Delivering Transport to Health in Partnership Peter Llewellyn Assistant Director of Strategic Partnerships Hywel Dda University Health Board
What is Non Emergency Patient Transport (NEPT)? Transportation of a patient who, whilst requiring treatment, does not need the skills of an ambulance paramedic or technician, but may require trained patient care ambulance personnel to undertake a journey to or from a health facility. Eligibility Criteria Welsh Government Health Circular (2007) defines who is eligible to receive NHS-funded transport. A need for treatment does not automatically imply a need for transport. Only patients who have a medical need for specialist transport is eligible.
Mobility Categories T1 Patient walks with minimal assistance C1 Patient walks with minimal assistance (cannot go by ambulance car) C2 Patient requires double crew C3 Patient in own wheelchair (single crew required) C4 - Patient in own wheelchair (double crew required) C5 Patient in own electric wheelchair (double crew required) C6 Patient requires stretcher (double crew required)
Griffiths Review of NEPT National Programme Board established. National SLA / Performance Framework. Commissioning Framework / Operational SLA s Good Practice identified across Wales e.g. Patient Needs Assessment. Link in IT systems to avoid aborted journeys. Tell me only once initiative Single Booking Pathway. On Line Booking / Text messaging. Mixed Service provision / Key Stakeholder input.
Griffiths Review Key Recommendations: Guaranteeing citizen focus and continuing partnership approach to future commissioning and performance arrangements. Health Boards to incorporate agreed commitments for transfer of best practice into their three year plans. WAST to incorporate the recommendations arising from the review within its PCS Modernisation Plan. Establishment of Transport Access Groups across Wales.
WAST Transformation Programme. To develop a service model which is responsive to the needs of the commissioners. Supportive and caring towards the team who deliver the service. Focus on patient experience in terms of quality of care and service. Three options under discussion include Collaborative approach or part transfer or full transfer of PCS activity. Workstreams currently in place to take forward commissioning, financial and WAST organisational arrangements linked to the options identified.
Mixed provision Hywel Dda University Health Board. WAST Ambulance Car Scheme Volunteer Drivers undertake 35% of WAST journeys. WAST vehicles undertake remaining 65% of journeys. Local Authority Social Care Vehicles Vehicles used during downtime between Day Centre runs Over 300 patients conveyed each month SS vehicles. Voluntary Sector / Community Transport Over 450 patients conveyed each month. Independent Sector Over 300 patients conveyed each month. 90% of patients are discharged within one hour of being ready. In total alternative provision provide 1,200 patient journeys per month 29% of the total conveyed.
Mixed provision statistics December 2014 3,467 WAST journeys undertaken: 1,208 Ambulance Car Service patient journeys. 2,259 WAST journeys by ambulance vehicle. 75 escorts conveyed and 10 ECR journeys arranged. 1,415 patient journeys by mixed provision. Social Care conveyed 357 patients. RVS carried out 360 renal journeys in Ceredigion. Dedicated Discharge Vehicles conveyed 348 patients across the region. 81 escorts conveyed and 130 ECR journeys arranged. Pembrokeshire Voluntary Transport made 81 patient journeys.
Pembrokeshire Voluntary Transport 7 seat minibus used to provide a dedicated service to convey mental health patients attending St Brynachs Day Hospital, Haverfordwest. Same vehicle, driver, passengers, pick-up times Enhanced patient experience Improved patient attendance rate Very efficient and cost effective service 3% Abort rate (Average for St Brynachs is 14%) Driver very friendly always got a smile on his face. Passenger assistant is very kind. She helps us down the steps I like having the same driver and vehicle. Music playing which everyone enjoys!
British Red Cross Vehicles from Carmarthen used for conveying patients to and from hospitals outside of Hywel Dda. Average of 30 patient journeys per month with positive feedback: Comfortable and direct journey Flexible and personal service Efficient and cost effective service
St. John Cymru Dedicated Discharge Vehicle at Bronglais Hospital Pilot started 8 th May 2012 Provision of 1 Vehicle 11am 7pm Crews report direct to Ambulance Liaison Officer 11am 4.30pm Crews report direct to Bed Manager out of these hours Flexible Start and Finish Times as required for early/late appointments Improved Patient flow with less chance of losing beds on hospital transfers as transport readily available Detailed reporting available via Cleric IT system. Average of 80 patient journeys per month.
Royal Voluntary Service Renal Services.
Royal Voluntary Service Renal Services. Due to capacity issues alternative arrangements sought in Ceredigion. Initial meeting on the 19 th December 2012 engaging with key stakeholders. Service began on a phased basis from April 2013. 90% of renal patients now conveyed by RVS. 360 patient journeys each month with over 10,500 miles covered. Improved patient experience and added value for money. Patient feedback positive e.g. All drivers are lovely Concerned re: availability of transport in poor weather No complaints at all / Very happy with service Grateful for service. Drivers doing a really good job Excellent service Very good service No problems- will let us know straight away if any problems Drivers are all perfect / Always on time, very friendly and helpful.
Royal Voluntary Service Volunteer drivers used to convey patients referred from rehabilitation settings to attend community based evidence based exercise programmes in Carmarthenshire (with particular regard to those at risk of falls/presenting with stroke). The initiative was funded through a well-being activity grant with 60 clients have benefitting from the service to date. Average age of participants is 83, age ranging from 69yrs- 89yrs. All identified as being at risk of falls, isolation and loss of balance/ confidence/reduced functional capacity. Transport + scheme established from Charitable Funding in Pembrokeshire.
Facilitated Hospital Discharge Menter Cwm Gwendraeth Min Nos Service Provides trained support workers who are based in the emergency departments and provide transport for patients to their discharge address. Operates Monday to Sunday 2pm-10pm. Over 800 patients taken home during 2013/14. 40% of which avoided admissions serving neighbouring areas. Pembrokeshire Intermediate Voluntary Organisations Team PIVOT Commissioned in July 2014 from Intermediate Care Fund. Pembrokeshire Association of Community Transport Organisations Care & Repair, RVS, British Red Cross, Age Cymru Pembrokeshire 237 patients supported to date. Positive impact on patients and ward / departments.
Other Community Transport Initiatives Parkinson's Disease Society Pembrokeshire Voluntary Transport and RVS used to convey patients attending the Hope Centre in Neyland. Carers Week - Ysbyty Ystwyth used to convey carers to and from various events. Followed by a specific service to support the Cylch Caron project in Tregaron. Country Cars initiative in Pembrokeshire, CTA development in Llanelli, supporting GP Practices, PACTO information leaflet distribution and supporting specialist nurse led clinics in rural areas. Cleddau Reach Day Centre - Pembrokeshire Voluntary Transport used to assist WAST and Social Services to convey clients into integrated Day Centre.
Extra Contractual Referrals (ECR S) Any patient journey not covered by the SLA with the Welsh Ambulance Service. I. Specialist Treatment II. Out of hours III. Repatriation to and from Clinical Commissioning Groups Prior to Project Support Manager post being established: Clinical staff/service Managers at each site were responsible for arranging ECRs. Expensive Time-consuming Disjointed
Future Strategic Intent and Partnership opportunities. Health Boards Integrated Medium Term Plans. Transformation of NEPT & new Service Specification. NHS Travel Scheme / Social Journeys. Potential investment in Country Cars Schemes by Health Boards. Enhanced transport service for Oncology and Renal Patients. Resulting in: A better service for patients that need / qualify for transport assistance, particularly those affected by service changes. Provide a more efficient transport service through the coordinated and maximised use of transport resources in the voluntary, community statutory and private sectors.