Reporting on the 2010 Survey

National Kidney Care Audit Patient Transport Survey Report Reporting on the 2010 Survey West Midlands SCG

Executive summary Across England, Wales and Northern Ireland 12,370 patients took part in the Kidney Patient Transport Survey in 2010, up from 11,689 when the survey was carried out in 2008. The number of patients in the West Midlands taking part was 1,159 and 1,269 in 2010 and 2008 respectively. In the West Midlands: The response rate for patient survey questionnaires was between 50-60%. The age profile of survey respondents remained largely unchanged between 2008 and 2010. The proportion of respondents using hospital arranged transport increased slightly from 57% in 2008 to 58% in 2010. However, there are issues regarding the reliability of these data. There is a known shortfall of responses from patients who do not use hospital arranged transport who mistakenly did not consider themselves eligible to complete the survey. 78% of all patients either claim back the cost of their journey or do not pay at all, compared to 76% in 2008. 76% of patients using hospital arranged transport were picked up within 30 minutes of the expected time on their way to dialysis, compared to 75% in 2008. 76% of all patients had a travelling time of 30 minutes or less to get to their dialysis unit, compared to 73% in 2008. 83% of all patients waited 30 minutes or less at the unit for dialysis to commence, compared to 80% in 2008. 73% of all patients waited 30 minutes or less to be picked up for the return journey after dialysis, compared to 72% in 2008. 88% of all patients said the transport they used (regardless of what type of transport it was) met their needs either all or most of the time, compared to 87% in 2008.

Contents 1. Foreword 2. Introduction 3. Methodology and data 4. Response rate 5. Age of respondents 6. Mode of transport used to get to/from dialysis 7. Payment for transport 8. Journey distance 9. Travel time 10. Waiting time 11. Patient satisfaction 12. Conclusion

1. Foreword We all know how frustrating a bad journey can be. It can leave us feeling stressed and tired when we arrive. And the prospect of the return journey can fill us with dread. The care we provide to patients who require haemodialysis in hospital is unique in its transport requirements. Most patients need dialysis three times each week, every week of the year, and the journey to and from the renal unit is an integral part of their whole experience of dialysis. Haemodialysis patients frequently highlight transport issues as the most important aspect of their care that needs improvement. Recognising this, the first national transport audit for kidney services was carried out in 2008. It aimed to enable providers, commissioners and patient groups to benchmark the current state of transport provision and to understand some of the barriers and challenges to improving transport for dialysis patients. We know that convenience and control and being able to enjoy a life beyond dialysis are fundamentally crucial for a patient s overall sense of wellbeing. Unsurprisingly, key transport issues for patients are the length of journey time, whether transport arrives when they expect it to (both early and late are equally frustrating) and how long they have to wait before they can return home. The audit was repeated in 2010 to assess progress. Disappointingly, it showed little real progress although, on the positive side, most patients are mostly satisfied with the transport services they receive. However, the real richness from the audit is in the local level reports where variations since 2008 are more marked and the data forms a valuable resource for highlighting what works well and where improvements are needed. This report is one of ten specialised commissioning group summaries which describe the 2010 survey findings and compare them with the findings from 2008. We hope that kidney care networks, commissioners and providers will find the detailed data in these reports useful for assessing and improving the transport services they currently provide. They will also be useful for local kidney patient associations and groups who should be actively involved in the commissioning of transport services. The audit will be carried out again in October 2012, offering an opportunity to assess progress. One of the main themes identified by the audit is the fragmentation of commissioning arrangements for transport services. Transport budgets are frequently held by PCTs rather than specialist commissioners and commissioned for all the trust s patients rather than for dialysis patients specifically. In many areas, it appears that a clearer line of sight is needed between the accountability for the budget and the accountability for providing the best service to patients. The process of carrying out this audit and exploring its findings has demonstrated how passionately both patients and staff care about transport. It is not just the patients who suffer when the system doesn t work; nursing staff frequently have to deal with the problems that patients experience and it has a negative impact on the quality of care that can be provided. Page 1

We hope that these audit findings can provide a valuable evidence base and starting point for the local work needed to improve transport services for all of our patients. Beverley Matthews Director, NHS Kidney Care 2. Introduction Patients on haemodialysis have highlighted transport issues as the most important aspect of their care that needs to be improved, and the Healthcare Quality Improvement Partnership (HQIP) commissioned the National Kidney Care audits on Patient Transport. The audits are managed by the NHS Information Centre for Health and Social Care (NHS IC), working in partnership with the National Kidney Federation and the UK Renal Registry. The first transport audit was carried out in 2008, when all non-home based haemodialysis patients in England, Northern Ireland and Wales were asked about their most recent experience of travel to and from dialysis, including travel and waiting times, and about their satisfaction with their transport arrangements. The NHS IC produced a national summary report on the 2008 survey 1 and reports detailing findings at Specialised Commissioning Group (SCG) level are available via the NHS Kidney Care website 2. The second transport audit survey took place in October 2010, and the NHS IC have published a national summary report 3 and unit level reports of these data 4. This report is one of 10 Specialised Commissioning Group (SCG) summaries which describe the 2010 survey findings, and compare with the findings from 2008. The reports have been produced by NHS Kidney Care in collaboration with the East Midlands Public Health Observatory (EMPHO). These summaries differ from the 1 2008 national report available at http://www.ic.nhs.uk/webfiles/services/ncasp/renal/pt%20survey%202008/nhsic_kidney%20case_ Amendments.pdf 2 2008 SCG level reports available at http://www.kidneycare.nhs.uk/_resources-reports- PatientTransportSurveyReport.aspx 3 2010 national report available at http://www.ic.nhs.uk/webfiles/services/ncasp/audits%20and%20reports/nhs_patient_transport_2010 _Final_Web_Version.pdf 4 2010 unit level reports available at https://groups.ic.nhs.uk/nationalkidneycareaudit/documents/forms/allitems.aspx? RootFolder=%2fNationalKidneyCareAudit%2fDocuments%2f2010%20Patient%20Transport%20Survey %20%20Unit%20Level%20Reports&FolderCTID=0x012000F89364C744DD4848B20E3E739B772F3200 2369E989E6CB594C86701C82BB30C18D Page 2

national report as they have been produced by using the NHS IC iview tool 1 to obtain and analyse data at SCG and PCT level. The report is aimed at commissioners of kidney services in PCTs and Kidney Care Networks as well as providers of kidney care services. 3. Methodology and data The methodology used for the 2010 survey was identical to that of 2008, as were the questions asked, with minor amendments of wording designed to improve clarity. The surveys were cross sectional rather than longitudinal in design. Longitudinal studies involve repeated observations of the same variables and, unlike cross-sectional studies, they track the same people over time. Therefore the differences observed in those people are less likely to be the result of temporal confounding differences. Although there will be a significant degree of overlap, the cohort of patients responding to the 2010 survey will not be the same group of people that responded in 2008. This is due to the flow of patients between treatment modalities over time, affecting their eligibility for participation, and also patients eligible to participate at both time points may have chosen not to respond on one or both occasions. This methodological issue means that it is possible that any changes between 2008 and 2010 may be due to changes in the participating cohorts at each time point rather than true change in the whole population over time. However, the expected high degree of overlap between the two cohorts means that it is reasonable to assume that there is validity in comparing the results of the two surveys directly. All the information in this report has been derived from the NHS IC iview toolkit 2. The toolkit provides details of values and proportions of responses for each of the items in the 2008 and 2010 survey questionnaires. The main NHS IC report includes data for England, Wales and Northern Ireland. This report includes England data only and so reported percentages differ slightly from the NHS IC report. At the time of this report SHA areas in England are coterminous with SCG areas, and SHA analysis is reported as SCG analysis in the text. Each of the figures on this report also includes data for the relevant SHA cluster (NHS London, NHS North of England, NHS Midlands and East or NHS South of England). 3 The PCT and SCG results included in this report are based on the postcode of the location from where the patient travelled to dialysis on the day the survey was completed. In most cases, although not always, this will be the same as the PCT/SCG of residence. Some patients may attend a unit in a PCT/SCG other than that from 1 http://www.ic.nhs.uk/iview 2 http://www.ic.nhs.uk/iview 3 SHA cluster areas announced in July 2011, see http://healthandcare.dh.gov.uk/sha-clusters/ Page 3

which they travelled. Conversely, the unit level results are based on all attending patients, including some who may be resident outside the region. By and large, however, patients attend units within their region of residence and there is relatively little cross-border flow. Renal units with small numbers of patients or responses were not included in the iview analysis as a precaution against the production of disclosive analysis. This affected all paediatric units and a small number of adult units. For access to iview or for further details on the patient transport audit, please contact the project team at kidneycare@ic.nhs.uk. Main renal centres include data relating to all their satellite units (where applicable). However, for the purposes of this report satellite unit data are summed to give an overall main unit figure. Satellite unit-level data are available within iview and also (to a limited extent) within the NHS IC Unit Level reports. All graph values in this report represent the percentage of valid responses to the specific question asked. In accordance with convention regarding analysis of survey data, missing or invalid responses are excluded from the denominator 1. This approach is particularly useful as iview does not allow data filters to be used. For example, certain questions were intended to be answered only by patients using hospital arranged transport, but iview does not allow this cohort to be selected for sub group analysis. However, in most cases the number of valid responses to these cohortspecific questions (i.e. excluding missing responses) matches almost exactly the number of patients using hospital arranged transport, so it is reasonable to assume that the cohort can be reasonably accurately identified by excluding responses with missing values. This limitation of iview also means that more detailed sub-group analysis by cross-tabulation of questions is not possible e.g. it is not possible to look at variations in findings by age group, or by day/time of attendance. Some of the charts in the report contain multiple categories of information (up to eight categories). To help distinguish the categories, the figures are labelled from left to right, with the category on the bar representing the sequence in the labels. Chart bars representing proportions of less than 5% are not usually labelled; this was an arbitrarily chosen cut off point to avoid cluttered charts and maintain visual clarity. 1 This approach differs from that used in the 2008 SCG level reports, and direct comparison should not be made between results calculated using the different methods. However, this report includes details of 2008 results recalculated using the revised method. Page 4

4. Response rate Response rate data were available at SCG level (Figure 1) and renal centre level (Table 1), but only in 10% groupings e.g. 50-60%. For presentation clarity, only the top figure of each response rate band is shown in the figures. For example, a response rate of 50-60% is displayed as 60%. Figure 1: SCG response rate The 2010 survey response rate for the West Midlands was 50-60%, lower than the response rate of 60-70% achieved in the 2008 survey. The individual unit response rates are shown in Table 1. In order to protect patient confidentiality, paediatric units and units with fewer than 11 responses were not reported in the iview survey results database. In the West Midlands responses have been removed for reasons of anonymity for two units: Birmingham Children s Hospital Tipton Response rate by unit varied from 10-20% to 90-100% within the region. The response rate by PCT was not available due to issues regarding calculation of the denominator population. However, Table 2 shows the actual number of responses achieved by PCT and main unit, in both 2008 and 2010. Page 5

Table 1: Response rate by renal unit Main unit Birmingham - Heartlands Hospital Birmingham - Queen Elizabeth Hospital Birmingham Children's Hospital Coventry - Walsgrave Hospital Dudley - Russells Hall Hospital Royal Shrewsbury Hospital University Hospital of North Staffordshire Wolverhampton - New Cross Hospital Unit Response rate (%) Balsall Heath, Runcorn Road 90 100% Birmingham - Heartlands Hospital 60 70% Castle Vale 70 80% Solihull District General 90 100% Sutton Coldfield Ashfurlong 50 60% Birmingham - Aston Cross 10 20% Birmingham - City Hospital Satellite Unit 30 40% Birmingham - King's Norton 40 50% Birmingham - Queen Elizabeth Hospital 70 80% Hereford Dialysis Centre 30 40% Kidderminster (QEH) 40 50% Lichfield Dialysis Centre 90 100% Tipton (QEH) Birmingham Children's Hospital Coventry - Walsgrave Hospital 60 70% Nuneaton - George Eliot Hospital 30 40% Rugby - St Cross Hospital 50 60% Stratford upon Avon 70 80% Whitnash - Leamington Spa 60 70% Dudley - Russells Hall Hospital 70 80% Kidderminster (Russells Hall) 40 50% Tipton (Russells Hall) Royal Shrewsbury Hospital 60 70% Telford 40 50% Crewe - Leighton Hospital 50 60% Stafford 70 80% Stoke - University Hospital of North Staffordshire 70 80% Cannock 70 80% Tipton (New Cross) Walsall Dialysis Centre (New Cross) 70 80% Wolverhampton - New Cross Hospital 40 50% Wolverhampton - Pond Lane 60 70% The number of responses for England is slightly lower than the national figure included in the main NHS IC survey report, which also includes data for Wales and Northern Ireland. In 2010 a total of 1,159 responses were received from residents in the West Midlands. At PCT level some areas have relatively low numbers of responses (particularly Herefordshire PCT in 2010). Analysis based on areas with low numbers of responses Page 6

should be interpreted with caution as the findings could be subject to response bias and random variation. The total number of SCG/PCT responses differs from the total number of unit responses as the former is based on the location from where the patient s journey to dialysis commenced whereas the latter is based on unit of attendance. Renal Registry data indicate that approximately 98% of patients resident in the West Midlands attend West Midlands units. A further 2% of patients resident in the West Midlands attend Derby City General Hospital, and the results for that unit are included in the East Midlands SCG report. Conversely, some patients attending West Midlands units are resident outside the West Midlands (for example, 4% of patients resident in the North West attend the University Hospital of North Staffordshire and a small number of patients resident in the East Midlands attend Coventry Walsgrave Hospital). Table 2: Number of survey responses, 2008 and 2010 Area Number of responses 2008 survey 2010 survey England 9,095 9,535 Midlands and East SHA cluster 3,002 3,129 West Midlands SHA 1,269 1,159 PCT Birmingham East and North PCT Coventry Teaching PCT Dudley PCT Heart of Birmingham Teaching PCT Herefordshire PCT North Staffordshire PCT Sandwell PCT Shropshire County PCT Solihull Care Trust South Birmingham PCT South Staffordshire PCT Stoke on Trent PCT Telford And Wrekin PCT Walsall Teaching PCT Warwickshire PCT Wolverhampton City PCT Worcestershire PCT Main unit Birmingham - Heartlands Hospital Birmingham - Queen Elizabeth Hospital Coventry - Walsgrave Hospital Dudley - Russells Hall Hospital Shrewsbury - Royal Shrewsbury Hospital Stoke - University Hospital of North Staffs Wolverhampton - New Cross Hospital 166 58 44 89 26 35 97 74 54 78 122 67 59 77 78 53 92 290 461 156 67 142 186 160 149 80 46 92 15 45 32 55 64 68 131 57 34 77 89 70 55 301 264 206 87 102 205 201 Page 7

5. Age of respondents In the West Midlands just under 55% of respondents were aged over 65 years, a similar proportion to England as a whole. The proportion aged over 65 years varied significantly by PCT, the highest being in Herefordshire PCT where over 73% of respondents were within this age group. Nationally, the age profile of participating patients in 2010 was similar to that in 2008. The extent to which the age distribution of survey respondents matches that of the total dialysis population is not fully known. However, comparison of national response rates with Renal Registry data suggests that there was a relatively lower response rate in younger adults compared to older adults. Figure 2: Age of respondents, 2010 Page 8

6. Mode of transport used to get to/from dialysis The survey asked detailed questions on the patient s mode of transport to and from dialysis. These were then grouped and reported under the main categories of Hospital Arranged, Public, or Private, as follows: 1. Hospital arranged transport Hospital transport vehicle Ambulance service vehicle Car provided by the hospital Taxi provided by the hospital 2. Public transport 3. Private Transport Travelled in own car Friends or family car Taxi arranged by patient Walk In the West Midlands 57.8% of patients reported using hospital arranged transport to travel from home to the renal unit, compared to 40.1% who used their own private transport. Very few used public transport (Figure 3). Mode of transport to renal unit varied by PCT and unit. For example, 78.6% of Herefordshire PCT patients used hospital transport compared to 45.7% of Dudley PCT patients. In some units across England, patients who did not use hospital arranged transport were mistakenly not asked to complete the survey, so the figures for public and private transport may be under-represented. Page 9

Figure 3: Mode of transport from home to renal unit, 2010 Across the West Midlands the proportion of patients using hospital arranged transport to travel from home to renal unit did not change significantly between 2008 and 2010. Page 10

Figure 4: Patients using hospital arranged transport to travel from home to dialysis unit, comparison of 2008 and 2010 Not all patients used the same mode of transport in both directions and Figures 5 and 6 below show mode of transport from renal unit to home. Findings are broadly similar to those given above for mode of transport from home to renal unit. Slightly more patients reported using their own transport to return home than to travel to the unit, but the change was small. Page 11

Figure 5: Mode of transport from dialysis unit to home, 2010 Page 12

Figure 6: Patients using hospital arranged transport to travel from dialysis unit to home, comparison of 2008 and 2010 Page 13

7. Payment for transport Patients were asked if they had to pay for their transport to dialysis, if they paid then claimed it back or if they did not pay at all. The national survey reports payment for transport by transport mode, but it is not possible to carry out this analysis at SCG/PCT level using iview. In the West Midlands 22.5% of patients said they had to pay for transport to/from dialysis (i.e. those who pay and cannot claim back the costs). This is higher than 18.8% of patients who have to pay across England. There is significant variation by PCT and unit. Only 9.1% of Telford and Wrekin PCT patients have to pay, compared to 32.8% of Solihull Care Trust patients. However, the relatively low number of responses in some PCTs should be considered when interpreting the significance of this variation. Page 14

Figure 7: Payment for transport, 2010 Across England, the proportion of patients who pay for transport has reduced slightly between 2008 and 2010 (from 19.2% to 18.8% of patients). The proportion of West Midlands patients who pay has similarly reduced (from 24.0% to 22.5%). Some West Midlands PCTs have seen little change over the period whereas others have seen larger changes in the proportion of patients who have to pay (e.g. Solihull Care Trust reduced from 44.9% to 32.8%). Page 15

Figure 8: Patients who pay for transport, comparison of 2008 and 2010 Patients were also asked whether they had been given the chance in the last six months to review whether they have to pay for dialysis transport. In the West Midlands only 5.0% of patients said they had been offered such an opportunity (compared to 5.4% of patients across England). Page 16

8. Journey distance Each respondent was asked for their home postcode or to estimate how far away from the dialysis unit they lived. The distances quoted are the combination of the calculated direct (as the crow flies) distances from the postcode and the estimated distances. Almost three quarters of patients in the West Midlands (71.2%) live within five miles of their dialysis unit, and a further 19.0% live six to ten miles away. Only a small proportion of patients (1.1%) live more than twenty miles away (Figure 9). There was significant variation by PCT and unit. Almost 90% of Birmingham Heartlands Hospital patients live within five miles of their unit, compared to only 39.4% of Royal Shrewsbury Hospital patients. Figure 9: Distance travelled to dialysis unit, 2010 Across the West Midlands there was no significant change in the proportion of patients who live within 10 miles of their renal unit between 2008 and 2010. Page 17

Figure 10: Patients travelling less than ten miles to dialysis unit, comparison of 2008 and 2010 In 2010 patients were asked whether they were having dialysis in the unit of their choice and, if not, whether they would prefer to have dialysis in a unit closer to where they live. An equivalent question was not included in the 2008 survey. Across the West Midlands 7.2% of patients said they were not having dialysis in their unit of choice, slightly higher than for England (6.5%). However, this varies from 2.0% Page 18

of University Hospital of North Staffordshire patients to almost one in eight (14.4%) of Royal Shrewsbury Hospital patients. Figure 11: Patient having dialysis in unit of choice, 2010 Nationally, only 8% of patients who said they were not dialysing in the unit of their choice expressed a preference for a unit closer to their home. It is not possible to analyse this data below national level due to not being able to apply data filters in iview. Page 19

9. Travel time For the following analysis it has not been possible to distinguish journey times between those travelling by hospital transport and other means. The times in this report, therefore, refer to all journey times including private, hospital and public transport. The Renal Association Haemodialysis clinical guidelines (1.3) state that, except in remote geographical areas, travel times between home and a dialysis unit should be 30 minutes or less for patients 1. In the West Midlands most patients (76.5%) have a travel time to the unit of less than 30 minutes. This is slightly higher than the proportion across England as a whole. However, some patients have much longer travel times, particularly those residing in Worcestershire PCT where almost 6% have a travel time of more than one hour. Figure 12: Travel time - home to dialysis unit, 2010 1 http://www.renal.org/clinical/guidelinessection/haemodialysis.aspx#s1 Page 20

In the West Midlands the proportion of patients with a travel time from home to unit of less than 30 minutes improved slightly between 2008 and 2010. This improvement was especially marked for Dudley Russells Hall Hospital, where 85.1% of patients had a travel time of less than 30 minutes in 2010 compared to 75.0% in 2008. Figure 13: Patients with travel time less than 30 minutes, home to dialysis unit, comparison of 2008 and 2010 Page 21

The findings for transport time from dialysis unit to home (Figures 14 and 15) were broadly the same as those for journey time from home to the dialysis unit. Figure 14: Travel time - dialysis unit to home, 2010 Page 22

Figure 15: Patients with travel time less than 30 minutes, dialysis unit to home, comparison of 2008 and 2010 Page 23

10. Waiting time Four questions on waiting time were included in the survey: Wait for hospital arranged transport to collect from home Arrival time at unit compared to allocated dialysis time Wait between arrival at unit and start of dialysis session Wait between end of dialysis and being ready to leave, and actually leaving the unit The Renal Association Haemodialysis clinical guidelines (1.4) state that patients should be collected within 30 minutes of their arranged collection time before and after dialysis, and should not have to wait more than 30 minutes after they arrive at the dialysis unit to commence their treatment 1. The question regarding wait for collection from home was intended to be answered only by patients using hospital arranged transport, and the national report presents data relating only to this cohort. Unfortunately, iview does not allow a filter to be applied to allow this cohort of patients to be separately identified for analysis by SCG/PCT/unit. However, the number of responses to this question (excluding missing/invalid responses) matches almost exactly the number of patients using hospital arranged transport, so it is reasonable to assume that analysis of valid responses to this question will include mainly hospital arranged transport patients. It is possible, however, that a small number of responses from patients using public or private transport are also included. The remaining waiting time questions were intended to be answered by all patients, regardless of mode of transport. The main survey report limits analysis to hospital transport patients only, but it is not possible to replicate this as iview data does not allow such filters. In the West Midlands almost half of all patients (48.5%) were collected within 10 minutes of the expected time. Early pick up was more common than late pick up, with 17.7% of patients in the West Midlands collected over 30 minutes earlier than expected. Late pick up was especially common for Warwickshire PCT residents, where 15.6% were collected more than 30 minutes later than expected. By unit, Birmingham Queen Elizabeth and Coventry Walsgrave units had more late pick ups compared to the other West Midlands units. 1 http://www.renal.org/clinical/guidelinessection/haemodialysis.aspx#s1 Page 24

Figure 16: Waiting time for pick up prior to dialysis, 2010 In the West Midlands the proportion of patients picked up within 30 minutes of the expected time improved slightly between 2008 and 2010 (from 74.9% to 76.4%). However, in some units the proportion of patients picked up within 30 minutes of the expected time decreased between 2008 and 2010, most notably at Dudley Russells Hall Hospital. Page 25

Figure 17: Patients picked up prior to dialysis within 30 minutes of expected time, comparison of 2008 and 2010 Just over 42% of patients in the West Midlands arrived within 10 minutes of their booked time. Most of the remaining respondents arrived early with a significant proportion (17.6%) arriving more than 30 minutes early. Only a small proportion (3.2%) arrived more than 30 minutes later than their allocated time. However, this may cause stress for the patient and organisational difficulties for the unit. Recommendations for the provision of a patient centred renal transport service, arising from the Cheshire and Merseyside Renal Transport Action Learning Set, propose that a Page 26

minimum of 85% of patients should arrive on the dialysis unit no earlier than 30 minutes before their dialysis start time 1. This standard has been adopted by many units. Figure 18: Arrival time compared to allocated dialysis time, 2010 Over 79% of patients in the West Midlands arrived at the unit within 30 minutes of their allocated dialysis time, a small improvement from 78% in 2008. 1 http://www.kidney.org.uk/campaigns/dialysis/patienttransport/renal-transport-cheshire-and- Merseyside.pdf Page 27

Figure 19: Patients arriving at unit within 30 minutes of allocated dialysis time, comparison of 2008 and 2010 In the West Midlands 32.1% of patients started their dialysis within 10 minutes of arriving at the unit, and a further 50.6% started within 10 to 30 minutes of their arrival. Approximately 17% waited more than 30 minutes for dialysis to commence. Long waits were most common for Dudley Russells Hall Hospital, where almost one third of patients waited more than 30 minutes for dialysis to commence. However, this should Page 28

be considered alongside the data on arrival time compared to allocated time as in some cases waits may be due to early arrival at units. Figure 20: Waiting time between arrival at unit and start of dialysis, 2010 Almost 83% of patients in the West Midlands started dialysis within 30 minutes of arrival at the unit, an increase from 80.5% in 2008. Page 29

Figure 21: Patients starting dialysis within 30 minutes of arrival at unit, comparison of 2008 and 2010 Page 30

The Renal Association Haemodialysis clinical guidelines (1.4) state that haemodialysis patients who require transport should be collected to return home within 30 minutes of finishing dialysis 1. In the West Midlands 73.2% did not have to wait more than 30 minutes. However, there still remains a significant minority waiting longer than 30 minutes, with 8.9% waiting more than one hour (Figure 22). This varies significantly by unit, and 37.8% of Birmingham Queen Elizabeth Hospital patients waited over 30 minutes compared to only 18.0% of University Hospital of North Staffordshire patients. Figure 22: Waiting time for pickup after dialysis, 2010 1 http://www.renal.org/clinical/guidelinessection/haemodialysis.aspx#s1 Page 31

Over 73% of West Midlands patients were picked up within 30 minutes of being ready to leave after dialysis, a similar proportion to 2008. Figure 23: Patients picked up after dialysis within 30 minutes of being ready to leave, comparison of 2008 and 2010 Page 32

11. Patient satisfaction Patients were asked a number of questions regarding their personal satisfaction with the current arrangements: General satisfaction (overall, does transport meet your needs) Satisfaction with the following aspects of hospital arranged transport: o Cleanliness o Comfort o Punctuality o Number of patients picked up o Ease of access o Friendliness of staff o Cost o Staff understanding my needs. The first general satisfaction question regarding whether transport meets patients needs was intended to be answered by all respondents, regardless of mode of transport. The remaining questions regarding specific aspects of transport were intended to be answered only by patients using hospital arranged transport, and the national NHS IC report presents data relating only to this cohort. Unfortunately, iview does not allow a filter to be applied to allow this cohort of patients to be separately identified for analysis by SCG/PCT/unit. However, the number of responses to these questions (excluding missing/invalid responses) closely matches the number of patients using hospital arranged transport, so it is reasonable to assume that analysis of these questions includes mainly hospital arranged transport patients. It is possible, however, that a small number of responses from patients using public or private transport are also included. The only exception to this is the question regarding satisfaction with cost where the number of valid responses is much lower than for the other questions. It is likely, however, that patients who do not pay for transport self-screened and did not answer this question. In the West Midlands, 87.6% of patients said that their transport met their needs all or most of the time. Only a small proportion (4.3%) said it did not meet their needs. There was a small improvement in general satisfaction between 2008 and 2010. These findings are similar to the England average. Page 33

Figure 24: Patient general satisfaction rating: does transport meet needs, 2010 Page 34

Figure 25: Patients with transport needs met all or most of the time, comparison of 2008 and 2010 Patients who used hospital arranged transport were asked to rate their satisfaction with various aspects of the service they received on a five point scale (very happy, happy, neutral, unhappy, very unhappy). The following figures (26 to 41) show that the majority of patients were largely happy or very happy with all aspects of the service in the majority of dimensions measured. The main exception was punctuality where satisfaction levels were lower. Happiness with Page 35

staff-related factors (friendliness of staff and understanding of patients needs) was particularly high. Figure 26: Satisfaction with cleanliness, 2010 Page 36

Figure 27: Patients happy or very happy with cleanliness, comparison of 2008 and 2010 Page 37

Figure 28: Satisfaction with comfort, 2010 Page 38

Figure 29: Patients happy or very happy with comfort, comparison of 2008 and 2010 Page 39

Figure 30: Satisfaction with punctuality, 2010 Page 40

Figure 31: Patients happy or very happy with punctuality, comparison of 2008 and 2010 Page 41

Figure 32: Satisfaction with number of patients picked up, 2010 Page 42

Figure 33: Patients happy or very happy with number of patients picked up, comparison of 2008 and 2010 Page 43

Figure 34: Satisfaction with ease of access, 2010 Page 44

Figure 35: Patients happy or very happy with ease of access, comparison of 2008 and 2010 Page 45

Figure 36: Satisfaction with friendliness of staff, 2010 Page 46

Figure 37: Patients happy or very happy with friendliness of staff, comparison of 2008 and 2010 Page 47

Figure 38: Satisfaction with cost, 2010 Page 48

Figure 39: Patients happy or very happy with cost, comparison of 2008 and 2010 Page 49

Figure 40: Satisfaction with staff understanding of needs when use transport, 2010 Page 50

Figure 41: Patients happy or very happy with staff understanding of needs when use transport, comparison of 2008 and 2010 Page 51

12. Conclusion These SCG reports are purely descriptive and there is no attempt at drawing conclusions or making recommendations. They should be used in conjunction with the national, and unit level, NHS IC summary reports, and can be used by commissioners to provide evidence to inform commissioning priorities and as a means of measuring change between the 2008 and 2010 transport audits. The patient transport audit and analysis provides organisations with an ideal opportunity to evaluate and improve transport services for renal patients. By bringing together specialist commissioners, patients and their carers, renal unit managers and clinical staff to look at these issues, improvements can be made in areas that have a big impact on the quality of life for haemodialysis patients and deliver more effective renal services. An action planning page holding copies of local plans, case studies and other resources is available on the NHS Information Centre website 1. Date: September 2011 1 http://www.ic.nhs.uk/services/national-clinical-audit-support-programme-ncasp/kidney-care/patienttransport/action-planning Page 52

This report has been produced by the East Midlands Public Health Observatory (EMPHO) on behalf of NHS Kidney Care. It uses data provided by the Information Centre and the UK Renal Registry. Some of the data reported in the report have been sourced from the NHS Information Centre. Copyright 2011, re-used with the permission of the Health and Social Care Information Centre. All rights reserved. www.kidneycare.nhs.uk www.empho.org.uk Page 53