PTS Update for HCC Health Topic Group 28.06.06

Non- Emergency Patient Transport Services (PTS)

Update for Hertfordshire County Council Health Topic Group,

Wednesday 28 June 2006.

1.Introduction

In December 2005, the Health Topic Group were asked to approve a temporary service change by a East & North Hertfordshire NHS Trust to restrict Patient Transport Services (PTS) to exclude all patients capable of walking (patients classified as A1). This proposal was agreed as a temporary measure, pending subsequent consultation.

The need to revise PTS eligibility criteria arose after the Strategic Health Authority was asked to arbitrate on the Service Level Agreement for 2005/06 which had been negotiated on a consortium basis by the acute Trusts in Bedfordshire and Hertfordshire with BHAPs. The arbitration decision was made in favour of BHAPs, with a resulting shortfall of £1m to be divided between the acute Trust and the PCT. To resolve the cost pressure of £500K, the Trust had to either find the additional resource, or reduce activity to the SLA level.

The outcome of the Health Topic Group meeting was a request for more detailed information about transport services and a request that the public consultation would establish long-term assessment criteria for continued PTS in East & North Hertfordshire.

2.Progress since Briefing for Health Topic Group December 05

2.1 Responses to the queries raised by the Health Topic Group on 6th December 2006 were supplied. The information supplied to the Topic Group included:

  • A copy of the eligibility criteria against which patient transport needs are assessed. This was provided under restricted circulation, for Health Topic Group members only.
  • The criteria that entitle patients to re-claim costs of travel to hospital.
  • Details of how the Health Shuttle is assessed, charged for and organised.
  • Details of a four day initial training scheme for call-centre staff, and on-going training.
  • Data quoted by BHAPS of the activity for E&NHT for 2004/5 and year to date at Month 8 (November) 2006.
  • Confirmation that the NHS Travellink Centre have scripted greetings and accept/decline phrases and an explanation on why the remainder of the calls are deliberately unscripted.
  • An invitation for any members of the Health Topic Group who wished to find out more about the system, to visit the centre and listen in to calls and to speak to the operators involved.

The NHS Travellink Centre has been visited by David Davies from Bedfordshire & Hertfordshire Strategic Health Authority. Other Trusts, for example Peterborough, Manchester and Brighton, have also visited the call centre because of interest in the Hertfordshire model.

The revised eligibility were applied in December 2005, following the Health Topic Group Meeting as a temporary measure, with an agreement for public consultation in 2006 prior to any substantive change.

2.3The TrustPatient Advice & LiaisonService has been working to ensure that there is coordination and sharing between various transport services. A workshop, hosted by PALS, entitled “Better Coordination of Patient Transport Services Proposed” was held at the ListerHospital on 9th June. It was chaired by Cllr Dr Dennis Lewis, the Chairman of Welwyn Hatfield Alliance and until recently Chairman of the Primary Care Trust Scrutiny Committee. Representatives attended the workshop from a range of non-commercial transport services within and outside Hertfordshire. The aim of the group was to ensure that any patient within Hertfordshire, who has a need to travel to a facility for health care for consultation or treatment, can do so easily and at a reasonable cost. Although the Trust has no direct control over these services, this initiative demonstrates that it is committed to working with partners to ensure that information about various existing transport services is coordinated and easily available.

2.4Competitive Tendering Update

A full meeting of interested parties was held on 22nd May, convened by the Consortium, at which the specification details were agreed. Seven potential service providers, including BHAPS, have been short-listed. The tender specification is being finalised and is expected to be issued in July. A revised time for implementation of the new contract is 1st April 2007.

It should be noted that the tender specification includes higher standards than previous contracts. For example there are more quality measures included, such as limited waiting times, and more flexibility in journeys, particularly out of hours.

3Impact & Benefits

3.1Impact on activity and costs

The activity and service costs for the year 2005/06 are enclosed in Appendix 1. Due to a change in the method of reporting in September 2005 the data for the first 6 months is an average of the actual total and cost.

Table 1 below details actual activity, costs and resultant savings for the third and fourth quarter 2005/06.

Table 1 Activity and costs for Quarter 3 & 4, 2005/06
Activity in units / Cost
October, November, December*2005 / 26,408 / £470,885
January, February, March 2006 / 22,059 / £393,432
Savings following restricted criteria - pye. / 4,349 / £77,453.

*Restricted criteria implemented during December 05

As detailed in the previous briefing for the Health Scrutiny Topic Group, in order to close the funding gap, the Trust needed to reduce the activity for 2005/06 units and to generate £418,556 annual savings.

PTS Contract Activity/Cost £ 2004/05 v's 2005/06
2004/05 / 2005/06 / Diff
Service / In units / In units / In units
E&N Main Contract / 67799 / 61088 / 6711
Renal / 40519 / 37141 / 3378
Cancer / 17929 / 13501 / 4428
Total / 126247 / 111730 / 14517
Cost/Activity 2004/05 v's 2005/06
Outturn / Outturn
In units / £
Outturn 2004/05 / 126247 / 2,414,000
Outturn 2005/06 / 111730 / 1,995,874
Savings / 14517 / 418,126
Note
The outturn figures above exclude HPT/Leg Ulcer activity, which was recharged to the relevant trust mid year.
The 2004/05 Outturn in £'s has been taken from initial estimates of the new sla cost model in early 2005/06. This was used to
calculate the potential financial risk for the trust in that year.
The actual outturn figures for 2005/06 in £'s may reduce further as a result of the full year effect of the criteria adjustments put in
place in November 2005.

Impact on Outpatient non-attendances

The outpatient ‘did not attend’ (DNA) data has been analysed for the six months before the change to the PTS service was implemented in December 05, and for the following six months. Table 2 shows that revising the criteria for PTS eligibility does not appear to have impacted on those unable to keep their appointments. Appendix 2 shows the DNA information by hospital site, confirming that there has been no significant change in DNA’s to whichever location of the outpatient departments

Table 2 ENHT Trust DNA rate June 2005 – May 2006

Trust Total
Jun-05 / Jul-05 / Aug-05 / Sep-05 / Oct-05 / Nov-05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Apr-06 / May-06 / Grand Total
New Patient DNA / 719 / 722 / 795 / 740 / 753 / 811 / 676 / 741 / 637 / 657 / 525 / 686 / 8462
Return Patient DNA / 2100 / 1886 / 1990 / 2132 / 1913 / 2084 / 1850 / 2186 / 2031 / 2048 / 1733 / 2143 / 24096
Grand Total / 2819 / 2608 / 2785 / 2872 / 2666 / 2895 / 2526 / 2927 / 2668 / 2705 / 2258 / 2829 / 32558

Impact on Patient Satisfaction/Dissatisfaction

The complaints that have been received formally by the Trust or through the Patient Advice and Liaison Services (PALS) regarding the Non-emergency Patient Transport Services have been analysed for six months before the change to criteria was introduced and for six months afterwards. These are shown in Table 3 below:-

Table 3: Transport Related Formal complaints June 2005 – May 2006

Jun – Oct 05 / Nov-05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Apr-06 / May-06 / Total
0 / 1 / 1 / 3 / 3 / 3 / 2 / 0 / 13

Five of the above recorded complaints were generated through patients’ M.P’s. In addition to formal complaints, the Trust also received telephone calls from patients who had previously been entitled to PTS transport but were no longer eligible because of the revised criteria. Patients were advised on the appeal process. The number of transport-related complaints received by the PALS service are shown in Table 4 below:-

Table 4: Transport RelatedPALS Complaints by Site June 2005 – May 2006

Jun –Nov 05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Apr-06 / May-06 / Total
HertfordCounty / 0 / 2 / 2 / 1 / 2 / 1 / 0 / 8
ListerHospital / 0 / 1 / 2 / 1 / 1 / 0 / 0 / 5
QEIIHospital / 0 / 0 / 0 / 2 / 0 / 0 / 0 / 2
Total / 0 / 3 / 4 / 4 / 3 / 1 / 0 / 15

Although Lister and QEIIHospitals incur the majority of outpatient appointments, the number of complaints in relation to the activity is low. This may be due to the fact that these hospitals are served by the Health Shuttle transport service.

It should be noted that the majority of complaints were received between December 05 and March 06. The Complaints Department and PALS advise that the number of telephone calls in relation to PTS have reduced recently.

4Consultation

4.1Purpose of Consultation

The purpose of the planned public consultation will be to seek views on the parameters used to determine eligibility for PTS services.

The consultation documentation will include information about demand for and cost of PTS services, factors taken into account when determining eligibility and advice about reclaiming transport costs and alternative means of travelling to hospital. The consultation will also aim to clarify that people who receive mobility allowances already receive transport funding, and therefore should not automatically be entitled to PTS. Information on alternatives to public transport and PTS such as the Volunteer Driver Scheme and Health Shuttle will be included.

4.2Draft Consultation Questions

Proposed issues that views will be sought on are likely to include:

  • Should the Trust be funding transport services for those patients who are able to use other means of transport, eg taxi, bus, public transport, health shuttle
  • Is it right that the available funding is concentrated on providing ambulance transport for sicker patients such as those with renal problems or cancer?
  • How important is transport in relation to other aspects of health care provision. Should eligibility criteria be revised or cuts make in other services instead?
  • Is it as hard to get to GP’s surgeries/other health care providers as it is to get to hospital?
  • Do the public know how to access information about transport to hospital?

4.3Scope of Consultation

It is suggested that sections of the public the consultation is aimed at these sections of the public within the Lister, QEII and Hertford County catchment areas who are more likely to require assistance travelling to hospital.

Specific groups, who are most likely to be affected by the restriction to the eligibility criteria, will be targeted. For example:

  • Age Concern
  • Stevenage Community Voluntary Services
  • Patient User Groups, especially Renal Transport Group and Cancer Action North East Hertfordshire
  • Residential Nursing Homes
  • PPI Forums
  • GP’s, and other medical professionals
  • Carers in Herts

5Next steps

  • Final tender specification to be agreed and issued.
  • Develop consultation documentation including:

-Summary document - for general public circulation & stakeholders, including tear-out response form

-Full document – available on request and on website

-Technical document including activity data and financial implications collected now - available on the website

-Dedicated website, including interactive response mechanism

-Articles for inclusion in Trust publications ie. Grapevine, Trust bulletin

-Media notification

-Consultation Plan

6Outline Consultation Timetable

Activity / Timescale
Commence Consultation / October 2006
End Consultation / January 2007
Decision-making following consultation / March 2007
Obtain Health Scrutiny Committee approval of consultation process and outcome / April 2007
Implementation / May onwards – depending on outcome of consultation

7Conclusion

The Health Topic Group are asked to:-

a)Note the update provided

b)Note and advise upon the proposed consultation timetable

c)Note and advise upon the proposed consultation questions and scope of consultation.

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PTS Update for HCC Health Topic Group 28.06.06

APPENDIX 1

PTS Contract
Financial summary - Actual Costs/activity for 2005/06
Apr-05 / May-05 / Jun-05 / Jul-05 / Aug-05 / Sep-05 / Oct-05 / Nov-05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Total
Activity / 10,544 / 10,544 / 10,544 / 10,544 / 10,544 / 10,544 / 9,248 / 9,251 / 7,909 / 7,789 / 6,796 / 7,474 / 111,730
Cost / £188,593 / £188,593 / £188,593 / £188,593 / £188,593 / £188,593 / £165,047 / £165,270 / £140,568 / £138,694 / £121,251 / £133,487 / £1,995,874
Notes
New contract agreed in September 05 which changed method of reporting. Therefore the first six months shown in table are an average of the activity April-Sept 05. October 05- March 06 reflect actual costs.

APPENDIX 2

Number of New and Return DNA's by hospital site and month during the period June 2005 - May 2006
HertfordCountyHospital
Jun-05 / Jul-05 / Aug-05 / Sep-05 / Oct-05 / Nov-05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Apr-06 / May-06 / Grand Total
New Patient DNA / 79 / 91 / 125 / 101 / 89 / 117 / 96 / 83 / 88 / 110 / 89 / 98 / 1166
Return Patient DNA / 167 / 175 / 201 / 174 / 169 / 199 / 180 / 210 / 202 / 191 / 192 / 240 / 2300
Grand Total / 246 / 266 / 326 / 275 / 258 / 316 / 276 / 293 / 290 / 301 / 281 / 338 / 3466
ListerHospital
Jun-05 / Jul-05 / Aug-05 / Sep-05 / Oct-05 / Nov-05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Apr-06 / May-06 / Grand Total
New Patient DNA / 336 / 339 / 349 / 329 / 328 / 336 / 301 / 339 / 282 / 297 / 250 / 325 / 3811
Return Patient DNA / 1097 / 940 / 1014 / 1059 / 952 / 1039 / 929 / 1070 / 1033 / 1045 / 883 / 1094 / 12155
Grand Total / 1433 / 1279 / 1363 / 1388 / 1280 / 1375 / 1230 / 1409 / 1315 / 1342 / 1133 / 1419 / 15966
QEIIHospital
Jun-05 / Jul-05 / Aug-05 / Sep-05 / Oct-05 / Nov-05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Apr-06 / May-06 / Grand Total
New Patient DNA / 304 / 292 / 321 / 310 / 336 / 358 / 279 / 319 / 267 / 250 / 186 / 263 / 3485
Return Patient DNA / 836 / 771 / 775 / 899 / 792 / 846 / 741 / 906 / 796 / 812 / 658 / 809 / 9641
Grand Total / 1140 / 1063 / 1096 / 1209 / 1128 / 1204 / 1020 / 1225 / 1063 / 1062 / 844 / 1072 / 13126
Trust Total
Jun-05 / Jul-05 / Aug-05 / Sep-05 / Oct-05 / Nov-05 / Dec-05 / Jan-06 / Feb-06 / Mar-06 / Apr-06 / May-06 / Grand Total
New Patient DNA / 719 / 722 / 795 / 740 / 753 / 811 / 676 / 741 / 637 / 657 / 525 / 686 / 8462
Return Patient DNA / 2100 / 1886 / 1990 / 2132 / 1913 / 2084 / 1850 / 2186 / 2031 / 2048 / 1733 / 2143 / 24096
Grand Total / 2819 / 2608 / 2785 / 2872 / 2666 / 2895 / 2526 / 2927 / 2668 / 2705 / 2258 / 2829 / 32558

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