Agenda item

Ian Ayres (Accountable Officer, NHS West Kent CCG) was in attendance for this item.

(1)       The Chairman welcomed Mr Ayres to the Committee and asked him to introduce the item. Mr Ayres began by updating the Committee on NSL’s performance. He explained that although there had been an improvement in the transport of renal patients, the rest of the service’s performance had flat lined for three months.

(2)       Mr Ayres explained that the contract with NSL was a standard NHS contract; the contract was for three years with two twelve-month extension periods. There were two clauses for early termination: a no fault termination by either party to terminate the contract early with a twelve month notice period or termination by one of the parties, with immediate effect, if the contract had been breached including the persistent and repetitive breach of a quality requirement. Although the CCG believed that NSL had breached the quality requirement; if this route was pursued by the CCG, it was likely that there would be a legal challenge by NSL to determine a breach.

(3)       Mr Ayres confirmed that the CCG was reviewing the contract with procurement experts. As a large and significant contract, it would need to be re-procured with an advert in the European Journal. It would be a full procurement lasting a minimum of 12 – 15 months and a maximum of 18 months. This would mean that the earliest the contract would be re-procured was nine months before the contract expired.

(4)       Mr Ayres stated that the CCG would be in a position to talk publically about the future of the contract by September following discussions with NSL and the acute trusts. There were no providers who would be able to deliver the Kent and Medway contract immediately. NSL was now the biggest Patient Transport Services (PTS provider) in the country. It had grown from a small to large company in five years. Mr Ayres raised concerns about the rapid growth of the company and local leadership. Mr Ayres noted that the specification would be revised in advance of procurement at which time the  CCG would ask the Committee if it views the changes as a substantial variation of service.

(5)       Members of the Committee then proceeded to ask a series of questions and made a number of comments. A Member raised a concern about the quality of the contract. Mr Ayres explained that in the first three – six months there was a range of problems with the quality of the contract; these had been remedied and resolved by December 2013. For the last six months, there was no explanation for NSL’s performance; the road networks, geography, staff and vehicles did not hinder performance.

(6)       A specific question was asked about the achievability of the contract. Mr Ayres explained that the CCG had looked at targets set, by other CCGs, for PTS providers; the targets for NSL were reasonable and achievable. It was difficult to compare NSL to the service before; targets were not centrally measured as a number of different providers were contracted to provide services.

(7)       A number of questions were asked about alternative providers. It was explained that there was a significant range of providers who wanted to bid for the contract. Whilst NSL had a large number of contracts, it was explained it did not have a monopoly over PTS contracts; a number of PTS contracts were held by local ambulance trusts. Mr Ayres stated that nationally PTS commissioners were struggling with ambulance and private sector providers.

(8)       A Member enquired about the use of penalty clauses and the logistical movement of patients. Mr Ayres explained that there were one or two penalty clauses in the contract; the CCG was looking to change penalty clauses when PTS was re-procured. Evidence had shown that penalties did not drive performance or change behaviour. A Member made reference to the efficient operation of freight companies to transport goods and produce. Mr Ayres stated that although PTS patients could not be treated as freight he acknowledged that managing logistics to enable the correct utilisation of vehicles and staff was key to provision.

(9)       A number of comments were made about a reduction in funding for PTS and the difficulty in accessing patients’ properties. Mr Ayres explained that eligibility for PTS was set nationally and had to be provided despite any cost pressures. Patients who were eligible for PTS were not able to use alternative transport; difficulty in accessing properties was part of a PTS provider’s role through its talented and committed staff.

(10)     RESOLVED that Mr Ayres be thanked for his attendance at the meeting, and that he be requested to take note of the comments made by Members during the meeting and that he be invited to attend a meeting of the Committee in September.