Gloucestershire Health and Care Scrutiny Committee

Gloucestershire Health and Care Scrutiny Committee Report Title Purpose of Report Is this for information or decision? Author Organisation Gloucestershire Clinical Commissioning Group update on Non- Emergency Patient Transport Briefing paper to report on the Arriva Transport Solutions Ltd. nonemergency patient transport service This report is for information. Gill Bridgland Commissioning Implementation Manager NHS Gloucestershire Clinical Commissioning Group Key Issues: Performance of the Arriva Transport Solutions Ltd. non-emergency patient transport service Appendix 1 of this report includes feedback from Patients and the Public provided by Healthwatch Gloucestershire. Recommendations to the Committee: Paper for information only Financial/Resource Implications: Not applicable

Gloucestershire Clinical Commissioning Group update on Non-Emergency Patient Transport for Gloucestershire Health and Care Overview and Scrutiny Committee (HCOSC) March 2015

Gloucestershire Clinical Commissioning Group update on Non- Emergency Patient Transport 1 Background Arriva Transport Solutions Ltd (ATSL) was awarded contracts by Bath and North East Somerset (BaNES), Gloucestershire, Swindon and Wiltshire CCGs for non-emergency patient transport in summer 2013, the service went live on 1December 2013. The NHS-funded Patient Transport Service (NEPTS) is for those who, due to their mobility or medical needs, cannot travel safely by any other means. During the first 14 months of the Arriva contract there have been a number of challenges, involving as it does the provision of a NEPTS service to patients across four CCG areas; patients attending four acute trusts within the CCG boundaries and a number of significant patient flows to acute trusts outside the CCG boundaries; replacing a multitude of bespoke service arrangements that had developed over time within the different acute trusts. A significant challenge has been the misalignment of predicted vs actual activity and mobility profiles. 2 Governance Governance, arrangements are now well established. Contract Performance Boards continue monthly with key risks and issues escalated as appropriate. Performance and activity data is provided by ATSL monthly, by CCG. Additional ad hoc reports are provided on request by the CCG analytics team and ATSL. CCG Quality leads meet bi-monthly, with commissioning leads and ATSL, to review relevant issues. The ATSL Quality Report provides a summary of quality information relating to the delivery of the non-emergency patient transport service across the four CCG areas. A separate Patient Experience Report is produced to sit alongside the Quality Report. The following are reported as standard bi-monthly: Workforce/staffing including sickness and turnover and agency and third party usage Training schedules and mandatory training compliance Incidents including monthly trend analysis, patient safety and any harm identified, identified actions and learning Actions and learning from Serious Incidents Infection control including vehicle deep cleaning Any Care Quality Commission visits and recommendations Safeguarding referrals The report has been developed along with ATSL and is kept under review. For clarity, any serious incidents are reviewed in real time and the learning from them is shared at these meetings. ATSL locality managers are based at, and work closely with, each hospital trust to address issues and an Arriva escalation process enables healthcare staff to escalate issues as required. ATSL managers regularly join the daily Alamac conference calls in Gloucestershire to provide information regarding ATSL activity. (There is a separate report on the March 2015 HCOSC agenda which describes the Alamac process). Transport Working Groups (led jointly by ATSL and GHNHSFT in Gloucestershire) meet regularly to address local issues. Specific acute-trust/community hospital level monthly dashboards are in place, which allow the hospital trusts to review their own performance in

relation to the booking of transport e.g. the number of bookings made in advance vs number made on the day, number of aborted journeys by ward/dept. etc. Lead commissioners engage directly with respective hospital trusts to help to address issues. GCCG continue to have monthly executive director meetings with GHNHSFT, GCSNHST and ATSL to identify issues and closely monitor improvement plans. 3 Patient Experience 3.1 GCCG PALS Feedback The number of complaints to GCCG, relating to the ATSL service, has reduced over the last six months. The key theme remains delays to services and a concern that this has sometimes led to missed appointments or the need to rearrange an appointment due to a delayed outbound pick up. All complaints and concerns are forwarded to ATSL for their investigation and response. The patient experience feedback is also shared with the commissioning manager. Where appropriate, GCCG also provides the client with a response to identify the work we are doing with the providers to identify lessons learned from patient experience and use this to improve PTS. During Q3 GCCG has been collecting direct patient feedback. The CCG Patient Experience Coordinator has gathered patient feedback in three settings to elicit views from both regular and occasional users of the service. Reception staff, who booked journeys and resolved waiting issues on behalf of patients at the Oncology Unit at Cheltenham General Hospital, were also interviewed. A structured patient interview format was followed. The sites visited were: A day (8.30am 3pm) on an Arriva vehicle with a crew, collecting patients from home and bringing into Gloucestershire Royal Hospital outpatient departments A morning in the Cotswold Dialysis Unit, Gloucestershire Royal Hospital A morning in the Oncology Unit at Cheltenham General Hospital The feedback from this engagement exercise is currently being collated and analysed. It is the intention that this experience data be considered in conjunction with the Healthwatch Gloucestershire Patient Transport Survey data to identify common themes and learning points. The Healthwatch Gloucestershire survey is currently underway; we anticipate receiving feedback from Healthwatch Gloucestershire during Quarter 1 2015/15. Complaints received by GCCG PALS January 2014 January 2015 GCCG PALS have been monitoring contacts from the general public since the start of the contract with ATSL at the end of 2013. The chart below shows that the number of complaints received by GCCG each month has reduced from a high of 4/5 complaints each month during Quarter 4 of 2014/15, to 2 or fewer since April 2014 (with a spike in June 2014).

Number of Complaints % Complaints in relation to activity Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Complaints (relating to ATSL) received by GCCG 6 5 4 3 2 1 Complaint or Concern Advice and Information Compliment Incidents 0 3.2 ATSL Feedback ATSL have demonstrated the importance they place upon resolving issues and complaints, through the implementation of a new complaints process. ATSL recognise that sometimes things will go wrong. However, they are committed to resolve issues as swiftly as possible and have invested in their customer care team to improve experiences. They have recruited more people and invested in new technology meaning they are better equipped to meet future challenges. ATSL has received 279 complaints from Gloucestershire patients (inclusive of those above) during the period January 2014 to January 2015 (this equates to 0.2% of total activity). Complaints January 2014 January 2015 45 40 0.5 0.4 35 0.4 30 25 20 15 10 5 0 0.3 0.3 0.2 0.2 0.1 0.1 0.0 Number of Complaints % Complaints in relation to activity

Complaint Type (recorded by ATSL) Staff Behaviour/poor patient care Call centre/communication Driving standards/vehicle conditions Eligibility Incorrect bookings Late to appt Unacceptable waiting times Missed appt No transport provided Misc Transport provided at unsociable hours General dissatisfaction 3.3 Healthwatch Gloucestershire Feedback Healthwatch Gloucestershire has provided feedback through their Master Comment quarterly report on the number and nature of contacts recorded by Healthwatch Gloucestershire regarding the ATSL non-emergency transport services. This is information is shared with ATSL and GCCG. GCCG regularly reviews this feedback, which is used to inform contract quality discussions. Healthwatch Gloucestershire and GCCG are working together to develop the Master Comments database to ensure data capture is as accurate as possible. A recent adaption has been the addition of an Action tab, which indicates any actions taken by Healthwatch Gloucestershire in relation to a particular contact. As mentioned above, Healthwatch Gloucestershire are currently carrying out a patient survey of experience of Patient Transport in Gloucestershire. This survey is not exclusive to patients who have used ATSL transport but applies to all transport providers in Gloucestershire. 4 Improvement Measures 4.1 Current Performance It is important to review the concerns/complaints within the overall context of ATSL activity and performance.

Number of Gloucestershire patient journeys undertaken (including aborted journeys). Jan-15 Dec-14 Nov-14 Oct-14 Sep-14 Aug-14 Jul-14 Jun-14 May-14 Apr-14 Mar-14 Feb-14 Jan-14 9492 9500 8778 8924 9380 9475 8900 9109 9294 9968 9866 10051 10154 8000 8500 9000 9500 10000 10500

ATSL Performance January 2014 January 2015 Ref Quality Requirements Target Feb 14 Mar 14 Apr 14 May 14 Jun 14 Jul 14 Aug 14 Sep 14 Oct 14 Nov 14 Dec 14 Jan 15 PTS01 PTS02 PTS03 PTS04 PTS05 PTS06 Patients travelling < 10 miles should not spend >60 minutes on either an outward or return journey. Patients travelling >10 miles and < 35 miles Patients travelling >35 miles and <50 miles should not spend 120 minutes on the vehicle. % of patients arriving within - 45 minutes to +15 minutes of scheduled appointment time Patients should not wait more than 60 minutes after their agreed pick up time for outward or return journeys. Same day discharge /transfer requests. Patients will be picked up within agreed timeframes. 95% 93.30 92.32 92.12 92.89 95.38 95.19 95.34 95.33 94.99 94.21 95.38 95.40 90% 93.19 92.26 93.01 93.24 95.33 94.79 95.79 95.19 94.72 92.97 95.17 96.01 85% 91.76 91.35 94.78 94.92 93.96 89.17 93.97 97.62 96.55 92.63 92.05 94.38 95% 74.38 77.22 78.60 82.10 85.13 82.30 83.35 85.26 84.56 80.71 80.89 83.69 85% 73.62 78.63 81.57 79.03 82.83 82.03 84.75 83.68 84.36 81.23 81.50 83.30 85% 84.88 86.52 86.72 79.07 82.67 84.42 87.13 86.65 88.37 90.69 87.69 88.58 PTS07 % of journeys cancelled by ATSL. 0% 0.24 1.17 0.15 0.31 0.21 0.06 0.23 0.20 0.08 0.10 0.09 0.04 PTS08 PTS09 Missed collection % of non-aborted journeys for which no collection is made by ATSL. % of inbound calls to ATSL call centre answered within 30 seconds (after the end of the introductory message) 0% 0 0 0 0 0 0 0 0 0 0 0 0 85% NA 63.19 91.29 73.49 73.58 74.50 66.57 84.01 71.36 89.28 89.31 94.95 PTS10 Application of Eligibility 100% 99.97 99.98 99.96 99.94 100 99.96 99.99 99.96 100 99.93 99.99 100

Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Although performance has significantly improved against a number of the Key Performance Indicators (KPIs) ATSL is currently not meeting the required standards across all indicators in Gloucestershire. The main KPIs look at three aspects of patient experience: time spent on vehicle on-time inbound journeys on-time collection for outbound journeys The main issues with service delivery that have led to complaints from patients and problems for acute trusts and community hospitals and which ATSL, commissioners, and acute trusts, are continuing to work to address remain: Delays for inbound journeys (PTS04 below). Although performance is improving, there is more to be done to improve the number of patients brought in within KPI timescales and reduce the number of patients arriving late or missing appointments. 100% PTS 04 : On time arrival -45 > + 15 mins Gloucestershire 90% 80% 70% 60% 50% On-time pick-up for planned outbound journeys (PTS05) remains just below KPI, meaning some patients have long or very long waits. 100% PTS 05 : 60 minute pick up (planned) Gloucestershire 90% 80% 70% 60% 50% 40% 30%

Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May- 14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 On-time pick-up for outbound journeys booked on the day (PTS06 below) is reaching the KPI standards but in some cases at the expense of planned bookings. 100% 95% 90% 85% 80% 75% 70% 65% PTS 06 : 4 hour pick up (on the day) Gloucestershire Difficulty and long waits to get through when healthcare staff calling the booking centre is very much improved but further work is required to increase the use of the on-line booking service by hospital staff. Problems with incorrect mobility healthcare staff booking incorrect mobility leading to the wrong vehicle being deployed. Significant numbers of aborted journeys where the patient is not ready to travel. These are avoidable and contribute to overspend, rebooking, longer delays for those patients and knock-on delays to other patients. 4.2 Agreed Actions All of the issues above and a range of other operational issues are being addressed, and progress is being made. Actions include: Ensuring that resources are in place going forward to manage the changing transport activity profile and increase in long distance journeys. Working with hospital trusts to understand the discharge profile, particularly at weekends. Actively monitoring and managing long waiters and ensuring that patients are appropriately prioritized e.g. if discharge time is critical. Providing additional training for call handlers to improve the escalation process. Modelling capacity requirements during periods of escalation Training and awareness (myth-busting) sessions to improve transport booking. Reducing the number of on the day bookings, as these add significant pressure to efficiency. Reducing the number of aborted journeys which waste resources. Reviewing methodology for assessing eligibility. Monitoring the rise in dialysis transport (see Appendix A for number of journeys). Agreeing local CQUIN measures to improve patient experience.

5 INITIATIVES AND SUPPORT TO THE GLOUCESTERSHIRE HEALTH AND CARE COMMUNITY ATSL has provided support to the healthcare community during recent periods of escalation and provides input to daily Alamac calls. A flexible approach is taken to provision of resources, particularly over weekends, to align them to increased activity during this period. Support was commissioned by the CCG in the form of an additional PTS vehicle to help to manage demand and patient flow through the urgent care system. This vehicle was commissioned for a trial period of four days with agreement reached the CCG and ATSL for the vehicle to be utilised differently to traditional PTS business in that it would (in some cases) be taking the patient directly into the Emergency Department. The pilot was successful and a review is being undertaken as to whether this admissions vehicle is required on a longer term basis. ATSL is working with GHNHSFT and GCSNHST (via the Single Point of Access) to streamline discharge flow between the two organisations. Consideration is being given to the establishment of a ring-fenced discharge vehicle for GHNHSFT to improve flow out of the system. 6 CONCLUSION It is clear that the introduction of the ATSL NEPTS service has been, and remains, challenging but much work has been done, and continues to be done, to ensure the service reaches a level where it consistently achieves the required standards. We are assured that ATSL, in collaboration with the CCG and wider health community, are committed to make the necessary improvements. Gill Bridgland Commissioning Implementation Manager February 2015

Appendix A 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% % Top 4 YTD Categories of Journeys Outpatient Dialysis Oncology Patient Discharge Transfer Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14