NHS non-urgent Patient Transport Service (PTS) Engagement Report September 2015
Introduction The Sussex PTS is currently provided by the South East Coast Ambulance Service (SECAmb). Around 280,000 PTS journeys are booked each year, with patients being moved to and from NHS-funded treatment at a range of sites across Sussex including acute hospitals and local venues providing community-based care. The service provides some 23,000 journeys per month for people who are unable to use public or other transport owing to medical conditions. The service is booked by patients and health care professionals through the Patient Transport Bureau (PTB) and is free at the point of use for people who meet certain medical criteria which would otherwise prevent them from getting to their appointment. It does not include urgent ambulance journeys. PTS is for patients who have been clinically assessed as having a condition that means: They need the assistance of ambulance staff or other skilled personnel for the journey, and/or; It may be medically harmful to their health to travel by other means. In mid-2014, SECAmb stated it did not wish to extend the existing contract under the current terms beyond the scheduled end date of 31 March 2015. However, SECAmb subsequently agreed a twelve month transition period to support the commissioning of a new, more innovative and more patient-centred service extending the current contract to the 31 March 2016. NHS Crawley Clinical Commissioning Group (CCG) and NHS Horsham and Mid Sussex CCG are working with the other CCGs in Sussex including: High Weald Lewes Havens Eastbourne, Hailsham and Seaford Hastings and Rother Brighton and Hove Coastal West Sussex Engagement Approach From the start the CCGs have been clear that the public, service users and their carers must have the opportunity to feed in their thoughts and views and to be able to feedback on plans as they developed. The aim is to deliver a future patient transport service that can take account of patients different needs and transport requirements and provide a high quality and safe service with equitable access for all people registered with a Sussex GP practice
Engagement has been led by the CCGs and the approach has been based on Sussex wide plan and materials, which have included: Online survey / questionnaire available on CCGs websites Hard copy survey / questionnaire including freepost address envelopes distributed widely including being available on PTS vehicles Posters promoting public engagement events, encouraging people to give their views and complete the survey along with contact details for further information Horsham and Mid Sussex CCG and Crawley CCG specific engagement activities have included: Five patient and public engagement events that were held across Crawley, Horsham and Mid Sussex during January and February 2015. This was part of a wider number of events that were held across Sussex Face to face interviews with service users and staff at Surrey and Sussex Healthcare NHS Trust, Princess Royal Hospital in Haywards Heath and the Crawley Kidney Treatment Centre The project manager spending the day as an observer on a Patient Transport vehicle. To maximise promotion of the survey / questionnaire and public engagement events the following methods were used: Distribution to HMS and Crawley Clinical Patient Reference Groups for dissemination to Patient Participation Groups within GP Surgeries Distribution to all members of HMS and Crawley Health Networks (HMS 154 Members / Crawley 253 made up of both members of public and voluntary and community organisations) Distribution to all CCGs Stakeholders Lists (made up of local voluntary, community and statutory organisations) Promotion of survey / questionnaire via all local media including Mid Sussex County Times, East Grinstead Courier, Crawley News, Crawley Observer Internal Intranet All GP membership to HMS and Crawley CCGs Social medial including Twitter and Facebook Survey A total of 190 surveys were completed, 34 received via the PTS Project Engagement Freepost address, the remaining 156 online. We wanted to know what people liked and disliked about the current service and how, in their opinion, it could be improved. To ascertain this, the survey posed the following questions and below is an analysis of the answers given. Complete survey results can be found in Appendix 1:
1. How often do you use the Patient Transport Service? 140 120 100 80 60 40 20 0 Weekly Monthly Occasionally Once or twice Never 2. Based on your experience, what did you like about the service? (eg. journey and waiting times, the way you were treated by staff, the comfort and cleanliness of the vehicle) 125 People responded to this question focusing on 3 major themes; staff, waiting times and the PTS ambulance. As only a low number of responders had actually used the service, we have to presume that the remaining responders are responding because they had a relative who has or a member of staff who has first-hand knowledge. The majority were extremely complimentary of the staff and service in general. Some commented that the vehicles were clean and well maintained. Issues around waiting times and a lack of information of service and eligibility criteria were raised.
Overall satifaction from PTS Bad Good Mixed No experience 19% 17% 14% 50% I am extremely grateful for the services/help we receive; all the drivers are kind and helpful in every way. I feel so guilty when some appointments seem to last for ever but each time the drivers are philosophical about the unexpected delays. I can't thank them and the transport organisers enough As someone who books transport for patients from time to time to come to hospital appointments in our department, I find that the system usually works well. The people who arrange the transport, and the drivers, both ambulance staff and volunteers, are communicative and helpful. If there is a problem, the organisers let us know as soon as they can.
3. Is there anything you think could be improved about the service? (eg. journey and waiting times, the way you were treated by staff, the comfort and cleanliness of the vehicle) From the 128 people that responded many commented that waiting times for both drop-off and pick-up could and should be improved. Patients commented that they were often picked up to 2 hours before their appointment time to allow for traffic and other numerous pick-ups. Respondents commented that a more personalised taxi type service would improve the service. Staff, patients and relatives commented that return journeys often resulted in long waits without the patient or staff being informed what was happening. Frail, elderly and vulnerable patients became anxious thinking that they had been forgotten. This impacted on staff who often had to follow up with PTS and continue to reassure the patient. Suggestions to alleviate this include better communication between patient, staff and PTS and better use of technology which would enable staff / patient to be informed of anticipated time of arrival and any delays. Areas for improvement Lack of PTS Lounges 7% Non Applicable 16% No Response 4% Parking at the hospital 0% Service Delivery incl booking system 5% Waiting Times 22% Hospital Handover 0% Vehicles 28% PTS Staff 13% Communications 5%
Ideally the service would be run like a taxi service where pick up times could be designated more exactly. More practically waiting around for an hour for a pick-up from my home is more acceptable than waiting on my own in a hospital waiting area for up to 2-3 hours wondering whether I have been forgotten. If it is lunchtime or late afternoon there may be no one around to check on when I will be picked up. It is at such times I feel vulnerable and anxious.. 4. Based on your experience, what did you not like about the service?(eg. journey and waiting times, the way you were treated) A comparatively low number people responded to this question (31) and those who did mainly commented on waiting times for both to and from journeys. For those who commented on the way they had been treated, all were complimentary towards staff with two individuals commenting that all aspects of the service was good and had nothing negative to comment.
What you did not like about the service Service Delivery 16% No Response 63% Waiting Times 15% Vehicles 1% Communication 3% Booking 2% Waiting to be picked up - Driver not turning up until nurses had to ring around to find out why. Reason - he couldn't find me and was told that I was not due to until later in the week, which was true but another appointment on that same week had been arranged. Booking an appointment to travel to hospital - No transport turned up, on phoning transport office was told that none was booked..
Horsham and Mid Sussex CCG and Crawley CCG specific engagement activities Public Meetings To ensure equitable access for the public, five meetings were held across West Sussex as follows: Date Location Numbers 15.01.2015 Charis Centre, Crawley 13 19.01.2015 Drill Hall, Horsham 14 23.01.2015 East Court Mansion 12 28.01.2015 Clair Hall. Haywards Heath 10 05.02.2015 St Andrews Church Hall, Burgess Hill 4 Total 53 The programme and format for all events was the same and commenced with a presentation informing attendees of the current service, eligibility criteria, what the new PTS must achieve and potential service models. Following a Q&A session attendees were asked to work in groups and discuss the following questions: 1) What do you like about the current services (what works well)? 2) What don t you like about the current services (what doesn t work well)? 3) What ideas do you have to improve the service (what changes would you make)? 4) What stops the service being an excellent service? 5) What top three priorities would you like us to focus on? Below is a summary of what attendees told us, full feedback reports can be found in Appendix 2 (Note there is no feedback report for the event held in Burgess Hill due to the low number of attendees, however their feedback has been included within the summary below) Current service: Very few people know about PTS, how to contact, information about the eligibility criteria and how to book. There needs to be better information about the service and it needs to be more readily and widely available There are often long waits to get through to the Patient Transport Bureau (PTB) with callers waiting up to 20-30 minutes to get through The eligibility criteria do not appear to be consistently applied There needs to be the facility for PTS to subcontract, particularly with community transport organisations. Integration would make better use of capacity that is available within community transport and mean PTS is better placed to respond to on the day requests for transport.
Booking: Online booking system would enable healthcare professionals and patients to plan and book, amend and cancel a booking at any time Online system would also mean patients and staff could track their transport and receive up to date information around estimated time of arrival There must be telephone access for people who are not computer literate Better information needs to be captured at the booking phase and passed to the PTS crews. This needs to include the correct address and postcode, further information for hard to find addresses and specific information relating to the house and immediate surroundings, e.g. if there a significant incline/multiple stairs. This could alleviate the need for an ambulance if only a car is required and avoid delays if parking in street is difficult. The journey: Start the day on time as delays at 8am will impact through the day Improve communication so patients and staff know where vehicles/drivers are and when they can expect to be picked up We agree with the requirement for the new service to confirm the booking 24 hours ahead and that crews will ring 30-60 minutes before the scheduled pickup time to confirm transport on the way People need to be confident that they will get to their appointment on time Improve communication between crews and the base so bookings and schedules are constantly updated People waiting for transport need access to information or people who can keep them updated Patients can wait many hours to get home. If this is the case then they must be provided with food/drink, information, support and reassurance and help going to the toilet. Technology: There should be satellite navigation in every vehicle so drivers do not get lost and ask patients for direction A patient ready button or facility would be really helpful People can get forgotten whilst waiting in hospital departments in the larger hospitals. Would be good if all people waiting for transport waited in one area (or had locators- a system that works at Gatwick Airport!).
Face to Face Interviews To ensure that we sought real-time feedback from those patients who regularly use patient transport, face to face interviews with patients and members of staff, were held at the following: Date Location 09.04.2015 Princess Royal Hospital, Haywards Heath 13.04.2015 Princess Royal Hospital, Haywards Heath 20.04.2015 East Surrey Hospital, Redhill 22.04.2015 Dialysis Unit, Whitworth Road, Crawley No set format or set questions were used when interviewing and we simply asked for them to relay their experience of using the service if they were a patient or give their perception of the service if a member of staff. All feedback recorded during the interviews can be found in Appendix 3. Next Steps Following the completion of the engagement activities all feedback, regardless of source, was collated and analysed so that main themes could be identified and used to inform the development of a service specification describing the requirements for the new service. We wanted to ensure that the views of service users and the public continued to inform and influence the final service specification, the new procurement for the new PTS and the start-up of the new service. To achieve this, a Patient Forum was formed, which was made up of users of the service or carers for people using the service and represented each of the CCG areas. The Patient Forums purpose was to: Assist in the development of the final service specification: Ensure it reflects the key themes fed back in the PTS patient and public engagement events; Supports the delivery of a safe, fair, reliable patient-centred service. Support the PTS procurement: Help to devise the questions and criteria that will formed part of the evaluation process; A proportion of forum representatives will also have the opportunity to be part of the evaluation panel. Support the implementation of the new service: Ensure it develops in line with the service specification; Ensure it is meeting the quality and performance standards set. Involvement in development of all patient and public communications;
Ensure the needs of patients and their carer(s) are always considered. To support members of the Patient Forum we provided: Contact details of one of the PTS project managers An appropriate induction programme On-going training including procurement training Covered out of pocket expenses Conclusion This engagement exercise has proved to be extremely valuable as the feedback given has helped us identify and understand patient and other service user experience of the current service and how it might be improved. It has also highlighted some of the excellent aspects of the current service such as the personalised, caring service given by many members of the PTS crews. In conclusion the local people who contributed have significantly informed the specification and procurement process which should result in a new service that better meets the needs of the users. Acknowledgements We would like to thank all those local people who took the time to complete the survey, attend one of our public engagement meetings, took part in a face to face interview or joined the Patient Forum. Their feedback has been key to informing a specification for a new Patient Transport Service that will best meet the needs of local people and will deliver the improvement we all want.