Patient Transport Services Engagement Report

Patient Transport Services Engagement Report March 2015 1

Contents Page 1. Purpose of the report 3 2. Background 3 3. Key drivers and considerations 3 4. Analysis of existing information 4 5. Engagement process 6 6. Findings from the engagement process 7 Patient Survey Results Discussion Group with West Riding Kidney Patients Association Surveys results for staff who organise PTS on behalf of patients 8 15 16 7. Overall findings and common themes 20 8. How the findings will be used and next steps 21 Appendices Appendix 1: Engagement timeline Appendix 2: Engagement action plan Appendix 3: Public survey Appendix 4: Staff survey Appendix 5: Equality Monitoring for patient survey Appendix 6: Equality Monitoring for staff survey 2

1. Purpose of the report The Engagement team at Yorkshire and Humber Commissioning Support (YHCS) were asked to engage with patients and providers that refer their patients to the Patient Transport Service on behalf of North Kirklees Clinical Commissioning Group (CCG). A communications and engagement plan set out the legal obligations for the engagement and the process for engaging on Patient Transport Services and gathering patient views. The purpose of this report is to present the findings of the engagement activity. 2. Background Yorkshire Ambulance Service (YAS) currently provide the Patient Transport service based on a joint contract of the 10 CCGs across West Yorkshire. The contract runs out in April 2015 and the 10 CCGs are currently considering whether to issue a tender waiver or go to procurement. The service consists of pre-booked transport for outpatient appointments, transport for renal patients having dialysis in 8 CCG areas (not Bradford District CCG & Bradford City CCG). Wakefield and North Kirklees also contract a same day service for discharged patients. 3. Key drivers and considerations Health and Social Care Act 2012 The White Paper, Equity and excellence: Liberating the NHS, and the subsequent Health and Social Care Act 2012, set out the Government's long-term plans for the future of the NHS. It is built on the key principles of the NHS - a comprehensive service, available to all, free at the point of use, based on need, not ability to pay. It sets out how the National Health Service (NHS) will: Put patients at the heart of everything it does Focus on improving those things that really matter to patients Empower and liberate clinicians to innovate, with the freedom to focus on improving healthcare services. It makes provision for CCGs to establish appropriate collaborative arrangements with other CCGs, local authorities and other partners, and it also places a specific duty on CCGs to ensure that health services are provided in a way which promotes the NHS Constitution and to promote awareness of the NHS Constitution. Specifically, CCGs must involve and consult patients and the public: in their planning of commissioning arrangements in the development and consideration of proposals for changes in the commissioning arrangements where the implementation of the proposals would have an impact on the 3

manner in which the services are delivered to the individuals or the range of health services available to them, and in decisions affecting the operation of the commissioning arrangements where the implementation of the decisions would (if made) have such an impact. The Act also updates Section 244 of the consolidated NHS Act 2006 which requires NHS organisations to consult relevant Overview and Scrutiny Committees on any proposals for a substantial development of the health service in the area of the local authority, or a substantial variation in the provision of services. The Equality Act 2010 Section 149 of the Equality Act 2010 states that a public authority must have due regard to the need to a) eliminate discrimination, harassment and victimisation, b) advance Equality of Opportunity, and c) foster good relations. It unifies and extends previous disparate equality legislation. Nine characteristics are protected by the Act, which are age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion and belief, sex and sexual orientation. The NHS Constitution The NHS Constitution came into force in January 2010 following the Health Act 2009. The constitution places a statutory duty on NHS bodies and explains a number of patient rights which are a legal entitlement protected by law. One of these is the right to be involved directly or through representatives: in the planning of healthcare services the development and consideration of proposals for changes in the way those services are provided, and in the decisions to be made affecting the operation of those services 4. Analysis of existing information This section aims to provide a summary of the key issues raised through the analysis of existing information. There were no PALS or Patient Opinion queries received from the public in respect of the providers of the services included in this review. Those cases, which were received by the PALS service related to care provided by the Mid Yorkshire Hospitals NHS Trust. These are noted below: Need for clear protocol; for health care providers as to who is responsible for booking and funding transport. Patients reporting that GP practices, Hospitals and other health providers disputing who should be arranging it, leaving patients without transport. Issues around provision for transport for people on low incomes or information on reimbursement for travel costs 4

Need for clear communication about who to contact and where to complain by patients e.g. difficulties contacting the clinic/hospital when a booked ambulance did not arrive to take patient and escort to the hospital Issue about patient safety where 3 patients could not safely be transported in the back of the car as they were unable to fasten the seat belts, patient then advised he had refused transport and had to wait for transport to become available so he could be transported home. Transport not being informed by health provider of changes to appointments and patients then missing appointments Eligibility criteria: No clear consistent message being given to patients about who is considered eligible. Patients experiencing sudden withdrawal of service, or some will be allowed by or refused depending on clinician or provider. Speaking to Outpatients What did we learn? MYHT January 2015 (Healthwatch Wakefield and Kirklees) Patients in Wakefield and Kirklees told Healthwatch they were experiencing problems with appointments in outpatient clinics. From October to December 2014, Healthwatch Kirklees sat in outpatient clinics throughout Mid Yorkshire Hospitals Trust, Spire Dewsbury and Spire Methley Park. Staff and volunteers spoke to patients about their experiences using a survey. Questions covered booking appointments, cancellations, waiting times, requesting additional support, booking in, waiting areas, delays and private hospital appointments. Patient transport was raised in one of the questions, key themes were: medical staff were not always aware of the service or the eligibility criteria, and they did not always offer the service even if applicable some patients felt family members were expected to take them to hospital which affected their choice of hospital or treatment, and were concerned if family member couldn t take them some patients experienced financial difficulty paying for taxi fares because they were unaware of the patient transport service or were told they were not eligible the level of service from the patient transport varied and waiting times could be lengthy the responsibility for who could organise transport on behalf of patients was not always clear National Kidney Audit 2012: The patient transport audit was commissioned by NHS Kidney Care and was carried out by the East Midlands Public Health Observatory. More than 11,000 patients completed the survey, from 246 of the 256 haemodialysis units in England, Wales and Northern Ireland. 5

Just under 90 per cent of respondents said their current transport arrangements met their needs either all or most of the time. Two thirds of patients who travel regularly for haemodialysis treatment do so using hospital arranged transport Units may find it more cost effective to reimburse patients using other modes of transport if this leads to a reduction in reliance on hospital arranged transport Patients usually wish to minimise the distance they travel to get to their dialysis unit and the survey found for the majority of patients the distance travelled to get to their dialysis unit is less than 10 miles. Travelling time is important for patients and, except due to local geographical circumstances, it is recommended that travel time to a haemodialysis unit should be less than 30 minutes. Reducing transit time for hospital arranged transport patients can be achieved by minimising diversions to collect or drop off other patients where possible, ensuring journeys are more direct. It is recommended that patients using hospital arranged transport are collected within 30 minutes of their scheduled pick up time and collected to return home within 30 minutes of finishing dialysis. Users of hospital arranged transport were particularly happy with friendliness of staff and staff understanding of their needs, though far less so with punctuality and with the number of additional patients collected or dropped off by their vehicle. Unit managers and staff at units were sometimes unaware of how transport services are commissioned, monitored and managed. Transport issues affect dialysis unit staff, either through having to change working patterns to cover late arrivals or spend time resolving problems. Staff also observe the physical and psychological impact on patients. 5. Engagement Process Four commissioners across the 10 CCGs engaged with patients and staff to gain insight into their experience of the current service. A timeline and action plan for delivery was agreed (see appendix 1 and 2). There had not been any previous engagement work or equality impact assessment carried out on patient transport, so each of the four CCGs carried out a survey. There were two services delivered in each area: Survey 1: for public, patients, carers and service users (see appendix -3) Survey 2: for staff who wants to organise transport services (see appendix 4) Public, patients, carers and service users were surveyed using various methods and approaches, these were: 6

Patient surveys in hospital settings such as discharge lounges, outpatient departments, patient transport waiting areas and renal dialysis units Renal patient groups: West Riding Kidney Patient Association Patient Reference Groups and forums Carers using networks and forums The wider public using local networks and the voluntary sector The views of staff who may manage bookings or referrals on behalf of patients were also surveyed, these people are: Care homes All GP practices in North Kirklees Commissioners Hospital staff in Pontefract and Dewsbury renal dialysis units Hospital staff in outpatients and discharge lounges at Mid Yorkshire Hospital Foundation Trust The engagement was aimed at both users of the service and referrers to the service and was delivered from 1 December 2014-16 February 2015. The timescale was extended to allow for the festive period. 6. Findings from the engagement process The engagement team attended Dewsbury and Pinderfield s hospitals to encourage and support users of the patient transport service to complete surveys. Each site was attended on 8 separate occasions. The team ensured that they engaged with a cross section of patients and carers within discharge lounges, outpatients and renal units. In addition to the engagement team attending hospital sites, Mid Yorkshire staff handed out surveys to patients attending during the engagement period and YAS sent a sample number of surveys to patients at home. In addition to the survey a discussion group was held with West Riding Kidney Patients Association. Overall, 209 patient surveys and 27 staff surveys were completed. 7

a. Patient survey results Question 1: Please tell us the first part of your postcode (e.g. WF1, WF7 etc) WF5 3 1% WF7 1 0.5% WF12 30 16% WF13 27 15% WF14 26 14% WF15 11 6% WF16 8 4% WF17 38 21% HD3/4 5 3% BC18 1 0.5% BD4/10/11/12/13/18 5 3% BD19 25 15% LS27 1 0.5% Answered questions total 181 Skipped 28 Survey responses have been received from a range of local areas in North Kirklees with an even spread of responses from the central areas with some outlying areas providing a few returns. Patient transport services currently support 1,710 patients living in the North Kirklees area. In total they make 9,375 journeys per year. The response rate has ensured we have received a sample group which has provided the views of 12% of the North Kirklees population currently using services. Question 2: Are you completing this on behalf of... 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Yourself, as someone that has used / does use Patient Transport Services Someone you care for that has used / does use Patient Transport Services Care Home arranging transport on behalf of someone Other (please specify) 8

207 people responded to this question, the majority of responses (168 in total) have been received directly received from service users with carers providing a sample group of 27 individual responses overall. Question 3: What do you use the Service for? (please tick all that apply) Answer Options Response Response Percent Count Travel to and from outpatients appointments 78.8% 160 Renal services appointments 14.3% 29 Travel home after discharge from hospital 19.2% 39 Travel home from after discharge from Harrogate DFT Same day 1.0% 2 Other (please specify) 5.4% 11 answered question 203 skipped question 6 The biggest reason for travel is to attend an outpatients appointment (160 people in total), with discharge home from hospital providing a smaller sample group of 28 patients. It is worth noting that some patients in the sample group may have transferred from one hospital to another or in some cases to another care provider explaining why the total is higher in the travel home after discharge figures. Renal services provided a sample group of 28 patients who were mostly interviews in the hospital setting. Question 4. When did you last use this service? 45.0% 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% In the last week In the last 2 weeks This month Last two months Over two months ago 9

201 people responded to this question, the majority of respondents 79% or 159 people had used the service in the last month, ensuring that the views captured are from current service users and relate to the situation for current transport services. Question 5. How often do you use this service? 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% More than once a week Every week Every two weeks Every month Over two months ago 176 people responded to this question, the majority of respondents 70% (123 people in total) used the service at least one day each month ensuring the views of regular transport users have been captured. There were some first time patients who had not previously used the service and from this sample these were mainly discharge lounge patients. Question 6: How is your transport usually booked and arranged? Answer Options Response Response Percent Count Care Home staff 5.2% 10 GP 25.5% 49 Hospital 59.4% 114 Carer/relative 4.2% 8 I did it myself 5.7% 11 Other (please tell us more) 11 answered question 192 skipped question 17 Feedback from patients illustrated that the process varies depending on the source of referral to the healthcare provider. For example: If a patient is referred by the GP for a test at the hospital and the GP would organise or for a first hospital appointment but this is not always the case. 10

If the hospital has organised the appointment the patient would receive a letter and be asked if they needed transport or in some cases the hospital had already been informed. Once they start attending the hospital regularly the individual departments often book the transport but this isn t always the case. Renal and discharge patients are clear who books transport and how the system works. Outpatient patients and other patients were not always clear who should organise it or how. Question 7: How would you like to book your transport in the future? Answer Options Response Response Percent Count Care Home staff 5.8% 11 GP 30.7% 58 Hospital 52.9% 100 By myself 10.6% 20 Carer/relative 5.3% 10 Other (please specify) 10 answered question 189 skipped question 20 There was very little change from the current system of booking transport to people s preferred future options. There was an increase in GPs booking transport on behalf of the patient or the patient booking it themselves of just under 5%. Question 8: How were you informed about your transport booking? Answer Options Response Response Percent Count By letter 41.8% 66 By telephone 49.4% 78 By email 1.3% 2 By text message 1.3% 2 Wasn't informed 13.9% 22 Other (please tell us more) 34 answered question 158 skipped question 51 Very few patients received a booking confirmation via technology such as email or text, with the majority 91% (144 people in total) receiving confirmation by letter or telephone contact. 14% were not informed of their booking which is 22 people in total. 11

Question 9: How would you like to be informed about your booking in the future? Answer Options Response Response Percent Count By letter 44.8% 77 By telephone 55.2% 95 By email 6.4% 11 By text message 9.3% 16 Other (please specify) 17 answered question 172 skipped question 37 The use of technology to confirm bookings needs to be considered in any future plans as an increase in booking confirmation by email or text by just under 16% of those responding (30 people in total) would be a preferred option. Question 10: Was the information you received about the service clear and easy to understand? 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Yes No Don t know I did not receive any information Those receiving information 75% (141 people in total) felt that the information was clear and easy to understand. From the 17% who stated they had not received any information some of this sample group were those who received information over the telephone. However just over 5% or 10 people said information was not clear or easy to understand. This sample group may want to be identified further by protected characteristics to see if there were issues around equality. 12

Question 11: Thinking about the last time you used the transport service, how would you rate the following? Answer Options Transport arrived at a reasonable time Very good 38% (75) Good Satisfactory Poor 37% (72) 18% (34) 5% (10) Very Response poor Count 2% (5) 196 Cleanliness of the vehicle 47% (91) 43% (84) 9% (17) 1% (2) 0% (0) 194 Safety of the vehicle 50% (95) 44% (85) 4% (8) 2% (4) 0% (0) 192 Ease of getting into the vehicle 45% (86) 43% (84) 10% (19) 2% (4) 0% (0) 193 Comfort during the journey 43% (82) 42% (80) 12% (22) 3% (6) 0.5% (1) 191 Attitude of staff 64% (121) Arriving at your appointment on time 48% (90) 33% (63) 34% (64) 1.5% (3) 7% (14) 1% (2) 10% (19) 0.5% (1) 1% (2) 190 189 How long you had to wait for transport after your appointment 20% (36) 36% (63) 26% (45) 11% (20) 7% (13) 177 Support to get back into the house at the end of journey 49% (92) 39% (72) 8% (15) 2% (4) 2% (3) 186 Please note that the patients from the discharge lounge would be waiting for periods of time not always due to YAS. Patients waiting in outpatients and renal units had different expectations around acceptable waiting times and this was in part due to the level of physical discomfort or fatigue they were experiencing. Question 12: Please tell us more, particularly if you ticked satisfactory, poor or very poor 111 (53%) responded to this question, the common themes were: Many patients said the waiting times for both pick up and the return journeys home are far too long. Some commented that they had to wait for over 2 hours for transport to arrive. 13

Although some patients did say that they recognised that it was not a taxi service and understood that they may have to wait. Patients explained that they were late for their appointments due to having to pick other patients up on route and that there should be better planning when picking up and dropping off patients in terms of where patients live. Physical accessibility of the transport provided caused issues for patients. Many commented on the condition of the vehicles such as seat belts broken, vehicles shaking and the need for upgrading to improve comfort. Question 13: From your experience of the service please describe what parts of the service work well? 140 (67%) responded to this question, the common themes were: The majority of patients are happy with the service and are very appreciative of the service. Many patients have high praise for the staff. Patients found the staff friendly, polite, helpful, caring and pleasant. One patient commented The staff were brilliant. So helpful and caring and didn't rush us when we needed time Most patients explained how they are extremely grateful of the support from the drivers. Waiting times for patients is an issue especially after the appointment. Question 14: What would improve your experience of the transport service? 97 (46%) responded to this question, the common themes were: Waiting times: Patients wanted shorter waiting times on their return journey. Getting to the appointment on time or not being too early for their appointment. Communication: Being told accurate collection times so patients know when to be ready for their appointment. It was suggested that the driver could ring or text them on route to advise them when they were close by, so they could ensure they were ready. To receive confirmation of booking. More local drivers who are aware of the geographical area. Some suggested it would be useful to have drivers that could speak the local community languages. Accessible transport: Comfort, some vehicles need upgrading. Correct type of vehicle being sent for disabled patients. 14

Question 15: Is there anything else you would like to tell us? 51 (24%) responded to this question, the common themes were: Positive Overall patients were very happy and extremely grateful for the service. Specific mention was made with regards to the attitude of the staff with them being described as friendly, polite and helpful. Areas for improvement The booking service was highlighted as problematic and could be made easier Patients wanted shorter waiting times on their return journey and for the driver to arrive on time when collecting them from home. Mention was made to preferring to being transported by car rather than ambulance and whether this could be an option for patients. b. Discussion Group with West Riding Kidney Patients Association A discussion group was held in December 2014 with a small number of patients who are part of the West Riding Kidney Patients Association. Below are the themes raised during the discussion: Patient Transport has a major impact on renal patients who if attending hospital or one of the satellite renal unit for dialysis may often attend the same site 3 times a week (same time, same place). However, since 17th November 2014 the level of service seems to have deteriorated, which has negatively impacted on patients. There have been, on occasions, 6 patients per ambulance, involving pick-ups in different areas, involving lengthy journeys for the first to be collected. This has an impact on the running of the unit, in that staff are awaiting the arrival of patients, and a large number arrive in one lot. This has been compounded by a second vehicle arriving at the same time making 8 patients to be put on to dialysis. Recently for example 8 patients arrived at 7.25am. Each patient has a 15 minute slot so this then affects the whole day for everyone. Late running also impacts on the trip home. (current KPI 30 minutes allotted time) YAS need to know pretty early on about the change of time for trip home. They do accommodate this but it can be difficult. Since the 17th November, there has been no consistency in the times of pick-ups. In one example pickups have been at 6.30am, 7.00am, 7.15am, 7.30am and 8.50am. This makes it difficult for patients to prepare themselves and makes them anxious when the transport has not arrived. 15

We used to have regular drivers who knew when we were expected at the unit. In the month after the changed contractual arrangements, I have had 13 different drivers, some of whom I have had to direct. Though it would be asking too much to expect the same driver on each occasion, continuity is important and valued not only by patients but by drivers. At least one driver has been disappointed that the way the service operates has meant limited possibilities for developing relationships with patients, which was one of the reasons for joining the renal drivers' team. Is it possible to develop an incentive so that patients bring themselves in i.e. reimbursement? Taxis could be used but there are issues, and they need to be provided by an approved/managed provider. Assessment/risk (collection/home) YAS are very good during bad weather unlike taxis and not collecting due to bad weather. c. Survey results for staff who organise PTS on behalf of patients The views of staff who may manage bookings or referrals on behalf of patients were also surveyed. Surveys were distributed to: Care homes All GP practices in North Kirklees Commissioners Hospital staff in Pontefract and Dewsbury renal dialysis units Hospital staff in outpatients and discharge lounges at Mid Yorkshire Hospital Foundation Trust 27 surveys were completed. Question 1: Please tell us the first part of your postcode (e.g. HX1, HD3, WF13, WF3, BD2 etc) HD2 1 4% HD4 1 4% HX3 1 4% WF12 4 17% WF13 7 29% WF15 4 17% WF16 2 8% WF17 4 17% Answered questions Total 24 Skipped 3 It should be noted that respondents may have completed this question based on either their place of work or home. 16

Question 2: Do you work in? 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% GP practice Hospital Care Home Other (please specify) All 27 respondents completed this question, the results show the majority of respondents were from GP practices (16, 59%). Two respondents selected other and described their place of work as respire care and DART. Question 3: When did you last use this service? 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% In the last week In the last 2 weeks This month Last two months Over two months ago 25 (93%) people responded to this question and the majority had used the service in the previous two weeks. 17

Question 4: How often do you refer to this service? 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% More than once a week Every week Every two weeks Every month Over two months ago 25 (93%) people responded to this question and the majority referred to the service more than once a week. Question 5: Do you know what the eligibility criteria for using the PTS service are? 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Yes No Don t know 25 (93%) people responded to this question and the majority felt they knew the eligibility criteria for using the PTS service. 18

Question 6: How would you rate the service in terms of: Answer Options Very good Good Satisfactory Poor Very poor Response Count Convenience 33.5% (8) 33.5% (8) 17% (4) 8% (2) 8% (2) 24 Waiting times 21% (5) 29% (7) 26% (6) 21% (5) 4% (1) 24 Communication 33% (8) 21% (5) 29% (7) 17% (4) 0% (0) 24 Ease of booking 35% (8) 13% (3) 26% (6) 22% (5) 4% (1) 23 Response to queries 37% (9) 25% (6) 25% (6) 13% (3) 0% (0) 24 The following comments were also raised: Patients having to endure long journey times to attend appointment and then wait too long for their return journey. Inappropriate transport being used which led to patient being unable to attend appointment. GP practice spends a lot of time booking transport for patients when this could be done by patients, especially those that have previously accessed patient transport. There have been problems and delays in being able to access the telephone booking service. Many felt it would be great to book through the online booking service. It was mentioned that this has been launched but was still not fully up and running. Question 7: From your experience of the service please describe what parts of the service work well. 16 (59%) people responded to this question, the main themes raised were: Booking is easy enough either online or over the phone, however, it can be difficult to access the booking service. Staff are friendly and helpful 19

Question 8: What Improvements, if any, do you think should be made to Patient Transport Services? 15 (56%) people responded to this question, the main themes raised were: Reduce the amount of time patients have to wait both before and after their appointment time. A crib sheet for practices to follow to ensure all questions are covered before booking transport, rather than the practice having to go back to the patient/gp to get further information. Enable patients and care homes to book their own transport. Improve the booking process by making it easier to access online and over the phone. Question 9: Is there anything else you would like to tell us about the service? 14 (52%) people responded to this question, the main themes raised were: Positive Staff are helpful and provide a good service The online booking service was seen as a real asset Negative It takes too long to get through on the phone to make a booking, which impacts on receptionist time. Suggestion was made that the hospital would be better placed to make the booking as have a better understanding of the patients needs. 7. Overall findings and common themes The main themes taken from the existing data and the engagement were: Patients Overall the majority of patients were pleased and grateful for the service that they received and praised the friendliness of the staff. In terms of improvements to the service, they wanted a service that meant they didn t have to wait long periods of time both before and after their appointment. To ensure they were ready for when the transport arrived, they wanted to be kept up to date, either by phone or text on when they would be collected. They wanted comfortable transport that was appropriate for their needs and for it to be easy to access. 20

They wanted consistency in the drivers that take them to appointments; this was specifically raised by renal patients. Patients also wanted drivers that were local to the area so they were aware of the geographical area, with some suggesting that it would be useful to have drivers that could speak the local community languages. Staff The comments raised by staff were very similar to those raised by patients, in that overall they were very pleased with the service being provided and praised the staff they came into contact with. Again, staff also felt that the waiting times that patients have to endure both before and after their appointments are too long. Mention was also made of inappropriate transport being used which had led to patients being unable to attend appointments. Suggestions were made to enable patients and care homes to book their own transport and that perhaps at times hospitals were better placed to make bookings rather than GP practices. GP practices felt that they spent a lot of time booking transport for patients and encountered many problems and delays in being able to access the telephone booking service. At the time of the survey the online booking process had only been up and running a few months. Those that had used it gave it mixed reviews, with some encountering some teething problems. Once these have been ironed out the staff were hopeful that this would reduce the time spent on booking transport. 8. How the findings will be used and next steps This engagement process has provided a snapshot of the views from patients and staff on their experience, knowledge and understanding of Patient Transport Services. This report will be made publically available and feedback provided to those respondents who have requested it. We would like to thank all respondents who have given their time to share their views. 21

Appendix 1- Engagement timeline Activity 6/10 13/10 20/10 27/10 3/11 10/11 17/11 24/11 1/12 8/12 15/12 22/12 29/12 5/1 12/1 19/1 26/1 2/2 Develop a draft patient and referrer survey Sign off draft surveys and draft plan Gain agreement from YAS for distribution of survey to patients Develop media release Start of engagement Survey and information to be uploaded to websites Survey to be sent to VCS, PRG Networks, People databases, Healthwatch and other key stakeholders 22

Activity 6/10 13/10 20/10 27/10 3/11 10/11 17/11 24/11 1/12 8/12 15/12 22/12 29/12 5/1 12/1 19/1 26/1 2/2 YAS to distribute survey to random sample of patients Attendance at Discharge lounge at DDH Referrer survey to be distributed to those to that refer patients to the service End of engagement Collation of existing patient feedback Analysis of both existing and data from current engagement Production of Engagement report Present the report to CCG Feedback on engagement and next steps 23

Appendix 2- Engagement Plan Action Who By when Progress Develop patient and referrer surveys CSU Comms & Engagement Send surveys, covering letters and plan to CCG for assurance and sign off CSU Comms & Engagement Gain agreement from YAS for them to distribute survey CSU Comms & Engagement w/c 24/11/14 Develop media release CCG w/c 24/11/14 Survey and information to be made available on line CSU Comms & Engagement 1/12/14 Referrer survey to be distributed to those that refer patients to the service. Survey to be distributed by YAS to random sample of patients accessing the service. Survey and covering letter to be sent to VCS, PRG Networks, People databases, Healthwatch and other key stakeholders CCG / CSU Comms & Engagement CSU Comms & Engagement CSU Comms and Engagement 1/12/14 Commence w/c 1/12/14 and continue throughout the 7 week period w/c 1/12/14 24

Action Who By when Progress Collation of existing patient feedback including previous consultations / engagement, PALS, Complaints, Patient Opinion, patient experience feedback CSU Comms & Engagement 19/01/15 Analysis of existing patient feedback and data collated through engagement CSU Comms & Engagement w/c 19/01/15 Engagement report produced CSU Comms & Engagement Analysis and report to be available w/c 02/02/15 Present the report to CCGs CSU Comms & Engagement w/c 02/02/15 Feedback on engagement and next steps CSU Comms & Engagement TBA 25

Target audience Objective Action Who By when Patients / Carers of patients currently accessing services Ensure patients / carers of patients are given the opportunity to give their feedback Survey for patients/carers to be developed Agreement for distribution via YAS CSU Comms & Engagement w/c 24/11/14 Ongoing throughout engagement Voluntary and Community Groups with interest Ensure groups of interest are given the opportunity to give their feedback Email survey offering representatives from CCG to meet with groups to discuss the engagement and answer any questions and attend any engagement event(s) CSU Comms & Engagement w/c 1/12/14 Arrange for CCG staff to attend any groups ongoing throughout engagement Relationship matrix Ensure groups of interest are given the opportunity to give their feedback Email survey CSU Comms & Engagement w/c 1/12/14 Local people Ensure local people are given the opportunity to give their feedback Survey to be uploaded to CCG website Emails / letters sent to people on databases Add to INVOLVE database Media release CSU Comms & Engagement w/c 1/12/14 PRG Networks and PRGs Ensure PRG networks and individual PRGs are given the opportunity to give Email survey and add to agenda for PRG Network meeting being held in December. CCGs / CSU Comms & Engagement w/c 1/12/14 26

Target audience Objective Action Who By when their feedback GPs, practice staff Ensure practices are given the opportunity to give their feedback Referrer survey distributed via sharepoint to GP practices. CSU Comms and Engagement 1/12/14 HWBB Ensure are given the opportunity to give their feedback Stakeholder letter CCG w/c 01/12/14 Councillors and MPs Ensure are given the opportunity to give their feedback Stakeholder letter CCG w/c 01/12/14 LMC Ensure are given the opportunity to give their feedback Stakeholder letter CCG w/c 01/12/14 Media Ensure are aware and how the public can give feedback Press release CSU Comms & Engagement w/c 01/12/14 Dewsbury Hospital Ensure are aware and given opportunity for feedback Referrer survey distributed to relevant departments. CCG w/c 01/12/14 27

Target audience Objective Action Who By when Care Homes Staff (Commissioners and Providers) Ensure are aware and given opportunity for feedback Ensure staff are aware. Referrer survey distributed to relevant departments. CCG w/c 01/12/14 Provide staff briefings Provide information and link to survey in internal newsletters and intranet Providers / CCG w/c 01/12/14 and ongoing throughout the engagement 28

Appendix 3- Local Patient Survey Patient Transport Service NHS organisations across West Yorkshire are committed to continuously improving the healthcare services available to all the people in the area. As part of this continued work, we want to look at how the Patient Transport Service is provided. The Patient Transport Service supports people in getting to and from outpatient appointments when they are unable to make their own way. In some areas, it also supports those who travel for regular renal services appointments and when leaving the hospital. If you or someone you care for has used / or are using any of the above services, we would like to hear about your experiences and gather your opinions about how we could improve these services. We would like to take this opportunity to ask you for your views by completing and returning our short survey. This is also available online at: https://www.surveymonkey.com/s/patienttransportnorthkirklees If you would like more information or to discuss this survey, please contact: Zubair Mayet on Tel: 01484 464024 Email: Zubair.mayet@nhs.net Please tell us the first part of your postcode (e.g. HX1, HD3, WF13, WF3, BD2, LS9) Please enter here Prefer not to say 1. Are you completing this on behalf of Yourself, as someone that has used / does use Patient Transport Services Someone you care for that has used / does use Patient Transport Services Care Home arranging transport on behalf of someone Other (please specify) 2. What do you use the Service for (please tick all that apply) Travel to and from outpatients appointments Renal services appointments Travel home after discharge from hospital Other (please specify) Travel home from after discharge from Harrogate DFT Same day 3. When did you last use this service? In the last week In the last 2 weeks This month Last two months Over two months ago 29

4. How often do you use this service? More than once a week Every week Every two weeks Every month Over two months ago 5a. How is your transport usually booked and arranged (Please circle which applies)? Care Home staff GP Hospital I did it myself Carer/relative Other (please tell us more) 5b. How would you like to book your transport in the future (Please circle as appropriate)? Care Home staff GP Hospital By myself Carer/relative Other (please tell us more) 6a. How were you informed about your transport booking? ( Please circle all that apply) By letter By telephone By email By text message Wasn t informed Other (please tell us more) 6b. How would you like to be informed about your booking in the future (Please circle which applies)? By letter By telephone By email By text message Other (please tell us more) 7. Was the information you received about the service clear and easy to understand? (Please circle which applies) Yes No Don t know I did not receive any information 30

8a. Thinking about the last time you used the transport service, how would you rate the following? (Please tell us below): Transport arrived at a reasonable time Cleanliness of the vehicle Very good Good Satisfactory Poor Very poor safety of the vehicle Ease of getting into the vehicle Comfort during the journey Attitude of staff Arriving at your appointment on time How long you had to wait for transport after your appointment Support to get back into the house at the end of journey 8b. Please tell us more particularly if you ticked satisfactory, poor or very poor Experience of the service 9. From your experience of the service please describe what parts of the service work well. 31

10. What would improve your experience of the transport service? 11. Is there anything else you would like to tell us? If there are any future developments regarding this service and you are willing to get involved, please complete the details below. This information will be kept separately from the rest of your answers. Name E-mail address.. Address 32

Equality Monitoring In order to ensure that we provide the best services for all of our communities, and to ensure that we do not knowingly discriminate against any section of our community, it is important for us to gather the following information. No personal information will be released when reporting statistical data and all information will be protected and stored securely in line with data protection rules. This information will be kept confidential and you do not have to answer all of these questions, but we would be very grateful if you would. What sex are you? Female Male Prefer not to say Transgender Is your gender identity different to the sex you were assumed to be at birth? Yes No Prefer not to say What is your age? Under 16 16-25 26-35 36-45 46 55 56-65 66-75 76-85 86 + Prefer not to say What is your sexual orientation? Bisexual (both sexes) Lesbian (same sex) Gay man (same sex) Heterosexual/ Straight (opposite sex) Other: Please specify Prefer not to say What is your ethnic background? Asian, or Asian Black, or Black Mixed / multiple British British ethnic group White Other Chinese African Asian & White British Arab Indian Caribbean Black African & White Gypsy/Traveller Pakistani Black Caribbean & Irish White Other Mixed / Other Asian Other Black Other White multiple ethnic background background background background Prefer not to say Other: Please specify any other ethnic group here Do you consider yourself to belong to any religion? Buddhism Christianity Hinduism Islam Judaism Sikhism No religion Prefer not to say Other: Please specify 33

Do you consider yourself to be disabled? The Equality Act 2010 states that a person has a disability if: a person has a physical or mental impairment, and the impairment has a substantial and long-term adverse effect on that their ability to carry out normal day-to-day activities Yes No Prefer not to say If yes above, what type of disability do you have? (Tick all that apply) Learning Long-standing illness or Mental Health condition disability/difficulty health condition Physical or mobility Hearing Visual Prefer not to say Other: Please specify Do you provide care for someone? Such as family, friends, neighbours or others who are ill, disabled or who need support because they are older. Yes No Prefer not to say Thank you for taking the time to complete this form. Please return to (no stamp needed): FREEPOST RTER-LYHC-EJET Patient Transport Survey Yorkshire and Humber CS Engagement Team 4 th Floor Douglas Mill Bowling Old Lane BD5 7JR Please return this form no later than 16 th January 2015. Unfortunately, we cannot accept any responses after this date. 34

Appendix 4- Local Staff Survey Patient Transport Service NHS organisations across West Yorkshire are committed to continuously improving the healthcare services available to all the people in the area. As part of this continued work, we want to look at how the Patient Transport Service is provided. The Patient Transport Service supports people in getting to and from outpatient appointments when they are unable to make their own way. In some areas, it also supports those who travel for regular renal services appointments and when leaving the hospital. As a person who arranges transport on behalf of patients / residents, we want to hear about your experiences and gather your opinions about how we could improve these services. We would like to take this opportunity to ask you for your views by completing and returning our short survey. This is also available online at: https://www.surveymonkey.com/s/ptsreferralsnorthkirklees If you would like more information or to discuss this survey, please contact Zubair Mayet on: 01484 464024 Please tell us the first part of your postcode (e.g. HX1, HD3, WF13, WF3, BD2, LS9) Please enter here Prefer not to say 1. Do you work in GP practice Hospital Care Home Other (please specify) 2. When did you last use this service? In the last week In the last two weeks This month Last two months Over two months ago 3. How often do you refer to this service? More than once a week Every week Every two weeks Every month Over two months ago 35

4. Do you know what the eligibility criteria for using the PTS service are? Yes No Don t know 5.How would you rate the service in terms of: Convenience Waiting times Communication Ease of booking Response to queries Very good Good Satisfactory Poor Very poor 6 Any comments about your answer Experience of the service 7. From your experience of the service please describe what parts of the service work well. 36

8. What improvements, if any, do you think should be made to Patient Transport Services? 9. Is there anything else you would like to tell us about the service? 37

Equality Monitoring - OPTIONAL In order to ensure that we provide the best services for all of our communities, and to ensure that we do not knowingly discriminate against any section of our community, it is important for us to gather the following information. No personal information will be released when reporting statistical data and all information will be protected and stored securely in line with data protection rules. This information will be kept confidential and you do not have to answer all of these questions, but we would be very grateful if you would. Please tell us the first part of your postcode (e.g. HX1, HD3, WF13, WF3, BD2, LS9) Please enter here Prefer not to say What sex are you? Female Male Prefer not to say Transgender Is your gender identity different to the sex you were assumed to be at birth? Yes No Prefer not to say What is your age? Under 16 16-25 26-35 36-45 46 55 56-65 66-75 76-85 86 + Prefer not to say What is your sexual orientation? Bisexual (both sexes) Lesbian (same sex) Gay man (same sex) Heterosexual/ Straight (opposite sex) Other: Please specify Prefer not to say What is your ethnic background? Asian, or Asian Black, or Black Mixed / multiple British British ethnic group White Other Chinese African Asian & White British Arab Indian Caribbean Black African & White Gypsy/Traveller Pakistani Black Caribbean & Irish White Other Mixed / Other Asian Other Black Other White multiple ethnic background background background background Prefer not to say Other: Please specify any other ethnic group here 38

Do you consider yourself to belong to any religion? Buddhism Christianity Hinduism Islam Judaism Sikhism No religion Prefer not to say Other: Please specify Do you consider yourself to be disabled? The Equality Act 2010 states that a person has a disability if: a person has a physical or mental impairment, and the impairment has a substantial and long-term adverse effect on that their ability to carry out normal day-to-day activities Yes No Prefer not to say If yes above, what type of disability do you have? (Tick all that apply) Learning Long-standing illness or Mental Health condition disability/difficulty health condition Physical or mobility Hearing Visual Prefer not to say Other: Please specify Do you provide care for someone? Such as family, friends, neighbours or others who are ill, disabled or who need support because they are older. Yes No Prefer not to say Thank you for taking the time to complete this form. Please return to (no stamp needed): FREEPOST RTER-LYHC-EJET Patient Transport Survey Yorkshire and Humber CS Engagement Team 4th Floor Douglas Mill Bowling Old Lane BD5 7JR Please return this form no later than 16th January 2015. Unfortunately, we cannot accept any responses after this date 39

Appendix 5: Equality monitoring for patient survey What sex are you? Answer Options Response Response Percent Count Male 41.7% 73 Female 58.3% 102 Prefer not to say 0.0% 0 answered question 175 skipped question 34 Transgender Is your gender identity different to the sex you were assumed to be at birth? Answer Options Response Response Percent Count Yes 10.4% 13 No 88.8% 111 Prefer not to say 0.8% 1 answered question 125 skipped question 84 What is your age? Answer Options Response Response Percent Count Under 16 0.0% 0 16-25 0.0% 0 26-35 4.6% 8 36-45 4.6% 8 46 55 10.3% 18 56-65 16.1% 28 66-75 11.5% 20 76-85 35.6% 62 86 + 17.2% 30 Prefer not to say 0.0% 0 answered question 174 skipped question 35 40

What is your sexual orientation? Answer Options Response Response Percent Count Bisexual (both sexes) 1.6% 2 Lesbian (same sex) 0.0% 0 Gay man (same sex) 0.8% 1 Heterosexual/Straight (opposite sex) 93.7% 119 Prefer not to say 3.9% 5 answered question 127 skipped question 82 What is your ethnic background? Answer Options Response Response Percent Count Chinese 0.0% 0 Indian 6.9% 12 Pakistani 6.3% 11 Other Asian background 1.1% 2 Black African 0.6% 1 Black Caribbean 0.6% 1 Other Black background 0.0% 0 Asian & White 1.1% 2 Black African & White 0.0% 0 Black Caribbean & White 0.6% 1 Other Mixed / multiple ethnic background 0.6% 1 White British 79.9% 139 White Gypsy/Traveller 0.0% 0 White Irish 0.6% 1 Other White background 1.1% 2 Arab 0.6% 1 Prefer not to say 0.0% 0 answered question 174 skipped question 35 41