PATIENT TRANSPORT SERVICE SURVEY FOR PATIENTS AND HEALTHCARE WORKERS. Feedback Report September 2013

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1 PATIENT TRANSPORT SERVICE SURVEY FOR PATIENTS AND HEALTHCARE WORKERS Feedback Report September 2013

2 Contents Executive Summary... 4 Introduction... 7 The NHS Patient Transport Service... 7 Reason for this survey... 7 Methodology... 7 Results at a glance... 9 Summary of Key Themes PTS vehicles arriving too late or too early Difficulties when making a telephone booking Quality aspects of the PTS from a patient perspective Things that PTS currently does well Quality aspects of the PTS from the patient perspective Praise for PTS staff Advising on eligibility criteria Being accompanied on PTS journey by carer/ family/ friend Cancelling a PTS booking Things that PTS currently does not do well PTS vehicles arriving too late or too early It can be difficult to make a telephone booking Being declined by PTS Impact of hospital appointment changes and cancellations Rurality Promoting alternative PTS booking methods PTS capacity Meeting diverse needs Opportunities for change North Yorkshire Patient Transport Service Survey Feedback Report

3 Detailed survey results Section 1 - Capturing the right audience Section 2 Booking transport Section 3 - Timeliness of the service Section 4 - Amending/cancelling a PTS booking Section 5 Quality of Service Section 6 Future PTS service Section 7 About the respondents Appendix 1 Summary of face to face engagement Appendix 2 Feedback from the Yorkshire Ambulance Service Patient Relations Team - April Appendix 3 HaRD Discharge to care home questions Appendix 4 The relevance of the PTS to carers North Yorkshire Patient Transport Service Survey Feedback Report

4 Executive Summary The NHS Patient Transport Service (PTS) is for people who are unable to use their own or public transport because of their medical condition. This report contains the findings from the Patient Transport Services Surveys for patients and for healthcare workers that were conducted during July 2013 to support a commissioner review of the PTS model and its current performance against the current service specification. 91 patients and 45 healthcare workers (referred to as Professionals in some charts) completed the surveys which were aimed at people who had used PTS within the last year. 90% (81) patient respondents had used PTS more than once in the last year and 75% (67) patient respondents were over the age of 60. Feedback from respondents covered a wide range of areas. The top three areas that received the most feedback were related to PTS vehicles arriving too late or too early, difficulties when making telephone bookings and quality aspects of the PTS from a patient perspective: 1. PTS vehicles arriving too late or too early More feedback was received about vehicles arriving too late or too early than any other issue. In particular, lots of feedback indicated that patients often face long waits to be collected after appointments or upon hospital discharge and are not given a collection time. You just don't know what time you are going to get home. If you have a hospital appointment I generally rule the whole day out and make no further plans. Patient (Q11) Respondents 80 (52 patients, 28 healthcare workers) It would be good to see patients get home sooner rather than having long waits when they have been discharged. Healthcare worker (Q11) North Yorkshire Patient Transport Service Survey Feedback Report

5 2. Difficulties when making a telephone booking Difficulty in booking the service is a significant issue, particularly for healthcare workers booking on behalf of patients. The call was answered promptly Strongly Agree Agree Disagree Strongly disagree Patient 18% 10.5% 20% 17% 10.5% 31% Healthcare Professional 47% 41.5% Respondents 96 (66 patients, 29 healthcare workers) I was on the phone for this purpose for 90mins. I am a busy GP. Healthcare worker (Q7) On rare occasions when the line has been continuously busy I have had to reschedule the discharge date due to not getting through in time that day. Healthcare worker (Q7) 3. Quality aspects of the PTS from a patient perspective High levels of positive feedback were received about how well patients using the PTS are treated. Feedback covered many quality aspects ranging from vehicle comfort and cleanliness to safety, accessibility and staff helpfulness. Strongly Agree Agree Disagree The vehicle was comfortable 37% 56% 7% The transport was accessible 49% 47% 4% The staff treated me with dignity and respect 51% 49% (based on 100 responses 67 patients, 33 healthcare workers) North Yorkshire Patient Transport Service Survey Feedback Report

6 Feedback fell into two main areas covering things that respondents considered the PTS currently does well and things that PTS currently does not do well. Other themes that were identified in addition to the top three themes are summarised below and the Summary of Key Themes section of this report covers these in more detail: 1. Things that PTS currently does well: Quality aspects of the PTS from the patient perspective Praise for PTS staff Advising on eligibility criteria Being accompanied on PTS journey by carer/ family/ friend Cancelling a PTS booking 2. Things that PTS currently does not do well: Being declined by PTS Impact of hospital appointment changes and cancellations Rurality Promoting alternative PTS booking methods PTS capacity Respondents also made suggestions for meeting the diverse needs of PTS service users in relation to disability, age and rurality which are covered in the Summary of Key Themes section. Feedback highlighted a number of opportunities for change where there is potential to consider service improvements as part of the PTS commissioning review. This information is also covered in the Summary of Key Themes section. North Yorkshire Patient Transport Service Survey Feedback Report

7 Introduction The NHS Patient Transport Service The NHS Patient Transport Service (PTS) provides non-emergency transport between patients homes, hospitals, community settings or other treatment centres for people referred for consultations, treatments or procedures. The PTS is for people who are unable to use their own or public transport because of their medical condition. The North Yorkshire area is covered by four main Clinical Commissioning Groups (CCGs) that have a membership of GP practices in North Yorkshire and whose responsibility it is to meet the health needs of their local population. Harrogate and Rural District CCG Vale of York CCG Hambleton, Richmondshire and Whitby CCG Scarborough and Ryedale CCG Patients of the Bentham GP practice which is part of Cumbria CCG also use the North Yorkshire PTS. The Harrogate and Rural District CCG commissions PTS in North Yorkshire on behalf of the above organisations and the service is provided by the Yorkshire Ambulance Service. Reason for this survey A commissioner review of the PTS model and its current performance against the current service specification is underway. PTS surveys were carried out in July 2013 to gain views from patients and healthcare workers who have used the service to book transport within the last year. The survey invited respondents to give feedback on the existing service and how it might be improved. Methodology This report is a combination of the responses from two surveys conducted between 22 July and 2 August 2013: Patient Transport Survey - Patient - North Yorkshire - July 2013 Patient Transport Survey Healthcare Workers - North Yorkshire - July 2013 The surveys were distributed using the following methods: All 99 GP practices were provided with posters to promote the survey and provided with wording for any TV screens (as available). North Yorkshire Patient Transport Service Survey Feedback Report

8 Face to face surveying took place in outpatients, discharge lounges and main reception areas of the four main hospitals (York, Harrogate, Scarborough and Friarage Hospital at Northallerton). A web based version of the survey was promoted through the CCG websites, stakeholder mailouts, social media and via the Independent Care Group. This report covers the major themes that were fed back through the surveys and includes: Quantitative data (respondents were asked to tick their preferred answer). Qualitative data (respondents were asked to write their own views in a comment box). All charts in the Detailed Summary section show the number of actual respondents for each question as well as percentage of respondents. Wherever possible, the same question numbers have been used in this report as were in the questionnaire but some question numbers may differ as answers in this report are combined and the patient and healthcare worker questionnaires were different. Some additional sources were used and are available in the Appendices: Patient Transport Services in North Yorkshire Face to Face Engagement Report July/August 2013 Patient Advice and Liaison Service (PALS) data related to PTS from April 2013 July 2013 Review of discharges to care homes carried out by Harrogate and Rural District CCG June 2013 Further comments from a member of a stakeholder group on the relevance of PTS to carers August 2013 North Yorkshire Patient Transport Service Survey Feedback Report

9 Results at a glance 91 respondents completed the survey aimed at patients who had all used PTS within the last year, 90% (81) have used PTS more than once in the last year. 75% (67) of patient respondents were over the age of respondents completed the survey aimed at healthcare workers who had all used PTS within the last year to book transport on behalf of patients. 65% of patient and 79% of healthcare worker respondents felt that pick up times after appointments or for hospital discharge were too long. 35% of patient and 30% of healthcare worker respondents said that hospital appointment cancellation is the main reason that a PTS journey is cancelled. When asked to state one thing the PTS currently does well, 57% of patient and 55% of healthcare worker respondents praised staff, particularly the PTS drivers and crews. Over 90% of patients Strongly Agreed or Agreed that PTS get patient quality aspects of the service right. Around 90% of all respondents prefer to book, amend and cancel PTS journeys by telephone. North Yorkshire Patient Transport Service Survey Feedback Report

10 Summary of Key Themes This section summarises the main themes that were highlighted in feedback from respondents and is shown in order of popularity with the most commented upon areas coming first. Percentage responses are shown but all charts in the Detailed Survey Results section show the number of actual respondents for each question. Feedback covered many topics, most of which are categorised under two headings in this summary highlighting Things that PTS currently does well and Things that PTS currently does not do well. This summary also contains a section dedicated to Meeting diverse needs which covers considerations that were raised specifically around disability, age and rurality. Feedback highlighted a number of Opportunities for change where there is potential to consider service improvements as part of the PTS commissioning review and these are available at the end of this summary of key themes. The top three areas that received the most feedback were related to PTS vehicles arriving too late or too early, difficulties when making telephone bookings and quality aspects of the PTS from a patient perspective: PTS vehicles arriving too late or too early More feedback was received about vehicles arriving too late or too early than any other issue. In particular, lots of feedback indicated that patients often face long waits to be collected after appointments or upon hospital discharge and are not given a collection time. Difficulties when making a telephone booking Difficulty in booking the service is a significant issue, particularly for healthcare workers booking on behalf of patients. The main reasons are: Difficulty in getting through on the phone. The automated telephone system is not user friendly. Healthcare workers sometimes need to book urgent transport but PTS cannot always manage short notice or are fully booked. Quality aspects of the PTS from a patient perspective High levels of positive feedback were received about how well patients using the PTS are treated. Feedback covered many quality aspects ranging from vehicle comfort and cleanliness to safety, accessibility and staff helpfulness. North Yorkshire Patient Transport Service Survey Feedback Report

11 Things that PTS currently does well A significant amount of feedback received indicated that healthcare workers and particularly patients were very positive about aspects of the current PTS service. 1. Quality aspects of the PTS from the patient perspective 90% of patients Strongly Agree or Agree with the following statements: The vehicle was comfortable. The transport was clean. The transport was appropriate for my needs/had the right level of equipment. The transport was accessible. I felt safe whilst being transported. Staff treated me with dignity and respect. Staff were helpful whilst being transported e.g. assisted on/off. 2. Praise for PTS staff Many respondents stated how valuable the service is to them personally, expressing their appreciation for the service and praising PTS staff, particularly the vehicle crews. Over 90% of respondents felt the call taker had listened carefully Over 90% of respondents felt the call taker had a pleasant manner When asked to state one thing the PTS currently does well, the majority of feedback (57% patients and 55% healthcare workers) praised staff, particularly the PTS drivers and crews. It does take a long time to get through to speak to someone, but when you do the call handling is excellent and the staff are very helpful. (Q7) They show kindness, courteous and provide an efficient service. (Q17) The drivers are so helpful and get you to the right department in the hospital. (Q17) In view of the amount of calls they receive the organisation is done well under immense pressure. Staff are usually helpful. (Q17) Recently took my Guide Dog with me for the first time and he was dealt with excellently. (Q17) Over 90% of all patients and healthcare workers indicating that there are no major issues with call takers listening, being attentive and advising on eligibility of patients to use PTS. North Yorkshire Patient Transport Service Survey Feedback Report

12 3. Advising on eligibility criteria Survey feedback did not indicate any difficulties caused by ineligible patients using PTS. Over 90% of respondents said that the call taker had checked that the patient was eligible to use PTS. 4. Being accompanied on PTS journey by carer/ family/ friend Feedback in comments from both patients and healthcare workers suggested there are no issues with patients being accompanied as long as it is booked when the journey booking is made. We require all our patients to have an escort and this is never refused. (Q15) They always ask me when booking if I need an escort, but this is not required. (Q15) 5. Cancelling a PTS booking 92% of patient and 85% of healthcare worker respondents confirmed that they were aware of how to cancel a journey. Things that PTS currently does not do well Survey respondents were specifically asked to provide feedback about things they consider that PTS currently does not do well and the issues below were raised in response to that particular question and through other questions in the surveys. 1. PTS vehicles arriving too late or too early 1.1 PTS collection after hospital appointment or discharge 65% of patient and 79% of healthcare worker respondents felt that pick up times after appointments or for hospital discharge were too long. When asked what PTS doesn t do so well, healthcare workers commented: Give a return time home. (Q18) It would be good to see patients get home sooner rather than having long waits when they have been discharged. (Q18) The majority of comments indicated that pick up times are not given. A handful of patients waited under an hour but, for most, their wait was at least 2 hours and, for some, it was it was 4-5 hours. North Yorkshire Patient Transport Service Survey Feedback Report

13 You just don't know what time you are going to get home. If you have a hospital appointment I generally rule the whole day out and make no further plans. (Q11) The feedback also highlighted concerns about the impact of long waits on a vulnerable group of patients with no food or drink: Recent case of very disabled patient left unattended waiting for transport for several hours, arrived home at 7.15pm. Was out of his home for 6 hours, actual appointment took no more than 20 minutes. This resulted in great distress to the patient and their family. (Q11) The elderly have been dropped off very late on in the afternoon/evening - if they live alone no-one is there to ensure they have food and basic groceries. (Q11) The patient can be waiting over lunchtime for up to 4 hours- some patients are diabetics and haven't brought medication with them. At the end of the day i.e. 5pm patients can also be waiting. (Q11) When asked what PTS doesn t do so well: Advertise your other methods of booking more. (Q18) 1.2 PTS collection from home address When asked to state one thing that doesn t work so well about PTS, the majority of feedback (52% patients and 48% healthcare workers) was about lack of timeliness of vehicles, which gives a mixed point of view when taken with the positive feedback about timeliness below. 37% of patients Disagree or Strongly Disagree that PTS arrived within the expected time frame. 17.5% of patients felt transport turned up too early and 9% of patients felt transport had turned up too late. 35% of patients said that they never receive or only sometimes receive clear instructions about collection timings. A few times the timings were wrong and I ended up late for my appointment. (Q8) I was leaving hospital and it was a long wait. (Q8) Patients were reasonably OK with the 2 hour timeframe for collection but some found it a little difficult. Those that had a phone call to let them know that transport was on its way found this resolved the difficulty: North Yorkshire Patient Transport Service Survey Feedback Report

14 The two hour window is sometimes awkward for my carer. (Q8) I received a phone call from the driver to say he would be 15 minutes, this was very helpful. (Q8) When asked what PTS doesn t do so well one healthcare worker stated Give the patient a call or text 15 minutes before arrival. (Q18) 1.3 Some positive feedback was also received 74% of patients and 62.5% of healthcare worker respondents felt timings for collection from home were about right. When asked to state one thing that the PTS currently does well 10% of patients and 7% of healthcare workers praised timeliness of vehicles. The patients that commented about early and late PTS arrival often also commented that the service has improved recently: We have had some unfortunate experiences where we were once three hours delayed for an appointment but it has improved. 2. It can be difficult to make a telephone booking Healthcare workers indicated that difficulties in getting through to the booking line impacted on the running of clinical services. This included taxis being necessary and occasionally hospital discharge being delayed to the following day. Around 90% of all respondents prefer to book, amend and cancel transport by telephone. 30.5% of patient and 48% of healthcare worker respondents Disagreed or Strongly Disagreed that their calls were answered promptly. When asked to state one thing that does not work so well about PTS 26% of healthcare workers found booking appointments complicated but this compares to only 5% of patients. I was on the phone for this purpose for 90mins. I am a busy GP. (Q7) Numerous incidents where we couldn t get through - time on hold unacceptable. (Q16) Member of reception staff unable to navigate her way through the different options on one occasion. (Q16) On rare occasions when the line has been continuously busy I have had to reschedule the discharge date due to not getting through in time that day. (Q16) North Yorkshire Patient Transport Service Survey Feedback Report

15 3. Being declined by PTS Feedback indicated that bookings are usually declined appropriately, mostly due to short notice or ineligibility with PTS criteria. 55% of patient and 61.5% of healthcare workers felt they had been given a clear reason. However, feedback suggests that the way urgent bookings are classified can cause difficulties for healthcare workers and a little bit more flexibility would help: Usually [we are declined] if we need non-urgent but clinically important short notice transport. (Q5) I wanted to arrange for a wheelchair using patient with an urgent (but not emergency) problem to attend an urgent assessment in a burns clinic the next day. PTS could not assist as it was too short notice. (Q5) I was advised to ring an emergency ambulance the following morning, but that timing could not be guaranteed as they would be on A&E calls. I was disinclined to use the emergency service for a planned event (albeit at short notice). (Q5) When asked what PTS doesn t do so well, the following comment was received: Transporting patients with urgent clinical need at short notice. (Q18) 4. Impact of hospital appointment changes and cancellations Hospital cancellations was the main reason a PTS journey was cancelled, with 35% of patient and 30% of healthcare worker respondents giving this feedback. 5. Rurality 19% of healthcare workers fed back about PTS arriving late and fed back about the additional difficulty caused by serving a rural area: We have a Friday morning clinic for high risk diabetes patients using PTS from Wensley Dale/ Swaledale. We regularly have problems with delays in collection. (Q10) [PTS] often underestimate the time it takes to get to some of the more remote properties in the Dales. (Q10) North Yorkshire Patient Transport Service Survey Feedback Report

16 6. Promoting alternative PTS booking methods 14% of healthcare workers rely on faxing as their only method for booking PTS. Some patients commented that they had not been aware of alternatives to booking by telephone and there was some support for alternative booking methods, particularly internet (19% of healthcare workers and 6% of patients). 7. PTS capacity When asked to state one thing that doesn t work so well about PTS 13% of patients stated service sometimes gets fully booked and there is no alternative. Meeting diverse needs The majority of our patients requiring PTS are elderly, ill, do not have access to computers, live rurally, and do not have family/carers. (Q20) This section shows feedback that was provided in response to a question about meeting diverse needs of the people using PTS. 5% of patients and 32% of healthcare workers confirmed that diverse needs should be considered. A small number of comments and suggestions were also received (13 in total) and these are summarised below. Rurality There was a recognition that a significant part of the North Yorkshire population lives in a rural area making distance and waiting times more of a problem. Respondents suggested: Age Clinics are held in local health centres where possible. Smaller vehicles are used to pick up rural patients. Vehicles should be full to be more efficient. There was a recognition that rural areas also tend to have an ageing population and the following feedback was provided: Services should be mindful that elderly patients can get very tired, especially when having to wait around and travel long distances. Hospitals could help PTS by offering late morning/early afternoon appointments to rural PTS users. North Yorkshire Patient Transport Service Survey Feedback Report

17 Disability Respondents felt that the PTS is already set up well to accommodate disabled patients but fed back that it would be useful to ensure PTS staff have dementia awareness training and are supported to manage patients with dementia. Opportunities for change Survey feedback highlighted a number of areas where there is potential to consider service improvements as part of the PTS commissioning review. These are below: Monitor call handling A large frustration for PTS users was the length of time getting through. This could be monitored to assess busier periods when more call takers may be needed. The pick-up phone call The patients that had a phone call to let them know that transport was on its way found this very useful. Journey planning Consider how journey planning could be more efficient for rural areas. More flexible booking for healthcare workers Feedback showed that sometimes more booking flexibility is needed for nonurgent/non-emergency bookings that are necessary at short notice. Liaison with hospitals to minimise long waits One of the most evident difficulties that patients using PTS experience is the long waits to be taken home after an appointment or upon discharge. Further liaison and co-ordination with hospitals could be beneficial. Cancelled journeys due to cancelled hospital appointments This was fed back as the main reason that PTS journeys were cancelled. Further liaison between the hospital and PTS could be of benefit. Promote alternative PTS booking methods Some patients commented that they had not been aware of alternatives to booking by telephone and there was some support for alternative booking methods, particularly internet (19% of healthcare workers and 6% of patients). North Yorkshire Patient Transport Service Survey Feedback Report

18 Detailed survey results All charts in this section show the number of actual respondents for each question as well as percentage of respondents. Wherever possible, the same question numbers have been used in this report as were in the questionnaire but some question numbers may differ as answers in this report are combined and the patient and healthcare worker questionnaires were different. Section 1 - Capturing the right audience 1. Respondent type 91 respondents completed the survey aimed at patients who had all used PTS within the last year, 90% have used PTS more than once in the last year. 45 respondents completed the survey aimed at healthcare workers who had all used PTS within the last year to book transport on behalf of patients. Section 2 Booking transport 2. Who usually makes the booking for the PTS? Respondents = 99 (67 patients, 32 healthcare workers) Patient Hospital/doctor/GP surgery Carer/family/friend Healthcare professional Other 2.5% 0% 0% 5% 0% 17% 27% Patient 52% 47% 50.5% Professional Key feedback: Results vary between areas. According to responses from healthcare workers: 60% of patients in Hambleton, Richmondshire and Whitby booked their own transport. 60% of healthcare workers in Scarborough and Ryedale booked transport on behalf of patients. North Yorkshire Patient Transport Service Survey Feedback Report

19 3. ACTUAL method usually used to book PTS Total number of respondents = 100 (67 patients, 33 healthcare workers) Telephone Patients Professionals Always Mostly Never 90% 6% 4% 88% 12% Fax Patients Mostly 3% Never 97% Professionals Always Mostly Never 14% 0% 86% Patient Sometimes 3% Never 97% 4. What would be your PREFERRED method to communicate with PTS to book, amend and cancel transport? Respondents = 98 (66 patients, 32 healthcare workers) Patients Telephone 89.5% 89.5% 89.5% Internet 6% 8% 8.5% 2% 2% 4.5% Book Amend Cancel (No respondents selected Fax or Other as an answer) North Yorkshire Patient Transport Service Survey Feedback Report

20 Healthcare Workers (No respondents selected Fax as an answer) Key feedback: Telephone Internet Other 3% 3.5% 3.5% 3% 3.5% 4% 19% 25% 28.5% 75% 68% 64% Book Amend Cancel Telephone booking for PTS was the most popular ACTUAL and PREFERRED method by a large majority for all respondents. 14% of healthcare workers relied on the fax as their only method for booking. Some patients commented that they had not been aware of alternatives to booking by telephone and there was some support for alternative booking methods, particularly internet (19% of healthcare workers and 6% of patients). Although 14% of patients selected Other as their method for booking, it appears from comments that this indicated they had their transport booked for them by a healthcare worker. 5. Have you ever been declined PTS? 6. What reasons where given? Respondents 94 (65 patients, 29 healthcare workers) The qualitative feedback from these two questions has been combined as it is very similar. North Yorkshire Patient Transport Service Survey Feedback Report

21 The spread of respondents who had been declined PTS was more or less even across all geographical areas. Comments: Journeys had usually been appropriately declined in line with PTS guidelines. The main reason for healthcare workers was short notice for a non-urgent booking and for patients it was ineligibility to use PTS. 6 said notice was too short for a non-urgent booking Usually [we are declined] if we need non-urgent but clinically important short notice transport. I wanted to arrange for a wheelchair using patient with an urgent (but not emergency) problem to attend an urgent assessment in a burns clinic the next day. PTS could not assist as it was too short notice. Apparently, after 2pm an ambulance could not be booked to take the patient for an x- ray unless it was an emergency. I was advised to ring an emergency ambulance the following morning, but that timing could not be guaranteed as they would be on A&E calls. I was disinclined to use the emergency service for a planned event (albeit at short notice). 5 said it was because of ineligibility Patient didn't have all the information they needed to provide to qualify for the service. I was not eligible as I was able to access public transport, but since my physical health has deteriorated I am now eligible. I was told I did not qualify for PTS, so I phoned again and someone else answered and I booked my transport with no problems. Getting through on the phone One healthcare worker said that this had been an issue on more than one occasion: On occasions we have had to contact our YAS relationship managers to check there is no fault with the line as we couldn t get through. One particular case we were around and hour and a half trying to get through. This was resolved with a phone call to 111 relationship manager at YAS but [the relationship manager said PTS had] not been busy so didn t understand our problems and promised to check the lines to see if any issues and get back, no response ever received. However, during the last few weeks the service has improved considerably. Other feedback Fully booked (2 healthcare workers) Not allowed to book 2 appointments on the same day (1 healthcare worker) Key feedback: 55% of patient and 61.5% of healthcare workers felt they had been given a clear reason. Reasons stated mostly related to short notice or ineligibility with PTS criteria (notice periods and eligibility criteria). North Yorkshire Patient Transport Service Survey Feedback Report

22 Although journeys had usually been appropriately declined in line with PTS guidelines, feedback suggests that the way urgent bookings are classified can cause difficulties for healthcare workers and a little bit more flexibility would help: Usually [we are declined] if we need non-urgent but clinically important short notice transport. I wanted to arrange for a wheelchair using patient with an urgent (but not emergency) problem to attend an urgent assessment in a burns clinic the next day. PTS could not assist as it was too short notice. Apparently, after 2pm an ambulance could not be booked to take the patient for an x- ray unless it was an emergency. I was advised to ring an emergency ambulance the following morning, but that timing could not be guaranteed as they would be on A&E calls. I was disinclined to use the emergency service for a planned event (albeit at short notice). One healthcare worker fed back that getting through via telephone had been an issue on more than one occasion: On occasion we have had to contact our YAS relationship managers to check there is no fault with the line as we couldn t get through. One particular case we were around and hour and a half trying to get through. This was resolved with a phone call to 111 relationship manager at YAS but [the relationship manager said PTS had] not been busy so didn t understand our problems and promised to check the lines to see if any issues and get back, no response ever received. However, during the last few weeks the service has improved considerably. 7. Views about booking PTS Respondents 95 (66 patients, 29 healthcare worker) Respondents were asked for their views on the following statements about PTS and responded as follows: The call was answered promptly Strongly Agree Agree Disagree Strongly disagree Patient 18% 10.5% 47% 41.5% 20% 17% 10.5% 31% Healthcare Professional North Yorkshire Patient Transport Service Survey Feedback Report

23 The call taker listened carefully Strongly Agree 21.5% 35.5% Agree 57% 75% Disagree 1.5% 3.5% Strongly disagree 1.5% 0% Patient Healthcare Professional The call taker had a pleasant manner Strongly Agree 17% 35.5% Agree 58.5% 76% Disagree 1.5% 3.5% Strongly disagree 0% 3.5% Patient Healthcare Professional The call taker confirmed that the patient was eligible for PTS Strongly Agree 21.5% 37% Agree 55.5% 71.5% Disagree 1.5% 7% Strongly disagree 0% 0% Patient Healthcare Professional Comments It takes time I was on the phone for this purpose for 90mins. I am a busy GP. During one call I was given incorrect information and this wasted a lot of time. The last time, it took me 10 minutes to get a call answered. The calls take ages to be answered and at times you have to call back as you get rung off. North Yorkshire Patient Transport Service Survey Feedback Report

24 The service apparently has improved in recent weeks. Prior to this, however, the service was appalling - particularly when trying to get through, the length of time taken was simply unacceptable. Hopefully, this is now a thing of the past. Some delays in answering calls. It can be frustrating when the phone is not answered to book return journey for the patient. It does take a long time to get through to speak to someone, but when you do the call handling is excellent and the staff are very helpful. It can be frustrating Patient thinks it was all ok but he didn't make the call. Far too long and far too many questions. Surely all you need is the patient's name, address and destination and degree of urgency. Don't waste time on dates of birth (ethnic origin) and too much time spent checking on the surgery credentials and codes. 10 minutes of my time is another patient seen or 30 to the NHS. I made several phone calls to 0300 and 0845 numbers and each time was given conflicting information. I was bounced back and forth between these numbers and another telephone no. Other comments Early morning- can get through quicker. I needed an ambulance with a wheelchair but an error was made. PTS refuse patients for ambulance at the end of the day, so we have no option but to book hospital taxis to get patients home. At times it has been reported that some telephonist can be abrupt and very inflexible. Key feedback: Views highlighted that a significant number of respondents did not feel that their calls were answered promptly but experience of how long waits were varied. I was on the phone for this purpose for 90mins. I am a busy GP. The last time, it took me 10 minutes to get a call answered. Over 90% of all patients and healthcare workers strongly agreed or agreed with the remaining three statements, indicating that there are no major issues with call takers listening, being attentive and advising on eligibility of patients to use PTS. North Yorkshire Patient Transport Service Survey Feedback Report

25 8. PTS made it clear when I needed to be ready to be collected Respondents 64= patients 11% Sometimes Yes 64% No 25% Comments: 11 patients said they were told they would be collected up to 2 hours before their appointment and this happened with no problems. The remainder of the feedback mostly related to poor communication and missed collection times: Communication 6 patients said they were not given clear instructions about collection. 3 patients suggested a phone call as transport is arriving would be helpful. 5 patients said they received a phone call and it was very helpful. Missed Collection Times 5 patients said PTS sometimes arrived late. 3 patients said PTS arrived too early. Other feedback I was told to be ready at 8am for a 2pm appointment, so I declined the service and got in touch with dial a ride. Delays to surgery can mean the patient is not ready when PTS arrives. PTS don t ask about my return journey. It has always been left to the hospital to try and arrange transport back. Needs to be better communication between the service and the transport. Key feedback: Patients sometimes do not receive clear instructions about collection timings. There is some indication that PTS sometimes arrive too early or too late. The patients that had a phone call to let them know that transport was on its way found this very useful. North Yorkshire Patient Transport Service Survey Feedback Report

26 A few times the timings were wrong and I ended up late for my appointment. I was leaving hospital and it was a long wait. The two hour window is sometimes awkward for my carer. I received a phone call from the driver to say he would be 15 minutes, this was very helpful. 9. Please tell us if you agree/disagree with the following statements Respondents = 62 patients Comments: Sometimes too late/early In total, 5 patients made additional comments about PTS being late and 4 about PTS turning up early but often qualified their statements by saying it was unusual, PTS did what they could to help and the service has improved recently: One exception arrived 6 hours late. Most trips fine but for one occasion where driver failed to turn up. When contacted PTS said driver hadn't realised she's on duty that day and eventually arrived 1hr later. Meant me and other patients were all late for our appointments/treatments. PTS informed the clinics we would be late. We have had some unfortunate experiences where we were once three hours delayed for an appointment but it has improved. They may sometimes arrive earlier than expected, but this is not a problem. North Yorkshire Patient Transport Service Survey Feedback Report

27 There came earlier than expected, but I was ready. Other comments covered: Helpful drivers The driver got me to hospital but I was unsure where I needed to be, he sorted it out for me. The driver always gets you to the right department in the hospital. Home address (2 patients) They once went to my old address even though I gave them my new details on booking. I live in a remote area and they had difficulty in finding my home, they are a lot better now. No time given (2 patients) Key feedback: 37% indicated that issues exist with timings by disagreeing or strongly disagreeing that the driver arrived within the expected time frame. Just over half of these respondents were from the Vale of York area. The majority of patients indicated that there are no major issues with being collected from the correct home address and dropped off at the correct place. The patients that commented about early and late PTS arrival often also commented that the service has improved recently: We have had some unfortunate experiences where we were once three hours delayed for an appointment but it has improved. Section 3 - Timeliness of the service 10. Views on PTS arrival time for appointments Respondents = 83 (57 patients, 26 healthcare worker) North Yorkshire Patient Transport Service Survey Feedback Report

28 Comments Sometimes too late PTS had turned up late for 11 patients and this ranged from 10 minutes to 6 hours. 5 healthcare workers fed back about PTS arriving late and fed back about the additional difficulty caused by serving a rural area: We have a Friday morning clinic for high risk diabetes patients using PTS from Wensley Dale/Swaledale. We regularly have problems with delays in collection. [PTS] often underestimate the time it takes to get to some of the more remote properties in the Dales. Sometimes too early 3 patients and 4 healthcare workers said PTS came too early: Patients complain they are picked up too early nearly half of them do not have time to have breakfast and are waiting nearly all morning for their appointment. Sometimes on time but it varies PTS had been on time for 3 patients. 4 patients and 5 healthcare workers said PTS was variable: When taking patients to clinical appointments the service is reliable. If patient lives miles away they come too early, or too late. Recent improvements More recently, on booking we were told to be ready two hours before the appointment. A day before the appointment we got a phone call asking if we still required transport. On the day of the appointment I got a phone call to say the driver would be with us in 30 minutes. This is a fantastic service and I hope this continues like this. Key feedback: Three quarters of patients (74%) and two thirds of healthcare worker (62.5%) felt timings for appointment drop offs were about right. A discrepancy between patients and healthcare worker exists in HaRD where 100% of healthcare worker but only 21% of patients agreed that appointment drop off times were about right. A small but significant minority of patients felt that drop off times were too early (17.5%) or too late (9%) PTS had turned up late for 11 patients and this ranged from 10 minutes to 6 hours. 5 healthcare workers fed back about PTS arriving late and fed back about the additional difficulty caused by serving a rural area: We have a Friday morning clinic for high risk diabetes patients using PTS from Wensley Dale/ Swaledale. We regularly have problems with delays in collection. [PTS] often underestimate the time it takes to get to some of the more remote properties in the Dales. North Yorkshire Patient Transport Service Survey Feedback Report

29 One patient described recent improvements: More recently, on booking we were told to be ready two hours before the appointment. A day before the appointment we got a phone call asking if we still required transport. On the day of the appointment I got a phone call to say the driver would be with us in 30 minutes. This is a fantastic service and I hope this continues like this. 11. Views on PTS collection timings after appointments Respondents 80 (52 patients, 28 healthcare workers) Comments You never know your return time The majority of feedback indicated that pick up times to get home are not given. A handful said they waited under an hour but for most their wait was at least 2 hours and for quite a few of these it was 4-5 hours. You just don't know what time you are going to get home. If you have a hospital appointment I generally rule the whole day out and make no further plans. Recent case of very disabled patient left unattended waiting for transport for several hours, arrived home at 7.15pm. Was out of his home for 6 hours, actual appointment took no more than 20 minutes. This resulted in great distress to the patient and their family. A few other themes were raised in response to this question: Patients using the service are often vulnerable I am diabetic and was left waiting for my return journey for a long time when I was due my meal and medication. North Yorkshire Patient Transport Service Survey Feedback Report

30 If long wait would be nice for those of us not mobile to have access to drink, snacks or loo during wait. Once left at exit unable to get elsewhere under own steam as a wheelchair user. Patients get fed up of waiting, hungry and tired. 2 hours or more is too long to wait. We do not have facility to offer food and drink to patients and as we have elderly patients waiting too long is not good. The patient can be waiting over lunchtime for up to 4 hours- some patients are diabetics and haven't brought medication with them. At the end of the day i.e. 5pm patients can also be waiting. People can wait in the lounge for 5 hours at a time and get told they have a set driver for a certain time, then around time of collection it gets changed and patient is waiting for hours even when they are not suitable to be in the lounge for such long periods. The elderly have been dropped off very late on in the afternoon/evening - if they live alone no-one is there to ensure they have food and basic groceries. Taxis are necessary if patients finish appointments after PTS hours of operation Driver turned up too early to collect me, and then I had to wait for more than an hour for a shared taxi back home. Further delay was caused by having to divert to drop off another passenger. Sometimes residents arrive back in taxis so we try and get an appointment well within the PTS time. Weather affects timeliness (3 patients) Weather conditions can affect waiting times. Other feedback: Either they have gone to another job which is miles away or not enough staff/drivers If the ambulance is going to arrive outside the 'deadline' time we usually receive a phone call at the GP surgery to advise. This has been a recent change. Given the limited resources, I think the service does a good job I am grateful for the service. Key feedback: 65% of patient and 79% of healthcare worker respondents felt that pick up times after appointments were too long. The majority of comments indicated that pick up times to get home are not given. A handful said they waited under an hour but for most their wait was at least 2 hours and for some it was it was 4-5 hours. You just don't know what time you are going to get home. If you have a hospital appointment I generally rule the whole day out and make no further plans. The feedback also highlighted concerns about the impact of long waits with no food or drink on a vulnerable group of patients: Recent case of very disabled patient left unattended waiting for transport for several hours, arrived home at 7.15pm. Was out of his home for 6 hours, actual appointment North Yorkshire Patient Transport Service Survey Feedback Report

31 % of respondents took no more than 20 minutes. This resulted in great distress to the patient and their family. The elderly have been dropped off very late on in the afternoon/evening - if they live alone no-one is there to ensure they have food and basic groceries. The patient can be waiting over lunchtime for up to 4 hours- some patients are diabetics and haven't brought medication with them. At the end of the day i.e. 5pm patients can also be waiting. 12. Considering whether there are peak times of the day that impact on the ability of PTS to be make collections on time Respondents = 24 healthcare workers 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Time of day Earlier than average Business as usual Later than average n/a Response per survey type Key feedback: Feedback indicates that PTS may turn up earlier than expected at the beginning of the day and are more likely to struggle turning up on time in the latter half of the day. North Yorkshire Patient Transport Service Survey Feedback Report

32 The chart below shows some results of a question from The Review of Discharges to Care Homes HaRD Clinical Commissioning Group regarding the times patients are taken back to care homes when they are discharged. Most patients are returned to the care home in the afternoon and evening. (See Appendix 3) Section 4 - Amending/cancelling a PTS booking 13. Looking at general awareness of how to contact PTS to amend/ cancel a booking Respondents 91 (64 patients, 27 healthcare workers) Key feedback: Feedback indicated no significant issues 92% of patient and 85% of healthcare worker respondents confirmed that they were aware. The majority of respondents who added qualitative responses confirmed that they were aware how to cancel PTS bookings. North Yorkshire Patient Transport Service Survey Feedback Report

33 14. Looking at reasons why PTS journeys are cancelled Respondents 51 (31 patients, 20 healthcare workers) This was an open ended question, and they have been grouped into the following categories in the table below. Hospital appointment changed/cancelled Too ill to attend appointment Admitted to hospital Lift from carer/family/friend Havent had to cancel 0% 9% 15% 10% Patient 35% 30% 29% 25% 20% 32% Healthcare professional Key feedback: 35% of patient and 30% of healthcare worker respondents stated a change of hospital appointment as the reason the PTS journey was cancelled. Section 5 Quality of Service 14. Views on quality aspects of PTS Respondents = 57 patients Strongly Agree Agree Disagree The vehicle was comfortable 37% 56% 7% The transport was clean 46% 56% The transport was appropriate for my needs/had the right level of equipment 48% 47% 4% North Yorkshire Patient Transport Service Survey Feedback Report

34 Strongly Agree Agree Disagree The transport was accessible 49% 47% 4% The staff treated me with dignity and respect 51% 49% I felt safe whilst being transported 55.5% 45.5% The staff were helpful whilst being transported e.g. assisted on/off 56% 46% Comments: Half of the additional comments praised PTS staff. Half fed back concerns about lack of comfort due to size of ambulances or back problems: The ambulances are not comfortable, but this is not anyone s fault, it is just the vehicles due to size there is a lot of movement. I require a taxi rather than an ambulance due to back problems. One patient gave quite worrying feedback related to safety but it is a one-off comment: Normally feels safe but once went round a corner too fast and fell off stretcher. Key feedback: Over 90% of feedback in the quality section of the patient survey was positive. Half of the additional comments praised PTS staff. Half fed back concerns about lack of comfort due to size of ambulances or back problems. The ambulances are not comfortable, but this is not anyone s fault, it is just the vehicles due to size there is a lot of movement. I require a taxi rather than an ambulance due to back problems. North Yorkshire Patient Transport Service Survey Feedback Report

35 15. Being able to be accompanied on PTS by a carer/ family member/ friend when required Respondents 68 (43 patients, 25 healthcare workers) Yes 77% No 6% Sometimes 11% No Yes 4% 44% Sometimes 52% Key feedback: Feedback in comments from both patients and healthcare workers suggested there are no issues with patients being accompanied as long as it is booked when the journey booking is made. A healthcare worker commented that journeys are regularly booked for patients that all require accompanying and it has never been an issue. We require all our patients to have an escort and this is never refused. Some patients commented that the PTS call taker always offered them the opportunity to take another person at the time the journey is being booked. They always ask me when booking if I need an escort, but this is not required. 16. Difficulties in booking a PTS journey Respondents = 16 healthcare workers Key feedback: Half of the feedback related to length of time to get through on the telephone and some felt that the automated menu is difficult to navigate. Numerous incidents where we couldn t get through - time on hold unacceptable. On rare occasions when the line has been continuously busy I have had to reschedule the discharge date due to not getting through in time that day. North Yorkshire Patient Transport Service Survey Feedback Report

36 Member of reception staff unable to navigate her way through the different options on one occasion. 3 healthcare workers raised timing issues for collection by PTS vehicles. Section 6 Future PTS service 17. Views about what PTS currently does well Respondents = 74 (55 patients, 19 healthcare workers) This was an open ended question and responses have been grouped into categories below. Praise for staff Generally all good Was on time Advance booking Caller listened Decent vehicles Other 15% 10% 7% 5% 0% 5% 0% 0% 3% 5% 3% 27% 57% 55% Healthcare professional Patient Summary of comments Drivers are excellent. They show kindness, are courteous and provide an efficient service. The drivers are so helpful and get you to the right department in the hospital. The service is run very well, taking into account the amount of patients they deal with. Recently took my Guide Dog with me for the first time and he was dealt with excellently. I have no complaints about the service, even though I sometimes have to wait to go home, I am just very grateful for this service. I am impressed with all aspects of the PTS at the moment. It is easy to use and the patients are always happy. North Yorkshire Patient Transport Service Survey Feedback Report

37 In view of the amount of calls they receive the organisation is done well under immense pressure. Staff are usually helpful. Never a problem with getting the bookings details wrong. The PTS crew are always pleasant and helpful with patients. Improvements with transport for end of life patients have meant better timing available but still further improvements could be made. Keep up the good work. Key feedback: Respondents were asked to state one thing that PTS currently does well. Three themes were statistically significant: The majority of feedback (57% patients and 55% healthcare workers) praised staff, particularly the PTS drivers and crews. 15% of patient and 27% of healthcare worker respondents made general comments such as it is all good. Some feedback (10% patients and 7% healthcare workers) praised timeliness of vehicles. Summary of key comments: They show kindness, courteous and provide an efficient service. The drivers are so helpful and get you to the right department in the hospital. In view of the amount of calls they receive the organisation is done well under immense pressure. Staff are usually helpful. Recently took my Guide Dog with me for the first time and he was dealt with excellently. North Yorkshire Patient Transport Service Survey Feedback Report

38 18. Views about what the PTS does not do so well Respondents 77 (55 patients, 23 healthcare workers) This was an open ended question and responses have been grouped into categories below. Was not on time 52% 48% Nothing Complicated booking system Sometimes unavailable Disorganised No alternative if unavailable Unreliable in bad weather Service inequity Poor vehicle standard 0% 5% 1% 0% 5% 4% 0% 0% 1% 0% 1% 0% 1% 13% 29% 26% Healthcare professional Patient Summary of comments Collection and return times need to be improved. Planning. Nothing. Give a return time home. Often miscommunication between patients and hospital department. Weather can cause problems affecting the service. Tend to take the long routes, could be quicker. Give the patient a call or text 15 minutes before arrival. I wish they would send the right transport all the time. Some of the large vehicles are too loud. The service is not available to everyone. Transporting patients with urgent clinical need at short notice. A shame the service is not available on a weekend. North Yorkshire Patient Transport Service Survey Feedback Report

39 It would be good if the service provided tea and coffee as you don't want to leave the area in case you miss your journey home. Advertise your other methods of booking more. Answer the phone within an acceptable length of time. Does not have sufficient drivers to meet the needs for this service. On one occasion 7 professionals waited for a patient to arrive for over half an hour. Appointment was for 1.30 patient not picked up from home till 1.40 and arrived too late. Appointment had to be re-booked for a later date, patient distressed, time and money wasted. Need to be on time more and ensure the ambulances are used for efficiently and go out with more patients on. It would be good to see patients get home sooner rather than having long waits when they have been discharged. Offer alternative transport options for patients that are considered not eligible for PTS. Sometimes transport does not turn up at all and no explanation given. Key feedback: Three themes were statistically significant: The majority of feedback (52% patients and 48% healthcare workers) was about lack of timeliness of vehicles, which gives a mixed point of view when taken with the positive feedback about timeliness above. 26% of healthcare workers found booking appointments complicated compared to only 5% of patients. 13% of patients stated service sometimes gets fully booked and there is no alternative. Key comments: Give a return time home. Give the patient a call or text 15 minutes before arrival. Transporting patients with urgent clinical need at short notice. Advertise your other methods of booking more. It would be good to see patients get home sooner rather than having long waits when they have been discharged. North Yorkshire Patient Transport Service Survey Feedback Report

40 19. Suggestions for improvements to the PTS Respondents = 18 healthcare workers This was an open ended question and the suggestions have been grouped into the following categories: Improve timeliness 38% Improve booking system 27% More patient focused Route planning/rurality 11% 16% Performance reporting Vehicle quality Escalation process PTS/hospital communication 5% 5% 5% 5% Summary of comments: Waiting times better. Focus on who you're dropping off and what is best for the individual. Better engagement with primary care - understand the demands/needs and vice-versa. Ownership accepted by call handlers/team leaders. Visibility of performance i.e. reporting of KPIs to relevant organisation/audience including the number of inappropriate referrals to the service. Escalation route for managers when issues arise. Ensure more patients are on the ambulances and the planners have a greater understanding of routes to ensure the service is more efficient. When working locally to the hospital we can often wait for patients to have their appointment then return them home. The planning of routes needs to be improved. Keep drivers to one route only and not drive around the whole of North Yorkshire. Internet based bookings and real time updates of transportation. We are often told that we can only book on the morning that the transport is required. This makes it impossible to manage my service efficiently. The service is very patient focused and the drivers are excellent with the patients. It is not the drivers that need improving it is the system. People who plan the routes obviously don't know the areas and ambulances should go out full and not only have one patient on them. One point of contact for GP surgeries, speak to one person who will take the details and arrange what is necessary. Dedicated end of life care ambulance. North Yorkshire Patient Transport Service Survey Feedback Report

41 Could PTS use trackers linked to the GPS system in the vehicles so that the control room can assign vehicles to tasks they are near and if a patient calls to say the transport has not arrived the know where it is? 20. Suggestions for issues that should be considered in relation to diverse needs (for example, rurality, race, gender, disability, age, sexual orientation and religion & belief) Respondents = 85 (60 patients, 25 healthcare workers) The majority of our patients requiring the services are elderly, ill, do not have access to computers, live rurally, and do not have family/carers. Hence we do a lot of bookings. 5% of patients and 32% of healthcare workers answered Yes to this question. A very small number of comments and suggestions were also received (13 in total). The main themes are below: Disability The PTS is already set up well to accommodate disabled patients already. Make sure staff are aware and supported to manage patients with dementia. Rurality Age Try to put clinics in local health centres (closer to home) for rural communities. Try to use smaller vehicles to pick up rural patients when longer journeys are required. Make journeys more direct for patients from home to hospital. The vehicles should be full to be more efficient. (2 comments) Rurality IS a problem. Rural areas tend to also have an ageing population. (2 respondents commented) Co-operation of hospital to offer late morning/early afternoon appointments to rural PTS users would help with waiting times and increase efficiency. Be mindful that elderly patients can get very tired, especially if having to wait a while. (3 comments) North Yorkshire Patient Transport Service Survey Feedback Report

42 Section 7 About the respondents 21. Respondent type Respondents = 55 patients, 28 healthcare workers Patient survey Healthcare worker survey Health care worker Carer 10% /Family /Friend 15% Other 3% Patient 72% Care home 6% PTS 9% Other 12% Hospit al 33% GP practic e 40% Other healthcare workers were from a local hospice and learning disability services. 22. Which hospital was the patient taken to? Respondents = 60 patients Hospital taken to Number of patients Selby & York District Hospital 1% (1) St Helen's Rehab Hospital 1% (1) Uncategorized 1% (1) James Cook University Hospital (Middlesbrough) 3% (2) Leeds St James Hospital 3% (2) The Friarage Hospital 16% (10) Scarborough Hospital 16% (10) Harrogate District Hospital 21% (13) York District Hospital 34% (21) North Yorkshire Patient Transport Service Survey Feedback Report

43 Vale of York provided the most amounts of data for both surveys (22 patients living and 10 healthcare workers working) followed by Harrogate and Rural District having 12 patients living and Hambleton, Richmondshire and Whitby having 13 patients visiting hospital in their region. The other areas had a constant 6 healthcare workers working in their areas. 1 (3.4%) healthcare worker who ticked Other, did not disclose the geographical area that they worked in. 4 (6.3%) patients who lived outside of the 4 CCG areas lived in East Riding of Yorkshire (2) and Leeds (2). 23. For which type of appointment do you normally use PTS? Respondents = 62 patients Type of appointment PTS is used for North Yorkshire Patient Transport Service Survey Feedback Report

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