Agenda item

Ian Ayres (Accountable Officer, NHS West Kent CCG) and Adam Wickings (Joint Chief Operating Officer, NHS West Kent CCG) were in attendance.

(1)       Mr Ayres began by explaining that there had been problems with the previous provider and the patient transport services contract was reprocured at the earliest possible stage. He noted that patient transport services were mostly provided by commercial organisations and there were few providers of significant scale. He stated that G4S was awarded the new contract and mobilised last year; it was a quality driven procurement and G4S had the highest quality scores.

(2)       Mr Ayres stated that the three elements of the contract were mobilised on 1 July 2016: Kent and Medway patient transport excluding the transport of renal patients and transport to and from Dartford and Gravesham Hospital Trust; renal patient transport; and Kent and Medway patient transport to and from DGH sites. Transport into London was not mobilised until February 2017 until a due diligence process with London trusts was carried out. He explained that the mobilisation of the renal service had some initial problems but had stabilised and was operating well; both renal transport and transport to and from Dartford and Gravesham Hospital Trust had moved into business as usual mode.

(3)       Mr Ayres reported that the remaining part of the contract was being disrupted by the journeys to and from central London. Journeys to and from London represented 1 – 2 %  of all journeys and were being taken out of the contract due to the small volume of journeys with the exception of journeys to and from Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust. The CCG had sought independent advice to review activity to ensure that there were sufficient vehicles and staff to deliver the contract. The CCG had issued a performance notice to G4S regarding its complaints process; G4S had made significant progress and it was anticipated that the notice would be removed within a month.

(4)       Mr Ayres reported that mobilisation would be completed within three – six months. He stated that it was disappointing that the mobilisation had not been quicker but noted that it had been better than the previous provider. He recognised that there had been significant failures and confirmed that a detailed analysis would be undertaken to review and understand the mobilisation.

(5)       The Chair enquired about the provision of qualitative and quantitative performance data including details of the patient experience which the Committee had previously requested. Mr Ayres confirmed that this could be shared with the Committee once the detailed analysis of data had been completed.

(6)       A Member stated that delayed journeys had significantly impacted patients and their families and reported difficulties in them being able to contact G4S. Mr Ayres acknowledged that some patients had been let down very badly and he had a weekly phone call with the G4S Managing Director for Patient Transport Services to review performance. He stated G4S were required to have an onsite presence at every hospital and where the onsite presence worked well, there were fewer complaints; he reported that the onsite presence required improvement at two sites. The CCG was reviewing complaints categorised as unknown  as part of it performance notice. He noted that there had been initial complaints about eligibility criteria; G4S had worked with the CCG and hospital trusts to develop a clear schedule which set out eligibility and as a result the number of complaints had been reduced. He stated that he was pleased that G4S was working collaboratively to resolve issues as they occurred.

(7)       A Member expressed concerns about the performance of the current provider and its similarities with the performance of the previous provider. Mr Ayres stated that whilst he understood the concerns, he only recognised those in terms of the London activity. He explained that a key learning point from the previous contract was that inaccurate data led to difficulties with the procurement. He reported that the Kent activity in the new contract was mostly accurate; early identification of inaccuracies in the London activity had resulted in the mobilisation being delayed. Options being considered to improve transport to and from London included increasing G4S’ capacity and making arrangements with the London trusts for them to provide for patients with transport.

(8)       Members enquired about measures to prevent repeated failed journeys and the eligibility criteria. Mr Ayres reported that G4S monitored patients who had been let down during mobilisation to ensure that it did not happen again. He stated that CCGs were reviewing complaints to assure itself that incidents were reducing.  Mr Ayres explained that there was a national specification which set out the eligibility criteria for patient transport services to patients who had a medical need that prevented them from using private or public transport. Mr Ayres confirmed that changes to the eligibility criteria had not been reduced in order to meet performance targets. He stated that G4S was able to signpost patients who were not eligible for transport to local voluntary services; it was working with KCC to get an accurate and up-to-date list of services.

(9)       Members asked about contractual levers and the flexibility of trusts to see patients if they were delayed. Mr Ayres explained that the CCG was due to receive the reprofiling of the service in the next two – three weeks from G4S which could result in changes to the contract. He stated that there were a range of levers in standard NHS contract such as a removal of a service with one year notice which included a no blame clause. If the provider significantly breached its contract, CCGs can serve notice with immediate effect. There were a number of informal levels including the provision of a reference to the provider if they wish to bid for other services.. He reported that whilst trusts were being flexible and would accommodate delayed patients where possible, patients were more likely to be delayed on their return, rather than outward, journey.

(10)     In response to specific questions about the use of alternative modes of transport and volunteer drivers, Mr Ayres committed to finding out about use of trains for patient transport service journeys. He explained that although G4S did use volunteer drivers, they were mostly used as part of voluntary services. The previous provider had used volunteer drivers and it had not worked effectively. He confirmed that volunteer drivers did not require medical training as they provided care rather than medical interventions.

(11)     RESOLVED that:

(a)       the report on Patient Transport Services be noted;

(b)       NHS West Kent CCG be requested to provide an update in six months with:

(i)            qualitative and quantitative data including the details about patient experience and areas of underperformance;

(ii)          feedback from the action plan regarding complaints.