cancellations * 12,254 Males * - Females * - Unknown - 3,338 Males - 10 Females Source: Hospital Episode Statistics (HES) - 30 The information above covers the whole of the area covered by the RBH. In there were 568,164 outpatient appointments in , compared to 543,952 in , representing an increase of 24,212 from the previous year. Healthwatch Wokingham Borough 2015 Page: 10 of 17

11 8.7. Wokingham CCG; total medical episodes Table 9: Wokingham Clinical Commissioning Group; Total medical episodes Wokingham Clinical Commissioning Group: Medical episodes Total , , ,305 Source: Wokingham Clinical Commissioning Group 8.8. Attendances at Hospital for 2010: Wokingham CCG Table 11: Outpatients attendance by age at RBH from Wokingham CCG Outpatient Attendances by age group (%) RBH % who attended % who did not attend Source: HES Statistics Healthwatch Wokingham Borough 2015 Page: 11 of 17

12 8.9. Analysis of patient transport to RBH for Wokingham CCG Table 12: Analysis of patient transport for Wokingham Clinical to RBH Wokingham Clinical Commissioning Group No of assisted patient journeys % of total % of assisted non urgent journeys A & E Emergency ambulance transits by SCAS Non-emergency admissions arranged by NHS transport schemes Journeys completed by voluntary organisations for outpatients, day procedures and for extended hospitals stays Self-journeys Estimate of journeys completed by other providers and other ambulance services less 8 Total Source: Estimate by Healthwatch from statistics provided by participating organisations 2014 This table shows that the voluntary sector plays a significant role in patient transport. Whilst the overall percentage is only 2%, when self-transport is taken out, then volunteer transport accounts for 22% of assisted journeys Visits made by Wokingham Transport Forum members The main transport providers who belong to the Transport Forum have provided the following information on transport journeys which include medical and social journeys. Table 13: Total no of visits to hospitals clinics etc. Summary of Patient Transport Wokingham Borough Transport Organisation Period covered Total Patient trips to medical establishments Patient trips to RBH Patient trips to other medical establishments including GP practices Social and other trips Total of all trips Shinfield Voluntary Car Service 12 mos May Earley Volunteer 2013-Apr Drivers Bureau Keep Mobile Readibus Healthwatch Wokingham Borough 2015 Page: 12 of 17

13 Twyford/Wargrave & District Volunteer Centre Wokingham Volunteer Centre Woodley Volunteer Centre 12 mos to Apr 13- Mar May 2013-Apr Earleybus O Crowthorne Good Neighbours Total Source : Healthwatch Survey Total number of journeys where WBC have contributed to the cost Table 14: Total number of journeys where WBC have contributed to the cost RBH Other hospitals Medical/surgeries Dentist/physio/chiropractor Shopping Other Total number of trips Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total number of journeys where WBC contribute to the cost Source: Wokingham Transport Forum Members The information above was provided by Wokingham Borough Council and does not identify the providers or show financial information which is commercially sensitive so the providers are not identified. The voluntary sector provides a significant % of journeys to hospital outpatients and day treatments which we calculate to be 22% of the total when self-transport and A&E journeys are taken out of the figures. In addition the voluntary sector undertakes a large number of journeys to GP s dentists and other clinics and it is difficult to calculate a total for all these activities Healthwatch Wokingham Borough 2015 Page: 13 of 17

14 8.12. Southern Counties Ambulance Service (SCAS) South Central Ambulance Service NHS Foundation Trust (SCAS) is part of the National Health Service. It was established on the 1 July 2006 following the merger of four ambulance trusts in the counties of Berkshire, Buckinghamshire, Hampshire and Oxfordshire. This area covers approximately 3,554 sq. miles with a residential population of over four million. On 1 March 2012, it became a foundation trust. Its emergency operations centers handle around 500,000 emergency and urgent calls each year. The emergency operations centers handle around 500,000 emergency and urgent calls each year. SCAS also provide non urgent patient transport using special ambulance which can carry several patients, volunteer drivers using their own cars and a small number of paid drivers using SCAS cars. The following table gives the patient transport activity of Southern Counties Ambulance Service for a number of CCG s. SCAS is the principle provider of ambulance service to the Wokingham Clinical Commissioning Group. There will be a small amount of journeys provided by private ambulance services, but this is a very small number compared with journeys provided by SCAS Overall patient transport activity by SCAS for 12 months: Table 15: Overall patient transport activity by SCAS for 12 months: Overall patient transport activity by CCG and month ( ) Patient Practice CCG Grand Total Avg Activity per month NHS Bracknell And Ascot CCG NHS Slough CCG Nhs Windsor, Ascot And Maidenhead CCG Nhs Newbury And District CCG Nhs North & West Reading CCG Nhs South Reading CCG Nhs Wokingham CCG Grand Total Escorted journeys by CCG and month ( ) Patient Practice CCG Grand Total Avg Activity per month Nhs Bracknell And Ascot CCG Nhs Slough CCG Nhs Windsor, Ascot And Maidenhead CCG Nhs Newbury And District CCG Nhs North & West Reading CCG Nhs South Reading CCG Nhs Wokingham CCG Grand Total Aborted journeys by CCG and month ( ) Patient Practice CCG Grand Total Avg Activity per month Nhs Bracknell And Ascot CCG Nhs Slough CCG Nhs Windsor, Ascot And Maidenhead CCG Nhs Newbury And District CCG Nhs North & West Reading CCG Healthwatch Wokingham Borough 2015 Page: 14 of 17

15 Nhs South Reading CCG Nhs Wokingham CCG Grand Total Cancelled journeys by CCG and month ( ) CCG Grand Total Avg Activity per month Nhs Bracknell And Ascot CCG Nhs Slough CCG Nhs Windsor, Ascot And Maidenhead CCG Nhs Newbury And District CCG Nhs North & West Reading CCG Nhs South Reading CCG Nhs Wokingham CCG Grand Total Cancelled journeys for Royal Berkshire and Wexham Park Hospital ( ) Hospital Grand Total Avg Activity per month Royal Berkshire Hospital Wexham Park Hospital Source: Kath Habersham Provider Performance Lead & Contact Specialist: Central Southern Commissioning Support Unit August Analysis of SCAS journeys for Wokingham Clinical Commissioning Group Table 16: Analysis of SCAS journeys for Wokingham Clinical Commissioning Group Overall patient transport activity for Wokingham CCG and month ( ) Grand Total Avg. Activity per month Nhs Wokingham CCG Escorted journeys by CCG and month ( ) Nhs Wokingham CCG Aborted journeys by CCG and month ( ) Nhs Wokingham CCG Cancelled journeys by CCG and month ( ) Nhs Wokingham CCG Healthwatch Wokingham Borough 2015 Page: 15 of 17

16 Cancelled journeys for Royal Berkshire and Wexham Park Hospital ( ) Hospital Grand Total Avg Activity per month Royal Berkshire Hospital Wexham Park Hospital Source: Kath Haversham Provider Performance Lead & Contact Specialist: Central Southern Commissioning Support Unit August Background Information 9.1. Healthwatch Wokingham Borough The health and social care reforms of 2012 set a powerful ambition of putting people at the center of health and social care. To help realise that ambition, the reforms created a Healthwatch in every local authority area across England and Healthwatch England, the national body. The network is strongest working together to share information, expertise and learning in order to improve health and social care services. Healthwatch Wokingham Borough is the local representative for the 167,000 Wokingham Borough residents More information can be found at: Wokingham Clinical Commissioning Group The CCG is a clinically-led membership organisation and a fully authorised statutory public body. The CCG has a council of members which is made up of a representative from each of the member practices. The council appoints, through selection and election, a governing body who also has the power to amend the CCG's constitution. It is the main funding organisation for health services in Wokingham Borough Healthwatch Wokingham Borough 2015 Page: 16 of 17

17 Your feedback Healthwatch Wokingham Borough is keen to find out how useful this report has been to you, and/or your organisation in further developing your service. Please provide feedback below or via . We found the report to be: Useful / Not useful (please delete as appropriate) Why do you think this? We have made the following changes since reading this report: Any other comments?. Your name, organisation and contact details. Please mail to: Nicola.strudley@healthwatchwokingham.co.uk Or post to Healthwatch c/o CAB 2 nd Floor, Waterford House Erfstadt Court Wokingham Berkshire RG40 2YF. Healthwatch Wokingham Borough 2015 Page: 17 of 17