Non-Emergency Patient Transport: Transport Review Group and Tender. Item: 7.2

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1 Non-Emergency Patient Transport: Transport Review Group and Tender Trust Board Meeting Part 1 Item: July 2013 Enclosure: D Purpose of the Report: To advise the Board of the work underway to review the patient transport contract addressing issues raised by both patients and staff. FOR: Information Assurance Discussion and input Decision/approval Sponsor (Executive Lead): Simon Milligan Director of Finance Author: Richard Evans Transport Manager Simon Milligan Director of Finance Author Contact Details: Financial/Resource Implications: Risk Implications Link to Assurance Framework or Corporate Risk Register: Financial implications outlined under section 21. Possible cost pressure from re-tendering Legal / Regulatory / Reputation Implications: Quality Governance Implications: Link to Relevant CQC Standard: Link to Relevant Corporate Objective: Impact on Patients and Carers: Improved service would benefit patients Document Previously Considered By: EMT 22 July 2013 Recommendation& Action required by the Trust Board : The Board is asked to note the current challenges and concerns with the PTS contract and the improvements already implemented. The Board is also asked to note the plans and timescales for developing a tender. An update to the Board will be provided in November 2013 and the recommendation for the award during December. 0

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3 NON-EMERGENCY PATIENT TRANSPORT: TRANSPORT REVIEW GROUP & TENDER Executive Summary 1. At previous Board meetings concerns have been raised by a number of Non-Executive Directors regarding the Patient Transport Service (NEPTS) and its impact upon patients. This paper summarises the current situation as well as steps, already implemented or planned, to improve the service. 2. The Trust is obliged to provide a Non-Emergency Patient Transport Service (NEPTS) for all patients for whom travel by another method would be detrimental to their condition or recovery. There are strict DoH guidelines in place as to the eligibility of patients (and escorts) and these are considered by the medical professional requesting the booking. Transport is provided to their home address (be that a private residence or a care home) which for the vast majority of patients is within 10 miles. 3. The Trust s existing contract no longer fully reflects the needs of the service and does not interact smoothly with the Trust s processes and procedures which can lead to significant delays in the transport for a minority our patients. The Trust has already implemented additional checks and guidance for staff members to address the key issues of selecting the correct patient mobility, ensuring eligibility is correctly assessed and tightening up on the times of requested journeys to reduce delays in the late afternoon/evening. 4. A Transport Review Group has been set up to continue these improvements, further review the service and draw up an appropriate Service Level Specification for a new contract. Our existing contract is coming to an end and re-tendering is due to be carried out in the coming months. The appointment of a new contractor (or re-appointment) will need to be completed by January 2014 to allow for a seamless changeover with appropriate lead in times Background 5. Our NEPTS carries out about 25,000 journeys per year comprising a mixture of collections (and returns) for outpatient appointments and discharges. Trust staff are able to book transport journeys a maximum of 3 months in advance, there is no minimum booking time and a number of journeys are booked for immediate departure each day. These journeys are often subject to significant delays, or if they are prioritised cause significant delays for other users. Recent Trust initiatives have worked to improve the number of bookings made the day before or in the morning (for afternoon departures). The Trust has agreed prioritisation in the case of palliative care patients, and the ASP (Advanced Site Practitioner) will also prioritise journeys as appropriate. Out of hours bookings are prioritised by the ASP in conjunction with the ED co-ordinator. 6. Speciality bookings require previous day booking in order to be fulfilled as there are limited resources across London to deal with these types of requests. However while attempts are always made to meet last minute bookings they are often unsuccessful. 7. Each ward/department is charged for the journeys that it carries out. Detailed breakdowns are provided each month for them to be able to check that the re-charge is accurate and also to allow for tracking of usages/cost throughout the year. All booking forms are submitted electronically to a central mail folder to ensure that they are actioned and a clear audit trail is available to staff and our service providers. The centralised budget was devolved, based on historical usage, to the wards/departments 2

4 two years ago and each department is responsible for managing its own usage and meeting the cost for it. 8. Our existing contract is based on a projected usage during the day of normal journeys (a variety of walkers, wheelchair users and stretcher users) with all journeys above this agreed limit being chargeable as well as all out of hours journeys. In addition there is no agreed provision of specialist journeys (HDU, Bariatric, SCUBU) so these are also charged in addition to the base contract. The contract stipulates a single out of hours vehicle be available for use. The projected usage within the initial contract was inaccurate and this was rebased, with the assistance of our Service Provider, to better reflect our usage however the service continues to be used extensively. The Trust currently spends approximately 625k per year on core journeys and 250k per year on out of hours/specialist journeys. Major Areas of Concern 9. While the majority of feedback is positive a number of issues with the Trust s usage/contract have been highlighted from our patients and their carers/families. Trust users and our service provider have also highlighted areas which are in need of improvement. 10. Patient (and Family/Carer concerns) Discharge delays in afternoon/evening can be significant (leading to some patients not arriving at their destination until late in the evening). Lack of communication means that families/carers are often not aware of the delays. Those coming into the hospital for outpatient appointments are required to be ready to travel 2 hours prior to their appointments. Time spent on the ambulance can be up to 90 minutes when multiple patients are transported at one time which leads to discomfort. 11. Staff Concerns Lack of communication from Transport Controllers regarding delays. Inflexibility in options (for example wait/return for patients receiving treatment at other facilities), resubmission of booking forms required for changes in requests. Patients not collected at requested time bed blocks. Lack of effective discharge lounge (this concern is also shared with our Service Provider). 12. Service Provider Concerns Short notice/immediate bookings mean they are unable to plan journeys efficiently. Bottleneck of discharges in late afternoon means they are unable to collect at agreed times. Incorrect mobility types/destinations on booking forms cause long delays. Number of patients not ready to travel at booked times causes long delays/rebookings. 13. Overspend (Reasons for) The Trust books significantly more journeys than initially envisaged. Checks are not always stringently carried out (in terms of both eligibility and mobility type). A larger than projected number of speciality journeys are utilised. Journeys no longer needed are often not cancelled, resulting in fees still applying. 3

5 Improvements & Controls Already Implemented 14. The Trust has already taken significant steps to improve the patient experience and ensure additional steps are taken during the booking process to reduce delays. These include: Improvements to the Patient Transport Waiting Area including, following feedback from patients, installation of a TV (sponsored by RVS) and improved drinking facilities. Additional controls and guidance were released to staff earlier this year and this has resulted in a drop in usage for some areas and increased awareness and challenging from service managers and senior staff. The booking form has been updated and expanded to include a checklist and flow diagram to guide staff through the process and ensure that they check the patient s eligibility and mobility. The forms also require authorisation from a senior named individual to allow for an audit trail. (See Annex A) The booking system has been moved from predominantly fax based to , allowing for instant delivery of forms and an audit trail. Significant work at Matron level to ensure that stretchers are only used when appropriate and that a larger percentage of patients are correctly assessed as walkers or wheelchair users. Future Improvements 15. A number of areas have also been identified as needing improvement/review and have been picked up as parts of other, larger scale, plans. Review of the location of the PTS waiting area (being carried out as part of the Outpatients review). Increased usage of Discharge Lounges/Rooms to aid the discharge process. 16. The Transport Review Group has been set up to review the PTS and ensure that a fit for purpose service level specification is drawn up to address the above concerns and ensure that we are delivering an effective and efficient service for our patients. The group will be chaired by the Chief Operating Officer and will have both NED representation and patient representatives. From the Trust side are senior managers and key service users well as representatives from Procurement and Finance. Information from other London Trusts has been sought and shared at pan-london NEPTS meetings and will be available as a reference point for the group and to provide benchmarking data. A key objective for the Transport Review Group will be to accurately identify the Trust s current and, where possible, future requirements; also ensuring that the concerns of patients and staff are addressed so that the contract supports the discharge process and aids patient flow through the Trust. The increase in community work (such as the Raynes Park Health Centre) also provides new challenges as our patients may need to travel to multiple locations as part of their care. 17. There are identified key areas for this group to focus on; Correct service usage (eligibility, mode of transport, usage, escorts) PTS as part of the discharge process/patient experience Community developments (for example Raynes Park Health Centre) Value for money, KPIs and effective service delivery Re-tendering the contract (see below) 4

6 18. The group will then be in a position to implement further improvements/ recommendations throughout the divisions to ensure that the Trust improves its own processes and procedures to support changes in the PTS service. Re-tendering the new PTS Contract Process 19. The Transport Review Group (TRG) will provide guidance and management of the tender process, and utilise the work it has done to provide a clear picture of the Trust s expectations and requirements from the PTS contract. This will allow for a far more inclusive core contract, giving the Trust far greater security in what it can expect and the service provider greater knowledge of the needs of the Trust, allowing them to deliver these. 20. The TRG will also consider other options such as joint tendering/service provision with other Hospitals in the area as well as the use of an independent management company an approach taken by some hospitals which has led to significant cost reductions and carbon emission improvements. London Trusts using these services have been invited to provide feedback on their service performance and patient satisfaction. Process Stage Date for Achievement Internal group set up to begin tender awareness June 2013* Full meeting of TRG (including patient representatives) August 2013 and workstreams/subgroups decided on. Subgroup/Workstream reports completed 13 th September 2013 Initial tender specifications presented to group for consideration Prior to 27 th September 2013 Tender process through LPP started October 2013 Tender process completed December 2013 Recommendation for award made to Trust Board December 2013 *Action achieved Costs & Benchmarking 21. It may be that there will be additional core costs when compared to our previous contract (which did not uplift for 6.5 years), mainly due to the increase in fuel prices. The contract will also encompass more fully the Trust needs and vastly reduce the number and amount of additional charges by ensuring the main contract covers out of hours and specialist work as this will save in those areas. It is estimated that the cost of a new contract will be in the region of 1,000,000pa. This will represent a rise of approx % on the original contract seven years ago. The group will consider ways to minimise this rise, while still delivering a high level of service. Conclusion 22. The Board is asked to note the current challenges and concerns with the PTS contract and the improvements already implemented. The Board is also asked to note the plans and timescales for developing a tender. An update to the Board will be provided in November 2013 and the recommendation for the award during December. 5

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8 Annex A Enclosure D 7

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