Agenda item

Ian Ayres (Chief Officer, NHS West Kent CCG), Helen Medlock (Associate Partner, KMCS), Deborah Tobin (Senior Associate, KMCS), Alastair Cooper (Managing Director, NSL Care Services), Paul Costello (Client Account Manager, NSL Care Services), Felicity Cox (Kent and Medway Area Director, NHS England), and Dr John Allingham (Medical Secretary, Kent LMC) were in attendance for this item.

(a)       The Chairman introduced the item and asked the Committee’s guest to explain the background and the current situation.

(b)       It was explained that NSL Care Services took over the provision of Patient Transport Services (PTS) on 1 July 2013. This came at the end of a two year process. Previously there had been a patchwork of five providers, of which four were major providers. A decision had been reached by the old Primary Care Trust Board that a single provider was preferable. It was still the consensus now that one provider was preferable. The bid from NSL scored the best on value for money and quality.

(c)        The transfer to the new provider was very complex given the number of different providers previously with different shift patterns, fleets, operating procedures, organisational cultures and so on. 100 staff needed to be transferred under TUPE to the new provider. It was openly admitted that the transfer had not gone to plan. It was explained that there were two parts to the service. The first part, that of whether appointments were able to be booked, was going to plan. However, the second part, that of whether patients were being picked up and taken to their appointments at the appropriate time, was not. NSL were currently achieving 60-65% regarding timeliness.

(d)       Both the commissioner and provider apologised for this. It was explained that there was a recovery plan in place and things were improving. There were a number of performance indicators in the contract and Mr Ayres stated that he received updates on the 5-6 key ones daily, the top 8-9 ones weekly and the rest monthly. Performance data was being shared with the Acute Trusts and an independent expert was being brought in to review the measures being taken to improve the situation and this would report before the winter. NHS England was supportive of this approach.

(e)       It was further explained that the PTS eligibility criteria had not changed from the previous arrangement and that the criteria in Kent and Medway was more generous than elsewhere. They had been applied inconsistently in the past. It was reported that press stories about people being refused transport were cases where someone was not eligible for PTS or had not requested the service. A request was made for the eligibility criteria to be made available to the Committee.

(f)         One Member commented that subsequent to a recent news story, he had been contacted with a number of further examples. It was accepted that there was a problem around public confidence with the service.

(g)       Representatives from NSL explained that they had underestimated the challenge of setting up the new service. One challenge was the shift system. Some staff were on 9-5 contracts but the service requires a 24/7 shift system. A consultation was underway with staff to enable this to be changed. This consultation ended soon and a new shift system would be able to be brought in on 4 November. The role of supervisors was seen as key. At pinch points were demand could not be met, sub-contractors were used. The activity was also different to that anticipated, with a greater need of the use of stretchers. It was explained that when further activity data was available, NSL might acquire further vehicles capable of accommodating stretchers.

(h)        Members asked a series of questions and raised a number of points aiming at probing deeper into the reasons behind the problems with the transfer to a new provider. On being asked directly, the commissioners gave the judgment that the service was not as good as it was before the change, but that it would be better. The provider admitted to being surprised by the complexity of the challenge, but the point was also made that NSL successfully ran PTS contracts in other areas of the country and had a recent successful takeover of a contract in the South West of England. A Member made the counter point that this was not much comfort to patients in Kent.

(i)         In terms of the commissioning, the Committee was informed that the specification for the contract was drawn up based on information collected in the past. One Member drew attention to the statistics presented on page 30 of the Agenda. This indicated that there were more stretcher patients than planned and the number of wheelchair patients was higher than planned but then went below. The question was posed as to whether the levels would settle down to that expected. However, the numbers of high dependency patients were negligible compared to the planned numbers. It was explained that while there was good information about the bills relating to PTS in the past, the details around the number and type of journeys was less reliable. The numbers in East Kent could be out by 30-40% either way. On high dependency patients, these journeys were undertaken by a sub-contractor but the type of journey was not recorded. The uncertainty about the accuracy of the figures extended to the period between the awarding of the contract and NSL taking it over. In hindsight, it was acknowledged that a shadow period where accurate information could be gathered would have been a sensible approach. Commissioners had looked to the market for a solution of the problem but had not explained fully what was required of the service. Lessons had been learnt and would be applied to future procurements. The priority now was to ensure a sustainable service was being delivered and then a full review of the process would be able to be carried out. A request was made for the findings of any internal review undertaken to be shared with the Committee. The point that Kent County Council (KCC) had a good track record on procurement was well taken and it was explained that there were a number of areas where KCC and the NHS could learn from each other and procurement was one area where the NHS could learn from KCC.

(j)         The financial implications of the problems faced by the service were also explored by the Committee. It was explained that it was an activity based contract and even though NSL had been required to hire more staff and use sub-contractors, the commissioners would not be providing any more money. Only in cases where the activity was significantly above or below that specified in the contract would there need to be a conversation between commissioner and provider about the cost of the contract. There were clear performance indicators in the contract and it was possible that penalties would be imposed. Against this, the point was made that penalties were not enough on their own where there was an issue with the culture of a service or organisation.

(k)        On the subject of the key performance indicators, it was explained that these were reviewed by a programme board consisting of NHS organisations and patient representatives. However, it was accepted that a point made by a Member of the Committee was valid and that some thought would be given to an appropriate place to receive these reports where they would be more openly available, such as possibly the NHS West Kent CCG Board.

(l)         Of the 40% who did not undertake their journeys at the booked time, some were at their destinations much too early and some were late, but the exact figures for how many of each there were not available at the meeting. The Acute Trusts were being very supportive of the service and while the commissioners could ask for data on how many patients needed to have their appointments rescheduled, it was felt this would add an extra burden to the hospitals.

(m)      A number of questions were asked about the fleet. It was explained that there was a disinfectant/cleaning regime and that this did mean vehicles were out of action during cleaning. Additional vehicles were sourced to cover these times. In Kent a standard business fleet was used, with the exact type of vehicle depending on the availability of servicing in the area. Members gave examples of places where pods where used, enabling a wider range of vehicle types to be made available as the chassis would be interchangeable between them. This was something which would be looked at. In response to a specific question, it was explained that while tacographs were not used, a similar system was and data suitable for analysis was gained this way. It was accepted that while there were significant differences between patients and parcels, there could be lessons to learn from the logistics industry.

(n)        A series of specific questions were asked and responses received. It was accepted that better signposting to the service in GP surgeries would be appropriate. Volunteer drivers were used and they all had to undergo DBS checks. The service had six bases and these were at Dartford, Tonbridge, Larkfield, Ashford, Aylesham and Margate.

(o)       Questions were also asked about regular users of the service. On this issue it was explained that renal patients made up around a third of all journeys and these were programmed ahead of time. There was a full-time person whose role it was to contact each of the renal units four times each day to ensure the service was delivering at an acceptable level. Although only 50-60% of renal patients were delivered within the 30 minute window required, feedback suggested the current levels of service were acceptable. Lessons were being learnt from this and would inform the oncology service when it was rolled out.

(p)       There was a discussion on the recommendation and the Chairman, along with a number of Members, commenting positively on the honesty of both commissioner and provider. 

(q)       The Chairman proposed the following recommendation:

§         That the Committee thanks its guests for their attendance and contributions today along with their answers to the Committee’s questions, and asks for a written update report within 3 months and a return visit in 6 months.

(r)        AGREED that the Committee thanks its guests for their attendance and contributions today along with their answers to the Committee’s questions, and asks for a written update report within 3 months and a return visit in 6 months.