non-emergency patient transport service · 2 1) introduction non-emergency patient transport...
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Non-Emergency Patient Transport Service
Engagement Report – July 2019
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1) Introduction
Non-emergency Patient Transport Services (NEPTS) are typically the non-urgent, planned transportation of patients with a medical need from their place of residence to and from premises providing secondary NHS healthcare services and between healthcare providers
The CCGs have a responsibility to commission NEPTS for their registered patient population who meet the eligibility criteria.
Core services within the current contract are:
Outpatient/Day Hospital/Day Case - inward and outward journeys
Non-emergency hospital admissions
Hospital discharge/transfers
Inward & outward for renal dialysis patients
Extra Contractual Journeys (ECJs) – includes out of area locations and
journeys outside of core hours
The service covers a broad range of mobility needs including walkers, wheelchair patients, stretcher patients and bariatric patients.
The current service is provided by Arriva Transport Solutions Ltd (ATSL) and the
contract expires at the end of June 2019 with a Direct Award being put in place from
1 July to 30 November 2019 to allow for procurement to take place.
The procurement is being put in place to secure future provision, deliver an affordable and effective service and innovate where possible the current model to become more effective for patients, acute trusts and commissioners. No changes are proposed to the eligibility criteria for access to the service.
2) Engagement Activity Communication and engagement regarding NEPTS has been delivered in three phases that relate to the development of the service as follows;
Phase 1 - specification and pre- procurement
Phase 2 - procurement and contract award
Phase 3 - service mobilisation. The approach has been developed proportionate to there being no changes proposed to the service specification balanced with the need to keep key stakeholders either informed or involved or both as appropriate.
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2.1 Market testing and acute provider engagement During February 2019 market testing was undertaken with potential bidders to share information about the service specification and forthcoming procurement process. In parallel with this acute provider engagement was undertaken to outline the procurement proposals and discuss key performance indicators (KPIs). Emphasis was placed on the need for NEPTS to be delivered in partnership with the commissioner, transport provider and acute and hospital trusts and patients. Commissioners are in discussion with the acute trusts to agree trust led KPIs to include a reduction of on the day bookings, cancellations and aborted journeys. Additional KPIs related to online bookings and assessment of eligibility and mobility types. 2.2 Stakeholder Briefing Phase 1 of the wider stakeholder engagement commenced with circulation of a briefing that is included in Appendix A. The briefing addressed the following questions:
What is NEPTS?
Why is the service being recommissioned?
What does the re-commissioning process look like?
What is the timescale for this?
How can Patient Group be involved in this process? 2.3 Patient Groups Phase 1 of the engagement continued with a series of presentations to CCG patient groups across mid Nottinghamshire and Greater Nottingham as follows;
Mid Nottinghamshire Patient & Public Engagement Committee
2 April 2019 11 am – 1 30 pm
Ruschliffe Patient Cabinet Monday 8 April 2019 3 pm to 5 pm
Nottingham City People’s Council
24 April 2019 4 pm to 6 pm
Nottingham West Patient Reference Group
2 May 2019
Nottingham North & East Patient & Public Involvement Committee
21 May 2019 2pm to 3 pm
Bassetlaw Patient & Partnership Engagement Network
2.4 Insight arising from engagement activity
The Assistant Programme Manager, Urgent Care, attended meetings of five patient groups that sit within the governance structures of the five Clinical Commissioning Groups in mid-Nottinghamshire and Greater Nottingham. A copy of the presentation is included in Appendix B.
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The presentation included an explanation of NEPTS and the eligibility criteria to access the service, the reasons for the procurement and the key performance indicators to be used to monitor performance. Patient groups were asked to advise on a series of questions relating to application of the eligibility criteria. Outcomes of all discussions were captured and are included in Appendix C. The key themes are summarised below;
How can we ensure the eligibility criteria is applied fairly and robustly? o Training and clear understanding of the criteria and how to apply it
consistently for staff taking bookings. o Central administration function would help to ensure criteria is
applied fairly and consistently o Easier access to eligibility criteria for patients via website, FAQs,
posters in GP surgeries, briefing for staff, information within appointment letters.
o Better processes should be in place between service providers rather than shifting the burden to patients.
What questions should be asked to enable people to consider whether they do meet the eligibility criteria for NEPTS?
o Begin the conversation with a question about whether the patient receives mobility allowance.
o Ask about the treatment they will be having and the effects of that o Ask questions about their circumstances eg. do you need …. Can
you ….., how do you….., questions that will enable the call handler to build up a picture of the patients everyday/usual way of getting around and the mode of transport they use
o Vulnerable groups may need more practical help and support to access alternative provision.
o People with long term conditions experience changes to their health status on a daily basis and this should be taken into account when applying the eligibility criteria
What should be the response in circumstances when people request transport but are deemed not to meet the criteria?
o Provision of a clear explanation of why the criteria does not apply. o Signpost to other services that may be able to help, as appropriate. o Weblink providing details of criteria and signposting to alternative
options
How should non-eligible patients who book transport be managed? o Efforts should be made to try to prevent this happening through
implementation of the above actions. o Provide explanation about why the patient doesn’t meet the criteria
and signpost to other sources of help and support.
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o Emphasise the service is for patients who have no other way of getting to their appointment and include within future appointment letters.
o Clinical confirmation that the patient meets the criteria for NEPTS
Other comments; o Patients should be provided with text reminders regarding their pick
up time. Consideration should also be given to notification of patients without mobile phones.
o Explore reasons why patients are not there when transport arrives to collect them. May have tried to cancel booking or been admitted to hospital.
o Would it be possible to have tracking on vehicles to inform patients of the expected time of arrival of the vehicle
o Consideration should be given to negotiating a reduced rate for taxi journeys to and from hospital.
The CCG agreed to actively follow up outcomes of discussions with patient groups throughout the mobilisation period with the new provider ERS. In addition, the service provider will have plans in place to enable service users to make comments, compliments and complaints at all times and to have a process to monitor service user satisfaction with reports being provided to the Commissioner at least annually.
2.4 Procurement Panel
Two patient representatives – one from mid Nottinghamshire and another from Greater Nottingham - participated in the procurement panel and assessed bids against specific criteria to contribute to the overall scoring of bids and consequently the contract award.
3) Recommendation
Engagement activity with patient groups has delivered some helpful insight and it is recommended that this insight is reviewed with the new service provider to inform the mobilisation of the service. In addition, it is recommended that a record of how the insight has influenced service provision should be collated and shared with those patient groups who participated in the engagement and more widely through publication on the Commissioners’ websites.
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Appendix A
Stakeholder Briefing
Non-Emergency Patient Transport Service Procurement
What is the non-emergency patient transport service? The Non-Emergency Patient Transport Service (NEPTS) is defined as non-urgent pre-booked transport for patients to and from NHS funded points of care (excluding GP appointments). It is provided for patients who meet the eligibility criteria. There are no plans to change the eligibility criteria for patients to access this service. The service will be commissioned using the existing service specification and eligibility criteria. Why is the service being re-commissioned? Clinical Commissioning Groups (CCGs) are responsible for commissioning Non-Emergency Patient Transport (NEPTS) for their registered population. The current contract with Arriva Transport Solutions Ltd expires on 30 November 2019 and from 1 December 2019 arrangements will be in place for a new service to go live. The service is being commissioned for registered patients of the Greater Nottingham Clinical Commissioning Partnership, NHS Mansfield and Ashfield CCG, NHS Newark and Sherwood CCG and NHS Bassetlaw CCG. What does the re-commissioning process look like? Engagement took place on 13 and 15 February 2019 with potential service providers who came along to find out more information to help them decide if they would wish to put in a bid to deliver the service. Following this the formal procurement process has commenced. An invitation to tender was issued at the end February 2019 using the EU Procurement Light Touch Regime and the opportunity is live on OJEU and Contract Finder. The service has to be delivered within existing financial resources. What is the timescale for this? Service providers have until end March to submit their bid to deliver NEPTs. Following this, all bids will be subject to evaluation by a panel and will be scored to identify a preferred service provider. How can Patient Group be involved in this process? A representative of the NEPTS Programme Board would welcome the opportunity to meet with you during April 2019 to provide a further update and to have a discussion with you about the following;
How can we ensure the eligibility criteria is applied fairly and robustly?
What questions should be asked to support people to consider whether they do meet
the eligibility criteria for NEPTS?
What should be the response in circumstances when people request transport but
are deemed not to meet the criteria?
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Appendix C
Capturing Engagement Outcomes (Q & A sheet)
Patient Engagement: Patient & Public Engagement Committee
Date: 2 April 2019
Time: 4 30 pm
Venue: Birch House, Southwell Road West
Panel members: Julie Theaker
Questions raised Responses
Will the KPIs be used to deliver improvements for patients attending for radiotherapy treatment?
KPIs are included in the service specification in relation to arrival and departure times that should ensure waiting is kept to a minimum for this patient group. Reducing the number of aborted journeys should also release resource to deliver improvements for this patient group.
A scenario was shared regarding a patient who had attempted suicide and as a consequence required surgery. Due to social and financial reasons the patient was unable to access hospital. Ashfield Voluntary Action (AVA) put in place arrangements to get him there. Arriva deemed patient not to be eligible but enquiries made via Patient Experience Team confirmed patient was eligible. No fall-back position for patient and had support not been available from AVA patient would not have accessed treatment required.
Noted.
What has changed within the service specification? The key changes to the service specification relate to the delivery of services to ‘points of care’ which includes any facility where NHS healthcare is provided within a 10 mile boundary.
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Questions raised Responses
What do suppliers see as the biggest risk? The biggest risk relates to the number of on the day discharges. There is recognition of the need to address this and data has been provided as part of the Invitation to Tender (ITT) process. A Transport Facilitator will be based in each acute trust to support and monitor this. During a Governing Body discussion it had been confirmed that trusts have the data flow and it is within their gift to better plan discharges.
Where there is spare capacity on vehicles – could vacant spaces be used by non-eligible patients for a charge?
It was reinforced that the service is being commissioned solely for patients who meet the eligibility criteria for NEPTS.
Will mental health patients meet the eligibility criteria? A risk assessment would be undertaken to determine eligibility. Notts. Healthcare Trust usually transport their own patients and fund this.
Questions posed by CCG Responses
How can we ensure the eligibility criteria is applied fairly and robustly? What questions should be asked to enable people to consider whether they do meet the eligibility criteria for NEPTS? What should be the response in circumstances when people request transport but are deemed not to meet the criteria? How should non-eligible patients who book transport be managed?
Healthwatch referenced the Renal Transport Co-Ordinator introduced some years ago that is working well. Other suggestions from Healthwatch included:
Provision of information to patients advising what to do if appointment changes
Easier access to eligibility criteria
Provision of alternative options for patients who don’t meet the eligibility criteria for NEPTS
Provision of details of taxi firms who may be able to offer reduced rates
Information on wards asking patients and carers to think about how they are getting home.
PPEC members also recommended;
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Questions raised Responses
Consistency of approach regarding application of eligibility criteria
Information on website, Frequently Asked Questions, posters in GP surgeries, briefing for practice staff to be able to respond to questions
Sign off of eligibility for NEPTS by a health care professional who has current knowledge of the patient’s health status.
Non-Emergency Patient Transport Service Procurement
Response from Healthwatch Nottingham and Nottinghamshire
Question Response
How can we ensure the eligibility criteria is applied fairly and robustly?
Training and clear understanding of the criteria and how to apply it for staff taking bookings. Eligibility criteria communicated clearly through all channels. e.g. hospital clinics. Could information be given to patients with appointment letters? Information to contain eligibility criteria and examples of where people would be eligible and where they wouldn’t against each criteria, in simple and easy to understand terminology. Also that their eligibility may change depending on their current circumstances as some people may think they are ‘registered’ to use it after the first time.
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Question Response
What questions should be asked to enable people to consider whether they do meet the eligibility criteria for NEPTS?
Start with a question about whether they get mobility allowance. Ask about the treatment they will be having and the effects of that (if they know) Questions about their circumstances e.g do you need….., can you….. how do you…… things relating to their everyday/usual way of getting about and the mode of transport they use – all related to the criteria. E.g How do they normally travel? Who assists them? Also could use examples as above.
What should be the response in circumstances when people request transport but are deemed not to meet the criteria?
Empathetic but firm. Signpost to other services that my able to help. E.g Community Transport services.
How should non-eligible patients who book transport be managed?
Try to stop this happening through the above measures. Clear explanation of why the criteria does not apply, signpost to other services if appropriate. Apologise.
General Comments
Also need to provide information and clarity on the responsibility of the patient who has booked the
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Question Response
transport e.g you must wait for transport to come if you have booked it, you must let the transport service know if you are able to get there by other means, or are not attending the appointment and don’t need the transport.
Capturing Engagement Outcomes (Q & A sheet)
Patient Engagement: Rushcliffe Patient Cabinet
Date: 8 April 2019
Time: 3 pm
Venue: Easthorpe House, Ruddington
Panel members: Julie Theaker
Questions raised Responses
Have Arriva submitted a bid? No, it is in the public domain that Arriva have decided not to bid for the NEPTS contract.
How would support be provided to moderately frail upward group of patients, one of the groups least able to advocate for themselves?
It is recognised that there will be cohorts of patients who are vulnerable but do not meet the eligibility criteria. The new service specification includes provision for signposting to other sources of help and support to access other options.
Going forward, services will be delivered from locations that are more difficult to access, eg moving from hospital to care closer to home. How will the
The new service provider will transport patients to and from ‘points of care’ within a 10 mile boundary. As part of any service transformation, the impact on transport provision should be considered.
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Questions raised Responses
service respond to this?
What will constitute performance improvement? Examples of service improvement includes;
Sending text reminders
Working in partnership with acute trusts
Patient Transport Liaison Officer in each acute trust
What is the policy for children travelling via NEPTS being accompanied by an escort?
There is a specific criteria in relation to escorts but generally children under 16 years of age who meet the eligibility criteria would be able to be accompanied.
Will penalties apply to the service provider for any delays?
It is not possible to apply penalties to the service provider as delays are often outside their control, eg patient may not be ready to leave due to awaiting medication or not dressed. Work is taking place with acute trusts through the existing Transport Working Groups to reduce on the day bookings that are well above the national average of 50%. NUH 66% and SFHFT 80%.
Questions posed Responses
How can we ensure the eligibility criteria is applied fairly and robustly? What questions should be asked to enable people to consider whether they do meet the eligibility criteria for NEPTS? What should be the response in circumstances when people request transport but are deemed not to meet the criteria?
It was suggested that use of text messages to support two way conversations may be helpful, eg. patient being able to notify service provider they wish to proceed with journey. Healthcare professionals often book transport for patients so this may be difficult in some circumstances. Arriva are piloting text reminders and currently 15% of patients have signed up to this. Vulnerable groups need practical help and support to access other options.
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Questions raised Responses
How should non-eligible patients who book transport be managed?
Central administrative function would help to ensure criteria is applied fairly and consistently. Weblink detailing eligibility criteria and option of one-stop shop for signposting to in order to access alternative options would be useful. Noted plans to amend wording of offer of transport included in appointment letter to emphasise it is for eligible patients who have no other way of getting to their appointment. GP could indicate within referral if patient clinically meets eligibility criteria.
Capturing Engagement Outcomes (Q & A sheet)
Patient Engagement: Nottingham City People’s Council
Date: 24 April 2019
Time: 4 pm to 6 pm
Venue: Standard Court, Nottingham
Panel members: Julie Theaker
Questions posed by CCG Responses
How can we ensure the eligibility criteria is applied fairly and robustly? What questions should be asked to enable people to
If patients are eligible for patient transport they should be informed if their transport is running late as this may be reason they are not in and have opted to make their own way to their appointment to ensure they arrive on time.
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consider whether they do meet the eligibility criteria for NEPTS? What should be the response in circumstances when people request transport but are deemed not to meet the criteria? How should non-eligible patients who book transport be managed?
Text messages are a good idea for patients with mobile phones, however, consideration needs to be given to those patients who don’t have a mobile phone. Could they be reminded via a telephone call. People with long term conditions experience changes to their health status on a daily basis and this needs to be taken into account when applying the eligibility criteria. There is a need to have in place robust procedures for patients who are refused NEPTS because they do not meet the eligibility criteria. There needs to be better processes in place between service provides and Trusts rather than shifting the burden to patients.
Capturing Engagement Outcomes (Q & A sheet)
Patient Engagement: Nottingham West Patient Reference Group
Date: 2 May 2019
Time: 4 pm to 5 30 pm
Venue: Stapleford Care Centre
Panel members: Julie Theaker
Questions posed by CCG Responses
How can we ensure the eligibility criteria is applied fairly and robustly? What questions should be asked to enable people to consider whether they do meet the eligibility criteria for NEPTS?
NEPTS need to acknowledge the distance patients may have to travel when they arrive at hospital – from the entrance to the department. More wheelchairs should be available with personnel available to help if this is required. Patients who do not meet the eligibility criteria should be signposted to alternative transport provision.
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What should be the response in circumstances when people request transport but are deemed not to meet the criteria? How should non-eligible patients who book transport be managed?
Consideration should be given to negotiating with a taxi firm reduced rates for journeys to and from hospital appointments. KPIs should be in place in relation to pick up and collection times for patients attending renal dialysis. Patients should arrive no earlier than 30 minutes prior to their appointment time and should be collected no later than 30 minutes following completion of their treatment. Patients should be sent text messages as a prompt to cancel their transport if it is no longer required. Would it be possible to use a tracking system to monitor whereabouts of vehicles to be able to respond to any patient queries?
Capturing Engagement Outcomes (Q & A sheet)
Patient Engagement: Nottingham North & East Public Involvement Committee
Date: 21 May 2019
Time: 2 pm to 2 30 pm
Venue: Arnold Civic Centre
Panel members: Julie Theaker
Questions posed by CCG Responses
How can we ensure the eligibility criteria is applied fairly and robustly? What questions should be asked to enable people to consider whether they do meet the eligibility criteria
Explanation of eligibility criteria needs to be very clear. Fine patients who book transport but are not at home when transport arrives to collect them.
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for NEPTS? What should be the response in circumstances when people request transport but are deemed not to meet the criteria? How should non-eligible patients who book transport be managed?
Explore reasons why patients are not there when transport arrives to collect them. It may be that they have tried to cancel transport but were unable to get through on the phone, they may have been admitted to hospital or they are too poorly to attend their appointment. In circumstances Review application of criteria at regular intervals.