Arriva Transport Solutions Quality Account 2014/15

Arriva Transport Solutions Quality Account 2014/15

Company information Operates 16 NEPTS contracts across the UK 1,187 employees 502 vehicles 22 ambulance bases 11 satellite bases 3 call centres (with planning & control) 2 central staff office sites (excluding registered head office) 160,000 miles travelled each week across all contracts 2.7 million patient journeys completed since 1 July 2012 Where we operate: 1.3 million patient journeys completed in 2014 610,000 calls answered in 2014 2,500 calls answered a day Greater Manchester Rotherham Sheffield Chesterfield 2,700 bookings made online a day Nottinghamshire Leicestershire Dudley Birmingham Gloucestershire Swindon Bath and Wiltshire North East Somerset Homerton 1

Contents Part One p3-4 Introduction and Statement of Quality p5 Statement of Accuracy Part Two p6-8 Priorities for 2015/16 p9-10 Statements of Assurance p11-12 What Others Say p13 Data Quality Part Three p14-17 Review of Quality Performance P18-24 Review of priorities 2014/15 p25-32 Statements from Clinical Commissioning Groups, Healthwatch and Overview & Scrutiny Committees 2

Introduction and statement of quality by Jonathan May, UK Managing Director, on behalf of the board of directors I am extremely pleased to present Arriva Transport Solutions Quality Account for 2014/15. Arriva Transport Solutions is a leading provider of specialist transport solutions for the health and social care sector, delivering services on behalf of the local NHS. Undertaking 1.4 million patient journeys a year, using a variety of vehicles including seated, stretcher, wheelchair, bariatric ambulances and cars. Established in 2011, Arriva Transport Solutions (ATSL) has had an exciting journey so far. Following Arriva s acquisition of Ambuline, a private ambulance provider operating in the Midlands for nearly 30 years, Arriva Transport Solutions has grown into a thriving business, employing over 1,000 people. The Quality Account aims to provide information about the quality of our services, outline where improvements have been made across the business and demonstrate our commitment to remain accountable to not only those who commission our services, but also to the stakeholders and users of our service. Quality is central to our way of working at Arriva Transport Solutions Jonathan May Quality is central to our way of working at Arriva Transport Solutions. We continue to work closely with the Commissioning Quality Leads on all aspects of quality and are absolutely committed to delivering an excellent level of service to our patients in a safe and caring environment. The Governance and Quality team has put in place a number of measures to improve the quality and format of information received through our incident management systems. This has given us a far greater understanding of the types of incidents that occur so that we can mitigate risks and prevent similar 3 incidents from happening in the future. Jonathan May Alongside this, we have strengthened our employee engagement programme. This has included increased training and personal development to enhance the training levels of our already highly-skilled staff and provide a career development pathway for those who wish to progress. Other employee engagement initiatives we have introduced this year include face-to-face engagement sessions and the launch of our new staff intranet site. The success of our increased employee engagement is reflected in the results of our recent staff survey, which saw 89% of our staff say they understand what they can do to help deliver excellent service to our patients. Our stakeholder communications and engagement

Introduction and statement of quality by Jonathan May, UK Managing Director, on behalf of the board of directors programme ensures that we balance the needs of all our key stakeholders, without compromising the needs of one over the other, building mutually beneficial relationships that create value for all stakeholders. By measuring satisfaction levels and gaining patient feedback from our service users, the business can understand and act upon the areas of improvement that it needs to make and can track the progress of these changes. This year we have increased the amount of patient experience data we have gathered. We have strengthened our business in all areas this year through the hard work and dedication of our staff and the support of our partners in the healthcare community. We have also strenghthened the Patient Experience Team to capture feedback from patients that will be used to further improve the service we provide for them. We would really value your feedback on this Quality Account. If you have any comments or require any more information please contact Director of Governance & Quality, Paul Willetts on willettsp@arriva.co.uk or 0191 520 4226. Jonathan May, UK Managing Director 4

Statement of accuracy by Paul Willetts, Director of Governance and Quality In preparing our Quality Account, the Director of Governance & Quality has ensured that: The performance information reported in the Quality Account is reliable and accurate; There are proper internal controls over the collection and reporting of the measures of performance included in the Quality Account, and these controls are regularly reviewed to confirm that they are working effectively in practice The data underpinning the measures of performance reported in the Quality Account is robust and reliable, conforms to specified data quality standards and prescribed definitions, is subject to appropriate scrutiny and review; The Quality Account has been prepared in accordance with NHS guidance. Paul Willetts The Director Of Governance & Quality confirms to the best of his knowledge and belief that he has complied with these requirements in preparing this Quality Account. This has been confirmed through validation with the Board. by Paul Willetts, Director of Governance and Quality 5

Quality priorities for 2015/16 We have selected our priorities by considering the progress we have made this year. We want to continue our learning and development and have selected priorities based on wishing to increase our momentum and commitment to improve our service and patient experience. ATSL s priorities for improvement in 2015/16 are set out below. Priority 1: Patient safety Our priority: Introduce Datix and use the learnings from Incident Management information to carry out a review of health and safety risk assessments in place across all areas of our operation. Why? The activities of our staff and the way they are conducted is fundamental to ensuring the safety of both our staff and the patients we transport. The new incident management system implemented in 2014/15 has embedded a reporting culture and provided invaluable information which will aid the review of existing safe systems of work. This information also supports the suite of health and safety risk assessments currently in place and the issuing of refreshed guidance to operational staff in the safe performing of key tasks, e.g. transferring patients and assisting patients up the steps to vehicles. We have also seen an increase across the business in high-acuity patients e.g. those requiring wheelchairs and/or stretchers. The introduction of Datix will strengthen our mechanisms for reporting, recording and analysing incidents. Who will be responsible? Director of Governance and Quality. How will this be measured? The production of a new standard suite of health and safety documentation for all operational tasks; The number of staff that have gone through associated training/awareness of revised procedures The number, type and severity of incidents for 2015/2016 to show a positive impact on patient safety harm incidents. 6

Quality priorities for 2015/16 Priority 2: Effectiveness Our priority To review the governance arrangements associated with the use of third party providers, e.g. taxi companies, other transport organisations and volunteer car drivers. Why? In common with other patient transport providers, all areas of our business use a number of approved providers to assist in the transportation of patients. This includes the use of taxi companies, other private ambulance/transport providers, and community transport services. Additionally ATSL runs a successful volunteer car drivers scheme where volunteers carry out a number of journeys for suitable patients in their own vehicles. These providers are subject to strict screening by ATSL including duty of care inspections. They must also provide evidence of their adherence with all appropriate legal and regulatory requirements. Service level agreements are in place to enable monitoring of quality. Analysis of information from our incident management system, as well as feedback from patients through our improved complaints, comments and concerns processes, has identified a need to review these arrangements to include further controls and requirements for continuity of quality and patient experience when service is provided by a third party. Who will be responsible? Director of Governance and Quality. How will this be measured? A review/development of a suite of standard volunteer car driver documents involving our volunteers, community partners and interested partners e.g. Healthwatch in their production; A review/development of a sub-contractor compliance document to standardise the questions asked of sub-contractors including regular compliance visits. A questionnaire that a third party provider must complete to ensure they meet our standards. This will be enforced through face-to-face visits with each third party provider and the revised Service Level Agreement (SLA); Development of a revised SLA based on feedback through incidents, complaints and performance of third parties. 7

Quality priorities for 2015/16 Priority 3: Patient experience Our priority To review and develop the patient feedback processes across the business with a view to increasing the qualitative data received on patient experience. We will also continue to increase the number of responses in relation to patients transported (response rate). This will increase our organisation-wide learning and will be used to improve quality within service delivery. Introduce Datix and use the learnings from contacts with our Patient Experience Team to inform a review of patient experience across all areas of our operation. Why? Through creation of multiple feedback channels, ATSL is now receiving a large amount of feedback and needs to ensure that it continues to develop its methods of collection and also improves the quality of the information we collect. We need to continue to use this information effectively to improve the care we provide to our patients while also developing new methods of gathering feedback. For example we are holding roadshows within our major acute hospitals to engage with patients face-to-face at their point of care. The introduction of Datix will strengthen our mechanisms for reporting, recording and analysing comments, compliments and complaints. Who will be responsible for this? Head of Communications & Engagement and Director of Governance and Quality. How will this be measured? Increased number of feedback channels and opportunities for patients to give face-to-face feedback; Produce new patient experience survey with revised questions; Patient feedback reports with themes; Complaints reports with themes. 8

Statements of assurance from the board Review of services During 2014/15 Arriva Transport Solutions provided Non-Emergency Patient Transport Services in the following areas: Chesterfield Royal NHS Foundation Trust Homerton University Hospital NHS Trust Sheffield (PTS & GP urgent transport) Leicestershire Greater Manchester Swindon Gloucestershire. Birmingham Community Healthcare NHS Trust Dudley Rotherham Nottinghamshire Bath and North East Somerset Wiltshire In July 2012, ATSL acquired Ambuline Ltd as a wholly-owned subsidiary and sub-contracts some of its Patient Transport services to Ambuline. Arriva Transport Solutions has reviewed all the data available on the quality of care in all these areas. The income generated by the NHS services reviewed in 2014/15 represents 100 per cent of the total income generated from the provision of NHS services by ATSL for 2014/15. Participation in clinical audits During 2014/15, no national clinical audits and no national confidential enquiries covered NHS services that ATSL provides. During that period ATSL was not eligible to participate in any national clinical audits or any national confidential enquiries of the national clinical audits. As ATSL was ineligible to participate in any national clinical audits and national confidential enquiries, no data collection was completed during 2014/15, and therefore no cases were submitted for audit or enquiry as a percentage of the number of registered cases required by the terms of the audit or enquiry. As no national clinical audits covered the services provided by ATSL no reports of national clinical audits were able to be reviewed by the provider in 2014/15 and no actions to improve the quality of healthcare provided could be identified. 9

Statements of assurance from the board Local audits ATSL undertakes rolling audits in areas associated with: Infection Prevention and Control; Health and safety; Care Quality Commission compliance; Information Governance. Audit schedules are maintained and reviewed monthly by our compliance teams and reported to the Board by the Director of Governance & Quality. Local audits Arriva Transport Solutions did not recruit any of its patients receiving NHS services provided or sub-contracted by ATSL in 2014/15 to participate in research approved by a research ethics committee. Use of the CQUIN payment framework A proportion of ATSL s income in 2014/15 was conditional on achieving quality improvement and innovation goals agreed between ATSL and any person or body they entered into a contract, agreement or arrangement with for the provision of NHS services, through the Commissioning for Quality and Innovation payment framework. The themes included patient notification, mobility and Healthwatch engagement. Also, the early adoption of the Friends & Family Test in Manchester allowed us to embed effective reporting processes within the organisation before the mandatory implementation of the scheme nationwide. Arriva Transport Solutions was successful in achieving all the agreed CQUIN goals. 10

What others say about ATSL Statements from the CQC Arriva Transport Solutions is required to register with the Care Quality Commission and its current registration status is for Transport services, triage and medical advice provided remotely. Arriva Transport Solutions has no conditions to its registration. The Care Quality Commission has not taken enforcement action against ATSL during 2014/2015. ATSL has participated in special reviews or investigations by the Care Quality Commission during 2014/2015. During these investigations or reviews the CQC has evaluated the service against specific outcomes listed in the Essential Standards of Quality and Safety. Any non-compliance has been measured by the possible impact on people who use the service, with the following results: Leicestershire, 17 April 2014 Care and welfare of people who use services Supporting workers Assessing and monitoring the quality of service provision Birmingham, 4 August 2014 Cleanliness and infection control Supporting workers Assessing and monitoring the quality of service provision Leicestershire (revisited), 25 November 2014 Care and welfare of people who use services - moderate impact - minor impact - minor impact - moderate impact - moderate impact - moderate impact - minor impact Areas where there was a compliance action identified during their inspection, we developed and implemented a full action plan to address the areas raised. All have been fully implemented. Examples of actions taken as a direct result of CQC inspections: Comprehensive 2015/2016 audit programme New Supervision Policy for Observed Practice, PDR and 1:1 sessions Service Improvement Programme Updated Infection Prevention and control Policies and procedures Improved Maintenance systems Comprehensive Staff engagement programme Re-vamped training programme Details of CQC inspections can be viewed on their website: www.cqc.org.uk. 11

What others say about ATSL We received the following comments during CQC inspections in 2014/15: We saw that quality issues were cascaded to operational staff. The provider was producing monthly reports which detailed incidents, complaints, audits and information on key performance indicators. This information was shared with staff through noticeboards within their depots. We saw that compliance groups met on a monthly basis to share and learn from incidents that had happened across the wider organisation. We saw minutes from these meetings and saw that learning was shared. We saw that where risk was identified, the provider was responding and taking appropriate actions. The provider was able to demonstrate that safeguarding awareness, completion of audits and spot checks were planned throughout the coming year. We also asked to see the training records for the staff and saw that over 99% of staff had attended safeguarding training within the last year. CCG feedback The Arriva Transport Solutions team has been extremely helpful and accommodating during the recent escalation in the urgent care system. Our quality lead has also been very complimentary about the enthusiastic attitude of the team to get things right. Gloucestershire CCG Healthwatch feedback The complaints policy is clear and comprehensive with processes, responsibilities, time frames and expectations clearly laid out. It shows a great step forward and will encourage people to feel more confident about raising concerns. Alice Tligui, Chief Officer 12

Information governance Data quality Our Business Information and Systems team provide monthly data quality reports to help managers monitor and improve reporting and data quality within their teams. This identifies data completeness against minimum data sets (MDS) which are specified within each service area along with appropriate levels of completeness (%). Data Quality Improvement Plans are developed where appropriate. Data is handled in accordance with strict information security controls. NHS number and general medical practice validity information ATSL did not submit records during 2014/15 to the Secondary Uses service for inclusion in the Hospital Episode Statistics which are included in the latest published data. Information governance toolkit attainment levels Arriva Transport Solutions achieved Level 2 on the NHS Information Governance toolkit Assessment Report and was graded satisfactory. As a non-emergency patient transport provider this is the level we are required to attain for NHS England contracts. Clinical coding error rate ATSL was not subject to the Payment by Results clinical coding audit during 2014/15 by the Audit Commission. 13

Review of quality performance The review of quality performance contained within this year s quality account represents statistics pertaining to the organisation as a whole. We are committed to present the information in an agreed manner that is clear and meaningful to the reader. Health and Safety Arriva Transport Solutions recognises and accepts its responsibilities under the Health & Safety at Work Act 1974, applicable regulations and all other relevant legislation to undertake all reasonable steps to protect the health, safety and welfare of staff, patients and members of the public. The UK Managing Director assumes overall responsibility for health and safety and delegates to each operational Head of Service, the administration and implementation of all policies and procedures within their area of responsibility. Arriva Transport Solutions will ensure that: Health & safety issues and considerations are adequately resourced An appropriate organisational structure is established that supports a safety culture and management of risk throughout the business operations with full engagement of employees A systematic approach is employed to the identification of risk and the implementation of suitable and sufficient control measures to manage and minimise those risks It provides adequate arrangements for local and organisational learning from all incidents, accidents and near misses identified within the business. Arriva Transport Solutions requires its employees to: Take all reasonable steps to protect their own safety and the safety of others who may be affected by their acts or omissions Co-operate fully with management in all aspects of health & safety policy and procedure, this shall include all employees, volunteers and salaried staff To follow all work instructions, safety rules and regulations as directed by Arriva Transport Solutions Not to interfere with any equipment provided for the health, safety or welfare of themselves or others Undertake any health & safety training provided as appropriate for their role. 14

Patient safety - incidents An incident is an event or circumstance which results in unnecessary damage, loss or harm to a patient, staff member, visitor or member of the public. Staff are encouraged to report all incidents, whether major or minor. Incidents are investigated to resolve the immediate issues and recorded/reported through our internal processes to the Quality Team. The identified themes and trends are reviewed and discussed at internal compliance group forums where further learnings can be made to influence necessary changes in policies and/ or procedures. ATSL also complies with the requirements under the NHS Serious Incident Management Framework. During the first part of 2014, a revised incident management framework was implemented across ATSL, which included a revised policy as well as supporting documentation and a range of reporting forms. Prior to implementation this was subject to internal and external consultation. All incidents are now consistently logged across all business areas and reported through the production of a monthly summary for each contract area. Through understanding more about the types of incidents that occur and the trends surrounding them, we can better plan and risk-assess our service to minimise such events. We openly and regularly share all information gathered with our NHS stakeholders through operational meetings, for example transport working groups and tripartite meetings. At senior level this takes place with quality and compliance, typically with the CCG, with all actions recorded and monitored. Last year we said we wanted to increase the numbers of incidents reported internally. In 2013/14 we had 267 internal incidents reported compared to 970 at the end of year 2014/15. This indicates that our staff are more confident in reporting incidents and near misses. It also provides us with significant data to analyse and use across the business to improve service delivery. It is worth noting that the majority of incidents reported do not relate to patient safety. The implementation of a revised incident management system has allowed us to analyse in more detail incidents that are more directly related to the safety of our patients. It has been identified through our partnership working and discussion of incident reporting that further analysis, paticularly on timeliness and the impact on patients wellbeing, is important. The introduction of Datix will allow us to monitor this in 2015/16 and report on our findings and actions in next year s Quality Account. Below is a summary of the three top themes identified from the analysis this year: Theme: Vehicle incidents*. Action: Detailed analysis of the types of vehicle incidents; Installation of Masternaut technology into vehicles with real time analysis of the driver s technique; Increased awareness and monitoring by managers of vehicle incidents, especially where the ATSL driver was at fault; Additional driving skills training scheduled in mandatory training for 2015/2016 focussing on reversing and manoeuvring. *Our vehicles travel on average 160,000 miles every week. Theme: Patient slips, trips or falls where the ATSL crew was present. Action: Staff received additional manual handling training during mandatory training. Additional manual handling/patient handling training is planned for 2015/2016 with a focus on reducing falls. Theme: Staff injuries. Mostly lifting and handling injuries and either shoulder or lower back injuries. Action: Staff received additional manual handling training during mandatory training. Additional manual handling/patient handling training is planned for 2015/2016 with a focus on reducing falls. 15

Patient safety - incidents We report on all incidents on a regular basis to our contract leads. Following feedback on our Quality Account last year, and through our involvement with CCG quality leads in the areas in which we operate, the table below provides details of incidents involving patient or staff safety. 2014/15 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total Patient Journeys Incidents resulting in physical harm Incidents resulting in physical harm as a % of journeys Incidents categorised as serious* Incidents categorised as serious* as a % of journeys 92943 94145 93578 99901 99588 107872 112675 101917 101560 105825 99655 107010 1216669 4 8 11 5 5 7 9 8 9 11 8 1 83 0.0043% 0.0085% 0.0118% 0.0050% 0.0050% 0.0065% 0.0080% 0.0078% 0.0089% 0.0104% 0.0080% 0.0009% 0.0068% 2 1 1 0 0 1 1 0 3 0 0 1 11 0.0022% 0.0011% 0.0011% 0.0000% 0.0000% 0.0009% 0.0009% 0.0000% 0.0030% 0.0000% 0.0000% 0.0009% 0.0009% *categorised using the NHS Serious Incident Management Framework. 16

Effectiveness Arriva Transport Solutions recognises the need to provide effective training to all its employees prior to beginning work in the healthcare environment and throughout the course of their employment. As part of our induction programme, new employees are inducted into the Company over a period of two weeks where specific developmental training is undertaken. Every new Patient Transport Service (PTS) Care Assistant will be provided with a mentor to enable them to be supported as they become accustomed to working within Arriva Transport Solutions. All PTS employees are provided with annual mandatory training to ensure their skills are current and they are competent to undertake all aspects of their role. In addition, periodic reviews are used to identify training needs, which are then formulated into an employee s personal development plan (PDP). In order to enhance each employee s personal contribution to the business, it may be appropriate for some individuals to undertake extracurricular Developmental Training and/or Further Education.This will be determined following recruitment or their 1-2-1 objective meeting which may result in a personal development plan being produced. 17

Review of priorities 2014/15 Priority 1: Patient safety In 2013/14 we cited patient safety as our first priority. Adverse incidents have the potential to affect the safety of our staff, patients and all those we come into contact with. Through understanding more about the types of incidents that occur and the trends surrounding them, we can better plan and mitigate risks to avoid such events occurring and therefore improve the quality of service delivered. This involves effective reporting, full analysis of the type of incidents that occur and identifying the trends surrounding them. Our priority was To improve the quality and format of information received through our incident management systems to enable better and more consistent analysis of themes and trends To use the data analysis to influence decision-making on policies and processes in order to mitigate risks. We achieved this by implementing improvements to our incident management systems to ensure a robust and consistent process for the reporting, recording and investigation of incidents through the revised framework. Quality and Operational meetings allow for these to be reviewed, discussed and actioned formally on a regular basis. Why we chose this as a priority The process of identifying, recording, reporting, investigating, and learning from incidents was in need of review and a consistent application of the process across all areas of our service. This went hand in hand with an awareness campaign to ensure a culture of awareness and responsibility was cultivated and as a result the number of incidents/near misses reported has increased. This is welcomed as it enables better analysis of themes and trends. Who was responsible for this? Director of Governance and Quality. How did we measure this? The number and type of incidents were monitored and detailed analysis of reports produced through our internal compliance group structure and scrutiny 18 through NHS commissioner quality groups. What we achieved A revised incident management process was rolled out acrossall contracts during 2014. The incident management policy was revised with a focus on encouraging staff to report incidents, introducing a method of recording and promoting a culture of learning from incidents to improve patient safety. A series of online training sessions were held with all managers and team leaders to introduce the incident management process. 49 managers and supervisors attended these sessions during April and May 2014. The details of the new process were then cascaded to all staff. All areas of our operation saw an increase in reported incidents during 2014/2015. Further evidence of this is detailed in the Incidents section on Page 13. This increase is further analysed later in this report, however it is consistent with the awareness activities and the development of an enhanced culture for reporting incidents.

Review of priorities 2014/15 We recognise that the reporting of incidents is one stage in the process of developing quality improvements. Local managers have been held responsible for conducting investigations into every reported incident. This not only includes actual occurrences, but also near-miss reports. Where appropriate senior managers have also been involvedin investigating incidents along with support from the Compliance Team. These investigations are focused on preventing re-occurrences and encourages the full involvement of staff and where possible patients. A full time support officer was appointed during 2014/2015 with a focus on logging and tracking incidents. Two Compliance Managers have attended root cause analysis training during 2014/2015 to provide additional expertise and knowledge to support serious or complex investigations. A full analysis of all data from 2014/2015 to identify annual trends, themes and learning opportunities is being developed. Incident data and reports have been discussed internally and externally regularly throughout 2014/2015. Internal compliance groups have met monthly in most areas and incidents are a regular agenda item in order to both monitor the incident process within each area but also to promote shared learning. Monthly incident reports are also shared with commissioners in each contract area and root cause analysis reports following serious incidents are shared with the relevant Clinical Commissioning Group. 19

Review of priorities 2014/15 Priority 2: Effectiveness Our staff are pivotal to delivering a quality service and we must ensure we provide them with the right training essential to develop and maintain their skills in the delivery of patient transport services. Staff training is essential to delivering an effective service and to enhance the patient experience. Our priority was To enhance our staff training programme to include: BTEC Level 2 Customer Services to all frontline ambulance staff VRQ level 2 in Transporting Patients by Road which includes the qualification Ambulance Driving Non-Emergency VRQ Level 2 in Infection Control. Why we chose this as a priority This has significantly improved the training levels of our already highly-skilled staff and provided a career development pathway for staff to progress. This has had a direct impact on staff morale as well as capability and in turn improved the quality of care provided to our patients. Who was responsible for this? Human Resources Director. How we measured this Training and completion records for staff were reviewed by HR managers through the year to monitor progress and detailed analysis of reports produced through our internal compliance group structure and scrutiny through NHS commissioner quality groups. What we achieved In order for our staff to deliver a quality service we know it is essential to provide them with the right level of training and development in order for them to carry out their role. During 2014/2015 we have made a significant investment in our training offered to all levels of staff, from operational staff to supervisors and managers. We welcomed more than169 new members of staff during 2014/2015 and our training team delivered 32 two-week induction courses. During 20 these courses, as well as in-house training, all new staff received externally accredited qualifications in Infection Control and Essential First Aid. This related to 100% compliance. All existing operational staff also receive mandatory training every year in core topics and this was delivered across all of our areas in 2014/2015. During this more than 400 staff (over 50 per cent of the operational workforce) were enrolled onto a BTEC customer care course to further enhance our employees skills. In additional to operational staff we have invested heavily in training for our supervisors and managers. 63 supervisors/team leaders are undergoing a BTEC in supervision and more than 41 managers attended a series of management courses throughout 2014/2015. We also took the opportunity in 2014/2015 to review our training plans. This led to the formation of a national training steering group, which reports directly to the board of directors on the strategy for the development of training across the business. A significant outcome has been the development of a new induction package which is due to be rolled out in the first part of 2015/2016.

Review of priorities 2014/15 Priority 3: Patient experience (Part 1) ATSL recognises that patient feedback is vital. We aim to deliver a caring, quality service that meets the needs of our patients and stakeholders and contributes to a positive patient experience throughout their health journey. We have introduced a new role of Patient Experience Manager with an objective to improve the processes used to capture, review and report feedback that can be used to drive improvements to the patient s experience. Our priority was To increase the amount of patient feedback we gather. Why we chose this as a priority Gaining more feedback from the users of our service will enable a better representation of data for us to focus improvements on the areas that matter the most to patients. Who was responsible for this? Head of Communications & Engagement. How was this measured? Response rate of patient surveys. Feedback trends, positive and negative areas. What we achieved This year s patient feedback programme was developed to increase the amount of feedback gathered. This was done through increasing channels of communication, improving signposting and increasing the number of responses we receive for our patient feedback survey. The following methods were used to capture feedback: Patient survey - Postcards with freepost capability given out by drivers and within hospital discharge lounges (these are barcoded to identify which area they have been distributed in) - Online survey - Utilisation of tablet devices to target specific groups of patients Public and patient events/forums Patient feedback app Engagement with patient representative groups. Information from patients was recorded and analysed on a regular basis. This enabled the organisation to understand how it is performing from a patient perspective. This information is reported to commissioners and used to help shape the development of services with the involvement of patients and their relatives. We recognise the importance of gaining feedback from the users of the service and reviewing improvements/changes that can be made to service delivery as a result of this feedback. 21

Review of priorities 2014/15 Priority 3: Patient experience (Part 1) Patient Experience Survey Our aim in 2014/15 was to increase the response rate for our Patient Experience Survey. In 2013/14, the response rate of those patients invited to complete the survey was 11%. In 2014/15 the response rate increased to15%. Overall more than 2,500 patients took part in the survey with satisfaction levels increasing in all areas. Feedback from 2013/14 led to direct action being taken to improve patient satisfaction in 2014/15 in the following areas: Theme: Some patients found their journey was bumpy and commented on levels of noise inside vehicles. Action: Analysis of patients feedback revealed a number of causes for the bumpiness. In some instances the level of dissatisfaction was due to road conditions but in other cases we were able to take action. By re-assessing patients mobility, the type of vehicle they are assigned and where they are seated on it resulted in reduced levels of discomfort during journeys. We encouraged this practice with staff through team meetings to remind them to ensure they offer patients a choice of seat where possible, escalate any comments provided by patients regarding their comfort to control, and to check regularly during the journey that the patient is comfortable. Theme: Patients queried the use of and service delivered by third party providers. Action: Service level agreements are in place to monitor the care and quality delivered by third party providers. Providers are also subject to strict screening, including duty of care inspections. Analysis of information from our incident management system as well as patient feedback identified the need for us to review arrangements and ensure continuity in the quality of care when a service is provided by a third party. Therefore this forms our main priority under effectiveness this year. Theme: Some patients were confused about whether an escort can travel with them. Action: We have introduced a suite of patient information materials to ensure patients have a greater understanding of the service we provide. Some of the confusion over escort eligibility resulted from incorrect details being entered at the time of booking. As a result we have offered training to NHS colleagues who book transport and discussed ways we can improve the information we provide. 22

Review of priorities 2014/15 Priority 3: Patient experience (Part 2) Our priority was To improve patient experience by implementing improvements to our Complaints policy and processes. Why we chose this as a priority Learning from our complaints is imperative to improve our patient experience. Improvements to the process will ensure easier identification of themes and trends. Who was responsible for this? Director of Governance & Quality. How was this measured? Number and type of complaints monitored via a complaints dashboard Triangulated with patient survey information Identify and monitor trends through compliance forums to identify areas and actions to improve service quality. What we achieved The complaints process has been extensively improved, driven forward by the Patient Experience Manager as a result of extensive studies. Several proposals were looked into with recommendations for a new inclusive complaints software and new in-house team being approved. The complaints policy has been extensively rewritten with the policy circulated to UK-wide Healthwatch bodies, Commissioning bodies and local Patient Experience groups. The main theme from the policy is around encouraging patient feedback by opening up the methods of contact and taking actions and learnings following investigations from complaints. From March 2014 monthly standalone reports have been created for each contract area. The data was discussed internally and externally each month, from compliance meetings to Quality Groups with commissioners. The reports also included data from the patient surveys that were completed during set periods through the year. Other feedback initiatives were also included, such as the patient feedback app and direct contact with patients at events and forums. 2014/15 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Total Total no of PTS Journeys 2014/15 Contacts recorded 2014/15 Incidents 2014/15 as a 5 of journeys 92943 94145 93578 99901 99588 107872 112675 101917 101560 105825 99655 107010 1216669 162 258 270 247 152 202 237 181 140 119 184 240 2392 0.1743% 0.2740% 0.2885% 0.2472% 0.1526% 0.1873% 0.2103% 0.1776% 0.1378% 0.1124% 0.1846% 0.2243% 0.1966% 23

Review of priorities 2014/15 Priority 3: Patient experience (Part 2) Arriva Transport Solutions has, through the analysis of our patient feedback including complaints information we have, been able to identify that there are common misconceptions and misunderstandings about the patient transport service. This included access, service specification, booking process and eligibility. In response to this a targeted campaign has begun which aims to: Build a wider understanding of the PTS service that ATSL provides Ensure patients and other stakeholders understand the key fundamentals of the PTS specification, the commissioned service and the contract Work in collaboration with patients (groups, forum and representative groups) to increase public and patient understanding and awareness about the PTS service Ensure that patients are signposted correctly to provide feedback Build networks to increase our existing communications and engagement channels. We shall measure this campaign through the analysis of contacts relating to key themes identified in patient feedback: Booking process Eligibility Incorrect booking resulting in cancelled or aborted journeys Information and access. The following items have already been distributed in the majority of areas: Patient information leaflet Patient reminder card NHS staff information flyer FAQs Contract summary Website copy and images Patients have directly influenced the content of these materials through reading groups and forums and our partnership with the NHS and wider stakeholders e.g. Healthwatch. We shall continue to develop our action plans with patient feedback at the forefront of our decision making. We will maintain our current patient engagement methods and look into new methods of interaction. Theme: Patients queried the use of and service delivered by third party providers. Action: We worked to reduce the number of patients being transported by third party providers and strengthened our Service Level Agreement. We have also encouraged more Voluntary Car Service drivers which gain positive feedback from patients. Theme: Patients would like better communication, particularly when delays occur.. Action: We have introduced a text message service and call-ahead initiative to ensure patients are aware and prepared for their transport. Patients have also been given leaflets and telephone numbers to call if they require any further information about their transport. 24

Statements We would like to thank our colleagues from Healthwatch, Clinical Commissioning Groups and Local Authorities for reviewing our Quality Account for 2014/15. In the production of this year s Quality Account we have taken into account the feedback we received and have incorporated, wherever possible, the comments provided on this year s account. The visual style has been changed, including some language used and further explanation of terms to deliver a document that can be easily read by a member of the public. We have strengthened the information provided for our priorities and the details on the way we shall measure them. An introduction has also been added to the priorities section, detailing how we utilise our feedback and reporting mechanisms to highlight areas of focus forming the basis of this year s priorities. Further information on our internal and external incident and feedback reporting programmes to give background on how we work with our local NHS community to deliver effective change and share best practice. We have been unable to include region specific information this year and will carefully consider this for next year s account. Thank you again to all who have taken the time to comment, please find statements below. NHS Blackpool Clinical Commissioning Group (CCG) NHS Blackpool Clinical Commissioning Group (CCG) manages the Greater Manchester (GM) contract on behalf of the commissioning body (NHS Tameside and Glossop CCG), and the other eleven CCGs in GM, and as such welcomes the opportunity to review the 2014-15 Arriva Transport Solutions Ltd (ATSL) Quality Account. This statement is made by NHS Blackpool CCG on behalf of the twelve GM CCGs. While ATSL is only required to produce one Quality Account covering all contracts, in future it would be beneficial for contract specific data to be included. This would make the Quality Accounts more meaningful to service users at a local level. Performance concerns were raised with ATSL in 2013/14 in relation to achievement of some quality standards within the contract. An improvement plan was produced and monitored, which resulted in significant improvement and the query notice was removed in September 2014. Commissioners acknowledge all of the work undertaken by ATSL in achieving and maintaining the improvements in performance. We acknowledge the work undertaken to review the incident management process and to increase the reporting of incidents in 2014-15 which is a positive indicator of a risk aware culture. As part of the quality reporting by ATSL, the Commissioning Quality Group receives information on the incidents and measures being taken to reduce further occurrences. The Commissioners monitored the Commissioning Quality for Innovation (CQUIN) scheme throughout 2014-15 and the indicators were achieved. We were pleased that ATSL achieved the early implementation of the Friends and Family Test which demonstrates their commitment to innovation and to help Commissioners understand patient feedback.we look forward to working with ATSL in 2015-16 to promote mental health awareness, improve patient experience and identify actions to improve waiting times performance. Throughout 2014-15 Arriva worked with Healthwatch organisations in GM to build upon the engagement commenced in 2013-14; ensure that Healthwatch understand the key fundamentals of the PTS specification, the commissioned service and the contract; increase public and patient understanding and awareness about 25

Statements the PTS service; and increase patient feedback. It was pleasing that ATSL involved its stakeholders during the review of the complaints process and the patient information leaflets and now prepares a quarterly newsletter for key stakeholders. Commissioners continue to closely monitor complaint levels and themes of complaints to ensure that where common themes are identified ATSL are implementing actions and lessons learned to shape the development of the service. ATSL received an average of approximately 0.15% contacts (comments, compliments and complaints) as a percentage of their activity. The main themes of complaints and patient experience feedback in GM are timeliness, in particular the length of time to be prepared before an appointment and the wait to return home from hospital, and communication. As a result ATSL have implemented a call ahead and text message service to improve the patient experience. During 2014-15 ATSL has worked with individual CCGs and Acute Trusts and participated in tripartite meetings. They have also worked with the GM CCGs collectively, and this relationship will continue to develop during 2015/16 as ATSL attend the GM Area Ambulance Commissioning Group. Bath and North East Somerset, Gloucestershire, Swindon, and Wiltshire Clinical Commissioning Groups (CCG) Bath and North East Somerset, Gloucestershire, Swindon and Wiltshire Clinical Commissioning Groups (CCGs) are joint commissioners of patient transport services from Arriva. This statement is provided jointly by the four CCGs (referred to as the Commissioners ) who have reviewed the Arriva Quality Accounts for 2014/2015. The CCGs reviewed the Account in light of key intelligence indicators and the assurances sought and given in the monthly integrated Quality and Performance meetings attended by Arriva and the joint Commissioners. This evidence is triangulated with data from other information sources, including patient complaints made directly to the CCGs. Insofar as the Commissioners have been able to verify the factual details; the Commissioners confirm that the Quality Account appears to be accurate and fairly interpreted. The Commissioners fully supports Arriva s commitment to ensure quality is central to its service provision. The CCGs have responded to this Quality Account under the three domains of effectiveness, patient experience and safety. Effectiveness A skilled workforce is key to providing a safe and effective service. The Commissioners support Arriva s robust induction and mandatory training programme which includes safeguarding and infection control training which has been attended by all staff during 2014-15. The CCGs welcome Arriva s stated priority of enhancing governance arrangements for services provided by a third party through the ongoing analysis of incident and patient feedback data to ensure continuity of quality and patient experience. The Commissioners would like to see Arriva further develop this during 2015/16 by including the effectiveness of service delivery via the provision of a review of the key performance indicators linked to quality and how this can be supported via collaborative working with other organisations, including Healthwatch. Patient Experience Arriva has set out a number of feedback mechanisms aimed at collating patient experience feedback. 26