National Kidney Care Audit

Transcription

1 National Kidney Care Audit Patient Transport Survey Report Reporting on the 2008 survey Prepared in partnership with:

2 National Kidney Care National Kidney Care Audit Patient Transport Survey Report Reporting on the 2008 survey The NHS Information Centre (The NHS IC) for health and social care is working to make information more relevant and accessible to the public, regulators, health and social care professionals and policy makers, leading to improvements in knowledge and efficiency. The NHS IC is a special health authority that collects, analyses and distributes data to reduce the burden on frontline staff, releasing more time for direct care. Original Date of Publication: 2nd June 2009, Document Reference IC Revised Edition Date of Publication: 8th March 2010 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

3 Contents Contents Foreword Acknowledgements i ii Introduction 1 How HD units are organised 2 Why an audit of patient transport is important 2 Commissioning arrangements for HD and for transport 3 What is known about HD transport quality provision 4 Scope of this audit 4 Methods 5 Coverage 6 Case Study 7 Results 8 Patient survey 8 Response rate 8 Age of respondents 10 Distance from home to the dialysis unit 12 What form of transport did the patients use? 16 Waiting and transit times 20 Waiting time to be picked up pre-dialysis 20 Journey time on the way in to dialysis 22 Arrival time on the dialysis unit 25 Waiting time to go on to dialysis machine 28 Waiting time to be picked up post-dialysis 31 Journey time for the homeward journey 34 Reasons for long journey times 37 Satisfaction ratings of patients 40 Do patients have to pay for their transport? 54 Commissioners /dialysis unit managers survey 57 Free text comments 60 Summary of results comparison against audit standards 62 Case Study 63 Discussion 64 Coverage and validity 64 Travelling and waiting times for patients 64 Commissioning and managing renal patient transport 65 Recommendations 66 References 67 Appendices 68 Appendix A 68 Participating units with response rates, grouped by SHA and equivalent and main unit Appendix B 79 The Implementation Group for the National Kidney Care Audit Patient Transport Appendix C 80 Organisational questionnaire sent to unit managers and commissioners Appendix D 82 Patient Questionnaire Appendix E 88 A worked example using the NHS iview online interactive analysis tool to compare a main unit to its satellite units Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

4 Foreword Foreword I welcome this national kidney care audit of transport. When I ask people receiving haemodialysis what aspect of their kidney care could be improved, transport is invariably top of the list. Indeed on the day of the survey I travelled to a kidney unit over 100 miles away from my home; one of the patients I talked to there had a longer journey time than I did for her regular dialysis treatment! We now have the data to demonstrate why that is so. For people with kidney disease who receive haemodialysis treatment in hospitals or satellite units, transport to and from their dialysis is a major quality of life issue. When the journey times are short, staff are friendly and service is reliable, the experience of care is considerably enhanced. For many people on dialysis the experience is the outcome. When pick-up times are erratic, delays frequent, service anonymous or journey times always excessively long, the impact on patients wellbeing and negative effect can be so marked to the extent that it becomes the most frustrating and concerning aspect of treatment. For some individuals it leads them to decline dialysis. Over two thirds of people receiving haemodialysis completed the survey. That s a remarkable figure. It reflects the importance of the subject. Patients in every kidney unit volunteered to help with the development of action plans to address the inadequacies of local transport provision. Commissioners of care and kidney unit staff themselves have all responded positively. The challenge now that transport problems are visible is for every kidney team to make improvements in this aspect of care a priority. Patient transport services, acute trusts and other providers of dialysis, commissioners and kidney patient associations all have responsibilities and need to work together. Part of the planning might be providing more home dialysis both home haemodialysis and peritoneal dialysis, provision of more local dialysis as well as more personal and responsive transport and parking arrangements at current units. Better transport will also help reduce our carbon footprint and help with the green nephrology agenda. I believe that the kidney community can rise to that challenge in doing so experience of care, sense of wellbeing and indeed the quality of haemodialysis treatment can be considerably improved. Dr Donal O Donoghue National Clinical Director for Kidney Care i Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

5 Acknowledgements Acknowledgements The National Kidney Care Audit is commissioned by the Healthcare Quality Improvement Partnership (HQIP). The audit is managed by The NHS Information Centre for health and social care (The NHS IC), who are working in partnership with the National Kidney Federation and the UK Renal Registry. There are two distinct areas of audit; the provision of timely and appropriate surgery for permanent vascular access and patient transport for haemodialysis patients. Throughout the development of the audit we have had invaluable support from patients and their representatives, clinical staff and other health professionals, IT and operational staff within The NHS IC, commissioners and patient transport provider representatives. We acknowledge how vital their input has been into ensuring that the audit has been successful. In particular, we would like to express thanks to all the patients, renal unit managers, clinical staff and commissioners who made this survey possible through their support and hard work. The input of the patient transport implementation group and the commitment of all those who have encouraged participation in the audit across England, Wales and Northern Ireland have also been essential. Our thanks also go to the patient transport clinical lead, Dr Alistair Chesser, who has drafted this report and to Dr Mike Sandell at The NHS Information Centre, who has produced the analysis it contains. Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. ii

6 Introduction Introduction What haemodialysis involves Renal Replacement Therapy (RRT) takes the form either of dialysis or kidney transplantation. Not all patients are suitable for a kidney transplant (either because they are not physically well enough, there is no suitable donor kidney, or patient choice). These patients have dialysis. Dialysis takes the form either of peritoneal dialysis (PD) or haemodialysis (HD). Peritoneal dialysis is usually home based, and is not the subject of this report. HD can be performed at home, but far more often takes place in a dialysis unit. Most renal centres have a main unit, geographically part of a renal unit in a hospital with inpatient beds and other supporting services, and satellite unit(s), which may be based in associated hospitals or be free standing. Figure 1 Types of treatment for end stage renal disease. The numbers of patients in the UK in each group are shown (data calculated from the 2008 UK Renal Registry report 1 ) Haemodialysis patients who do not dialyse in their own homes (in the shaded boxes) are the subject of this audit. End stage kidney disease Kidney transplantation 21,132 Dialysis 24,352 Conservative management of kidney faliure Haemodialysis 19,706 Peritoneal dialysis 4,646 Homebased haemodialysis based haemodialysis 19,149 Main centre based haemodialysis 11,462 Satellite unit based haemodialysis 7,687 1 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

7 Introduction How HD units are organised This audit covers England, Wales and Northern Ireland. There were 247 haemodialysis units in England, Wales and Northern Ireland at the time of this survey, including 12 specialist paediatric units. Many centres have satellite units, which are positioned either in associated hospitals or are free-standing. Satellite units are run by the main centre, with shared patients and staff. Appendix A gives the names and hierarchical relationships of these units. Haemodialysis patients usually have dialysis three times per week. Patients spend approximately four hours on dialysis, during which time they are physically attached to the dialysis machine (though there is variability in dialysis duration between patients). Dialysis can be arduous treatment for the patient, with many patients finding it fatiguing and feeling unwell for some time after the end of each treatment. Most patients have dialysis either on Monday, Wednesday and Friday or on Tuesday, Thursday and Saturday. Most dialysis units run 2-3 shifts of dialysis per day, so that patients dialyse either in the morning, afternoon or evening. Why an audit of patient transport is important The Renal National Service Framework (NSF) 2 states: Adequate transport is so important to people on haemodialysis that it plays a vital role in the formation of patient views and attitudes towards dialysis. Good transport systems can improve patient attendance and shorter travel times can improve patient cooperation if the dialysis treatment frequency needs to be increased. Efficient transport facilities reduce interruption of patients social lives and may therefore improve their quality of life. Renal NSF Part 1 Long travel and waiting times adversely affect quality of life for haemodialysis patients. There is support for this assertion in the literature. Moist et al 3 reported data from the DOPPS (Dialysis Outcomes and Practice Patterns Study) cohort, demonstrating that longer travel time was associated with a greater adjusted risk of death as well as with lower scores in quality of life questionnaires. There is also evidence that the prevalence of haemodialysis tends to fall with increasing travel time to the nearest dialysis unit. White et al 4 found that HD prevalence fell with increasing travel time from dialysis units in Wales. When a new HD unit was built in Aberystwyth, prevalence rose in the next two years from a significantly low level to one consistent with the national average. Other studies have demonstrated this association, with evidence of a falling prevalence rate of HD as travel time to the nearest unit exceeds approximately 30 minutes 5,6 The UK Renal Association Clinical Practice Guidelines 7 group have recognised the importance of travel time for HD patients, and state: Except in remote geographical areas the travel time to a haemodialysis facility should be less than 30 minutes or a haemodialysis facility should be located with 25 miles of the patients home. In inner city areas travel times over short distances may exceed 30 minutes at peak traffic flow periods during the day. Haemodialysis patients who require transport should be collected from home within 30 minutes of the allotted time and be collected to return home within 30 minutes of finishing dialysis. Renal Association Clinical Practice Guidelines for Haemodialysis 2007 There is recognition that achieving a travel time of less than 30 minutes is not always practical, especially in urban areas with traffic congestion. The optimal geographical placement of satellite units to minimise patient travelling time can help with this 8. There is increasing evidence that the majority of patients can receive their dialysis safely and efficiently in satellite units 9. It is not only distance and traffic congestion which dictate travel time for patients, but also the efficiency of the transport provider. The Scottish Cross Party Group on Kidney Disease 10 reported that 49 per cent of HD patients in Scotland had travel times of greater than 30 minutes despite the fact that only 10 per cent lived more than a 30 minute drive away from their local HD unit. Longer travel times were affected by journeys which picked up and dropped off other patients. It is important to remember that the total journey time for the patient includes not just the time in transit, but also the time waiting for the transport to arrive, and the time spent on the dialysis unit after Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 2 of 94

8 Introduction arrival waiting to go on the machine. Both the Renal Association 7 and the Scottish Cross Party report 10 recommend that waiting times should not exceed 30 minutes at any stage. Commissioning arrangements for HD and for transport Commissioning for dialysis is undertaken at SHA level by specialised commissioning groups, each representing their constituent Primary Care Trusts. Dialysis centres are paid per patient receiving dialysis, with no national tariff in place at the time of this audit and costs locally agreed. A significant proportion of haemodialysis patients are unable to transport themselves to and from dialysis. Commissioning of transport varies by SHA: in some areas the costs of patient transport are included in the fee paid for HD, and in others it is paid separately or as part of a larger contract between PCTs and the hospital Trust. Usually dialysis centres tender and commission their own transport for patients. Some may use the same transport provider as is used by other patients in that Trust, while others commission independently. Quality standards in transport provision are therefore the responsibility of the provider unit, overseen by the commissioning group, with much local variation in practice. Thus commissioning arrangements vary across the UK, and lines of accountability are often not clear. The Cheshire and Merseyside Action Learning Set 11 reported that in one SHA there were 35 separate Service Level Agreements (SLAs) for patient transport, and in only one of these was there a renal specific element though many of the others also involved HD transport. While commissioning is often disjointed and opaque, HD unit staff are usually the health care professionals who are in the front line for identifying problems with transport. Patients complain first to their dialysis nurse or doctor. Delays in transport can significantly impact on the daily routine of a HD unit. Delays for one patient can lead to delays for the patient due to dialyse next, and to renal unit staff having to work beyond the end of their shift times. There is a perception that fragmentation of commissioning arrangements and the dissociation between those responsible and those who are affected by the quality of the service lead to difficulty in setting and maintaining standards. The Audit Commission report on non-emergency patient transport (2001) 12 reported that there are no nationally agreed minimum quality standards for non-emergency patient transport. Standards are set by local hospital trusts and commissioners. In some cases hospital trusts and transport services continue to trade informally with little or no attention to written standards in service agreements. It specifically identified HD as an area where patient transport is important with the need for defined arrival times so that treatment is not interrupted by transport inadequacy. Amongst its recommendations were that commissioning bodies should treat appropriate provision of free transport as part of the package of health care, and patients views should be surveyed regularly. It also recommended that quality standards should be set after consultation with patients, and that these standards should be publicised locally. Contracts should encourage and reward achievement of standards. The NHS Purchasing and Supply Agency (PASA) 13 in its guide to procurers states that: You may wish to consider exploring the options of a dedicated (renal) service... because the need is entirely predictable, the necessary resource allocation is much easier to quantify. In the case of renal patients, the attendance will perhaps be three times per week for years if not for life. Given the frequency of the attendance and the degree of debilitation associated with the condition it is vital that these patient groups receive a totally reliable service with knowledgeable staff. A dedicated service will foster closer relationships between driver and patients which will not only allow for a greater degree of personal care at this point of the episode but which will also enhance the patient experience. 3 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

9 Introduction What is known about HD transport quality provision The Pan-Thames Renal Audit Group (PTRAG) reported on an audit of HD transport in 2008 in London and the South East of England 14. It questioned all HD patients on one of their dialysis days about their most recent journey. It reported: A 65 per cent response rate (2787 patients) 57 per cent of the respondents used hospital provided transport 43 per cent of the respondents lived within five miles of the unit where they received dialysis 41 per cent of patients on hospital transport travelled for longer than 30 minutes, with 11 per cent travelling for longer than one hour 53 per cent of patients on hospital transport had commenced dialysis within 30 minutes of their arrival on the dialysis unit, but 14 per cent waited for more than one hour There was considerable variation in travel and waiting times between HD units, and within dialysis centres between main units and the satellite units. The PTRAG report concluded that units in London and the South East of England are failing to meet the Renal Association Guidelines for HD transport, while recognising that a 30 minute journey time is often unrealistic in London. It also identified a lack of monitoring and standards within Trusts, an absence of clear criteria on eligibility of hospital transport and poorly developed audits of patient satisfaction and collection of patients views. Scope of this audit The Patient Transport Section of the National Kidney Care Audit (NKCA) was commissioned to conduct two surveys of patient transport for HD patients. We report here the results of the first of these surveys, conducted in October The second survey is due to take place in October This audit was designed to address the following questions: 1. How does the provision of patient transport services for HD patients compare with the national average and the best performance nationally? 2. What is the variation in travel and waiting times for patients and how do these times compare with the standard of 30 minutes travel time each way? The survey was designed in two parts, a patient questionnaire in which patients views were captured directly with a paper form, and a separate electronic survey which was sent to HD unit managers and commissioners for HD services The standards against which the responses were measured were: Patients should not wait more than 30 minutes to be picked up from home prior to their dialysis session Travel times between home and the dialysis unit should be 30 minutes or less for patients (though with recognition that this may be hard to achieve in some areas) Patients should wait no longer than 30 minutes following the completion of dialysis to be picked up for their journey home The reasons for long journey times when appropriate, including measurement of journey distance and the number of other patients picked up or dropped off during the journey Patient should be satisfied with their transport arrangements There should be clear criteria for assessing eligibility for non-emergency transport for HD patients Patients should not be charged for their journeys to and from dialysis Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 4 of 94

10 Methods Methods An implementation group was set up and given responsibility for the audit. The group included a patient advocate, renal nurse, nephrologist, renal specialised commissioner, social worker, transport provider, information analyst and others. Members of the implementation group are listed in Appendix B. The audit consisted of two questionnaires. The first of these was sent to renal unit managers and commissioners, and is shown in Appendix C. The second was designed to ask patients about their most recent journey home from dialysis, and also about their journey in to the dialysis unit on the day of the audit. The questionnaire for patients is shown in Appendix D. Patients were asked questions about: What mode of transport they used for these journeys (hospital provided, private car, public transport, walking or taxi) Where they live in relation to the dialysis unit to enable distances of journeys to be calculated For those using hospital transport, the waiting time from scheduled pick-up time to when the transport set off (both pre and post dialysis) Transit time for the outward and homeward journeys Satisfaction with the service, globally and with respect to specific criteria (cleanliness, politeness of staff etc) The number of other patients picked up or dropped off during the journey Whether patients pay for their transport The questionnaire was piloted in August The pilot covered 1000 patients in main and satellite dialysis units in London and Liverpool (including one paediatric unit). Feedback from patients and staff following the pilot study led to some changes in the design of the final questionnaires. The patient questionnaire was given to all patients receiving dialysis in participating units on either 15 October or 16 October These dates were chosen because they captured weekday journeys, avoided school or national holidays, and were felt to be representative of average days. By distributing the questionnaire on two consecutive days all patients who had dialysis on three or more days per week (and many of the small number of patients who received dialysis only twice per week) in participating units were captured once. All dialysis units in England, Wales and Northern Ireland were invited to participate, including all paediatric units. Scotland undertook a seperate patient transport survey. Questionaire information was shared to enable comparative analysis to be undertaken with Scottish results. Dialysis unit staff were asked to encourage patients to complete the questionnaire. Written and verbal reassurance was given to all patients that their responses would be treated confidentially, anonymised and collated so that it would not be possible to trace replies back to individuals. Help was given by dialysis unit staff to those who requested it, including with translation when possible. All patients were assured that participation was voluntary and would not affect the care they were given. Staff at The NHS Information Centre attempted to identify the manager of each dialysis unit and the commissioning manager for dialysis transport in the SHA and PCT. These individuals were invited to complete the managers/commissioners questionnaire online at the same time as the paper patient questionnaire was sent out. Non-responders were sent follow up s to encourage responses. The questionnaires were collated and analysed by staff at The NHS Information Centre. A high level summary of the results is provided in this report. The results are available for NHS staff and patients to see and self-analyse using an interactive programme on the National Kidney Care Audit website: 5 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

11 Methods Coverage At the time of the survey there were 247 separate locations for unit or satellite unit based dialysis in England, Wales and Northern Ireland. Five of these locations did not participate in the survey (see Table 1). Table 1 Non-participating HD units in England, Wales and Northern Ireland Dialysis unit Parent unit SHA Aintree University Hospital Liverpool Aintree University Hospital North West St George s Hospital London St George s Hospital London Stratford upon Avon Coventry Walsgrave Hospital West Midlands Whitnash Leamington Spa Coventry Walsgrave Hospital West Midlands Yeovil (Devon and Exeter) Exeter - Royal Devon and Exeter Hospital South West The remaining 242 locations are listed in Appendix A, along with their affiliation to their parent unit. In this report we amalgamate the responses of satellite units and main units, and report the results only at the level of 62 non-paediatric main units. Thus the results shown for one centre contain the amalgamated results from all of that centre s satellite units. It is recommended that interested parties study the more detailed breakdown of results by individual satellite unit and location which can be found on the website: there are clear differences in responses between different satellite units attached to the same main unit. Lack of space prevents publication of these detailed results in this report. s that submitted returns for ten or fewer patients have been excluded from this report, in order to ensure protection of patients anonymity. These excluded units include all but two of the 12 paediatric locations. The remaining two paediatric units have also been removed, as it was felt inappropriate to compare these two units to the non-paediatric units. There are plans to feed the information back to these smaller units in a manner which protects confidentiality compatible with information governance best practice. Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 6 of 94

12 Case Study Transport for kidney patients a personal perspective Roy Jones Haemodialysis patient Roy Jones, 66 travels five miles to a satellite unit in Northamptonshire for treatment and uses hospital transport. Without the service he would have to rely on public transport to reach the unit. I would have to get at least two buses and I m not good at walking, so I wouldn t be able to do it. The patient transport service is essential for me, said Roy, who has had kidney failure since the age of 25. Although Roy is generally happy with the transport service, a clearer approach to pick-up times, allocated drivers, and transport routes could help improve his experience. You never know what driver you have these days we always used to know and the driver never picks me up at the same time so I don t know when to be ready. he said. I can t understand the variation in times, even with the traffic, and the earlier we get to the unit the earlier we can get on with treatment. The patients at the unit all seem to moan about the same thing about having to wait. One woman does three hours on dialysis, but the man she travels with does four hours and she has to wait for him. If close dialysis times are sorted out for people who live close together, then we wouldn t have to wait as long to travel home. Roy, whose kidneys failed completely after he suffered a heat attack aged 50, thinks a better awareness of where patients live in relation to each other would not only shorten waiting times, but also patient journeys. One man at the unit lives five minutes away from me and I am supposed to go home with him, but this works for about two weeks and then I have to go back with another lady, even though she lives in another village much further away, he said. One day I was four minutes away from my house, but the driver turned off to the lady s village and then we had to double-back to take me home. I can be home about 45 minutes quicker if I am taken home with the man rather than the lady. The drivers keep changing so they don t understand, and people who don t live close to each other are put on the same transport. You can see that me and the man have the same postcode, so it should be simple. These are small things that are sorted out easily and people wouldn t complain. 7 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

13 Results Patient survey Response rate The results contain data from 216 of the 242 locations that participated. (24 locations provided returns from ten or fewer patients and are not included, as are the remaining two paediatric units as discussed). The 216 adult units that are included cover 98.6 per cent of all the patient responses received.the overall response rate for non-paediatric units in England, Northern Ireland and Wales was 67.2 per cent, and for paediatric units was 81.2 per cent. Response rates varied by country (Figure 2), with the highest response rate in Northern Ireland. There was also significant variation in response rates by renal centre, reported in Figure 3 in 10 per cent bands in order to protect anonymity, with response rates varying from 20 per cent to 100 per cent. Figure 2 Response rate by country. Northern Ireland England Wales 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Response rate Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 8 of 94

14 Figure 3 Response rates by renal centre, grouped by country. Chelmsford - Broomfield Hospital Gloucester Royal Hospital Response rate ENGLAND 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Ipswich Hospital Southend Hospital Brighton - Royal Sussex County Hospital Cambridge - Addenbrooke's Hospital Carlisle - Cumberland Infirmary Kent & Canterbury Hospital Liverpool - Aintree University Hospital Newcastle - Freeman Hospital Salford - Hope Hospital Shrewsbury - Royal Shrewsbury Hospital Basildon Birmingham - Heartlands Hospital Derby City General Hospital Doncaster Royal Infirmary Exeter - Royal Devon and Exeter Hospital Leeds - St James's University Hospital - Ward 55 London - West London Renal and Transplant Centre - Auchi Acute Dialysis Preston - Royal Preston Hospital Stoke - University Hospital of North Staffordshire Sunderland Royal Hospital Birmingham - Queen Elizabeth Hospital Bristol - Southmead Hospital Coventry - Walsgrave Hospital Leicester General Hospital Liverpool - Royal Liverpool University Hospital London - King's College Hospital London - St Barts Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Manchester Royal Infirmary Middlesbrough - The James Cook University Hospital Norfolk & Norwich University Hospital Oxford Radcliffe Hospital Reading - Royal Berkshire Hospital Truro - Royal Cornwall Hospital, Treliske Wirral - Arrowe Park Hospital Bradford - St Luke s Hospital Dudley - Russells Hall Hospital Hull Royal Infirmary London - Royal Free & Middlesex Hospital Portsmouth - Queen Alexandra Hospital Sheffield - Northern General Hospital Stevenage - The Lister Hospital Wolverhampton - New Cross Hospital York District General Hospital Colchester General Hospital Dorchester - Dorset County Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Nottingham City Hospital Renal and Transplant Plymouth - Derriford Hospital 9 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

15 Response rate NORTHERN IRELAND 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Belfast - Ulster Hospital Belfast City Hospital Newry - Daisy Hill Hospital Antrim Area Hospital Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital WALES 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Rhyl - Glan Clwyd Hospital Swansea - Morriston Hospital Cardiff - University Hospital of Wales Wrexham - Maelor Hospital Bangor - Gwynedd Hospital Age of respondents There was considerable variation in the self-reported ages of the respondents (see Figure 4). Those respondents saying they were aged 65 years or older varied from as high as 74.0 per cent (Truro) to as low as 33.0 per cent (Barts and The London). Figure 4 Age distributions for renal centres, ordered by country and proportion of patients aged 65 years and above. ENGLAND Truro - Royal Cornwall Hospital, Treliske Dorchester - Dorset County Hospital Exeter - Royal Devon and Exeter Hospital Gloucester Royal Hospital Chelmsford - Broomfield Hospital Brighton - Royal Sussex County Hospital Carlisle - Cumberland Infirmary Plymouth - Derriford Hospital Reading - Royal Berkshire Hospital Norfolk & Norwich University Hospital Bristol - Southmead Hospital York District General Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Cambridge - Addenbrooke's Hospital Stevenage - The Lister Hospital Portsmouth - Queen Alexandra Hospital Hull Royal Infirmary Southend Hospital Leeds - St James's University Hospital - Ward 55 Sheffield - Northern General Hospital Shrewsbury - Royal Shrewsbury Hospital Middlesbrough - The James Cook University Hospital Kent & Canterbury Hospital Oxford Radcliffe Hospital Derby City General Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 10 of 94

16 Birmingham - Heartlands Hospital Nottingham City Hospital Renal and Transplant Wolverhampton - New Cross Hospital Birmingham - Queen Elizabeth Hospital London - Guy s and St Thomas - 4 th Floor Dialysis London - West London Renal and Transplant Centre - Auchi Acute Dialysis Leicester General Hospital Colchester General Hospital Doncaster Royal Infirmary Stoke - University Hospital of North Staffordshire Wirral - Arrowe Park Hospital London - Royal Free & Middlesex Hospital Coventry - Walsgrave Hospital Basildon Bradford - St Luke s Hospital Dudley - Russells Hall Hospital Newcastle - Freeman Hospital Preston - Royal Preston Hospital London - King's College Hospital Liverpool - Royal Liverpool University Hospital Ipswich Hospital Salford - Hope Hospital Liverpool - Aintree University Hospital Manchester Royal Infirmary Sunderland Royal Hospital London - St Barts Hospital NORTHERN IRELAND Belfast - Ulster Hospital Antrim Area Hospital Omagh - Tyrone County Hospital Newry - Daisy Hill Hospital Derry/Londonderry - Altnagelvin Hospital Belfast City Hospital WALES Swansea - Morriston Hospital Cardiff - University Hospital of Wales Wrexham - Maelor Hospital Bangor - Gwynedd Hospital Rhyl - Glan Clwyd Hospital years years 65 years and above No response No useful data 11 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

17 Distance from home to the dialysis unit Patients were asked their home postcode per cent of patients provided this information, in which case the distance as the crow flies from the patients home to the dialysis unit was calculated. 9.2 per cent of patients did not give a postcode but did provide an estimate of the distance to the unit from their home. The combined results are shown Figure per cent of respondents live within five miles of their dialysis unit, while 18.3 per cent live more than 10 miles away. Figure 5 Distribution of distances travelled. 70% 60% 50% Percentage of patients 40% 30% 20% 10% 0% No response 0-5 miles 6-10 miles miles miles Over 40 miles Don t know No useful data Figure 6 Distribution of distances travelled by renal centre, ordered by country and proportion of patients travelling 5 miles or less. ENGLAND Southend Hospital Birmingham - Heartlands Hospital Dudley - Russells Hall Hospital Wolverhampton - New Cross Hospital London - King's College Hospital Wirral - Arrowe Park Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Bradford - St Luke s Hospital London - St Barts Hospital Coventry - Walsgrave Hospital London - Royal Free & Middlesex Hospital Salford - Hope Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Manchester Royal Infirmary Sunderland Royal Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 12 of 94

18 Stoke - University Hospital of North Staffordshire Liverpool - Royal Liverpool University Hospital Hull Royal Infirmary London - Guy s and St Thomas - 4 th Floor Dialysis Birmingham - Queen Elizabeth Hospital Reading - Royal Berkshire Hospital Nottingham City Hospital Renal and Transplant Leeds - St James's University Hospital - Ward 55 Bristol - Southmead Hospital Doncaster Royal Infirmary Ipswich Hospital Stevenage - The Lister Hospital Plymouth - Derriford Hospital Sheffield - Northern General Hospital Leicester General Hospital Basildon Portsmouth - Queen Alexandra Hospital Newcastle - Freeman Hospital Liverpool - Aintree University Hospital York District General Hospital Oxford Radcliffe Hospital Shrewsbury - Royal Shrewsbury Hospital Kent & Canterbury Hospital Preston - Royal Preston Hospital Brighton - Royal Sussex County Hospital Gloucester Royal Hospital Dorchester - Dorset County Hospital Derby City General Hospital Middlesbrough - The James Cook University Hospital Norfolk & Norwich University Hospital Carlisle - Cumberland Infirmary Chelmsford - Broomfield Hospital Exeter - Royal Devon and Exeter Hospital Truro - Royal Cornwall Hospital, Treliske Colchester General Hospital Cambridge - Addenbrooke's Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Belfast City Hospital Belfast - Ulster Hospital Antrim Area Hospital Newry - Daisy Hill Hospital Omagh - Tyrone County Hospital WALES Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Bangor - Gwynedd Hospital 0 to 5 miles 6 to 20 miles 21 miles and over Don t know No useful data No response 13 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

19 Distance from the unit is only one factor in determining journey times. With the postcode information we were given, we calculated the percentage of patients in each unit who lived in an area classified as urban or rural. Of the 88.3 per cent of respondents who provided the necessary information, 82.5 per cent of these lived in an area classified as urban and 17.5 per cent in a rural area. Analysis by unit is shown in Figure 7. Those who lived in urban areas lived significantly closer (p<0.05) to their dialysis unit than those with rural addresses (Figure 8). Figure 7 Geoclassification of patients homes into urban or rural, by renal centre, ordered by country and proportion of patients in the urban classification. ENGLAND London - St Barts Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - Royal Free & Middlesex Hospital Southend Hospital Wolverhampton - New Cross Hospital Salford - Hope Hospital Birmingham - Heartlands Hospital Liverpool - Aintree University Hospital London - King's College Hospital Wirral - Arrowe Park Hospital Liverpool - Royal Liverpool University Hospital Bradford - St Luke s Hospital Manchester Royal Infirmary London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Basildon Stevenage - The Lister Hospital Coventry - Walsgrave Hospital Sunderland Royal Hospital Leeds - St James's University Hospital - Ward 55 Dudley - Russells Hall Hospital Birmingham - Queen Elizabeth Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Brighton - Royal Sussex County Hospital Preston - Royal Preston Hospital Portsmouth - Queen Alexandra Hospital Stoke - University Hospital of North Staffordshire Doncaster Royal Infirmary Bristol - Southmead Hospital Sheffield - Northern General Hospital Derby City General Hospital Reading - Royal Berkshire Hospital Newcastle - Freeman Hospital Kent & Canterbury Hospital Nottingham City Hospital Renal and Transplant Gloucester Royal Hospital Leicester General Hospital Ipswich Hospital Middlesbrough - The James Cook University Hospital Hull Royal Infirmary Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 14 of 94

20 Oxford Radcliffe Hospital Colchester General Hospital Dorchester - Dorset County Hospital Plymouth - Derriford Hospital Shrewsbury - Royal Shrewsbury Hospital Exeter - Royal Devon and Exeter Hospital York District General Hospital Chelmsford - Broomfield Hospital Norfolk & Norwich University Hospital Cambridge - Addenbrooke's Hospital Carlisle - Cumberland Infirmary Truro - Royal Cornwall Hospital, Treliske NORTHERN IRELAND Belfast City Hospital Derry/Londonderry - Altnagelvin Hospital Belfast - Ulster Hospital Antrim Area Hospital Newry - Daisy Hill Hospital Omagh - Tyrone County Hospital WALES Cardiff - University Hospital of Wales Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Bangor - Gwynedd Hospital Urban Rural No useful data Figure 8 Distribution of distances travelled by urban/rural classification. 80% 70% 60% 50% Percentage of patients 40% 30% 20% 10% 0% 0 to 5 miles 6 to 10 miles 11 to 20 miles Urban Distance band Rural 21 to 40 miles Over 40 miles 15 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

21 What form of transport did the patients use? We asked patients what form of transport they used to get to and from their dialysis. Responses have been grouped together as follows: Hospital Arranged Transport - Hospital transport vehicle - Ambulance service vehicle - Car provided by the hospital - Taxi arranged by the hospital Public transport - All forms of public transport Private transport - Own car - Friends or family car - Taxi arranged by patient - Walk The distributions of responses are shown in Figure 9 (for the journey from home to dialysis) and Figure 10 (for the homeward journey). In total 20.1 per cent of patients (2,313 of 11,522) reported a different mode of transport for the journey home compared to the journey in (Figure 11), with a pattern of more patients making their own way into dialysis and relying on hospital transport to take them home. In total, 62.4 per cent of respondents used hospital arranged transport for the journey in, 3.5 per cent used public transport and 29.6 per cent used their own or self-arranged car (4.5 per cent of respondents provided uninterpretable responses). Figure 9 Distribution of transport categories by renal centre, for the journey to dialysis. ENGLAND Colchester General Hospital Preston - Royal Preston Hospital Hull Royal Infirmary Leeds - St James's University Hospital - Ward 55 Bradford - St Luke s Hospital Dorchester - Dorset County Hospital Truro - Royal Cornwall Hospital, Treliske Plymouth - Derriford Hospital Carlisle - Cumberland Infirmary Portsmouth - Queen Alexandra Hospital Middlesbrough - The James Cook University Hospital Sheffield - Northern General Hospital Oxford Radcliffe Hospital Manchester Royal Infirmary Brighton - Royal Sussex County Hospital Kent & Canterbury Hospital Cambridge - Addenbrooke's Hospital Stoke - University Hospital of North Staffordshire Exeter - Royal Devon and Exeter Hospital Bristol - Southmead Hospital York District General Hospital Nottingham City Hospital Renal and Transplant Chelmsford - Broomfield Hospital Newcastle - Freeman Hospital Gloucester Royal Hospital Wirral - Arrowe Park Hospital Norfolk & Norwich University Hospital Leicester General Hospital Sunderland Royal Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 16 of 94

22 Derby City General Hospital London - St Barts Hospital Salford - Hope Hospital Shrewsbury - Royal Shrewsbury Hospital Birmingham - Queen Elizabeth Hospital Wolverhampton - New Cross Hospital Coventry - Walsgrave Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Reading - Royal Berkshire Hospital Liverpool - Royal Liverpool University Hospital Doncaster Royal Infirmary London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation London - Royal Free & Middlesex Hospital Ipswich Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Basildon Liverpool - Aintree University Hospital Birmingham - Heartlands Hospital London - King's College Hospital Dudley - Russells Hall Hospital Stevenage - The Lister Hospital Southend Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Antrim Area Hospital Newry - Daisy Hill Hospital Belfast - Ulster Hospital Belfast City Hospital WALES Bangor - Gwynedd Hospital Cardiff - University Hospital of Wales Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Hospital Arranged Transport Public Transport Private Transport No useful data 17 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

23 Figure 10 Distribution of transport categories by renal centre, for the journey home. ENGLAND Preston - Royal Preston Hospital Colchester General Hospital Truro - Royal Cornwall Hospital, Treliske Carlisle - Cumberland Infirmary Hull Royal Infirmary Leeds - St James's University Hospital - Ward 55 Bradford - St Luke s Hospital Dorchester - Dorset County Hospital Portsmouth - Queen Alexandra Hospital Manchester Royal Infirmary Middlesbrough - The James Cook University Hospital Kent & Canterbury Hospital Plymouth - Derriford Hospital Oxford Radcliffe Hospital Sheffield - Northern General Hospital Newcastle - Freeman Hospital Exeter - Royal Devon and Exeter Hospital Brighton - Royal Sussex County Hospital Cambridge - Addenbrooke's Hospital York District General Hospital Bristol - Southmead Hospital Norfolk & Norwich University Hospital Stoke - University Hospital of North Staffordshire London - St Barts Hospital Gloucester Royal Hospital Chelmsford - Broomfield Hospital Nottingham City Hospital Renal and Transplant Leicester General Hospital Shrewsbury - Royal Shrewsbury Hospital Sunderland Royal Hospital Salford - Hope Hospital Birmingham - Queen Elizabeth Hospital Derby City General Hospital Wirral - Arrowe Park Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Reading - Royal Berkshire Hospital Wolverhampton - New Cross Hospital Liverpool - Royal Liverpool University Hospital Coventry - Walsgrave Hospital London - Royal Free & Middlesex Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Liverpool - Aintree University Hospital Basildon Ipswich Hospital Doncaster Royal Infirmary London - King's College Hospital Stevenage - The Lister Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 18 of 94

24 Birmingham - Heartlands Hospital Dudley - Russells Hall Hospital Southend Hospital NORTHERN IRELAND Omagh - Tyrone County Hospital Derry/Londonderry - Altnagelvin Hospital Antrim Area Hospital Newry - Daisy Hill Hospital Belfast - Ulster Hospital Belfast City Hospital WALES Bangor - Gwynedd Hospital Cardiff - University Hospital of Wales Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Hospital Arranged Transport Public Transport Private Transport No useful data Figure 11 The change in the proportion of patients using each mode of transport, by country. Positive values indicate more people using the mode when travelling home than when travelling to dialysis, and negative values the converse. 3% 2% 1% Change in percentage 0% Hospital transport vehicle Ambulance service vehicle Car provided by the hospital Taxi arranged by the hospital Public transport Travelled in own car Friends or family car Taxi arranged by patient Walk Other No useful data No response -1% -2% -3% -4% Transport mode England Northern Ireland Wales 19 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

25 Waiting and transit times Waiting time to be picked up pre-dialysis We asked patients how long after their scheduled pick-up time from home for the journey to dialysis their transport arrived. We include here only the 62.4 per cent of respondents who used hospital patient transport services for their journey to dialysis. 4.7 per cent had to wait for more than 30 minutes for their hospital arranged transport to arrive after their scheduled pick-up time. There was a wide variation in punctuality between different units: for those who said their transport arrived to pick them up within 10 minutes of the appointment time the range went from 17.2 per cent (Coventry) to 86.1 per cent (Derry/Londonderry). There was no obvious pattern in the responses with respect to rurality or the size of the dialysis unit. Figure 12 Waiting time to be picked up by hospital arranged transport for the journey to dialysis by renal centre, ordered by country and the proportion in the Within 10 minutes category. ENGLAND York District General Hospital Bradford - St Luke s Hospital Colchester General Hospital Sunderland Royal Hospital Preston - Royal Preston Hospital Middlesbrough - The James Cook University Hospital Shrewsbury - Royal Shrewsbury Hospital Truro - Royal Cornwall Hospital, Treliske Portsmouth - Queen Alexandra Hospital Kent & Canterbury Hospital Ipswich Hospital Chelmsford - Broomfield Hospital Doncaster Royal Infirmary Carlisle - Cumberland Infirmary Stoke - University Hospital of North Staffordshire Oxford Radcliffe Hospital Stevenage - The Lister Hospital Manchester Royal Infirmary Plymouth - Derriford Hospital Derby City General Hospital Dudley - Russells Hall Hospital Wirral - Arrowe Park Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Salford - Hope Hospital Birmingham - Heartlands Hospital Gloucester Royal Hospital Exeter - Royal Devon and Exeter Hospital Leeds - St James's University Hospital - Ward 55 Dorchester - Dorset County Hospital Hull Royal Infirmary Wolverhampton - New Cross Hospital Reading - Royal Berkshire Hospital Cambridge - Addenbrooke's Hospital London - Royal Free & Middlesex Hospital Sheffield - Northern General Hospital London - King's College Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 20 of 94

26 London - Guy s and St Thomas - 4 th Floor Dialysis Southend Hospital Brighton - Royal Sussex County Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Liverpool - Royal Liverpool University Hospital Norfolk & Norwich University Hospital Liverpool - Aintree University Hospital London - St Barts Hospital Bristol - Southmead Hospital Leicester General Hospital Birmingham - Queen Elizabeth Hospital Newcastle - Freeman Hospital Basildon Nottingham City Hospital Renal and Transplant Coventry - Walsgrave Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Belfast City Hospital Belfast - Ulster Hospital Antrim Area Hospital Newry - Daisy Hill Hospital WALES Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Cardiff - University Hospital of Wales Wrexham - Maelor Hospital Bangor - Gwynedd Hospital Over 30 minutes early 10 to 30 mins early Within 10 mins of the time 10 to 30 mins late Over 30 mins late No useful data 21 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

27 Journey time on the way in to dialysis Patients were asked how long their journey took to dialysis on that day. Figure 13 shows the journey time for patients using hospital arranged transport, and Figure 14 that for patients transporting themselves, either by public or private transport. For hospital transport users, overall 58.2 per cent of patients had a journey time of 30 minutes or less, while 7.6 per cent had a journey time of 60 minutes or longer. Again, there was wide variation between units. The percentage of patients whose journey time was 30 minutes or less ranged from 28.3 per cent (Newry) to 83.3 per cent (Derry/ Londonderry). Only in six units (9.7 per cent) was the journey time less than 30 minutes for 75 per cent or more patients, when considering those who rely on hospital arranged transport. For those who arranged their own transport, 74.8 per cent of patients had a journey time of 30 minutes or less, and 3.3 per cent a journey time of 60 minutes or longer. Figure 13 Journey time to the dialysis unit for Hospital Arranged Transport users by renal centre, ordered by country and the proportion travelling for 30 minutes or less. ENGLAND Wirral - Arrowe Park Hospital Doncaster Royal Infirmary Hull Royal Infirmary Manchester Royal Infirmary Stoke - University Hospital of North Staffordshire Birmingham - Heartlands Hospital Basildon Sunderland Royal Hospital Ipswich Hospital Kent & Canterbury Hospital Middlesbrough - The James Cook University Hospital Bradford - St Luke s Hospital Wolverhampton - New Cross Hospital Bristol - Southmead Hospital Southend Hospital Newcastle - Freeman Hospital Preston - Royal Preston Hospital Leeds - St James's University Hospital - Ward 55 Shrewsbury - Royal Shrewsbury Hospital Truro - Royal Cornwall Hospital, Treliske Dudley - Russells Hall Hospital Liverpool - Aintree University Hospital Sheffield - Northern General Hospital Nottingham City Hospital Renal and Transplant Derby City General Hospital Leicester General Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Exeter - Royal Devon and Exeter Hospital Portsmouth - Queen Alexandra Hospital Coventry - Walsgrave Hospital York District General Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Plymouth - Derriford Hospital Reading - Royal Berkshire Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 22 of 94

28 Stevenage - The Lister Hospital Salford - Hope Hospital London - King's College Hospital Cambridge - Addenbrooke's Hospital Liverpool - Royal Liverpool University Hospital Norfolk & Norwich University Hospital Dorchester - Dorset County Hospital Oxford Radcliffe Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Brighton - Royal Sussex County Hospital Birmingham - Queen Elizabeth Hospital London - Royal Free & Middlesex Hospital Carlisle - Cumberland Infirmary Gloucester Royal Hospital Chelmsford - Broomfield Hospital London - St Barts Hospital Colchester General Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Belfast City Hospital Belfast - Ulster Hospital Omagh - Tyrone County Hospital Antrim Area Hospital Newry - Daisy Hill Hospital WALES Wrexham - Maelor Hospital Rhyl - Glan Clwyd Hospital Cardiff - University Hospital of Wales Bangor - Gwynedd Hospital Swansea - Morriston Hospital Less than 10 mins 10 to 30 mins 31 to 60 mins More than 1 hour No useful data No response 23 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

29 Figure 14 Journey time to the dialysis unit for patients using Public or Private Transport by renal centre, ordered by country and the proportion travelling for 30 minutes or less. ENGLAND Sunderland Royal Hospital Middlesbrough - The James Cook University Hospital Southend Hospital Hull Royal Infirmary Doncaster Royal Infirmary York District General Hospital Wolverhampton - New Cross Hospital Wirral - Arrowe Park Hospital Birmingham - Heartlands Hospital Bradford - St Luke s Hospital Preston - Royal Preston Hospital Manchester Royal Infirmary Leeds - St James's University Hospital - Ward 55 Ipswich Hospital Coventry - Walsgrave Hospital Gloucester Royal Hospital Liverpool - Royal Liverpool University Hospital Sheffield - Northern General Hospital Dudley - Russells Hall Hospital Portsmouth - Queen Alexandra Hospital Stevenage - The Lister Hospital Stoke - University Hospital of North Staffordshire Salford - Hope Hospital Bristol - Southmead Hospital Reading - Royal Berkshire Hospital Kent & Canterbury Hospital Chelmsford - Broomfield Hospital Truro - Royal Cornwall Hospital, Treliske Birmingham - Queen Elizabeth Hospital Shrewsbury - Royal Shrewsbury Hospital Leicester General Hospital Cambridge - Addenbrooke's Hospital Newcastle - Freeman Hospital Plymouth - Derriford Hospital Nottingham City Hospital Renal and Transplant Liverpool - Aintree University Hospital Basildon Dorchester - Dorset County Hospital Derby City General Hospital Brighton - Royal Sussex County Hospital Exeter - Royal Devon and Exeter Hospital Norfolk & Norwich University Hospital London - King's College Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Oxford Radcliffe Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 24 of 94

30 London - Royal Free & Middlesex Hospital London - St Barts Hospital Carlisle - Cumberland Infirmary Colchester General Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Belfast - Ulster Hospital Belfast City Hospital Antrim Area Hospital Omagh - Tyrone County Hospital Newry - Daisy Hill Hospital WALES Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Swansea - Morriston Hospital Cardiff - University Hospital of Wales Less than 10 mins 10 to 30 mins 31 to 60 mins More than 1 hour No useful data No response Arrival time on the dialysis unit We asked patients whether they arrived at the scheduled time for their dialysis, and the replies are shown in Figure 15 for hospital arranged transport users and Figure 16 for patients who arranged their own transport. For all patients (hospital transport and own transport combined), 18.8 per cent of patients arrived more than 30 minutes before their arrival time and 3.2 per cent arrived more than 30 minutes after their scheduled arrival time. When considering hospital transport users, 51.1 per cent arrived more than 10 minutes before their appointment time, and nearly half of these (21.5 per cent of the total) more than 30 minutes before their scheduled time. Early arrival was much more common than late arrival, with 11.4 per cent of hospital transport users arriving more than 10 minutes later than their appointment time and only 4.2 per cent more than 30 minutes late. For those who made their own way to the dialysis unit, 13.7 per cent arrived 30 minutes or more before their scheduled arrival time, 32.6 per cent arrived minutes early, while only 1.4 per cent arrived more than 30 minutes late and 4.4 per cent minutes late. Figure 15 Arrival punctualities for Hospital Arranged Transport users by renal centre, ordered by country and the proportion arriving within 10 minutes of their appointment time. ENGLAND York District General Hospital Bradford - St Luke s Hospital Preston - Royal Preston Hospital Chelmsford - Broomfield Hospital Doncaster Royal Infirmary Portsmouth - Queen Alexandra Hospital Stoke - University Hospital of North Staffordshire Colchester General Hospital Shrewsbury - Royal Shrewsbury Hospital Carlisle - Cumberland Infirmary Kent & Canterbury Hospital Birmingham - Heartlands Hospital Sunderland Royal Hospital Liverpool - Aintree University Hospital Middlesbrough - The James Cook University Hospital Truro - Royal Cornwall Hospital, Treliske 25 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

31 Ipswich Hospital Dorchester - Dorset County Hospital Leeds - St James's University Hospital - Ward 55 Derby City General Hospital Plymouth - Derriford Hospital Hull Royal Infirmary Exeter - Royal Devon and Exeter Hospital Brighton - Royal Sussex County Hospital Sheffield - Northern General Hospital Liverpool - Royal Liverpool University Hospital Manchester Royal Infirmary Cambridge - Addenbrooke's Hospital Norfolk & Norwich University Hospital Gloucester Royal Hospital Oxford Radcliffe Hospital London - King's College Hospital Stevenage - The Lister Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Salford - Hope Hospital London - Royal Free & Middlesex Hospital Wirral - Arrowe Park Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation London - West London Renal and Transplant Centre - Auchi Acute Dialysis Wolverhampton - New Cross Hospital Leicester General Hospital Birmingham - Queen Elizabeth Hospital London - St Barts Hospital Coventry - Walsgrave Hospital Nottingham City Hospital Renal and Transplant Bristol - Southmead Hospital Dudley - Russells Hall Hospital Basildon Reading - Royal Berkshire Hospital Newcastle - Freeman Hospital Southend Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Belfast City Hospital Newry - Daisy Hill Hospital Antrim Area Hospital Belfast - Ulster Hospital WALES Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Cardiff - University Hospital of Wales Bangor - Gwynedd Hospital Wrexham - Maelor Hospital Over 30 mins early 10 to 30 mins early Within 10 mins of the time 10 to 30 mins late Over 30 mins late No time allocated No useful data Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 26 of 94

32 Figure 16 Arrival punctualities for patients using Public or Private Transport by renal centre, ordered by country and the proportion arriving within 10 minutes of their appointment time. ENGLAND Preston - Royal Preston Hospital Wirral - Arrowe Park Hospital York District General Hospital Hull Royal Infirmary Portsmouth - Queen Alexandra Hospital Exeter - Royal Devon and Exeter Hospital Middlesbrough - The James Cook University Hospital Shrewsbury - Royal Shrewsbury Hospital Liverpool - Aintree University Hospital Dorchester - Dorset County Hospital Cambridge - Addenbrooke's Hospital Norfolk & Norwich University Hospital Bristol - Southmead Hospital Gloucester Royal Hospital Bradford - St Luke s Hospital Ipswich Hospital Plymouth - Derriford Hospital Dudley - Russells Hall Hospital Derby City General Hospital Reading - Royal Berkshire Hospital Liverpool - Royal Liverpool University Hospital Sheffield - Northern General Hospital Newcastle - Freeman Hospital Doncaster Royal Infirmary Stoke - University Hospital of North Staffordshire London - Guy s and St Thomas - 4 th Floor Dialysis Birmingham - Heartlands Hospital Leicester General Hospital London - St Barts Hospital Leeds - St James's University Hospital - Ward 55 Brighton - Royal Sussex County Hospital Kent & Canterbury Hospital Manchester Royal Infirmary Oxford Radcliffe Hospital Coventry - Walsgrave Hospital London - Royal Free & Middlesex Hospital Basildon Southend Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Sunderland Royal Hospital London - King's College Hospital Salford - Hope Hospital Stevenage - The Lister Hospital Birmingham - Queen Elizabeth Hospital Chelmsford - Broomfield Hospital Carlisle - Cumberland Infirmary 27 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

33 Wolverhampton - New Cross Hospital Truro - Royal Cornwall Hospital, Treliske Nottingham City Hospital Renal and Transplant Colchester General Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Newry - Daisy Hill Hospital Omagh - Tyrone County Hospital Belfast City Hospital Belfast - Ulster Hospital Antrim Area Hospital WALES Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Over 30 mins early 10 to 30 mins early Within 10 mins of the time 10 to 30 mins late Over 30 mins late No time allocated No useful data Waiting time to go on to dialysis machine We asked patients how long after their arrival on the dialysis unit they actually started their dialysis treatment. Figure 17 shows these results for hospital arranged transport users and Figure 18 for patients who use their own or public transport. Again, there was significant variation between units. For hospital transport users, the proportion of patients who got on to the dialysis machine within 30 minutes of their arrival on the unit varied between 48.3 per cent and 97.2 per cent. For those using their own transport, the corresponding range was 56.0 per cent to per cent. These responses have to be interpreted alongside those shown in Figures 15 and 16 (arrival time compared to scheduled arrival time). A long wait to go on to the dialysis machine may be the consequence of arriving earlier than scheduled, rather than the dialysis unit running late. Whatever the cause, this sometimes translates into long waits for patients: 5.4 per cent of hospital transport users waited an hour or more after their arrival on the unit before going on to dialysis. Only 11 units (17.7 per cent) have 85 per cent or more of its hospital transport users on dialysis within 30 minutes of them arriving on the unit. Figure 17 Wait time at the unit, before going on to dialysis machine, for Hospital Arranged Transport users by renal centre, ordered by country and proportion waiting less than 30 minutes. ENGLAND Portsmouth - Queen Alexandra Hospital Stoke - University Hospital of North Staffordshire Carlisle - Cumberland Infirmary Ipswich Hospital York District General Hospital Chelmsford - Broomfield Hospital Hull Royal Infirmary Wirral - Arrowe Park Hospital Leeds - St James's University Hospital - Ward 55 Bradford - St Luke s Hospital Birmingham - Heartlands Hospital Preston - Royal Preston Hospital Dorchester - Dorset County Hospital Sheffield - Northern General Hospital Exeter - Royal Devon and Exeter Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 28 of 94

34 Kent & Canterbury Hospital Derby City General Hospital Liverpool - Royal Liverpool University Hospital Norfolk & Norwich University Hospital Southend Hospital Middlesbrough - The James Cook University Hospital Coventry - Walsgrave Hospital Wolverhampton - New Cross Hospital Gloucester Royal Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Nottingham City Hospital Renal and Transplant Brighton - Royal Sussex County Hospital Leicester General Hospital Shrewsbury - Royal Shrewsbury Hospital Sunderland Royal Hospital Doncaster Royal Infirmary Bristol - Southmead Hospital Oxford Radcliffe Hospital Salford - Hope Hospital Truro - Royal Cornwall Hospital, Treliske Colchester General Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Plymouth - Derriford Hospital Liverpool - Aintree University Hospital Birmingham - Queen Elizabeth Hospital Manchester Royal Infirmary Stevenage - The Lister Hospital London - King's College Hospital Cambridge - Addenbrooke's Hospital London - St Barts Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Basildon Reading - Royal Berkshire Hospital London - Royal Free & Middlesex Hospital Newcastle - Freeman Hospital Dudley - Russells Hall Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Belfast City Hospital Antrim Area Hospital Belfast - Ulster Hospital Newry - Daisy Hill Hospital WALES Wrexham - Maelor Hospital Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Bangor - Gwynedd Hospital Cardiff - University Hospital of Wales Less than 10 mins 10 to 30 mins 30 mins to 1 hour 1 to 2 hours More than 2 hours No useful data 29 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

35 Figure 18 Wait time at the unit, before going on to dialysis machine, for patients using Public or Private Transport by renal centre, ordered by country and proportion waiting less than 30 minutes. ENGLAND Sheffield - Northern General Hospital Preston - Royal Preston Hospital Portsmouth - Queen Alexandra Hospital Dorchester - Dorset County Hospital York District General Hospital Southend Hospital Wirral - Arrowe Park Hospital Exeter - Royal Devon and Exeter Hospital Stoke - University Hospital of North Staffordshire Plymouth - Derriford Hospital Middlesbrough - The James Cook University Hospital Derby City General Hospital Ipswich Hospital Basildon Shrewsbury - Royal Shrewsbury Hospital Liverpool - Aintree University Hospital Norfolk & Norwich University Hospital Wolverhampton - New Cross Hospital Gloucester Royal Hospital Leeds - St James's University Hospital - Ward 55 Coventry - Walsgrave Hospital Cambridge - Addenbrooke's Hospital Kent & Canterbury Hospital Leicester General Hospital Bristol - Southmead Hospital London - St Barts Hospital Hull Royal Infirmary Liverpool - Royal Liverpool University Hospital Birmingham - Heartlands Hospital Carlisle - Cumberland Infirmary London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Salford - Hope Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Sunderland Royal Hospital Brighton - Royal Sussex County Hospital Bradford - St Luke s Hospital Stevenage - The Lister Hospital Birmingham - Queen Elizabeth Hospital Newcastle - Freeman Hospital Oxford Radcliffe Hospital London - King's College Hospital Chelmsford - Broomfield Hospital Dudley - Russells Hall Hospital Nottingham City Hospital Renal and Transplant Reading - Royal Berkshire Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - Royal Free & Middlesex Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 30 of 94

36 Colchester General Hospital Truro - Royal Cornwall Hospital, Treliske Doncaster Royal Infirmary Manchester Royal Infirmary NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Belfast - Ulster Hospital Newry - Daisy Hill Hospital Belfast City Hospital Antrim Area Hospital WALES Wrexham - Maelor Hospital Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Cardiff - University Hospital of Wales Less than 10 mins 10 to 30 mins 30 mins to 1 hour 1 to 2 hours More than 2 hours No useful data Waiting time to be picked up post dialysis Figure 19 shows the waiting time to be picked up for hospital transport users after the end of the dialysis session. Overall 34.6 per cent of hospital transport users waited 30 minutes or more for their transport to set off post-dialysis, with 12.1 per cent waiting longer than 60 minutes. Only in five units (8.1 per cent) did 85 per cent or more of hospital transport patients get picked up within 30 minutes of completing their treatment. Figure 19 Waiting time to be picked up after dialysis for Hospital Arranged Transport users by renal centre, ordered by country and proportion waiting 30 minutes or less. ENGLAND York District General Hospital Carlisle - Cumberland Infirmary Ipswich Hospital Plymouth - Derriford Hospital Preston - Royal Preston Hospital Sunderland Royal Hospital Exeter - Royal Devon and Exeter Hospital Bradford - St Luke s Hospital Truro - Royal Cornwall Hospital, Treliske Shrewsbury - Royal Shrewsbury Hospital Cambridge - Addenbrooke's Hospital Kent & Canterbury Hospital Stoke - University Hospital of North Staffordshire Hull Royal Infirmary Sheffield - Northern General Hospital Middlesbrough - The James Cook University Hospital Leeds - St James's University Hospital - Ward 55 Manchester Royal Infirmary Portsmouth - Queen Alexandra Hospital Dorchester - Dorset County Hospital Derby City General Hospital Doncaster Royal Infirmary Wirral - Arrowe Park Hospital 31 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

37 Norfolk & Norwich University Hospital Newcastle - Freeman Hospital Gloucester Royal Hospital London - King's College Hospital Oxford Radcliffe Hospital Stevenage - The Lister Hospital Liverpool - Aintree University Hospital Wolverhampton - New Cross Hospital Bristol - Southmead Hospital Brighton - Royal Sussex County Hospital Dudley - Russells Hall Hospital Leicester General Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Salford - Hope Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Chelmsford - Broomfield Hospital London - St Barts Hospital Basildon Birmingham - Heartlands Hospital Nottingham City Hospital Renal and Transplant Colchester General Hospital Southend Hospital Reading - Royal Berkshire Hospital London - Royal Free & Middlesex Hospital Liverpool - Royal Liverpool University Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Birmingham - Queen Elizabeth Hospital Coventry - Walsgrave Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Antrim Area Hospital Newry - Daisy Hill Hospital Belfast - Ulster Hospital Belfast City Hospital WALES Bangor - Gwynedd Hospital Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Less than 10 mins 10 to 30 mins 30 mins to 1 hour 1 to 2 hours More than 2 hours No useful data Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 32 of 94

38 Figure 20 is provided for comparison and shows how long public and private transport users waited on the unit after their dialysis. For these patients one presumes the decision to leave the unit rested solely on whether they felt well enough to do so. Only 2.5 per cent of these patients chose to wait 30 minutes or longer before leaving for home. Figure 20 Waiting time to be picked up after dialysis for patients using Public or Private Transport by renal centre, ordered by country and proportion waiting 30 minutes or less. ENGLAND Doncaster Royal Infirmary York District General Hospital Sunderland Royal Hospital Hull Royal Infirmary Brighton - Royal Sussex County Hospital Portsmouth - Queen Alexandra Hospital Southend Hospital Reading - Royal Berkshire Hospital Liverpool - Aintree University Hospital Sheffield - Northern General Hospital Wirral - Arrowe Park Hospital Chelmsford - Broomfield Hospital Gloucester Royal Hospital Middlesbrough - The James Cook University Hospital Wolverhampton - New Cross Hospital Derby City General Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Bradford - St Luke s Hospital Cambridge - Addenbrooke's Hospital Birmingham - Queen Elizabeth Hospital Kent & Canterbury Hospital Birmingham - Heartlands Hospital Norfolk & Norwich University Hospital Leeds - St James's University Hospital - Ward 55 Manchester Royal Infirmary Dudley - Russells Hall Hospital London - King's College Hospital Basildon Stevenage - The Lister Hospital Liverpool - Royal Liverpool University Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Exeter - Royal Devon and Exeter Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Dorchester - Dorset County Hospital Plymouth - Derriford Hospital Ipswich Hospital Leicester General Hospital Salford - Hope Hospital London - Royal Free & Middlesex Hospital Oxford Radcliffe Hospital Nottingham City Hospital Renal and Transplant Truro - Royal Cornwall Hospital, Treliske 33 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

39 London - St Barts Hospital Newcastle - Freeman Hospital Coventry - Walsgrave Hospital Stoke - University Hospital of North Staffordshire Preston - Royal Preston Hospital Bristol - Southmead Hospital Shrewsbury - Royal Shrewsbury Hospital Colchester General Hospital Carlisle - Cumberland Infirmary NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Antrim Area Hospital Belfast - Ulster Hospital Belfast City Hospital Newry - Daisy Hill Hospital Omagh - Tyrone County Hospital WALES Bangor - Gwynedd Hospital Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Swansea - Morriston Hospital Cardiff - University Hospital of Wales Less than 10 mins 10 to 30 mins 30 mins to 1 hour 1 to 2 hours More than 2 hours No useful data Journey time for the homeward journey Patients were asked how long their journey time to return home after dialysis took after their previous dialysis session. Figure 21 shows the journey time for patients using hospital arranged transport, and Figure 22 that for patients transporting themselves, either by public or private transport. For hospital transport users, overall 55.3 per cent of patients had a journey time of 30 minutes or less, while 10.5 per cent had a journey time of 60 minutes or longer. For those who arranged their own transport, the corresponding figures are 75.3 per cent and 3.2 per cent. In only five units (8.1 per cent) did 75 per cent or more of the hospital transport patients report a journey time of 30 minutes or less. The range extended from Chelmsford, where only 32.4 per cent of hospital transport patients had a journey time of 30 minutes or less, to Ipswich and Derry/ Londonderry where 83.0 and 85.7 per cent of patients had a journey time of 30 minutes or less. Figure 21 Journey time home after dialysis for Hospital Arranged Transport users by renal centre, ordered by country and the proportion travelling for 30 minutes or less. ENGLAND Ipswich Hospital Hull Royal Infirmary Sunderland Royal Hospital Doncaster Royal Infirmary Stoke - University Hospital of North Staffordshire Bradford - St Luke s Hospital Southend Hospital Manchester Royal Infirmary Wirral - Arrowe Park Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 34 of 94

40 Bristol - Southmead Hospital Birmingham - Heartlands Hospital Shrewsbury - Royal Shrewsbury Hospital Truro - Royal Cornwall Hospital, Treliske Middlesbrough - The James Cook University Hospital Dorchester - Dorset County Hospital Liverpool - Aintree University Hospital Derby City General Hospital Kent & Canterbury Hospital Wolverhampton - New Cross Hospital Leeds - St James's University Hospital - Ward 55 Preston - Royal Preston Hospital Dudley - Russells Hall Hospital Sheffield - Northern General Hospital Basildon Newcastle - Freeman Hospital York District General Hospital Salford - Hope Hospital Leicester General Hospital Reading - Royal Berkshire Hospital Portsmouth - Queen Alexandra Hospital Stevenage - The Lister Hospital Exeter - Royal Devon and Exeter Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Coventry - Walsgrave Hospital Cambridge - Addenbrooke's Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Oxford Radcliffe Hospital Norfolk & Norwich University Hospital London - King's College Hospital Nottingham City Hospital Renal and Transplant Plymouth - Derriford Hospital Liverpool - Royal Liverpool University Hospital Carlisle - Cumberland Infirmary Gloucester Royal Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Brighton - Royal Sussex County Hospital Birmingham - Queen Elizabeth Hospital London - St Barts Hospital London - Royal Free & Middlesex Hospital Colchester General Hospital Chelmsford - Broomfield Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Belfast City Hospital Belfast - Ulster Hospital Omagh - Tyrone County Hospital Newry - Daisy Hill Hospital Antrim Area Hospital 35 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

41 WALES Wrexham - Maelor Hospital Bangor - Gwynedd Hospital Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Cardiff - University Hospital of Wales Less than 10 mins 10 to 30 mins 31 to 60 mins 1 to 2 hours More than 2 hours No useful data Figure 22 Journey time home after dialysis for patients using Public or Private Transport by renal centre, ordered by country and the proportion travelling for 30 minutes or less. ENGLAND Sunderland Royal Hospital Wirral - Arrowe Park Hospital Middlesbrough - The James Cook University Hospital Bradford - St Luke s Hospital York District General Hospital Ipswich Hospital Wolverhampton - New Cross Hospital Southend Hospital Stoke - University Hospital of North Staffordshire Hull Royal Infirmary Leeds - St James's University Hospital - Ward 55 Birmingham - Heartlands Hospital Gloucester Royal Hospital Truro - Royal Cornwall Hospital, Treliske Salford - Hope Hospital Manchester Royal Infirmary Portsmouth - Queen Alexandra Hospital Reading - Royal Berkshire Hospital Coventry - Walsgrave Hospital Plymouth - Derriford Hospital Sheffield - Northern General Hospital Doncaster Royal Infirmary Dudley - Russells Hall Hospital Liverpool - Royal Liverpool University Hospital Newcastle - Freeman Hospital Birmingham - Queen Elizabeth Hospital Cambridge - Addenbrooke's Hospital Nottingham City Hospital Renal and Transplant Stevenage - The Lister Hospital Leicester General Hospital Kent & Canterbury Hospital Dorchester - Dorset County Hospital Basildon Bristol - Southmead Hospital Preston - Royal Preston Hospital Liverpool - Aintree University Hospital Derby City General Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 36 of 94

42 Exeter - Royal Devon and Exeter Hospital Norfolk & Norwich University Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Brighton - Royal Sussex County Hospital Shrewsbury - Royal Shrewsbury Hospital London - King's College Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Oxford Radcliffe Hospital Chelmsford - Broomfield Hospital London - Royal Free & Middlesex Hospital London - St Barts Hospital Carlisle - Cumberland Infirmary Colchester General Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Belfast - Ulster Hospital Belfast City Hospital Antrim Area Hospital Omagh - Tyrone County Hospital Newry - Daisy Hill Hospital WALES Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Swansea - Morriston Hospital Bangor - Gwynedd Hospital Less than 10 mins 10 to 30 mins 31 to 60 mins 1 to 2 hours More than 2 hours No useful data Reasons for long journey times We compared the 10 per cent of patients who reported the shortest to the 10 per cent who reported the longest journey plus wait ( round trip ) times. Figure 23 (over) shows that the majority of the subgroup with the longest journey time used hospital transport, while the majority of those with the shortest journey time used private transport. 37 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

43 Figure 23 Transport categories for the journey to dialysis for the top and bottom 10 per cent of patients based on round-trip time Top 10% Bottom 10% 800 Number of patients Hospital Arranged Transport Public Transport Private Transport No useful data Transport category We found, unsurprisingly, that those who had to travel a longer distance had a longer journey time (Figure 24). Figure 24 Distribution of distances between home and dialysis unit for the top and bottom 10 per cent of patients (drawn from all respondents irrespective of transport modality) based on round-trip time Top 10% Bottom 10% 800 Number of patients No response 0-5 miles 6-10 miles miles miles Over 40 miles Don t know No useful data Distance band Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 38 of 94

44 We then examined the number of pick-ups or drop-offs of other passengers that respondents experienced and compared this to round-trip time (Figure 25). It is evident, though again not surprising, that multiple pick-ups or drop-offs are associated with longer journeys. For those with the longest round trip times, it is routine to pick-up or drop-off one, two or more patients en route. Inevitably such breaks and detours in the journey add to the travelling time. Figure 25 Number of other patients picked up on the journey to dialysis, for the top and bottom 10 per cent of patients (drawn from all respondents irrespective of transport modality) based on round-trip time Top 10% Bottom 10% Number of patients None 1 other patient 2 other patients 3 or more Not applicable No response No useful data patients Number of other patients picked up Figure 26 Number of other patients dropped off on the journey home after dialysis, for the top and bottom 10 per cent of patients (drawn from all respondents irrespective of transport modality) based on round-trip time Top 10% Bottom 10% 300 Number of patients None 1 other patient 2 other patients 3 or more Not applicable No response No useful data patients Number of other patients dropped off 39 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

45 Satisfaction ratings of patients We asked patients whether their current transport arrangements met their needs. These results are presented by SHA or equivalent (Figure 27) and by main unit (Figure 28). Overall 61.2 per cent of patients feel that their current transport arrangements fully meet their needs, and only a small number of respondents feel it does not meet their needs. For those on hospital provided transport, 61.0 per cent of patients reported that their arrangements fully meet their needs. Figure 27 Overall satisfaction ratings, by SHA and equivalent. SHA ENGLAND North East Strategic Health Authority South Central Strategic Health Authority East Of England Strategic Health Authority West Midlands Strategic Health Authority North West Strategic Health Authority South East Coast Strategic Health Authority Yorkshire And The Humber Strategic Health Authority South West Strategic Health Authority London Strategic Health Authority East Midlands Strategic Health Authority NORTHERN IRELAND Western HSSB Northern Ireland Northern HSSB Northern Ireland Southern HSSB Northern Ireland Eastern HSSB Northern Ireland WALES Mid and West Wales South East Wales North Wales Yes, it meets my needs It meets my needs most of the time It meets my needs some of the time No, it does not meet my needs No useful data No response Figure 28 Overall satisfaction ratings, by renal centre. Hub/Centre ENGLAND Sunderland Royal Hospital Truro - Royal Cornwall Hospital, Treliske Ipswich Hospital York District General Hospital Southend Hospital Bradford - St Luke s Hospital Wolverhampton - New Cross Hospital Middlesbrough - The James Cook University Hospital Plymouth - Derriford Hospital Birmingham - Heartlands Hospital Preston - Royal Preston Hospital Portsmouth - Queen Alexandra Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Kent & Canterbury Hospital Doncaster Royal Infirmary Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 40 of 94

46 Hub/Centre Oxford Radcliffe Hospital Stevenage - The Lister Hospital Dorchester - Dorset County Hospital Carlisle - Cumberland Infirmary London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Dudley - Russells Hall Hospital Hull Royal Infirmary Cambridge - Addenbrooke's Hospital Gloucester Royal Hospital London - Royal Free & Middlesex Hospital Norfolk & Norwich University Hospital Sheffield - Northern General Hospital Salford - Hope Hospital Manchester Royal Infirmary Reading - Royal Berkshire Hospital Basildon Birmingham - Queen Elizabeth Hospital Stoke - University Hospital of North Staffordshire Leicester General Hospital Newcastle - Freeman Hospital Derby City General Hospital Liverpool - Royal Liverpool University Hospital Shrewsbury - Royal Shrewsbury Hospital Liverpool - Aintree University Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - St Barts Hospital Colchester General Hospital Exeter - Royal Devon and Exeter Hospital Brighton - Royal Sussex County Hospital Bristol - Southmead Hospital Chelmsford - Broomfield Hospital London - King's College Hospital Leeds - St James's University Hospital - Ward 55 Wirral - Arrowe Park Hospital Nottingham City Hospital Renal and Transplant Coventry - Walsgrave Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Belfast City Hospital Antrim Area Hospital Newry - Daisy Hill Hospital Belfast - Ulster Hospital WALES Swansea - Morriston Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Bangor - Gwynedd Hospital Rhyl - Glan Clwyd Hospital Yes, it meets my needs It meets my needs most of the time It meets my needs some of the time No, it does not meet my needs No useful data No response 41 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

47 We also asked the patients who used patient transport services about how happy they were with eight aspects of their transport service (cleanliness, comfort, punctuality, pick-ups, ease of access, friendliness of staff, cost, and understanding of staff to patients needs). The results are shown in Figure 29 to Figure 36. Overall, the majority of patient transport users pronounced themselves happy in all of these areas. Figure 29 Happiness ratings for cleanliness for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND Basildon Chelmsford - Broomfield Hospital Southend Hospital Truro - Royal Cornwall Hospital, Treliske Wolverhampton - New Cross Hospital Bristol - Southmead Hospital Ipswich Hospital Coventry - Walsgrave Hospital Newcastle - Freeman Hospital Bradford - St Luke s Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Derby City General Hospital Oxford Radcliffe Hospital Exeter - Royal Devon and Exeter Hospital Birmingham - Heartlands Hospital Hull Royal Infirmary Middlesbrough - The James Cook University Hospital Kent & Canterbury Hospital Liverpool - Royal Liverpool University Hospital Leeds - St James's University Hospital - Ward 55 Doncaster Royal Infirmary Norfolk & Norwich University Hospital Dudley - Russells Hall Hospital Salford - Hope Hospital Sheffield - Northern General Hospital Stevenage - The Lister Hospital Shrewsbury - Royal Shrewsbury Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Stoke - University Hospital of North Staffordshire Brighton - Royal Sussex County Hospital Plymouth - Derriford Hospital Gloucester Royal Hospital Liverpool - Aintree University Hospital York District General Hospital Cambridge - Addenbrooke's Hospital London - King's College Hospital Birmingham - Queen Elizabeth Hospital Leicester General Hospital Manchester Royal Infirmary Sunderland Royal Hospital Dorchester - Dorset County Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 42 of 94

48 London - Royal Free & Middlesex Hospital Preston - Royal Preston Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Carlisle - Cumberland Infirmary Wirral - Arrowe Park Hospital Nottingham City Hospital Renal and Transplant Portsmouth - Queen Alexandra Hospital London - St Barts Hospital Colchester General Hospital Reading - Royal Berkshire Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Antrim Area Hospital Belfast - Ulster Hospital Newry - Daisy Hill Hospital Omagh - Tyrone County Hospital Belfast City Hospital WALES Swansea - Morriston Hospital Cardiff - University Hospital of Wales Wrexham - Maelor Hospital Rhyl - Glan Clwyd Hospital Bangor - Gwynedd Hospital Unhappy Neither happy nor unhappy Happy No useful data No response Figure 30 Happiness ratings for comfort for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND Ipswich Hospital Southend Hospital Truro - Royal Cornwall Hospital, Treliske Stoke - University Hospital of North Staffordshire Doncaster Royal Infirmary Wolverhampton - New Cross Hospital Dorchester - Dorset County Hospital Gloucester Royal Hospital Cambridge - Addenbrooke's Hospital Derby City General Hospital Bristol - Southmead Hospital Exeter - Royal Devon and Exeter Hospital Bradford - St Luke s Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Newcastle - Freeman Hospital Kent & Canterbury Hospital Middlesbrough - The James Cook University Hospital Plymouth - Derriford Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Preston - Royal Preston Hospital 43 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

49 Birmingham - Heartlands Hospital Nottingham City Hospital Renal and Transplant Brighton - Royal Sussex County Hospital Liverpool - Aintree University Hospital York District General Hospital Leeds - St James's University Hospital - Ward 55 Sheffield - Northern General Hospital Basildon Manchester Royal Infirmary Oxford Radcliffe Hospital Shrewsbury - Royal Shrewsbury Hospital Coventry - Walsgrave Hospital Wirral - Arrowe Park Hospital Sunderland Royal Hospital London - Royal Free & Middlesex Hospital Portsmouth - Queen Alexandra Hospital London - St Barts Hospital Hull Royal Infirmary Dudley - Russells Hall Hospital Carlisle - Cumberland Infirmary Salford - Hope Hospital London - King's College Hospital Liverpool - Royal Liverpool University Hospital Chelmsford - Broomfield Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Stevenage - The Lister Hospital Norfolk & Norwich University Hospital Birmingham - Queen Elizabeth Hospital Leicester General Hospital Reading - Royal Berkshire Hospital Colchester General Hospital NORTHERN IRELAND Antrim Area Hospital Derry/Londonderry - Altnagelvin Hospital Newry - Daisy Hill Hospital Omagh - Tyrone County Hospital Belfast City Hospital Belfast - Ulster Hospital WALES Rhyl - Glan Clwyd Hospital Swansea - Morriston Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Bangor - Gwynedd Hospital Unhappy Neither happy nor unhappy Happy No useful data No response Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 44 of 94

50 Figure 31 Happiness ratings for punctuality for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND York District General Hospital Bradford - St Luke s Hospital Sunderland Royal Hospital Southend Hospital Truro - Royal Cornwall Hospital, Treliske Plymouth - Derriford Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Stoke - University Hospital of North Staffordshire Colchester General Hospital Portsmouth - Queen Alexandra Hospital Kent & Canterbury Hospital London - Royal Free & Middlesex Hospital Ipswich Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - Guy s and St Thomas - 4 th Floor Dialysis Oxford Radcliffe Hospital Preston - Royal Preston Hospital London - King's College Hospital Cambridge - Addenbrooke's Hospital Chelmsford - Broomfield Hospital Norfolk & Norwich University Hospital Shrewsbury - Royal Shrewsbury Hospital Gloucester Royal Hospital Sheffield - Northern General Hospital Brighton - Royal Sussex County Hospital Middlesbrough - The James Cook University Hospital Carlisle - Cumberland Infirmary Leeds - St James's University Hospital - Ward 55 Wolverhampton - New Cross Hospital Dorchester - Dorset County Hospital Birmingham - Heartlands Hospital Doncaster Royal Infirmary London - St Barts Hospital Stevenage - The Lister Hospital Dudley - Russells Hall Hospital Reading - Royal Berkshire Hospital Manchester Royal Infirmary Bristol - Southmead Hospital Newcastle - Freeman Hospital Hull Royal Infirmary Derby City General Hospital Liverpool - Aintree University Hospital Exeter - Royal Devon and Exeter Hospital Salford - Hope Hospital Liverpool - Royal Liverpool University Hospital Wirral - Arrowe Park Hospital Basildon 45 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

51 Leicester General Hospital Birmingham - Queen Elizabeth Hospital Nottingham City Hospital Renal and Transplant Coventry - Walsgrave Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Belfast - Ulster Hospital Newry - Daisy Hill Hospital Antrim Area Hospital Omagh - Tyrone County Hospital Belfast City Hospital WALES Swansea - Morriston Hospital Rhyl - Glan Clwyd Hospital Cardiff - University Hospital of Wales Bangor - Gwynedd Hospital Wrexham - Maelor Hospital Unhappy Neither happy nor unhappy Happy No useful data No response Figure 32 Happiness ratings for the number of other patients picked up for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND Ipswich Hospital Truro - Royal Cornwall Hospital, Treliske London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Plymouth - Derriford Hospital Stoke - University Hospital of North Staffordshire Birmingham - Heartlands Hospital Gloucester Royal Hospital Oxford Radcliffe Hospital Sunderland Royal Hospital Middlesbrough - The James Cook University Hospital Stevenage - The Lister Hospital Exeter - Royal Devon and Exeter Hospital Southend Hospital Brighton - Royal Sussex County Hospital Coventry - Walsgrave Hospital Sheffield - Northern General Hospital Basildon Dorchester - Dorset County Hospital Norfolk & Norwich University Hospital London - Royal Free & Middlesex Hospital Newcastle - Freeman Hospital Bristol - Southmead Hospital Cambridge - Addenbrooke's Hospital Dudley - Russells Hall Hospital Portsmouth - Queen Alexandra Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 46 of 94

52 Leeds - St James's University Hospital - Ward 55 Liverpool - Aintree University Hospital Shrewsbury - Royal Shrewsbury Hospital Manchester Royal Infirmary Kent & Canterbury Hospital Preston - Royal Preston Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Nottingham City Hospital Renal and Transplant Chelmsford - Broomfield Hospital Derby City General Hospital Carlisle - Cumberland Infirmary London - King's College Hospital Hull Royal Infirmary York District General Hospital Liverpool - Royal Liverpool University Hospital Reading - Royal Berkshire Hospital Doncaster Royal Infirmary Leicester General Hospital Wirral - Arrowe Park Hospital London - St Barts Hospital Salford - Hope Hospital Birmingham - Queen Elizabeth Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Bradford - St Luke s Hospital Wolverhampton - New Cross Hospital Colchester General Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Newry - Daisy Hill Hospital Antrim Area Hospital Belfast City Hospital Omagh - Tyrone County Hospital Belfast - Ulster Hospital WALES Swansea - Morriston Hospital Wrexham - Maelor Hospital Rhyl - Glan Clwyd Hospital Cardiff - University Hospital of Wales Bangor - Gwynedd Hospital Unhappy Neither happy nor unhappy Happy No useful data No response 47 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

53 Figure 33 Happiness ratings for ease of access for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND Basildon Ipswich Hospital Southend Hospital Truro - Royal Cornwall Hospital, Treliske Stoke - University Hospital of North Staffordshire Gloucester Royal Hospital Bradford - St Luke s Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Shrewsbury - Royal Shrewsbury Hospital Sheffield - Northern General Hospital Chelmsford - Broomfield Hospital Derby City General Hospital Oxford Radcliffe Hospital Hull Royal Infirmary London - Royal Free & Middlesex Hospital Wolverhampton - New Cross Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Leeds - St James's University Hospital - Ward 55 Cambridge - Addenbrooke's Hospital Sunderland Royal Hospital Nottingham City Hospital Renal and Transplant Leicester General Hospital Brighton - Royal Sussex County Hospital Newcastle - Freeman Hospital Middlesbrough - The James Cook University Hospital York District General Hospital Norfolk & Norwich University Hospital London - King's College Hospital Preston - Royal Preston Hospital Exeter - Royal Devon and Exeter Hospital Manchester Royal Infirmary London - St Barts Hospital Portsmouth - Queen Alexandra Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Liverpool - Royal Liverpool University Hospital Plymouth - Derriford Hospital Wirral - Arrowe Park Hospital Doncaster Royal Infirmary Bristol - Southmead Hospital Dudley - Russells Hall Hospital Salford - Hope Hospital Kent & Canterbury Hospital Stevenage - The Lister Hospital Dorchester - Dorset County Hospital Birmingham - Queen Elizabeth Hospital Birmingham - Heartlands Hospital Carlisle - Cumberland Infirmary Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 48 of 94

54 Coventry - Walsgrave Hospital Liverpool - Aintree University Hospital Reading - Royal Berkshire Hospital Colchester General Hospital NORTHERN IRELAND Antrim Area Hospital Newry - Daisy Hill Hospital Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Belfast City Hospital Belfast - Ulster Hospital WALES Cardiff - University Hospital of Wales Swansea - Morriston Hospital Wrexham - Maelor Hospital Rhyl - Glan Clwyd Hospital Bangor - Gwynedd Hospital Unhappy Neither happy nor unhappy Happy No useful data No response Figure 34 Happiness ratings for the friendliness of staff for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND Chelmsford - Broomfield Hospital Colchester General Hospital Dudley - Russells Hall Hospital Ipswich Hospital Southend Hospital Stoke - University Hospital of North Staffordshire Wolverhampton - New Cross Hospital Shrewsbury - Royal Shrewsbury Hospital Bradford - St Luke s Hospital Truro - Royal Cornwall Hospital, Treliske Newcastle - Freeman Hospital Middlesbrough - The James Cook University Hospital Liverpool - Royal Liverpool University Hospital Leeds - St James's University Hospital - Ward 55 Birmingham - Queen Elizabeth Hospital Basildon Derby City General Hospital Salford - Hope Hospital Portsmouth - Queen Alexandra Hospital London - St Barts Hospital Brighton - Royal Sussex County Hospital Coventry - Walsgrave Hospital Cambridge - Addenbrooke's Hospital Sheffield - Northern General Hospital Manchester Royal Infirmary 49 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

55 London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Exeter - Royal Devon and Exeter Hospital Hull Royal Infirmary Doncaster Royal Infirmary Stevenage - The Lister Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Oxford Radcliffe Hospital London - King's College Hospital Bristol - Southmead Hospital Birmingham - Heartlands Hospital Kent & Canterbury Hospital London - Royal Free & Middlesex Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Wirral - Arrowe Park Hospital Leicester General Hospital Norfolk & Norwich University Hospital Carlisle - Cumberland Infirmary Plymouth - Derriford Hospital Gloucester Royal Hospital Preston - Royal Preston Hospital Liverpool - Aintree University Hospital York District General Hospital Nottingham City Hospital Renal and Transplant Sunderland Royal Hospital Dorchester - Dorset County Hospital Reading - Royal Berkshire Hospital NORTHERN IRELAND Newry - Daisy Hill Hospital Antrim Area Hospital Derry/Londonderry - Altnagelvin Hospital Belfast City Hospital Omagh - Tyrone County Hospital Belfast - Ulster Hospital WALES Swansea - Morriston Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Rhyl - Glan Clwyd Hospital Bangor - Gwynedd Hospital Unhappy Neither happy nor unhappy Happy No useful data No response Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 50 of 94

56 Figure 35 Happiness ratings for cost for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND Basildon Bradford - St Luke s Hospital Cambridge - Addenbrooke's Hospital Colchester General Hospital Coventry - Walsgrave Hospital Derby City General Hospital Doncaster Royal Infirmary Dorchester - Dorset County Hospital Dudley - Russells Hall Hospital Ipswich Hospital Liverpool - Aintree University Hospital Nottingham City Hospital Renal and Transplant Portsmouth - Queen Alexandra Hospital Southend Hospital Truro - Royal Cornwall Hospital, Treliske York District General Hospital London - St Barts Hospital London - Royal Free & Middlesex Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation London - King's College Hospital Birmingham - Heartlands Hospital Middlesbrough - The James Cook University Hospital Stoke - University Hospital of North Staffordshire Liverpool - Royal Liverpool University Hospital Gloucester Royal Hospital Wolverhampton - New Cross Hospital Brighton - Royal Sussex County Hospital Leeds - St James's University Hospital - Ward 55 Bristol - Southmead Hospital Wirral - Arrowe Park Hospital Sheffield - Northern General Hospital Sunderland Royal Hospital Hull Royal Infirmary Kent & Canterbury Hospital Norfolk & Norwich University Hospital Exeter - Royal Devon and Exeter Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Preston - Royal Preston Hospital Birmingham - Queen Elizabeth Hospital Manchester Royal Infirmary Salford - Hope Hospital Oxford Radcliffe Hospital Newcastle - Freeman Hospital Shrewsbury - Royal Shrewsbury Hospital Chelmsford - Broomfield Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Reading - Royal Berkshire Hospital 51 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

57 Leicester General Hospital Carlisle - Cumberland Infirmary Stevenage - The Lister Hospital Plymouth - Derriford Hospital NORTHERN IRELAND Derry/Londonderry - Altnagelvin Hospital Newry - Daisy Hill Hospital Antrim Area Hospital Belfast - Ulster Hospital Omagh - Tyrone County Hospital Belfast City Hospital WALES Rhyl - Glan Clwyd Hospital Swansea - Morriston Hospital Cardiff - University Hospital of Wales Wrexham - Maelor Hospital Bangor - Gwynedd Hospital Unhappy Neither happy nor unhappy Happy No useful data No response Figure 36 Happiness ratings for the understanding of staff to their needs for Hospital Arranged Transport Users, by renal centre, ordered by country then increasing unhappiness. ENGLAND Chelmsford - Broomfield Hospital Dudley - Russells Hall Hospital Ipswich Hospital Liverpool - Aintree University Hospital Southend Hospital Truro - Royal Cornwall Hospital, Treliske Stoke - University Hospital of North Staffordshire London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Coventry - Walsgrave Hospital Portsmouth - Queen Alexandra Hospital Basildon Newcastle - Freeman Hospital Sheffield - Northern General Hospital Bradford - St Luke s Hospital Leeds - St James's University Hospital - Ward 55 Oxford Radcliffe Hospital Birmingham - Heartlands Hospital London - Royal Free & Middlesex Hospital Cambridge - Addenbrooke's Hospital Doncaster Royal Infirmary Wolverhampton - New Cross Hospital Exeter - Royal Devon and Exeter Hospital Shrewsbury - Royal Shrewsbury Hospital London - St Barts Hospital London - King's College Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 52 of 94

58 Sunderland Royal Hospital Plymouth - Derriford Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Brighton - Royal Sussex County Hospital Manchester Royal Infirmary Hull Royal Infirmary Stevenage - The Lister Hospital York District General Hospital Kent & Canterbury Hospital Liverpool - Royal Liverpool University Hospital Preston - Royal Preston Hospital Bristol - Southmead Hospital Norfolk & Norwich University Hospital Nottingham City Hospital Renal and Transplant Reading - Royal Berkshire Hospital Salford - Hope Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Derby City General Hospital Dorchester - Dorset County Hospital Leicester General Hospital Middlesbrough - The James Cook University Hospital Wirral - Arrowe Park Hospital Gloucester Royal Hospital Colchester General Hospital Birmingham - Queen Elizabeth Hospital Carlisle - Cumberland Infirmary NORTHERN IRELAND Antrim Area Hospital Newry - Daisy Hill Hospital Derry/Londonderry - Altnagelvin Hospital Belfast - Ulster Hospital Belfast City Hospital Omagh - Tyrone County Hospital WALES Swansea - Morriston Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales Rhyl - Glan Clwyd Hospital Bangor - Gwynedd Hospital Unhappy Neither happy nor unhappy Happy No useful data No response 53 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

59 Do patients have to pay for their transport? We asked patients if they have to pay for their transport, or for part of their journey. Their replies are shown in Figure 37 and Figure 38. Overall 17.2 per cent of patients said that they have to pay for their own transport, and a further 4.8 per cent said they had to pay but were able to claim the money back at a later date. For those using hospital arranged transport, with the exception of a handful of units, almost all patients said they did not have to pay for their transport. For those using private or public transport, per cent of patients reported that they pay for at least some of their own transport. The range was wide, and not obviously related to country or SHA. Figure 37 Patients eligibility for free transport, for patients using Hospital Arranged Transport in at least one direction, by renal centre, ordered by country then proportion having to pay. ENGLAND Plymouth - Derriford Hospital Stevenage - The Lister Hospital Southend Hospital Exeter - Royal Devon and Exeter Hospital Colchester General Hospital Birmingham - Heartlands Hospital Wolverhampton - New Cross Hospital London - Guy s and St Thomas - 4 th Floor Dialysis Salford - Hope Hospital London - St Barts Hospital Birmingham - Queen Elizabeth Hospital Reading - Royal Berkshire Hospital Newcastle - Freeman Hospital Chelmsford - Broomfield Hospital Nottingham City Hospital Renal and Transplant Manchester Royal Infirmary York District General Hospital Ipswich Hospital Coventry - Walsgrave Hospital London - West London Renal and Transplant Centre - Auchi Acute Dialysis Oxford Radcliffe Hospital Liverpool - Aintree University Hospital London - Royal Free & Middlesex Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Dorchester - Dorset County Hospital Basildon Bristol - Southmead Hospital Derby City General Hospital Liverpool - Royal Liverpool University Hospital Leicester General Hospital Kent & Canterbury Hospital Leeds - St James's University Hospital - Ward 55 Hull Royal Infirmary Norfolk & Norwich University Hospital Stoke - University Hospital of North Staffordshire Middlesbrough - The James Cook University Hospital London - King's College Hospital Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 54 of 94

60 Portsmouth - Queen Alexandra Hospital Brighton - Royal Sussex County Hospital Sheffield - Northern General Hospital Bradford - St Luke s Hospital Cambridge - Addenbrooke's Hospital Carlisle - Cumberland Infirmary Doncaster Royal Infirmary Dudley - Russells Hall Hospital Gloucester Royal Hospital Preston - Royal Preston Hospital Shrewsbury - Royal Shrewsbury Hospital Sunderland Royal Hospital Truro - Royal Cornwall Hospital, Treliske Wirral - Arrowe Park Hospital NORTHERN IRELAND Belfast City Hospital Belfast - Ulster Hospital Antrim Area Hospital Derry/Londonderry - Altnagelvin Hospital Newry - Daisy Hill Hospital Omagh - Tyrone County Hospital WALES Swansea - Morriston Hospital Cardiff - University Hospital of Wales Bangor - Gwynedd Hospital Rhyl - Glan Clwyd Hospital Wrexham - Maelor Hospital I have to pay I have to pay but I can claim the costs back No, I do not have to pay at all I don t know No useful data No response Figure 38 Patients eligibility for free transport, for patients using Public or Private Transport in both directions, by renal centre, ordered by country then proportion having to pay. ENGLAND Ipswich Hospital Hull Royal Infirmary Doncaster Royal Infirmary Leicester General Hospital Exeter - Royal Devon and Exeter Hospital Norfolk & Norwich University Hospital York District General Hospital Liverpool - Royal Liverpool University Hospital Sunderland Royal Hospital Birmingham - Heartlands Hospital Cambridge - Addenbrooke's Hospital Carlisle - Cumberland Infirmary Middlesbrough - The James Cook University Hospital Reading - Royal Berkshire Hospital Basildon Kent & Canterbury Hospital Salford - Hope Hospital 55 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

61 Sheffield - Northern General Hospital Manchester Royal Infirmary Stoke - University Hospital of North Staffordshire Derby City General Hospital Dudley - Russells Hall Hospital Gloucester Royal Hospital Chelmsford - Broomfield Hospital Colchester General Hospital London - Guy s and St Thomas - 4 th Floor Dialysis London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - St Barts Hospital Wirral - Arrowe Park Hospital Newcastle - Freeman Hospital Leeds - St James's University Hospital - Ward 55 Brighton - Royal Sussex County Hospital London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Birmingham - Queen Elizabeth Hospital London - King's College Hospital Wolverhampton - New Cross Hospital London - Royal Free & Middlesex Hospital Shrewsbury - Royal Shrewsbury Hospital Coventry - Walsgrave Hospital Truro - Royal Cornwall Hospital, Treliske Southend Hospital Liverpool - Aintree University Hospital Plymouth - Derriford Hospital Nottingham City Hospital Renal and Transplant Bristol - Southmead Hospital Preston - Royal Preston Hospital Dorchester - Dorset County Hospital Portsmouth - Queen Alexandra Hospital Bradford - St Luke s Hospital Oxford Radcliffe Hospital Stevenage - The Lister Hospital NORTHERN IRELAND Belfast - Ulster Hospital Antrim Area Hospital Belfast City Hospital Newry - Daisy Hill Hospital Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital WALES Rhyl - Glan Clwyd Hospital Swansea - Morriston Hospital Wrexham - Maelor Hospital Cardiff - University Hospital of Wales I have to pay I have to pay but I can claim the costs back No, I do not have to pay at all I don t know No useful data No response Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 56 of 94

62 Commissioners / dialysis unit managers survey Dialysis unit managers and commissioners were asked a series of questions, and the majority of these are shown in Table 2 to Table 5 with their amalgamated responses. Dialysis unit managers responses are reported for 212 of the 247 dialysis units (both main unit and satellites, response rate 85.8 per cent). Commissioners were asked to report for each renal centre they commissioned from, and there were replies received relating to 59 of the 65 (90.8 per cent). Replies to questions about assessing eligibility for patient transport services are shown in Table 2, charging regimes in Table 3, the management of service level agreements in Table 4, and the monitoring of quality in Table 5. Table 2 Assessment of eligibility criteria for non-emergency transport: responses of dialysis unit managers and commissioners. Due to rounding the sum of the percentages might not total 100 per cent. ELIGIBILITY CRITERIA Are there published criteria for providing free and appropriate transport to renal patients? Are there published criteria for providing free and appropriate transport to escorts / carers? Are there clear arrangements for dealing with appeals and complaints about decisions on whether to provide free transport? Is each patients eligibility for free transport reviewed regularly? Is there a regular review of each patients transport needs? DIALYSIS UNIT MANAGERS RESPONSE (n=212) Yes (%) No (%) Don t know (%) No response (%) COMMISSIONING MANAGERS RESPONSE (n=59) Yes (%) No (%) Don t know (%) No response (%) 120 (57) 60 (28) 31 (15) 1 (0) 28 (47) 9 (15) 22 (37) 0 (0) 81 (38) 72 (34) 59 (28) 0 (0) 20 (34) 9 (15) 30 (51) 0 (0) 92 (43) 54 (25) 60 (28) 6 (3) 25 (42) 4 (7) 30 (51) 0 (0) 70 (33) 113 (53) 27 (13) 2 (1) 15 (25) 5 (8) 39 (66) 0 (0) 129 (61) 66 (31) 17 (8) 0 (0) 18 (31) 2 (3) 39 (66) 0 (0) Table 3 Charging regime for non-emergency transport: responses of dialysis unit managers and commissioners. Due to rounding the sum of the percentages might not total 100 per cent. CHARGING REGIME Can patients / carers reliably park for free close to the haemodialysis unit if they wish to? Do all users of non-emergency Renal Patient Transport Services travel for free? DIALYSIS UNIT MANAGERS RESPONSE (n=212) Yes (%) No (%) Don t know (%) No response (%) COMMISSIONING MANAGERS RESPONSE (n=59) Yes (%) No (%) Don t know (%) No response (%) 163 (77) 49 (23) 0 (0) 0 (0) 26 (44) 8 (14) 25 (42) 0 (0) 179 (84) 21 (10) 11 (5) 1 (0) 34 (58) 1 (2) 24 (41) 0 (0) 57 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

63 Table 4 Management of service level agreements: responses of dialysis unit managers and commissioners. Due to rounding the sum of the percentages might not total 100 per cent. MANAGEMENT OF SERVICE LEVEL AGREEMENT Is funding for renal transport clearly identified? Is a separate contract in place for renal transport? Is there a detailed specification for renal transport? Are patients involved in defining the required service levels for renal transport? Is there a single Renal Transport Coordinator or bureau in place? Is there a lead negotiator identified for taxi contracts and volunteer drivers? Do taxi and volunteer drivers receive formal training to enable them to show an awareness of patients needs and dignity? DIALYSIS UNIT MANAGERS RESPONSE (n=212) Yes (%) No (%) Don t know (%) No response (%) COMMISSIONING MANAGERS RESPONSE (n=59) Yes (%) No (%) Don t know (%) No response (%) 101 (48) 59 (28) 51 (24) 1 (0) 7 (12) 36 (61) 16 (27) 0 (0) 104 (49) 62 (29) 45 (21) 1 (0) 5 (8) 36 (61) 18 (31) 0 (0) 95 (45) 40 (19) 76 (36) 1 (0) 8 (14) 25 (42) 26 (44) 0 (0) 42 (20) 104 (49) 63 (30) 3 (1) 6 (10) 16 (27) 37 (63) 0 (0) 82 (39) 110 (52) 18 (8) 2 (1) 8 (14) 16 (27) 35 (59) 0 (0) 73 (34) 62 (29) 69 (33) 8 (4) 4 (7) 13 (22) 42 (71) 0 (0) 31 (15) 45 (21) 129 (61) 7 (3) 6 (10) 8 (14) 45 (76) 0 (0) Table 5 Monitoring of quality of hospital transport providers: responses of dialysis unit managers and commissioners. Due to rounding the sum of the percentages might not total 100 per cent. MONITORING OF QUALITY Are regular contract monitoring meetings held with the transport provider? Are patients views captured regularly as part of the monitoring of service quality? Is transport performance published as part of service quality? Do you receive notification of the numbers and/or details of aborted journeys undertaken by the Patient Transport Service provider? DIALYSIS UNIT MANAGERS RESPONSE (n=212) Yes (%) No (%) Don t know (%) No response (%) COMMISSIONING MANAGERS RESPONSE (n=59) Yes (%) No (%) Don t know (%) No response (%) 108 (51) 57 (27) 41 (19) 6 (3) 15 (25) 9 (15) 35 (59) 0 (0) 113 (53) 68 (32) 27 (13) 4 (2) 11 (19) 11 (19) 35 (59) 2 (3) 61 (29) 108 (51) 38 (18) 5 (2) 7 (12) 19 (32) 33 (56) 0 (0) 75 (35) 122 (58) 15 (7) 0 (0) 6 (10) 35 (59) 18 (31) 0 (0) Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 58 of 94

64 Though there is little support here for the notion that patients are involved in planning and monitoring transport, there is clear evidence from the patient s survey that many would like to be. In response to the question about whether they would like to be contacted to discuss their transport needs and satisfaction in more detail (see Figure 39), patients in all units said they would, ranging from 6.8 per cent of patients to 52.5 per cent of all respondents in the unit. Figure 39 Proportion of patients from each renal centre responding to the question We would like to get in touch with patients to discuss their transport needs and satisfaction in more detail. Would you like to be involved? ENGLAND Ipswich Hospital Colchester General Hospital Reading - Royal Berkshire Hospital Kent & Canterbury Hospital Portsmouth - Queen Alexandra Hospital London - King's College Hospital Leeds - St James's University Hospital - Ward 55 York District General Hospital Wirral - Arrowe Park Hospital Wolverhampton - New Cross Hospital Dorchester - Dorset County Hospital Brighton - Royal Sussex County Hospital Liverpool - Aintree University Hospital Sheffield - Northern General Hospital Exeter - Royal Devon and Exeter Hospital Carlisle - Cumberland Infirmary Hull Royal Infirmary Birmingham - Heartlands Hospital Middlesbrough - The James Cook University Hospital Derby City General Hospital Gloucester Royal Hospital Norfolk & Norwich University Hospital Oxford Radcliffe Hospital Leicester General Hospital London - St Barts Hospital Dudley - Russells Hall Hospital Birmingham - Queen Elizabeth Hospital Cambridge - Addenbrooke's Hospital Bristol - Southmead Hospital London - Royal Free & Middlesex Hospital Salford - Hope Hospital Newcastle - Freeman Hospital Manchester Royal Infirmary Liverpool - Royal Liverpool University Hospital Shrewsbury - Royal Shrewsbury Hospital London - Guys and St Thomas - 4th Floor Dialysis Basildon London - West London Renal and Transplant Centre - Auchi Acute Dialysis Southend Hospital Plymouth - Derriford Hospital Bradford - St Lukes Hospital Coventry - Walsgrave Hospital 59 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

65 Nottingham City Hospital Renal and Transplant Stevenage - The Lister Hospital Preston - Royal Preston Hospital Chelmsford - Broomfield Hospital Truro - Royal Cornwall Hospital, Treliske London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Stoke - University Hospital of North Staffordshire Sunderland Royal Hospital Doncaster Royal Infirmary NORTHERN IRELAND Omagh - Tyrone County Hospital Belfast - Ulster Hospital Antrim Area Hospital Belfast City Hospital Newry - Daisy Hill Hospital Derry/Londonderry - Altnagelvin Hospital WALES Rhyl - Glan Clwyd Hospital Bangor - Gwynedd Hospital Wrexham - Maelor Hospital Swansea - Morriston Hospital Cardiff - University Hospital of Wales Yes No No useful data Free text comments For logistical reasons, a free text box was not provided for patients to complete. managers and commissioners were invited to make free text comments however, and a representative selection is given below: Patients transport has been a sore point on the renal unit. They are unreliable, waiting time is the biggest problem: patients have to be ready 2/3 hours before appointment time, spend four hours on dialysis and then have to wait another 90 minutes before being picked up for home journey. On top of this they have other medical conditions eg : diabetes. This is mental torture for the patients and they all dread the transport system in place. How can we help these patients??????? (Main unit, London) Patients are often waiting at home and at the unit for their taxi/transport for excessive periods - staff and patients alike are unhappy with this. Whilst the ambulance service is their single point of contact - when they call they feel the ambulance service is often rude for no reason and are regularly unhelpful and unresponsive (Satellite unit, South Coast of England) Transport was very reliable on both audit days (Satellite unit, London) I am not able to answer all the questions as the transport is provided by the Trust and we just call the taxi company with the times (Satellite unit - North of England) Morning set of patients were late in. This happens at least two mornings per week and is usually down to poor planning of the transport service or that a driver has gone off sick and there is no contingency in place by the transport service to cover this (Satellite unit - Midlands) Please note that our clinic doesn t get involved in the decision making on who should receive free transport, it s entirely up to the transport service. Nevertheless if the clinic thinks that the patient Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 60 of 94

66 needs transport due to clinical reason, that s the time that we get in touch with the transport provider via the Trust to make some arrangement (Satellite unit - Midlands) Transport brought in patients late, having a knock on effect for the remainder of the day. Also transport staff put pressure on dialysis staff to cut down patient s dialysis times and to ensure they were able to be taken home by This was never an agreement with transport (Satellite unit - East of England) Transport continues to be a daily problem as resources are never adequate to provide a functioning service. We continually have problems with patients coming in late, which then has a knock on effect making the next shift of patients late onto dialysis and can mean that we have to cut dialysis times as we do not have any spare capacity. This obviously can have a huge impact on the patients. If transport problems were to be resolved the impact on both patients and staff would be huge as it is the biggest problem that we face in a working day!! (Main unit - Midlands) A patient uses a wheelchair taxi as he has an amputated leg. Transport should have brought the patient to the unit for hrs, did not arrive until after hrs. Transport could not explain why. Homeward journey delayed: when time to go home unit informed that there were no wheelchair taxis. This meant the patient would have to wait for an a/e ambulance. It was unsafe but the patient said he would try and get in a normal car in the front seat as he could not bear to wait for an ambulance which could have been 4 hours + (Main unit - South West of England) Because we have a dedicated transport service consisting of two ambulances all patients from certain areas are brought in together and taken home together. This means that the waiting room is full of patients waiting to start treatment at 12md but many of the machines will not be ready until 1pm. Some then have to wait for the rest of their cohort to be ready in order to be taken home. I feel that we are working around the needs of the transport service rather than the other way around. (Satellite unit - Midlands) Patient transport services were improved over the two days of the audit (Satellite unit - North West England) Patients were not picked up by their allocated driver as planned but the control dept had made an error as the crew was not working at that time. Patients were also late being picked up, the unit ordered a taxi only for the crew to turn up before the taxi managed to get there incurring additional expense through lack of sufficient communication (Main unit, Midlands) Transport is a daily problem and results in delays onto dialysis, with dialysis time having to be cut as we have no spare capacity for late patients. This has a huge impact on both the patients who are not getting the required treatment and staff who are constantly dealing with complaints regarding transport (Main unit, Midlands) They have experienced the same issues as alwaysnamely, being picked up too early or too late. And having to travel around the countryside whilst other patients are being picked up-increasing their dialysis day. (Satellite unit, Wales) Patient missed her out patient appointment prior to dialysis due to late arrival of transport. Staff report less problems over the past two days which they believe is due to this audit being undertaken (Main unit, North West England) The renal transport contract is covered in part of the Trust transport contract - contractual meetings are held with the Trust and the provider but Renal are only invited if problems occur - no data is given despite requests (Main unit, East of England) Usually have so many problems on a regular basis difficult to keep track. Some of the serious problems are reported as incidents so are logged centrally as a patient safety incident (Satellite unit, Midlands) Although there are significant problems with renal transport within the service, this is recognised and over the last 12 months a significant amount of work has been undertaken to redesign the service in light of the DH Action Learning Set. This is being formulated at the moment and will result in dedicated renal transport systems, a 61 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

67 central bureau for transport, improved transport mechanisms, detailed eligibility criteria and service specifications, and a commissioner-led solution. This is still work in progress, and therefore although the current picture is gloomy, the future will hopefully improve significantly (South East of England, Commissioner) One patient, 70 years old, was brought in 2 hours early and returned home 2 hours too late. Patients were brought in late for am shift and had a knock on effect with the remaining shifts in the day... having to rebook transport as it was missed by late patients (Satellite unit, Midlands) The East Midlands Specialised commissioning group does not hold the contract for patient transport. The contracts are held with the relevant hospital Trusts. The individual units will hopefully provide you with the answers you are seeking. I would like to take this opportunity to say that transport needs are high on the renal patient s agenda and am pleased that such an audit is happening. I look forward to receiving the results. (Midlands, Commissioner) Summary of results comparison against audit standards Table 6 shows how the patients in England, Wales and Northern Ireland reported their experiences compared to the criteria set of the audit: Table 6 Summary of patients waiting more than 30 minutes for transport to pick them up, and of journey times of greater than 30 minutes, divided by country. % patients are picked up from home within 30 minutes of allocated time % patients for whom travel time to dialysis is 30 minutes or less % patients who wait 30 minutes or less after completing dialysis before commencing journey home % patients whose travel time going home is 30 minutes or less England Wales Northern Ireland Hospital provided transport 73.9 (6374 patients) 59.0 (6374 patients) 62.2 (6344 patients) 56.0 (6344 patients) Private or public transport Hospital provided transport N/A 75.3 (429 patients) 74.6 (3488 patients) 83.7 (3637 patients) 75.2 (3637 patients) 55.0 (429 patients) 64.7 (399 patients) 47.1 (399 patients) Private or public transport Hospital provided transport N/A 87.5 (391 patients) 80.6 (139 patients) 86.4 (176 patients) 79.5 (176 patients) 48.6 (391 patients) 75.3 (369 patients) 52.3 (369 patients) Private or public transport N/A 74.2 (182 patients) 91.6 (215 patients) 73.5 (215 patients) Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 62 of 94

68 Case Study Transport for kidney patients a personal perspective Tony O Brien The dedication of volunteer drivers is invaluable to dialysis patient Tony O Brien, who views their commitment as one of the best things about the kidney transport patient service. The drivers are unfailingly polite and helpful they recognise that renal patients often feel low after treatment and make allowances for our poor behaviour, said Tony, who makes the 75 mile round trip three times a week in an ambulance car to dialyse. The drivers never complain about us making them wait when we are late coming off dialysis, and they go to considerable trouble to track down locations to find patients when they have inaccurate or incomplete address details. Once when Tony needed to travel even further to an appointment at Leicester General Hospital, a driver got up at 4.30 am to ensure he would arrive on time. Living near the rural Lincolnshire coast with no access to trains and a limited bus service, Tony would struggle to get to his treatment sessions without the patient transport service. He thinks the service could be improved if the central scheduling of drivers time is better organised. The office seems to be staffed on many occasions by people unfamiliar with the area, or the ways of the renal service, he said. Officially the morning patients dialyse at 8am with almost all of us doing four hour sessions. The office tells drivers to collect us at 1pm, but everyone else involved knows the renal staff try and get started early and patients usually come out between 12.15pm and 12.45pm. Tony says patients who dialyse for three hours regularly have to wait an hour to be taken home with the four hour dialysis patients. He too has also experienced a long wait to go home due to driver scheduling. As patients we have had the experience of waiting for transport that doesn t come, he said. When the renal staff phone to enquire, the office then starts looking for someone. I once waited for nearly three hours and only got a driver then because one of them, who had finished his last trip, knew I was still waiting and volunteered to take me. There have also been occasions when drivers will telephone the office but their call is unanswered. Having used the transport service for four years, Tony is aware of how vital it is and overall very happy with his experience. He finds there is only a problem with around 10 of the 300 trips he takes to hospital every year. Transport scheduling is a difficult task, which seems to be under-regarded by management in both its complexity and worth, he added. The removal of this service would make it impossible for many renal patients to receive treatment which could be fatal. That such a vital service is dependent upon volunteer drivers in a scaring thought. 63 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

69 Discussion Discussion Coverage and validity The audit achieved broad coverage. Of the 247 dialysis units in England, Wales and Northern Ireland, 242 (98.0 per cent) participated including 12 paediatric units and all units in Wales and Northern Ireland. In participating units, 67.2 per cent of all nonpaediatric haemodialysis patients and 81.2 per cent of all paediatric patients (or their representatives) completed the questionnaire. The audit was conducted midweek in the middle of school term and there were no particular traffic problems reported. It seems reasonable to conclude that the results we have obtained are valid. All paediatric units and a handful of adult units with returns of ten patients or fewer are not included in this report, but will receive feedback independently on their results. Of the respondents included in this report, 62.4 per cent used hospital organised transport. Travelling and waiting times for patients We measured performance against a standard that patients should not wait for longer than 30 minutes for their transport to arrive, or once they arrive on the dialysis unit before they commence dialysis. Journey times for hospital transport users were 30 minutes or less for 58 per cent of patients on the way to dialysis, and 56 per cent for the homeward journey. For patients not using hospital organised transport, 75 per cent of patients had journey times of 30 minutes or less. Thus, for hospital transport users, more than 40 per cent of patients had a journey time longer than the standard stipulated. For some, the journey time was very long (more than an hour for 7.6 per cent of hospital transport users on the way to dialysis and 10.2 per cent of patients on the homeward journey). The results also show that some patients have long waits, both to be picked up from home, after the arrival on the dialysis unit while they wait to begin their treatment, and for transport to collect them after they complete the dialysis session. There was considerable variation: for example 63.7 per cent of hospital transport users were collected within 30 minutes of finishing their dialysis session, but 11.5 per cent waited for longer than an hour. Similar figures and variations were seen in all the potential waiting periods. The waits before dialysis appear often to be the result of being collected early from home by the transport service, with a large proportion of patients stating that they were picked up more than 30 minutes before the scheduled time from home and / or arriving more than 30 minutes before their dialysis start time on the unit. We found a wide range of responses when comparing different renal centres, and some variation between England, Wales and Northern Ireland. It should be emphasised again that the main centre responses are an amalgamation of responses of the main unit and all its satellites (for those centres which have satellite units). We have seen even greater variation for some units when comparing different satellites and the main unit, even when they fall under the umbrella of the same main centre. This report does not have space to demonstrate these results, but the interactive website easily enables users to do the analysis for their own units and comparable units. Local geographical and transport arrangements, and perhaps variations in unit organisation and working practices are likely to be the cause of such local differences. There are going to be useful lessons to be learned from those units with shorter waiting times. For individual units, the ability to analyse the distance their patients are travelling, the journey times, and the number of pickups and drop-offs they have during their journey should facilitate rationalisation of their transport and dialysis start times. Despite the obvious problems, patient satisfaction ratings are relatively high, with the majority of patients content with their transport arrangements most or all of the time. This satisfaction is particularly the case with respect to the attitude and support of front-line staff. The perceived contentment of patients needs to be reconciled with journey and waiting times which are longer than ideal. It may be the case that patients feel able to tolerate problems with their transport because other aspects of their care are excellent, or that they do not want to rock the boat by appearing unhappy (even in an anonymised questionnaire). For individual patients, in summary, while many patients are able to get to and receive their dialysis without delays of greater than 30 minutes at any one stage, for a large minority of patients there are long waits and long journey times. For some patients, this leads to an unacceptably arduous and long day. There are also implications for the smooth running of dialysis units, as when staff are unable to predict when patients will arrive it becomes impossible to stick to scheduled times. Comments made by one or two staff members about the dialysis hours being shortened Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 64 of 94

70 Discussion because of transport problems are particularly concerning: it would be entirely unacceptable for life-saving treatment to be threatened by patient transport issues. Commissioning and managing renal patient transport The survey of dialysis unit managers and responsible renal commissioners gives some clues as to why problems persist with patient transport for some HD patients. Renal unit managers report that only around one third of units have clear criteria for eligibility for hospital transport (to the knowledge of the managers of these units), and similar figures are obtained for charging criteria for patients and the management of service level agreements with transport providers. Only around 50 per cent of managers report that their units have mechanisms in place for monitoring the quality of the transport provision for which they are responsible. For many of these questions many unit managers answered don t know. Either the audit questionnaire was being answered by an inappropriate person (though the audit team went to great lengths to try and identify the person responsible for and most knowledgeable about patient transport on each unit), or patient transport takes a low priority for many renal unit managers. For commissioners, there is even more ignorance. Many of those who filled in the questionnaire on behalf of renal commissioners were unable to answer the questions on eligibility, charging, management of the service level agreement or quality. Commissioners pointed out, correctly, that in most areas transport is commissioned by hospital trust, and that therefore they are not directly involved. However commissioners should be interested in this key quality measure in haemodialysis treatment. These results show that information on quality is not getting back to commissioners, for whatever reason. It would be wrong to infer from this that dialysis unit managers and commissioners do not care about the transport service. The comments made in the free text form demonstrate powerfully that this is not the case. What comes across is a feeling amongst renal staff that they are powerless to influence the quality of the transport provision they and their patients are working with, though problems with transport can significantly affect their patients and staff. Improvements in the quality of the HD transport service are unlikely to take place unless the staff and patients directly affected are empowered to effect such changes. The survey will be repeated in The challenge for all those involved in HD is to ensure that standards are improved by the time of the repeat of the audit. We believe that commissioners have a responsibility to demand and to scrutinise quality data from their renal units, and renal units have a similar obligation with their transport providers. Patients should be part of this process, as their involvement means that attention will remain focused on the important aspects of the service from the patients perspective. Transport should be considered as integral to dialysis treatment and commissioning as dialysis adequacy, haemoglobin and clinical complications such as sepsis. Without reforms to the current systems, there seems to be little prospect of improvements in this timeframe. At the very least, there should be clear criteria for assessing the quality of patient transport on every HD unit, with regular collection of data and feedback from patients. Such data should be used to drive up quality. We conclude that while many patients are happy with their transport arrangements, a significant number of patients receive an unacceptable level of service. There is a clear need to improve the quality of transport provision for these patients. The benefits of improving the transport service do not only fall only on the individual: reliable and punctual transport allows dialysis units to run to a timetable, increasing the throughput of patients, increasing efficiency and maximising value for money. Renal unit managers often do not understand or control the commissioning, monitoring or control of the transport service used by their patients, and neither do commissioners. Thus no one person or group is currently in a position to ensure the delivery of a quality service. Without clear, high profile and transparent local systems for measuring performance and using that measurement to drive up standards, and without a re-dedication to this neglected part of the dialysis patients treatment, quality standards in HD transport are unlikely to improve. 65 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

71 Recommendations Recommendations 1. There should be clear and transparent commissioning arrangements for transport for haemodialysis patients. The lines of accountability and means of monitoring performance should be agreed between commissioners, hospital trusts, dialysis units and transport providers. Mechanisms for resolving complaints, appeals and for rectifying suboptimal performance without delays should be included in this framework. 2. Commissioners should take responsibility and ensure that they are able to monitor and enforce quality in transport provision for their HD patients. They should create mechanisms which enable them to understand transport performance. This might include regular audit and meetings with dialysis unit managers and transport providers to discuss performance and mutual interests. 3. Dialysis providers should be involved in the transport service which their patients use. Issues of eligibility, standards of performance, and quality of service should be explicitly agreed, monitored and enforced. There should be close liaison between secondary care transport officers and dialysis unit managers. 4. Patients should be involved in the commissioning and monitoring of transport. The audit demonstrates that patients want to contribute. They have unique insight into the process and a clear interest in driving up quality. 5. Renal units should continue to aspire to journey times as short as possible and certainly less than 30 minutes for all patients. We recognise that this cannot always be achieved. Minimising diversions to pick up other patients for those with longer journeys should be encouraged, though there is a balance to be struck with the cost and environmental impact of many vehicles doing similar journeys. 6. New dialysis units should always be planned with patient transport an important factor in the location of the unit. Proximity to the homes of patients and good road and public transport links are of paramount importance. Home based dialysis treatment should always be seriously considered, especially for those patients who would have a significant journey time to their nearest HD unit. 7. No patient should have to pay for transport to and from dialysis. Those who are able to use their own steam to get to dialysis should be encouraged and empowered to do so. Free and convenient parking and payment of public transport fares or private car fuel bills should be standard for all dialysis units. 8. All dialysis units should carry out regular audit of patient transport, including discovering the views of its patients. Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 66 of 94

72 References References 1. Ansell D, Feehally J, Fogarty D, Tomson C, Williams AJ, Warwick G. UK Renal Registry Report UK Renal Registry, Bristol, UK. 2. Department of Health. The National Service Framework for Renal Services Part 1: Dialysis and Transplantation. London, Moist LM, Bragg-Gresham JL, Pisoni RL et al. Travel time to dialysis as a predictor of health-related quality of life, adherence, and mortality: the Dialysis Outcomes and Practice Patterns Study (DOPPS). Am J Kidney Dis Apr; 51 (4): White P, James V, Ansell D et al. Equity of access to dialysis facilities in Wales. QJM Jul; 99(7): Roderick P, Clements S, Stone N et al. What determines geographical variation in rates of acceptance onto renal replacement therapy in England? J Health Serv Res Policy Jul; 4(3): Boyle PJ, Kudlac H, Williams AJ. Geographical variation in the referral of patients with chronic end stage renal failure for renal replacement therapy. QJM Feb; 89(2): Cross Party Group on Kidney Disease, The Scottish Parliament. Renal Disease in Scotland. A strategy for future management party_report-renal_disease_in-scotland.pdf 11. Recommendations for the provision of a patient centred renal transport service. Cheshire and Merseyside Renal Transport Action Learning Set Dialysis/PatientTransport/Renal-Transport- Cheshire-and-Merseyside.pdf 12. Audit Commission Improving Non Emergency Patient Transport Services. Audit Commission, (2001) NHS Purchasing and Supply Agency Provision of non emergency patient transport services and non patient transport services (2003) Pan-Thames Renal Audit Group. Accessibility of Haemodialysis s for Patients. Transport Audit. uk/files/documents/129_renal_transportexecutive_summary_august_2008.pdf 7. Renal Association. Treatment of adults and children with renal failure: standards and audit measures. 3rd Edition. London: Royal College of Physicians of London and the Renal Association, MacGregor MS, Campbell J, Bain M et al. Nephrol Dial Transplant Feb; 20(2): Roderick P, Armitage A, Nicholson T et al. A clinical and cost evaluation of hemodialysis in renal satellite units in England and Wales Am J Kidney Dis Jul: 441(1): of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

73 Appendices Appendix A Participating units with response rates, grouped by SHA and equivalent and main unit s highlighted in red did not return any patient questionnaires to the audit. s highlighted in blue are the 26 units that have been removed from this analysis for reasons of anonymity. SHA and equivalents SHA response rate Main response rate Derby City General Hospital Derby City General Hospital 70 to 80% Boston 30 to 40% Kettering General Hospital 90 to 100% Leicester - Belgrave 90 to 100% Leicester General Hospital 60 to 70% Leicester General Hospital Lincoln County Hospital 80 to 90% Loughborough Community Hospital 30 to 40% East Midlands Strategic Health Authority 60 to 70% Northampton General Hospital - Harborough Lodge Haemodialysis 90 to 100% Peterborough District General Hospital 50 to 60% Skegness 90 to 100% Ilkeston Community Hospital, Shipley Dialysis 20 to 30% East Of England Strategic Health Authority Nottingham City Hospital Renal and Transplant Nottingham Queens Medical Centre - Paediatric Nottingham City Hospital Centenary Wing Nottingham City Hospital Renal and Transplant Sutton-in-Ashfield, Mansfield - Kings Mill Nottingham Queens Medical Centre - Paediatric 60 to 70% 30 to 40% 60 to 70% 70 to 80% Basildon Basildon 70 to 80% Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 68 of 94

74 Appendices SHA and equivalents SHA response rate Main response rate Bury St Edmund s - West Suffolk Hospital 90 to 100% Cambridge - Addenbrooke s Hospital Cambridge - Addenbrooke s Hospital 60 to 70% Hinchingbrooke 90 to 100% King s Lynn 80 to 90% Chelmsford - Broomfield Hospital Chelmsford - Broomfield Hospital 90 to 100% Colchester General Hospital Colchester General Hospital 40 to 50% Ipswich Hospital Ipswich Hospital 90 to 100% Cromer Haemodialysis 70 to 80% Norfolk & Norwich University Hospital Gorleston, Gt Yarmouth - James Paget University Hospital Norfolk & Norwich University Hospital 60 to 70% 50 to 60% Southend Hospital Southend Hospital 90 to 100% Luton & Dunstable 30 to 40% Stevenage - The Lister Hospital Basildon St Alban s City 70 to 80% Stevenage - The Lister Hospital 50 to 60% London - Evelina Children s Hospital London - Great Ormond Street London - Evelina Children s Hospital London - Great Ormond Street Guernsey 90 to 100% London - Astley Cooper Dialysis - Guy s and St Thomas Hospital 0 to 10% London - Camberwell (Guy s) 90 to 100% London Strategic Health Authority 60 to 70% London - Guy s and St Thomas - 4th Floor Dialysis London - Forest Hill/ Lewisham London - Guy s and St Thomas - 4th Floor Dialysis 20 to 30% 30 to 40% London - New Cross Gate (Guy s) 60 to 70% London Bridge Hospital (Guy s) Tunbridge Wells - Pembury Hospital 90 to 100% London - King s College Hospital London - Bromley Satellite 40 to 50% 69 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

75 Appendices SHA and equivalents SHA response rate Main response rate London - Dartford Satellite 90 to 100% London - Dulwich Satellite 60 to 70% London - Fisk & Cheere Ward, King s College Hospital 40 to 50% London - King s College Hospital 80 to 90% London - Woolwich Satellite Renal 70 to 80% London Bridge Hospital (King s) London - Barnet 60 to 70% London - Camden (Royal Free) 50 to 60% London - Highgate 70 to 80% London - Royal Free & Middlesex Hospital London - Hospital of St John & St Elizabeth (Royal Free) 60 to 70% London - North Middlesex 20 to 30% London - Royal Free & Middlesex Hospital London - St Pancras - Mary Rankin 40 to 50% 70 to 80% London - Camden (Barts) 70 to 80% London - St Barts Hospital 80 to 90% London - St Barts Hospital London - The Royal London Hospital London - Whipps Cross University Hospital, Leytonstone London - Whipps Cross, Patience Ward 60 to 70% 30 to 40% 50 to 60% Romford - Queen s Hospital 80 to 90% London - St George s Hospital London - St George s Hospital Crawley (St Helier) London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation Croydon - The Elizabeth Ward Dialysis, Mayday Hospital 30 to 40% Farnham Dialysis 40 to 50% Kingston Dialysis 70 to 80% London - St Helier Hospital, Carshalton - South West Thames Renal & Transplantation 70 to 80% Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 70 of 94

76 Appendices SHA and equivalents SHA response rate Main response rate West Byfleet Dialysis 70 to 80% Ealing Hospital 60 to 70% Hayes 70 to 80% London - Central Middlesex Hospital London - Charing Cross Hospital 70 to 80% 40 to 50% London - West London Renal and Transplant Centre - Auchi Acute Dialysis London - Hammersmith Dialysis Centre 70 to 80% London - Northwick Park 70 to 80% London - St Charles Hospital 70 to 80% London - West London Renal and Transplant Centre - Auchi Acute Dialysis 70 to 80% London - West Middlesex Watford 90 to 100% Darlington Dialysis Centre 60 to 70% Middlesbrough - The James Cook University Hospital Middlesbrough - The James Cook University Hospital North Ormesby Dialysis Centre 30 to 40% 80 to 90% Stockton Dialysis Centre 80 to 90% North East Strategic Health Authority 70 to 80% Newcastle - Freeman Hospital Newcastle - Freeman Hospital 70 to 80% Newcastle - Royal Victoria Infirmary 90 to 100% Newcastle - Royal Victoria Infirmary - Paediatric Newcastle - Royal Victoria Infirmary - Paediatric Sunderland Royal Hospital Durham Dryburn Dialysis Centre 80 to 90% Sunderland Royal Hospital 60 to 70% Carlisle - Cumberland Infirmary Carlisle - Cumberland Infirmary 70 to 80% West Cumberland Hospital 80 to 90% North West Strategic Health Authority 60 to 70% Liverpool - Aintree University Hospital Liverpool - Aintree University Hospital Liverpool - Aintree University Hospital - Satellite 70 to 80% Liverpool - Waterloo 90 to 100% 71 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

77 Appendices SHA and equivalents SHA response rate Main Liverpool - Royal Liverpool Childrens Hospital - Alder Hey Liverpool - Royal Liverpool Childrens Hospital - Alder Hey response rate Liverpool - Broadgreen 40 to 50% Liverpool - Halton 90 to 100% Liverpool - Royal Liverpool University Hospital Liverpool - Royal Liverpool University Hospital 60 to 70% Liverpool - Whiston 90 to 100% Warrington 80 to 90% Manchester - Royal Manchester Children s Hospital Manchester - Royal Manchester Children s Hospital Ashton-under-Lyne - Tameside Hospital 90 to 100% Macclesfield General Hospital 90 to 100% Manchester Royal Infirmary Manchester - North Manchester General Hospital Manchester - Prestwich (Manchester RI) 50 to 60% Manchester - Wythenshawe 40 to 50% Manchester Royal Infirmary 50 to 60% Accrington Victoria 70 to 80% Blackpool - Clifton 60 to 70% Preston - Royal Preston Hospital Burnley - Burnley General Hospital 90 to 100% Chorley & District 90 to 100% Kendal - Westmorland General Hospital Preston - Royal Preston Hospital Bolton - Royal Bolton Hospital 80 to 90% 60 to 70% 80 to 90% Salford - Hope Hospital Rochdale Haemodialysis Satellite 90 to 100% Salford - Hope Hospital 70 to 80% Wigan 80 to 90% Wirral - Arrowe Park Hospital Chester - The Countess of Chester Hospital 70 to 80% Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 72 of 94

78 Appendices SHA and equivalents SHA response rate Main response rate Clatterbridge 80 to 90% Wirral - Arrowe Park Hospital 50 to 60% High Wycombe - Wycombe Hospital 70 to 80% Oxford Radcliffe Hospital Milton Keynes 30 to 40% Oxford Radcliffe Hospital 70 to 80% Swindon 90 to 100% Basingstoke 50 to 60% Bognor Regis - Springfield Dialysis, Bognor War Memorial Hospital 20 to 30% Chandlers Ford South Central Strategic Health Authority 50 to 60% Portsmouth - Queen Alexandra Hospital Havant 80 to 90% Hayling Island Isle of Wight 90 to 100% Milford-on-Sea Portsmouth - Queen Alexandra Hospital 40 to 50% Salisbury 90 to 100% Reading - Royal Berkshire Hospital Southampton General Hospital - Paediatric Reading - Royal Berkshire Hospital 80 to 90% Windsor Dialysis 40 to 50% Southampton General Hospital - Paediatric Bexhill Dialysis 90 to 100% Brighton - Royal Sussex County Hospital Brighton - Royal Sussex County Hospital 70 to 80% Crawley (Sussex) 90 to 100% South East Coast Strategic Health Authority 80 to 90% Worthing Dialysis 90 to 100% Ashford, Kent 50 to 60% Kent & Canterbury Hospital Dover - Buckland Satellite 90 to 100% Kent & Canterbury Hospital 90 to 100% 73 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

79 Appendices SHA and equivalents SHA response rate Main response rate Maidstone - Alan Squirrel 90 to 100% Margate - Alan Squirrel 90 to 100% Medway - Alan Squirrel 80 to 90% Bath - Royal ed Hospital 90 to 100% Bristol - Brunel 80 to 90% Bristol - Knowle, South Bristol 40 to 50% Bristol - Southmead Hospital Bristol - Southmead Hospital 30 to 40% Frome 60 to 70% Taunton (Southmead) Weston Super Mare - Ambleside 70 to 80% Yeovil (Southmead) Bristol Royal Hospital for Children Bristol Royal Hospital for Children Bournemouth 40 to 50% South West Strategic Health Authority 60 to 70% Dorchester - Dorset County Hospital Dorchester - Dorset County Hospital Poole 40 to 50% Yeovil (Dorset) 40 to 50% Exeter - Royal Devon and Exeter Hospital 70 to 80% Honiton 60 to 70% Exeter - Royal Devon and Exeter Hospital North Devon Satellite Kidney 90 to 100% Taunton (Devon and Exeter) 70 to 80% Torbay - Newton Abbot Hospital 70 to 80% Yeovil (Devon and Exeter) Gloucester Royal Hospital Gloucester - Severn 90 to 100% Gloucester Royal Hospital 90 to 100% Plymouth - Derriford Hospital Bodmin (Plymouth Derriford) Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 74 of 94

80 Appendices SHA and equivalents SHA response rate Main response rate Plymouth - Derriford Hospital 40 to 50% Bodmin (Royal Cornwall) 60 to 70% Truro - Royal Cornwall Hospital, Treliske Penzance - The Aubrey Williams Satellite, West Cornwall Hospital Truro - Royal Cornwall Hospital, Treliske 70 to 80% 50 to 60% Balsall Heath, Runcorn Road 80 to 90% Birmingham - Heartlands Hospital 60 to 70% Birmingham - Heartlands Hospital Castle Vale 70 to 80% Solihull District General 90 to 100% Sutton Coldfield - Ashfurlong 60 to 70% Birmingham - Aston Cross 40 to 50% Birmingham - City Hospital Satellite 30 to 40% Birmingham - King s Norton 40 to 50% Birmingham - Queen Elizabeth Hospital Birmingham - Queen Elizabeth Hospital 50 to 60% Hereford Dialysis Centre 50 to 60% West Midlands Strategic Health Authority 60 to 70% Kidderminster (QEH) 90 to 100% Lichfield Dialysis Centre 90 to 100% Tipton (QEH) 80 to 90% Birmingham Children s Hospital Birmingham Children s Hospital Coventry - Walsgrave Hospital Nuneaton - George Eliot Hospital 60 to 70% 60 to 70% Coventry - Walsgrave Hospital Rugby - St Cross Hospital 90 to 100% Stratford upon Avon Whitnash - Leamington Spa Dudley - Russells Hall Hospital Dudley - Russells Hall Hospital 50 to 60% Kidderminster (Russells Hall) 80 to 90% 75 of 94 Copyright 2010, The Health and Social Care Information Centre, National Heart Failure Report. All rights reserved.

81 Appendices SHA and equivalents SHA response rate Main response rate Tipton (Russells Hall) Shrewsbury - Royal Shrewsbury Hospital Shrewsbury - Royal Shrewsbury Hospital 80 to 90% Telford 80 to 90% Crewe - Leighton Hospital 70 to 80% Stoke - University Hospital of North Staffordshire Stafford 30 to 40% Stoke - University Hospital of North Staffordshire 80 to 90% Cannock 50 to 60% Tipton (New Cross) Wolverhampton - New Cross Hospital Walsall Dialysis Centre (New Cross) Wolverhampton - New Cross Hospital 70 to 80% 40 to 50% Wolverhampton - Pond Lane 40 to 50% Bradford - St Luke s Hospital Bradford - St Luke s Hospital 40 to 50% Skipton 70 to 80% Doncaster Royal Infirmary Doncaster Royal Infirmary 70 to 80% Bridlington Grimsby 90 to 100% Hull Royal Infirmary Hull Royal Infirmary 30 to 40% Yorkshire And The Humber Strategic Health Authority 60 to 70% Scarborough 50 to 60% Scunthorpe 90 to 100% Leeds - St James s University Hospital - Paediatric Leeds - St James s University Hospital - Paediatric Dewsbury District Hospital 60 to 70% Leeds - St James s University Hospital - Ward 55 Halifax - Calderdale Royal Infirmary Huddersfield - St Luke s Hospital 90 to 100% 70 to 80% Leeds - Beeston (St James) 60 to 70% Leeds - Seacroft (St James s) - Ward B 60 to 70% Copyright 2010, The Health and Social Care Information Centre, National Heart Failure Report. All rights reserved. 76 of 94

82 Appendices SHA and equivalents SHA response rate Main response rate Leeds - Seacroft, Frank Parsons 70 to 80% Leeds - St James's University Hospital - Ward to 50% Wakefield - Clayton Hospital 90 to 100% Barnsley 60 to 70% Chesterfield 90 to 100% Sheffield - Northern General Hospital Rotherham 50 to 60% Sheffield - Heeley/South Sheffield Sheffield - Northern General Hospital 30 to 40% 50 to 60% Easingwold 40 to 50% Harrogate 70 to 80% York District General Hospital York District General Hospital 40 to 50% Easingwold 40 to 50% Harrogate 70 to 80% Eastern HSSB Northern Ireland 90 to 100% Belfast - Royal Belfast Hospital for Sick Children York District General Hospital 40 to 50% Belfast - Royal Belfast Hospital for Sick Children Belfast - Ulster Hospital Belfast - Ulster Hospital 90 to 100% Belfast City Hospital Belfast City Hospital 90 to 100% Northern HSSB Northern Ireland Southern HSSB Northern Ireland 80 to 90% Antrim Area Hospital Antrim Area Hospital 80 to 90% 90 to 100% Newry - Daisy Hill Hospital Newry - Daisy Hill Hospital 90 to 100% Western HSSB Northern Ireland 80 to 90% Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Mid and West Wales 70 to 80% Swansea - Morriston Hospital Derry/Londonderry - Altnagelvin Hospital Omagh - Tyrone County Hospital Aberystwyth - Bronglais Hospital Carmarthen - West Wales Hospital 80 to 90% 80 to 90% 90 to 100% 50 to 60% Swansea - Morriston Hospital 70 to 80% Swansea Annexe 90 to 100% 77 of 94 Copyright 2010, The Health and Social Care Information Centre, National Heart Failure Report. All rights reserved.

83 Appendices SHA and equivalents SHA response rate Main response rate Bangor - Gwynedd Hospital Bangor - Gwynedd Hospital 10 to 20% North Wales 50 to 60% Rhyl - Glan Clwyd Hospital Rhyl - Glan Clwyd Hospital 80 to 90% Wrexham - Maelor Hospital Wrexham - Maelor Hospital 60 to 70% Cardiff - Llantrisant Pontyclun 60 to 70% Cardiff - Royal Infirmary, West Wing 40 to 50% South East Wales 60 to 70% Cardiff - University Hospital of Wales Cardiff - University Hospital of Wales Cardiff - University Hospital of Wales - Cardiff North Renal 60 to 70% 60 to 70% Merthyr Tydfil - Prince Charles Hospital 60 to 70% Newport - St Woolos 60 to 70% Cardiff - University Hospital of Wales - Children s Kidney Centre Cardiff - University Hospital of Wales - Children s Kidney Centre Copyright 2010, The Health and Social Care Information Centre, National Heart Failure Report. All rights reserved. 78 of 94

84 Appendices Appendix B The Implementation Group for the National Kidney Care Audit Patient Transport Name Role Representing Julie Henderson Project Manager The NHS Information Centre for health and social care Robert Dunn Patient Lead (VA and PT) National Kidney Federation, Advocacy Officer Deputy: Dennis Crane Alistair Chesser Clinical Lead (PT) Pan Thames Renal Audit Group Susannah Gibb Paediatrics Specialist British Assoc of Paediatric Nephrology (BAPN) Jenny Scott PT Service Commissioner North West Specialised Commissioning Team Diane Comer Renal Manager Association of Renal Managers Andy Hickson PT Service Provider Ambulance Trusts Ursula Turner Audit Communications Manager The NHS Information Centre for health and social care Catherine Faley Survey/Questionnaire developer The NHS Information Centre for health and social care Andrew Singfield Service Improvement NHS Institute for Innovation and Improvement Nick Wilson Network Manager North Wales Renal Network Manager Sarah Randall Patient Transport Lead Department of Health Monica Acheampong Renal Policy Lead Department of Health 79 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

85 Appendices Appendix C Organisational questionnaire sent to unit managers and commissioners Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 80 of 94

86 Appendices 81 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

87 Appendices Appendix D Patient Questionnaire Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 82 of 94

88 Appendices 83 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

89 Appendices Results Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 84 of 94

90 Appendices 85 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

91 Appendices Results Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 86 of 94

92 Appendices 87 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

93 Appendices Results Appendix E A worked example using the NHS iview online interactive analysis tool to compare a main unit to its satellite units. iview is an online tool provided by The NHS Information Centre that enables authorised users to access and extract information to meet their own needs; making selections, viewing comparisons, creating tables and generating graphs. For further details please see This document has focused reporting at the renal centre level, and generally this involved combining the responses from a number of units (see Appendix A). Results for all participating units are available through iview, and here we illustrate how to decompose the responses from a particular renal centre and compare the separate contributing units. The default view once a user has logged in and chosen the Patient Responses area shows the fractional distributions by country for the two journey times (to and from dialysis). This is shown in Figure 40. Figure 40 The default view after logging in to iview and selecting to view the Patient Responses. Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 88 of 94

94 Appendices There is not space here to fully explain the features shown in this image. The User Guide and FAQ on the audit web site, and forum (hosted by the Renal Association, are good starting points for further information. Figure 41 Deselecting the ReturnJourneyTime item from the Questions dimension. To achieve our goal of comparing the units that contribute results to the London - St Barts Hospital centre there are a number of steps we will take: 1. Display the results for only one question this will simplify the screen by having less data to show. 2. Use the drill-down feature to navigate through the organisational hierarchy using the mouse this will show us the data we are interested in. 3. Control the s by Centre SHA dimension to show only the results we are interested in this will simplify the screen and also make the charts more useable. Display the results for only one question The Questions dimension allows the user to select which question (or combination of questions) they are interested in. In the default view the dimension has already been placed in the Rows section to the right, and two questions have been selected, OutJourneyTime and ReturnJourneyTime, as is shown in the grid towards the bottom (Figure 40). We can click on the Questions dimension in the Rows section. This will bring up a list of all the questions, with check boxes so they can be selected for display. Figure 41 shows the list, with the ReturnJourneyTime being deselected. We will be working with just the OutJourneyTime data from here on. Drill down through the hierarchy Various items in iview are displayed with a cross to their left, as shown in Figure 41. This indicates the item can be expanded to show its constituent members, and applies to the countries seen in the grid too. Expanding a country drills down a level in the organisational hierarchy. In the default case this is the s by Centre SHA hierarchy, and so the next level to be displayed is the SHA and equivalent layer. The SHAs can also be expanded to reveal their constituent renal centres, which in turn can be expanded to show the individual units that service patients under the care of the centre. Click on the cross to expand the analysis. Figure 42 shows the grid after expanding the hierarchy to show the renal centres in the London SHA. The distribution of journey times for London St Barts Hospital is shown, and the renal centre could be expanded to show the distributions for all the units that contribute to the total for the centre. 89 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

95 Appendices Results Figure 42 Having drilled down through the hierarchy, the renal centres in the London SHA can be compared There is already a lot of information in Figure 42. The renal centres that make up the London SHA can be compared; the totals for London SHA are shown and can be compared to the other SHAs in England; the totals for England are displayed and can be compared to the other countries totals. Show only the results we are interested in The table in Figure 42 is fairly crowded and complex, and the graph generated by clicking on the Chart tab is fairly unwieldy. By making selections from the list of items in the s by Centre SHA dimension we can control how much data is displayed. The procedure is much the same as when we chose which questions to display data for. Clicking on the s by Centre SHA dimension in the Rows area will bring up an expandable list of all the items in the hierarchy, grouped at the various levels. The list will be expanded to reflect the data as it is displayed on the grid, so when going from the situation in Figure 42 we will see the list as in Figure 43a. The two buttons above the list are to select and deselect all the items; Figure 43b shows that all items have been deselected, before just the London St Barts Hospital item is selected in Figure 43c. Note that selecting a single centre will automatically select the relevant higher levels in the hierarchy, in this case London SHA and England. Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 90 of 94

96 Appendices Figure 43 (a, b, c) Manipulating the s by Centre SHA dimension. The grid is now much simpler, and can be simplified further by switching off the running subtotals by clicking on the appropriate button on the toolbar ( ). The renal centre can be expanded in the grid to show all of the contributing units, as is shown in Figure 44. Figure 44 The grid showing just the units that make up the London St Barts Hospital centre. 91 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

97 Appendices Results We have achieved our goal, comparing the responses from the individual units that contribute to the results presented elsewhere in this document. This process can be adapted to compare any of the 212 units present in the data for any of the 31 patient questions. Further manipulation is possible. For example the default chart that is produced from the data as laid out in Figure 44 is still somewhat unwieldy, and benefits from having the rows and columns interchanged using the pivot button ( ). The data can be saved for further processing and charting in a spreadsheet application if that is preferred. The organisational responses, covering the commissioners and dialysis unit managers survey (see page 57) also behave in a similar manner. All of this is beyond the scope of this short appendix. For further information or assistance please see the audit web pages Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 92 of 94

98 Notes 93 of 94 Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.

99 Notes Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved. 94 of 94

100 Need to know more? % [email protected] The NHS Information Centre for health and social care 1 Trevelyan Square Boar Lane Leeds LS1 6AE For further information please contact our Contact Centre, quoting document reference IC Copyright 2010, The Health and Social Care Information Centre, National Kidney Care Audit Patient Transport Survey Report. All rights reserved.