Non-emergency patient transport: the picture across Wales January 2018 0 P a g e
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Contents Section Page number About community health councils 3 Background 4 Introduction 6 What we did 7 What we found Availability of non-emergency patient transport across NHS services, including services outside hospitals How people are informed about nonemergency patient transport Suitability of non-emergency patient transport 8 8 11 14 Conclusion 15 Appendix 1 16 2 P a g e
About Community Health Councils This report has been produced by the Board of Community Health Councils on behalf of the Community Health Councils (CHCs) in Wales. CHCs are the independent watch-dog of NHS services within Wales and we seek to encourage and enable members of the public to be actively involved in decisions affecting the design, development and delivery of healthcare for their families and local communities. CHCs seek to work with the NHS and inspection and regulatory bodies to provide the crucial link between those who plan and deliver the National Health Service in Wales, those who inspect and regulate it, and those who use it. CHCs maintain a continuous dialogue with the public through a wide range of community networks, direct contact with patients, families and carers through our Enquiries Service, Complaints Advocacy Service, visiting activities and through Public and Patient surveys. Each of the 7 CHCs in Wales represents the Patient voice within their respective geographical areas. January 2018 3 P a g e
Background I had to pay 45 for my initial journey to Morriston from the Accident and Emergency Department at the Princess of Wales Hospital. No transport was offered, yet transport to my home from Morriston by taxi and mini-ambulance to Porthcawl was free. It was all arranged by the ward staff in Morriston. For the record, I had no objection for paying the taxi fare, it was good to get treated but why the discrepancy? CHCs across Wales are often contacted by people confused about the support available with transport to and from health care services. This can apply when accessing all areas of health care and is not limited to hospital appointments. In some cases issues can lead to formal concerns, particularly where people have felt that transport difficulties have left themselves or a loved one feeling vulnerable. Our advocacy teams across Wales frequently support people to raise concerns about a range of transport issues. Over the last year many of these concerns have related to prearranged non-emergency patient transport arriving late or being cancelled. Patients have also raised concerns about the poor co-ordination of patient transport with appointment times. In some cases this has led to people having to cancel appointments. 4 P a g e
In some circumstances, people have raised concerns because they have been provided with no transport options at all. This has led to people being unable to access healthcare services or being stranded without transport home. We include a selection of the issues raised with us over the past year throughout this report. Transport is an important part of people s health care experience and usually one of the first concerns people have when services are developed or changed. Introduction The majority of non-emergency patient transport for people who live in Wales is provided by the Welsh Ambulance Services Trust (WAST), although they are not commissioned to transport people to or from primary care facilities. There have been a number of reports and initiatives over the last 10 years aimed at getting things right. In 2016 the then Deputy Health Minister Vaughan Gething announced plans to: modernise the non-emergency transport service to improve overall quality of care through the provision of a safe and timely service to meet the needs of individual patients and reduce pressures on the 999 emergency service. These plans were to be introduced in a phased way, and completed by March 2017. In May 2017 the then Cabinet Secretary for Health, Well-being and Sport published a written statement updating on progress and the work that still needed to be done 1. Progress included: 1 http://gov.wales/about/cabinet/cabinetstatements/2017/patienttransport/?lang=en 5 P a g e
extending the availability of the service to 6am to 8pm Monday to Saturday putting in place the legislation that would over time, enable nonemergency patient transport to be commissioned nationally improved arrangements for renal dialysis, oncology and end of life patients. The Emergency Ambulance Services Committee (EASC) is leading a project designed to commission and oversee the delivery of nonemergency transport services across Wales. What we did We asked health boards in Wales to tell us about their arrangements for non-emergency patient transport services. The questions we asked are set out at appendix 1. 6 of the 7 health boards in Wales responded to our request. We did not received a response from Cardiff and Vale University Health Board. Our report therefore reflects the information provided by: Aneurin Bevan University Health Board Abertawe Bro Morgannwg University Health Board Betsi Cadwaladr University Health Board Cwm Taf University Health Board Hywel Dda University Health Board Powys Teaching Health Board We also looked at the information available electronically to patients and the public about non-emergency patient transport. 6 P a g e
What we found Availability of non-emergency patient transport across NHS services, including services outside hospitals All the health boards told us they provided non-emergency patient transport services in line with a national protocol issued by the Welsh Government in 2007 2. This protocol sets medical criteria under which patients should be offered non-emergency patient transport to or from a health facility. Most health boards told us that the funding for non-emergency patient transport is predominantly to enable access to secondary care. The protocol states: Patients who are not eligible for non-emergency patient transport should be advised of alternative methods of transport so they can make their own arrangements to go to the designated treatment centre/ hospital. If having tried all alternatives the patient has no other means of transport available to them then they should be considered. Health boards told us that patients who did not meet the criteria for non-emergency patient transport were encouraged to make their own arrangements. Health boards told us that patients were usually referred to Traveline Cymru to identify public transport options. Some health boards told us that patients were advised of the Hospital Transport Scheme 3 which can reimburse the cost of travel for people on some benefits. 2 http://www.wales.nhs.uk/documents/whc(2007)005.pdf 3 http://www.healthcosts.wales.nhs.uk/travel-costs 7 P a g e
All health boards told us that whilst the majority of their nonemergency patient transport was provided by WAST they also supported patients in other ways. Additional transport options varied significantly between health boards. Health boards described a range of circumstances in which they would consider offering transport and support. For some this was about responding to patient needs and local circumstances, for example: taxis for those in vulnerable situations 3 rd sector transport providers to travel to appointments outside Wales Partnerships with local authorities to overcome issues of rurality and isolation. Others focussed on cost limitation and patient flow issues. What needs to improve I have to get my wounds dressed every two days. This is no longer available at my local surgery so I have to travel by bus. I know my legs smell and I can see people on the bus moving away from me. It makes me feel embarrassed, but there is nothing I can do about the smell. The current protocol does not limit the availability of free nonemergency patient transport to secondary care. It is based on individual medical need. 8 P a g e
We find it difficult to see why or how medical need would automatically change based on whether the NHS service is being delivered in primary or secondary care. We also know that NHS plans for the future involve greater integration between health and social care, a move of services out of hospital in to community based settings and a bringing together of current local services in one place. Any new arrangements must provide support for people based on their individual medical need and not on where services are delivered or by whom within the NHS. The framework within which health boards take decisions about the provision of non-emergency patient transport for people who do not meet the eligibility criteria on medical grounds must be clearer. Any framework must be well communicated to front line staff and patients and ensure equitable and safe provision across Wales. I was taken by ambulance to A&E and discharged at 4am. I was told to find my own way home even though the staff were aware I lived alone, 30 miles away 9 P a g e
How people are informed about nonemergency patient transport Many of the health boards told us that there had been little communication with patients directly in recent months. They told us that they intended to undertake a more comprehensive programme of communication once new national arrangements are introduced. Some health boards told us that information was included in outpatient appointment letters. A few also told us they included information in letters regarding admission. Some health boards have provided information about non-emergency patient transport to be displayed in GP surgeries. Many told us that ward staff were responsible for making appropriate arrangements for people staying in hospital. Where health boards provide additional transport options and support, we were told that this is usually the responsibility of front line staff. For this approach to work effectively all front line staff need to be aware of the options available and recognise their responsibility to proactively consider what is appropriate. We looked at the information available on NHS websites about the provision of non-emergency patient transport. The information available varied between health boards but was often extremely limited, focused solely on hospital transport, difficult to find and had clearly not been reviewed for some time. The WAST website also provides information for patients. It describes its provision of non-emergency patient transport as patient care services in some places, and in others as the Non-Emergency Patient Transport Service. 10 P a g e
It states that The Patient Care Service (PCS) provides non-emergency transport to the residents of Wales who are unable for medical reasons to make their own way to hospitals and treatment centres. This includes: Outpatient appointments Patients for dialysis and cancer treatments Day centre and psycho-geriatric clinics Admissions and discharges, including inter-hospital transfers. The service acts as a vital link between communities and is an integral part of the overall package of health care the Welsh Ambulance Service provides in Wales. The website also lets people know how they can book transport. This includes a range of different telephone numbers. The numbers to call vary depending on whether or not people are booking their first journey or where they live in Wales. For first journeys, there is a single telephone number. Other journeys may be booked through regional centres; through a GP or arranged by the hospital department. This is confusing. We have been advised that there is now a national number that people can call however we did not find this listed on websites. We looked on NHS websites for information regularly reported to the public on the performance of non-emergency patient transport services across Wales. We could not find any. We have been advised that this will be addressed later in 2018. What needs to improve We recognise that health boards are planning to communicate with patients to support the introduction of new arrangements. However timelines for this are unclear and new arrangements may still be some way off. 11 P a g e
In the meantime the information available does not always empower patients to ask for the transport they need. Booking arrangements need to be simpler and easier for patients. Patients need to be properly informed about their transport options. NHS staff need to be empowered to take a proactive approach so that everyone, including people in the most vulnerable situations gets any support they need to access healthcare services and get home safely. Information on the performance of non-emergency patient transport services across Wales needs to reflect what is important to people about the services and be reported regularly to the public. Suitability of non-emergency patient transport Health boards told us that a national on-line assessment tool was used to assess the needs of patients. Some health boards told us they had a range of transport options from a variety of providers to meet identified needs. WAST describe an extensive programme of vehicle replacement for its non-emergency transport service, with further plans to replace vehicles. 12 P a g e
What needs to improve 'I live in Ceredigion and had an appointment to see my consultant in Cardiff at 4pm on [] January 2018. When I asked for transport I was told that the appointment time was too late, and that I would need to change it. When I asked the consultant's secretary for a different appointment I was told there would not be one available until July, 2018. I needed to attend this appointment as soon as possible. My only option was to travel by Megabus, stay overnight, and catch the Megabus back the next day. This was a totally exhausting procedure as neither my mobility or my stamina are very good at the moment.' Future arrangements must ensure a suitable range of transport options is available across Wales to meet peoples varying needs. There needs to be a joined up approach so that suitable transport is available to take people to and from appointments. Conclusion Non-emergency patient transport is a very important part of patients experience of accessing their NHS care, wherever it is delivered. It is essential that the public have confidence that their transport needs will be met, particularly when health services are changing and evolving. 13 P a g e
Whilst the progress made so far in extending the availability of nonemergency patient transport is welcome, much more needs to be done. In the longer term, new arrangements must take account of the views and experiences of people using non-emergency patient transport services, as illustrated in our report. It is also important there is some impetus to introduce the new arrangements at the earliest opportunity. In the meantime, health boards need to review their existing arrangements and the information available to patients and front line NHS staff. Board of Community Health Councils in Wales January 2018 14 P a g e
Appendix 1 Non-emergency patient transport Health Board Is patient transport available to take people to or from any of your NHS services, including primary and community services? If yes Under what circumstances? How are patients informed? How do you decide on your patient transport provision? Where services have moved, including transfer from secondary to community settings in the last 24 months how has this impacted on the availability of patient transport? 15 P a g e
Do you support patients with transport to get to or from any of your services in any other way?(eg pay for taxis, have arrangements with 3rd sector providers, subsidised bus routes etc) If yes Please give details of the provision and the circumstances in which support is available eg., the services involved and any qualifying criteria/ rationale If applicable, how are patients informed? How do you ensure the transport provided is suitable to meet the specific needs of individuals? Completed by: Date: 16 P a g e
Board of Community Health Councils in Wales 33 / 35 Cathedral Road Cardiff CF11 9HB 02920 235 558 enquiries@waleschc.org.uk www.communityhealthcouncils.org.uk @CHC_Wales 17 P a g e